Musculoskeletal Magnetic Resonance Imaging - Assignment Example

? MUSCULOSKELETAL MRI By Presented to [Your Femoroacetabular Impingement (FAI) Femoroacetabular Impingement (FAI) is the condition during which there is a lot of friction at the hip joint. In more explicit terms, the femoral head (ball) and the acetabulum (socket) rub against one another in an abnormal manner, which leads to the damage of the hip joint (HipFAI 2013). The damage from the friction is caused on the articular cartilage, which is the smooth, white coloured surface of the socket or the ball; the adjacent labral cartilage. The labral cartilage is the soft tissue-matter bumper, which is located at the socket (HipFAI 2013). FAI occurs in two forms that include pincer and cam. The cam form derives from the relationship between the femoral head and the neck, in the case the connection of the two is more aspherical than perfectly round. The name of the form cam – comes from the Dutch root-word that means cog. The condition, where the roundness of the connection is lost, makes the contact between the socket and the head abnormal (HipFAI 2013). The pincer form is different from the cam form. Pincer is derived from the French-root word that means to pinch. The pincer form is the situation where the acetabulum has more than normal enclosure of the femoral head (HipFAI 2013). This condition of over-coverage, ordinarily takes place around the front-top edge of the acetabulum (socket), resulting in the pinching of the labral cartilage – between the anterior femoral head-neck and the edge of the socket intersection area (Blankenbaker & Tuite 2006). The pincer form of FAI is ordinarily a result of retroversion, which is the condition where the socket turns backwards; profunda, where the socket part of the intersection is very deep; or protruding, which is the situation, where the ball extends to the pelvis area. Many times, the two forms of FAI exist mutually, which is referred as mixed impingement (HipFAI 2013). FAI is related to the damage of the cartilage, the tear of the labral, sports hernias, hip arthritis, hyperlaxity, and low back pain. FAI is much common among active persons and high activity athletes (HipFAI 2013). ‘A Normal Joint and the different forms of FAI: Cam FAI, Pincer FAI, and Mixed FAI’ (HipFAI 2013) ‘MRI image of Femoroacetabular Impingement (FAI)’ (Filigenzi and Bredella 2008) Coil Selection and Positioning a Patient for MRI of Hips Coil selection during an MRI for the hip depends on a number of considerations. These include whether the two hips of the patient are to be imagined, or whether only one is to be imaged. The decision of whether to image one or the two hips will also influence the selection of pulse sequence, and whether or not, to use injection contrast fluids intravenously, or intra-articularly, during the imaging process (Beltran et al. 2002). Coil selections, deciding whether to image the two hips or not, and whether to use contract materials are decision areas compounded by the radiologist, in the case they are not provided with the clinical information of the patient. In case the radiologist wants to image the two hips, it will be after they have determined that they are looking for metastasis or osteonecrosis. In case it is determined that a single hip imaging is most relevant – which offers higher contrast and spatial resolution – a dedicated surface coil will be used for the imaging (Beltran et al. 2002). In case that a bilateral hip imaging is required, a body coil is chosen. Consequently, when the imaging shows positive findings, the radiologist can choose to switch to single hip imaging (Beltran et al. 2002). The change will require a dedicated surface coil, for instance a flexible coil, which offers higher anatomical resolution from smaller structures like the acetabular labrum. It also offers better imaging for the evaluation of the subchondral area of the ball or the articular surfaces (Beltran et al. 2002). During the positioning of a patient when MRI imaging the hips, the patient is required to lie, and remain still while inside the tube-like structure, throughout the test. In some instances, they are required to stop all movement, including breathing, so that the images captured can be highly clear (WiseGeek 2013). During the positioning, the hip part of the patient should be placed closest to the hip area in order for the coils to send radio waves through the hip area, and to capture a detailed image of the hip area (WiseGeek 2013). Prior to patient positioning inside the machine, they will be required to remove all clothing and jewellery. They should also report any metals inside their body, before the imaging starts since some metals can be incompatible with the imaging. The positioning of the patient on the examination table will also depend on the type of imaging machine, as some may have the sides open, and others are tunnel-like (WiseGeek 2013). The patient is usually asked to lie on their back on a narrow table with the legs on the side of the table that is close to the machine as shown in the figure below. In this case, positioning the head away from the machine is crucial since the imaging focuses on the hip area. With the patient lying on their back position on the narrow table, the table then slides inside the machine, but only at the middle of the machine that captures the hips of the patient (Sachdev 2011). ‘The MRI bed and the MRI machine: Patient lies on the bed, then it slides into the MRI Machine’ (Sachdev 2011). Tennis Elbow Tennis elbow refers to an injury or condition, which results from the overuse of the fore arm, arm and hand muscles, resulting in a painful feeling around the elbow area. It is not only a condition that exists among tennis players, but it was named as such since it is common among tennis players (A.D.A.M 2012). The condition results from the subtle or the abrupt injury of the muscles and the tendons at the region outside the elbow area. The condition, particularly takes place at the area, where the tendons and the muscles of the fore arm connect to the lateral epicondyle (the outside bony area) of the elbow. The condition may be referred as lateral epicondylitis, in advanced medical terms. The condition is also referred as “golfer’s elbow,” which refers to the same injury, but in the case it is located at the inside side of the elbow (A.D.A.M 2012). From a medical point of view, the second version of the injury is referred as medical epicondylitis. The overuse of the forearm can also affect the posterior, or the back part, of the elbow. The condition, mostly affects the dominant arms of the patients. Hence, a right-handed person will most likely have the injury on the right hand, and a left-handed on the left hand. In rare cases, it can take place in the non-dominant hand. ‘MRI image of a Tennis Elbow with lateral epicondylitis (Illustration added)’ (Kathleen 2011). The symptoms of a tennis elbow include the cases, where the patient feels pain, which slowly increases around the outside area of the elbow. In rare cases, the pain develops abruptly. The pain of the injury gets worse, when the patient squeezes objects or shakes the injured hand. The pain of the injury is made worse, in the cases that the patient moves or stabilizes the wrist using force. Some cases that can worsen the pain include using hand held tools, lifting, handling utensils like forks, knives, and toothbrushes, as well as when opening jars (A.D.A.M 2012). Coil Selection and Positioning a Patient for MRI of an Elbow Coil selection during the MRI imaging of a tennis elbow influences the choice of coil, as the elbow is best positioned at the side, from the patient’s supine (Tirman 2002). This condition demands the imaging of the isocenter of the magnet, which, in most cases, limits the choice of the coil for use (Tirman 2002). Due to the fact that many of the parts imaged at the elbow area are small, there is need for high resolution imaging. Considering that the hand is imaged while at the side, commercial volume coils, which are used during the imaging of the wrist area, can be used to develop high quality images (Tirman 2002). Due to the fact that adequate coverage is required, a partially locked or flexed elbow will limit the process of imaging. Therefore, an extremity coil, which is detached from its base, may be useful in order to image the elbow while off centre. Alternatively, the arm can be extended through the space in a shoulder coil, which can allow for imaging, while it is flexed (Tirman 2002). The positioning of the patient during an elbow MRI imaging is much easier in recent times, as surface coils are readily available. With the right positioning of the patient’s elbow, either over the head (in the case it is movable) or at the side of the body, the soft tissues can be imaged effectively (Tirman 2002). Patient positioning will be determined by equipments that are available. It is more comfortable for the patient when they are supine, compared to the case where they are prone since they are more likely to register movements. When using the body coil, the arm should be lifted above the patient’s head, where a considerable level of movement between the shoulder and the elbow should be observed (Tirman 2002). However, it is more comfortable, in case the arm is placed next to the body, with the lower arm should be in pronation, and the palm resting at the thigh area, especially in case of the examination time being long. Placing cushions under the head, shoulder, and a pad under the limb used, increases the patient’s comfort and reduces the level of movement. The overhead position improves the closeness of the elbow to the isocenter of the MRI’s magnetic field (Tirman 2002). This positioning is much better in case the patient is in an oblique pose. The problem with this positioning is that it increases the level of discomfort, which is likely to trigger patient movement (Tirman 2002). Calcifying Tendonitis Calcifying tendonitis of the rotator cuff is a type of tendinitis, which is distinguished by the deposits of hydroxyapatite, which is a crystalline phosphate of calcium at tendon areas of the body. The condition commonly affects the tendons located at the shoulder (rotator cuff) resulting in inflammation and pain. The condition is believed to be a cause of frozen shoulder condition (Woodward and Gellman 2013). ‘Image of a Calcifying tendonitis of the rotator cuff’ (PhysioWorks 2012). ‘MRI Image of Calcific Tendonitis’ (Desai 2011). Clinical Presentation The clinical presentation of Calcifying tendonitis is different since patients suffering from this condition can have none, or few of its symptoms, during the formative stage. Other patients can experience acute symptoms during the resorptive stage of the condition. The resportive stage, which takes place later during the development of calcifying tendonitis, is often characterized by acute symptoms like pain (Lotke, Abboud and Ende 2008, p. 196). However, some patients of the condition can suffer from deposits, which accumulate, incidentally as a component of workup, due from impingement syndrome. The pain experienced during the resorptive stage is associated to an amplification of the intra-tendinous pressure that mounts from vascular proliferation, edema, the influx of inflammatory cells, and swelling. As the volume of the tendons increases, the limited size of the subacromial space is likely to cause more pressure to the adjacent tendons and in some cases causing secondary impingement. During the acute stages, the pain experienced can be extreme with the patients likely to experience a painful catching, which results from the localized impingement of the calcified matter, on the coracoacromial curve (Lotke, Abboud and Ende 2008, p. 196). Development and Course of this Entity The cause of calcium deposits at the rotator cuff is not fully understood. Different ideas have been developed to explain the condition, including the aging of the tendon and blood supply issues, but the evidence in support of these thoughts is not clear (PhysioWorks 2012). The more plausible explanation is that on delayed healing (Lotke, Abboud and Ende 2008, p. 196). Ordinarily, tendons heal through the action of the collagen cells referred as fibroblasts. However, after duration of months, the fibroblasts become less prevalent at the area and are consequently replaced by osteoblasts. Osteoblasts are the bone forming cells of the body. These cells enhance the growth of calcium deposits (bone) at the tendon area. Therefore, the most practical cause of calcific tendonitis seems to be the delay of healing. The condition develops slowly and most times, heals without the need for surgery. The process takes place though a number of stages, including the pre-calcific stage, the calcific stage, and the post-calcific stage (Lotke, Abboud and Ende 2008, p. 196). Appearance on X-ray and MRI The appearance of calcific tendonitis on X-ray appears like some solid deposits at the middle of the bones of the shoulder joint. The calcium is typically supraspinatous, on average 1-1.5 com from the insertion point and 1-1.5 cm in. ‘X-Ray image of Calcific tendonitis: a) Anteroposterior b) Lateral X-ray of acute calcific tendonitis of supraspinatus tendon c) Close-up image of a calcified lesion’ (PhysioWorks 2012). ‘X-ray image showing the position of calcific tendonitis at the shoulder’ (Welsh Shoulder and Elbow Clinic 2005) ‘MRI image of Calcific tendonitis: Number d) T1-weighted image e) T2 weighted MRI from a hypointense signal from the calcified lesion’ (PhysioWorks 2012). ‘Cor T2 Fat Sat Image and Cor T1 MRI images (respectively) of calcific tendonitis’ (PhysioWorks 2012). Reference List A.D.A.M., 2012. Tennis elbow: Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis –lateral. Pub Med Health Accessed on 29 March 2013 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001485/ Beltran, J., Patnana, M., Beltran, L., and Ozkarahan, G., 2002. MRI of the HIP. Applied Radiology, 31(11). Accessed on March 29, 2013 from http://www.appliedradiology.com/Article.aspx?id=19210&ekfxmen_noscript=1&ekfxmensel=e5a1dcbef_6_11 Blankenbaker, D., and Tuite, M., 2006. The painful hip: new concepts. Skeletal Radiology, 35, 352–370. Desai, P., 2011. Calcific Tendinopathy Supraspinatus. Radiopaedia Accessed on March 29, 2013 http://radiopaedia.org/images/867175 Filigenzi, J., and Bredella, M., 2008. MR Imaging of Femoroacetabular Impingement. Appl Radiol, 37(4),12-19.  HipFAI., 2013. Femoroacetabular Impingement (FAI). HipFAI Accessed on 29 March 2013 from http://www.hipfai.com/ Kathleen, S., 2011. Tennis Elbow aka Lateral Epicondylitis Accessed on 29 March 2013 http://photographybykathleenstites.blogspot.com/2011/02/tennis-elbow-aka-lateral-epicondylitis.html Lotke, P., Abboud, J., and Ende, J., 2008. Lippincott's Primary Care: Orthopaedics. Philadelphia: Lippincott Williams & Wilkins. PhysioWorks, 2012. Rotator Cuff Calcific Tendinitis. PhysionWorks Accessed on 29 March 2013 from http://physioworks.worldsecuresystems.com/injuries-conditions-1/rotator-cuffcalcific-tendinitis#.UVvKWaKNkgU Sachdev, N., 2011. Launch of MRI in Central Newfoundland. French Tribune. Accessed on 29 March 2013 http://www.frenchtribune.com/teneur/114304-launch-mri-central-newfoundland Tirman, P., 2002. MRI of the Elbow. Advanced MRI Accessed on March 29, 2013 from http://mri.cpson.com/pdf/MRI_of_the_Elbow.pdf Welsh Shoulder and Elbow Clinic, 2005. What is Rotator Cuff Tear? Welsh Shoulder and Elbow Clinic Accessed on March 29, 2013 from http://www.shoulderinfo.com/patients/shoulder/Calcific_Tendonitis.htm WiseGeek, 2013. What Should I Expect From a Hip MRI? Wise Geek Accessed on March 29, 2013 from http://www.wisegeek.com/what-should-i-expect-from-a-hip-mri.htm Woodward, A., and Gellman, H., 2013. Calcifying Tendonitis. Medscape Accessed on March 29, 2013 from http://emedicine.medscape.com/article/1267908-overview Read More