With musculoskeletal issues, traditional x-rays are the most common first imaging study performed. Musculoskeletal radiology is often performed because of sports injuries involving the joints, but radiological imaging can also be used for medical imaging of tumors of the bones and soft tissues.
“Musculoskeletal” encompasses bones, muscles, tendons, ligaments, and joints, and different types of radiology techniques are used depending on the level of detail needed. Computed tomography, nuclear imaging, and magnetic resonance imaging all have places in musculoskeletal radiology, and many of these imaging techniques complement each other when radiologists need to have the most accurate information about a musculoskeletal problem.
Musculoskeletal Pain and Its Causes
Musculoskeletal pain may originate in bones, muscles, tendons, ligaments, or nerves, and it may be acute or chronic. The pain may be completely localized, or widespread. Common types of musculoskeletal pain include lower back pain, muscle pain, tendonitis, and stress fractures. Injury is usually the cause of musculoskeletal pain, typically from car accidents, falls, direct blows, and sometimes repetitive use of a subset of musculoskeletal structures. In fact, around one-third of adults experience musculoskeletal pain from overuse, poor posture, or prolonged immobilization.
Symptoms depend on whether the musculoskeletal pain is due to injury or overuse, and generally include:
• Pain that gets worse with movement
• Aching or stiffness
• Difficulty sleeping
• Muscle twitching
• Burning or “pulled” sensation
The type of pain also depends on what structure it originates from. For example, bone pain is usually deep and penetrating, whereas muscle pain is often accompanied by cramping or spasms. Pain in tendons or ligaments is often worse when the affected area is moved or stretched. Joint pain is often accompanied by stiffness and swelling, while nerve compression pain (like carpal tunnel syndrome) may cause a burning sensation.
Radiology for Diagnosing and Treating Musculoskeletal Pain
A medical history, as well as questions about injuries or activities help a radiology specialist determine which imaging type is best for a particular instance of musculoskeletal pain. While doctors can often locate the origin of pain through manually handling an injury site, determining the underlying cause usually requires radiology studies and sometimes laboratory tests.
When images of bones are needed, x-rays are usually the first type of radiology study done. If more detailed imagery is required, CT scans may be ordered. With soft tissues like muscles, cartilage, tendons, and ligaments, magnetic resonance imaging (MRI) may be used. Treating musculoskeletal pain is a matter of treating its underlying cause, and may involve:
• Splinting or immobilization
• Physical or occupational therapy
• Heat or cold therapy
• Anti-inflammatory or anesthetic medications
• Stretching exercises
• Therapeutic massage
MRI in Musculoskeletal Imaging
Musculoskeletal problems related to soft tissues may be diagnosed using MRI due to the high resolution and contrast possible with this type of imaging. MRI can, for example, distinguish muscle tissue from scar tissue, which is important for advanced surgical procedures like those that treat blast injuries. It is also useful in diagnosing diseases like Duchenne muscular dystrophy and ankylosing spondylitis, potentially leading to earlier medical intervention in these diseases.
Because of cost and availability issues with MRI, it’s generally not the first radiology study ordered for most musculoskeletal issues, but in certain applications it is clearly superior. It is outstanding for detecting bony erosions, synovitis, and other conditions associated with rheumatoid arthritis, and can be used in whole-body mode to screen for primary and metastatic malignancies of the bone marrow.
Advantages of Working With a Subspecialist in Radiology
With diagnosis of musculoskeletal problems, working with a radiology subspecialist can be the key to obtaining the most accurate and complete diagnosis as quickly as possible. Musculoskeletal radiology subspecialists like Charles C. Cole, MD, who has expertise in nuclear medicine and MRI in addition to musculoskeletal specialty training, as well as musculoskeletal specialists Heather Sher, MD, George Koshy, MD, and Brett Staller, MD are regularly consulted for diagnosis of musculoskeletal problems by South Florida healthcare providers. By working closely with other specialists, including orthopedic surgeons, oncologists, and sports medicine specialists, they’re able to determine which imaging modality to use and interpret results with exceptional skill and accuracy.
SteleRAD is owned and operated by Board-certified radiologists like Drs. Cole, Sher, Koshy, and Staller, and is a trusted leading provider of imaging services to South Florida imaging centers, physician practices, and hospitals. To learn more, call SteleRAD at 954-358-5250 or contact us online.