musculoskeletal imaging

Joint Pain and MRI

By Stephen Janas, MD, Musculoskeletal Radiologist, Advanced MRI

ost of us at one time or another has experienced bone or joint pain. The sprained ankle, sore shoulder, trick knee, and painful hip are well-known to many. Musculoskeletal radiology is a subspecialty of radiology that deals with the imaging of bones and joints. As a musculoskeletal radiologist, I spend most days reviewing and interpreting images of painful joints. X-rays, CT scans, and ultrasound are all used to image musculoskeletal conditions and depending on the specific problem, one or more of these imaging modalities may be used. However, the indisputable star of the show in musculoskeletal imaging is magnetic resonance imaging. Magnetic resonance imaging, better known as MRI, is a noninvasive imaging technique first widely used in the early 1980s. Instead of using ionizing radiation as CT and X-rays do, MRI uses a strong magnetic field and radio waves (radiofrequency pulses) to generate images of the human body. This technique allows clear and detailed images of the bones, muscles, tendons, ligaments, cartilage and other soft tissue structures that can be sources of pain. Once the source of the pain is identified, a targeted treatment plan can be started. These strengths have made MRI one of the most valuable imaging procedures in the field of musculoskeletal imaging.
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How Will an MRI Help My (Knee, Shoulder, Wrist, Ankle, Hip, Etc) Pain? One of the most important roles of musculoskeletal imaging in general and MRI in particular is in the treatment decision-making process. Simply put, these tests can identify which conditions are likely to benefit from surgery and those conditions that are unlikely or less likely to benefit from surgery. Once a non-surgical problem is identified, treatment with physical therapy, anti-inflammatory medications, steroid injections, orthotics, braces, etc, can be started. Similarly, when a surgically correctable problem is identified, the patient can have a thoughtful discussion with their surgeon regarding the risks, benefits, alternatives, and likely outcomes of surgery. As a radiologist specializing in musculoskeletal imaging, a primary goal of every MRI that I interpret is to identify, as accurately as possible, the underlying cause of the patients symptoms. Once that goal is accomplished, the ordering medical provider can initiate the proper treatment. How Do I Know if I Need an MRI? In general, any patient with chronic or recurrent joint pain or dysfunction would be a candidate for MRI. An MRI is also com-

monly ordered following an acute injury, especially if this results in severe pain and functional impairment. Other relatively common indications for an MRI exam are for patients suspected of having a mass (tumor) or infection. A medical provider, who is trained in the treatment and diagnosis of orthopedic conditions, will order an MRI after a thorough evaluation and assessment of the patient. If an MRI is so Great, Do I Still Need X-Rays? In nearly all situations, radiographs (X-rays) should be performed prior to an MRI examination. X-rays provide a valuable overview of the bones and joint spaces. They are still one of the best and easiest ways to evaluate for fractures and for assessing joint alignment. X-rays remain the single best way to evaluate the aggressiveness of a bone tumor, if one is present. Small calcifications that are not well seen on MRI are well depicted on X-rays and can provide key diagnostic information. Since soft tissue detail is limited on X-rays and this is the strength of MRI, the two are best thought of as complementary examinations. What Joints Can be Evaluated by MRI? Pretty much any joint that you can think of can be imaged with MRI including knees, shoulders, hips, ankles, elbows, wrists, hands, and feet. Even the temporomandibular joint (TMJ), the joint that opens and closes the mouth has become a routine MRI examination. However, knees and shoulders are the two most commonly imaged joints. The reason is simple: these are the joints that are most often painful to patients. Knee MRI examinations can accurately diagnose many conditions, both surgical and non-surgical. Tears of the meniscus (thick

fibrocartilage that cushions the knee) that result in mechanical symptoms (clicking and locking) are often treated surgically as are tears of the stabilizing ligaments of the knee, most commonly the anterior cruciate ligament (ACL). Other problems such as bursitis, cysts, muscle and tendon strains, and bone bruises can be diagnosed and are more likely to result in non-surgical therapy. MRI can determine the extent of cartilage loss that occurs in osteoarthritis (wear and tear arthritis). When this becomes severe enough, another surgical treatment can be offered: the joint replacement. A similar decision-making process is encountered in shoulder imaging. The rotator cuff is a group of muscles and their tendons that wrap around the shoulder giving us strength and stability. A variety of problems can occur ranging from mild tendonitis to complete tearing. Depending of the degree of the injury, patients may require rest, anti-inflammatory medications, physical therapy, or surgery. Some problems require all of the above. In summary, MRI is particularly well suited for evaluation of the musculoskeletal system. It is extremely safe and can accurately diagnose the musculoskeletal conditions encountered in everyday life. Once a diagnosis is made, the appropriate treatment can be initiated and recovery and symptom relief can begin. For more information, you may contact Advanced MRI at 309-665-0640. They are located at 1709 Jumer Drive in Bloomington and offer the only 3T scanner in the Bloomington-Normal area.

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June 2013 Bloomington Healthy Cells Magazine Page 25