Posts tagged ‘tissue’

April 24, 2014

Ankles: Sprains and Pains

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For any building to be upright, it requires a solid foundation. Such is true for the human body: if what’s below the knees goes wonky it can have an effect on the body as a whole. Ankles are incredibly resilient joints but when they take a hit (or a fall or a twist) they can be problematic.

 

Ankle sprains are common, and can be seen in athletes and nonathletes alike. Sprains can result from the ankle turning from a misstep, from stepping down at an angle or from sideways movements. There are clinical rules which help determine who needs imaging- mild sprains may not need to be imaged.

 

Sprains typically result in injury to the ligaments, those soft tissue bands which connect bone to bone. If the ankle is unstable or if symptoms do not improve as expected, imaging with an MRI may be needed. This allows assessment of the bones of the ankle as well as the soft tissues, including the ligaments.

 

A fall from a height may lead to fracture or dislocation (ouch). Plain films of your ankle will be the starting point if fracture is suspected.  If a fracture is complex, CT is excellent at showing the anatomy and helping your surgeon plan treatment.

 

Achilles tendontears are often an event with a distinct injury, sometimes related to a sudden movement and abrupt tensing of the calf muscle (Remember those replays of Lebron James’ injury? Ouch!). Physical exam will often reveal a focal defect in the tendon your doctor can feel. We may want to image to see if the tendon is completely torn and the distance between the torn ends to help with surgical planning. Ultrasound can show this nicely, as can MRI.

 

Tendons about the ankle other than the Achilles can also be injured, torn or inflamed. Injuries to other ankle tendons can also be evaluated with ultrasound, although MRI is more commonly used. Tendons about the ankle include the peroneal tendons on the outer side of the ankle and the posterior tibial tendon on the inside.

 

It’s important to treat ankle injuries, because as a foundation for the body, adding a limp can lead to other problems including back pain (double ugh). If left untreated, ankle sprains can lead to chronic instability.

 

As ever, prevention is the best medicine. Some ankle strengthening exercises can be found here.

(Photo credit: Broken ankle Cast detail by FiDalwood via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

April 22, 2014

Knees: Scrapes, Twists and Tears

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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!

April 15, 2014

Shoulders, Knees and Toes, Knees and Toes

Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

Over the next few posts we’re going to highlight some common injuries affecting familiar joints. As the title suggests, we’re starting near the top.

 

But before we get ahead of ourselves and start talking about these individual parts, let’s talk about how we image them…

 

There are many techniques for imaging the body, and the ones we use depend upon the type of injury and the most likely tissues injured. Here’s a gimme: broken bones? We’ll start with an x-ray – perhaps a CT if it’s complex. Here’s a not-so-gimme: soft tissue injury like torn ligament? Options here include MRI, ultrasound and arthrograms.

 

First off, not every injury is imaged. Why? Sometimes a careful exam by your doctor can answer the question – imaging in these cases is not done, unless symptoms do not improve in the expected manner. There are carefully developed rules helping your doctors determine who will benefit the most from imaging in the case of many of the common injuries, for instance ankle sprains.

 

After your doctor’s initial evaluation, you may be sent for imaging. In many cases this will start with conventional films (x-rays) to exclude fractures or other bony changes. Beyond that, a patient will be directed based on the clinical concern.

 

Imaging of patients who have multiple sites of injury from a fall or motor vehicle accident for instance may be done with CT. This allows quick evaluation of bones as well as some types of soft tissue injuries. Multiple structures can be evaluated at the same time with CT, such as looking for fractures in the lower back, while also assessing the abdomen for signs of damage to internal organs.

 

Soft tissue damage, such as torn cartilage or ligaments, will often not be apparent on a conventional film. Visualizing soft tissues can be done with ultrasound, MRI or an arthrogram (where contrast material or dye is introduced into the joint space). We may follow the arthrogram with imaging with MRI or CT.

 

So… we will start our journey of the joints with your shoulders! (See you Thursday!)

 

(Photo credit: Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 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!

March 27, 2014

Ultrasound and Pregnancy: The Third Trimester

Whoa. Third trimester!

Whoa. Third trimester!

The third trimester of pregnancy can be a kick in the ribs – literally! As the newest member of your family grows and moves, the closer the crown of the head moves toward the birth canal. This is something of a slow somersault. Often times, it’s noticeable by the kicking-in-new-places.

But sometimes it’s not readily obvious. This doesn’t necessarily mean anything is wrong, but that may be a moment when your doctor would order a third trimester ultrasound.

Here’s What To Expect:

Third trimester ultrasounds are less common but not unheard of. Just as during the first or second term ultrasound, measurements can be taken to confirm size and due date.

Here’s What You’ll See:

This ultrasound can be used to look for fetal development, size, fluid and position.  The examination is typically performed by scanning with the probe on mom’s abdomen.  It is uncommon to perform transvaginal fetal ultrasound during the third trimester.

So, if you don’t need a third trimester ultrasound – that’s totally fine. As doctors we try to be judicious about the use of imaging. Again, while an ultrasound is harmless, why go in for unnecessary tests? If your doctor does recommend a third trimester ultrasound, again – don’t worry. We simply want the best possible health – for all!

If you’d like some really comprehensive further explanations of ultrasound and pregnancy, we recommend this link.

 

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

March 25, 2014

Ultrasound and Pregnancy: The Second Trimester

Normal 28 week fetus on second trimester ultrasound. We're getting bigger now Mom!

Normal 28 week fetus on second trimester ultrasound. We’re getting bigger now Mom!

While the first ultrasound of a pregnancy is necessary to confirm pregnancy and initial health of the fetus and the mother, there’s more to come!

Ultrasound: 2nd Trimester Pregnancy

The second trimester ultrasound is a fun one! Now, ultrasounds are not entertainment – they are a medical screening and we doctors take them seriously for the sake of the health of all.

Luckily, ultrasounds do not involve radiation so they are safe and non-invasive. Whereas a first trimester ultrasound requires what is known as a transvaginal probe, the second trimester is done entirely externally unless there are special circumstances with mom or the baby.

What to Expect

You will be asked to come to the exam with a full bladder – we actually use the full bladder as a “window” through which we can view the pregnancy.

The exam with the bladder full will be done using a transducer across your belly to get a good evaluation of the uterus and your pelvis. This is most helpful in demonstrating the pregnancy location and fetus position.

The whole process will take about half an hour.

So… what’s the fun? Want to know if it’s a boy or girl? Want to see a clearer picture of the fetus? Now’s the time! Because most people wait until the second term to announce their pregnancy to friends and family, these images often appear on places like Facebook as the first introduction of who’s-to-come. That’s a lovely bonus.

What We Can See

But the serious side of a second term ultrasound is to determine a few important things. First, we want to confirm size and due date for this pregnancy making sure the fetal size and expected due date match up. We also want to confirm overall fetal health while performing a fetal anatomic survey. This means we can see development of the fetus and detect any possible problems. If there is any point of concern by second trimester ultrasound study often more detailed ultrasound, fetal echocardiography or other imaging can be planned to further evaluate any potential problem.

Ultimately, the second ultrasound is something to look forward to. Great information comes from the second trimester ultrasound regarding the health and welfare of mom and her baby. And, ok, it’s a little fun too.

 

 

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

March 20, 2014

Ultrasound and Pregnancy: The First Trimester

Normal 12 week fetus on first trimester ultrasound. Hi Mom!

Normal 12 week fetus on first trimester ultrasound. Hi Mom!

When most people hear the term “ultrasound” one particular thought comes to mind: pregnancy. Every expectant parent loves a glimpse of who’s-to-come – and finding out which color to paint the nursery is a bonus for many!

However, ultrasound is far more powerful than simply providing in utero baby snapshots. Ultrasound has revolutionized the approach to pregnancy, giving information which can save lives – the baby’s or the mother’s or sometimes both. Ultrasound uses sound waves – not radiation – to produce images, so in trained hands it is safe to use at any time during pregnancy.

During the first trimester, ultrasound is used most frequently to confirm pregnancy (along with a blood test), to confirm the location of the pregnancy and to evaluate bleeding. In the first trimester, the ultrasound will likely involve images obtained through a distended bladder and a transvaginal exam.

Here’s what to expect:

First, you will be asked to come to the exam with a full bladder – we actually use the full bladder as a “window” through which we can view the pregnancy.

The first part of the exam with the bladder full will be done using a transducer across your belly to get a view of the uterus and your pelvis. This is most helpful in demonstrating the pregnancy location. Once these images are obtained, you will be able to empty your bladder and return for what is called a transvaginal ultrasound. This involves a small probe being placed into the vagina to image the pregnancy and pelvic structures. This transducer allows better depiction of the pelvic structures and will allow more detailed evaluation – this is used in the first trimester and occasionally later in pregnancy. In the first trimester when the pregnancy is so small, the transvaginal part of the study is often key. There is usually little or no discomfort with the transvaginal study.

The whole process will take about half an hour.

What can we see in the first trimester?

It depends on the age of the pregnancy. When first visualized, the pregnancy will be a small fluid filled sac. At around 6.5  weeks, the embryo is often seen as a small peanut shaped structure – heart beating away. By the end of the first trimester, you can distinguish the head, trunk and the limbs. Everything is small, so in general gender will not be determined. We will evaluate the age of the pregnancy and compare to what you should be; confirm that the pregnancy is in the uterus; count babies – twins anyone? – look for the heartbeat, which we can only see once the embryo is big enough (7 mm is the key embryo size to expect to see a heartbeat!); and look at the pelvic structures. Fetal anatomic detail is limited by the small size, but it is amazing what you can see!

We know having babies is stressful – and not always easy! We wish you all the best, and hope this helps explain the process of the first trimester obstetric ultrasound.

August 15, 2013

Arthrography: what body parts are studied? – Dr. Angela Noto