Posts tagged ‘muscles’

May 14, 2014

What’s Up with Your Neck? (and just below…)

Image

Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

April 22, 2014

Knees: Scrapes, Twists and Tears

Image

Knees are famous for scrapes (and bees). Little kids play rough and tumble and when they do, they land on ‘em. Little band-aids on a child’s knees are almost – dare we say – cute. They remind us of learning to ride bikes and popsicles on summer days and swingset leaps. Luckily, kids’ knees are resilient.

 

As we get older – not so much. Knees take a beating and unfortunately they’re really only meant to bend in one direction. We could go on and on about knee maladies (arthritis anyone?) but let’s pick one: sports injuries.

 

As we graduate from learning to ride bikes to learning to ski and more, we introduce a lot more opportunities to scrape, bang, twist and torque our knees. Knee injuries are incredibly common, especially in sports. There are a variety of tissues to damage – from bone to muscle to tendons to ligaments. Imaging may be needed to see all of the complex structures.

 

With sports injuries, damage to ligaments may occur, especially with twisting or blows from the side – ligaments (connecting bone to bone) include the anterior cruciate (ACL) and posterior cruciate ligaments which cross (cruciate comes from the Latin for “cross”) the center of the knee. The medial and lateral collateral ligaments stabilize the inner and outer aspects of the knee respectively.

 

Sometimes with a twisting motion, multiple structures will be involved in the injury. MRI is an excellent means of imaging the knee, allowing us to look at bone, soft tissue and cartilage all at the same time. You can even give a good estimation of the way a knee was injured based on the pattern of injuries present on the MRI. Injury to the ACL happens in athletes of all ages. The ligament can be torn partially or completely, and knee instability in a classic pattern will often be found on clinical exam of the knee.  ACL tears are often associated with bone bruises in classic places, and may be associated with damage to the other soft tissue structures, from other ligaments to meniscal tears.

Tendons (which connect muscles to bone) may also be injured – either the quadriceps tendon  coming to the top of the patella (kneecap), or the patellar tendon, coming from the bottom of the patella.  Often the tears can be felt by your doctor on exam. Imaging, often with MRI or with ultrasound, may be necessary to see if the tear is complete and look for other injuries. Muscle injury can also occur, and is well-imaged by MRI.

The menisci are discs of cartilage between the femur and tibia which provide cushioning and which can get torn. This can cause a sensation of something locking in the knee with motion (although other things can also do that) or may just cause pain. Meniscal tears are well-seen on MRI, and may also be evaluated with arthrography.

 

As with shoulders – you want to take care of your knees and keep ‘em strong. This doesn’t mean don’t play – it just means play smart. Other things you can do to help protect your knees can be found here.

(Photo credit: trufflekneehighs by boocub via Flickr Copyright Creative Commons Attribution- NonCommercial- NoDerivs 2.0 Generic (CC BY-NC-ND 2.0))

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!