Monday, October 6, 2008

Imaging Sports Injuries

Many athletes tend to “push through the pain,” continuing to work out even when it hurts. There are times when you may just be fighting through muscle fatigue, and continuing your workouts makes sense. If you are having severe pain or other physical symptoms, such as limitations in motion or giving way, these are more likely to send you to see a health care professional. Athletes often continue to train through chronic or lower grade pain, however. Unfortunately, continued stress of an injury or abnormality say lead to serious consequences. Continued ligament or cartilage damage may lead to the need for corrective surgery. How do you know if you are one of the athletes who could develop serious consequences from continued workouts without treatment?

The first step in evaluating a sports injury is seeing a health professional. They will do a physical exam, and will probably order xrays. Xrays will pick up bone changes, and may suggest a soft tissue injury. Many subtle abnormalities are not visible on xray, however, and CT or MRI is needed as the next step in evaluation. CT is best at looking at the cortex of bone- the hard shell around the softer inner marrow. This is good for looking for a fracture, stress thickening of bone cortex (early stress changes before a fracture), and degenerative bone changes. Newer “multi-slice” CT scanners can now image your leg or arm in just a few seconds, with crystal clear pictures of the bone. Software allows the reconstruction of the 2 dimensional CT images into 3D pictures which improve diagnostic accuracy.

MRI is best suited to looking at the marrow core inside the bone cortex and for evaluating all the many soft tissues that you use in sports (muscle, tendon, ligament, and cartilage). There are many injuries an MRI can demonstrate that would be missed on xrays. A meniscus tear in the knee of a runner, a rotator cuff tear in a tennis player, or a ligament tear in the wrist of a golfer, for example. These could be repaired surgically. Ignoring the pain from one of these injuries may lead to degenerative changes in the bone that could not be repaired easily, and could curtail your continued sports activity. Milder injuries seen on MRI can often be successfully treated by medication, an injection, or physical therapy, getting you back to pain-free training or competition. Newer MRI advances include higher strength magnets, including a 3T closed magnet and 1.2-1.5T open magnets. These are sort of like having higher pixels on your digital camera, giving sharper and better pictures.

CT or MRI imaging may also show that you have no significant abnormality. This could free you to continue training as tolerated, without the worry of having bone or soft tissue damage. Treatment of your pain or injury, or the peace of mind from knowing there is no significant soft tissue or bone injury, is a great reason to talk to a health professional if you are having pain. This can help you keep reaching for your personal athletic best for years to come.

This is an editorial submitted by Dr M. Kraut, MD. Dr. Kraut is a board-certified musculoskeletal fellowship-trained radiologist who also trained first as an orthopedic surgeon. Dr. Kraut has competed in swimming and track, and also completed several triathlons. Dr. Kraut works at MRI of Richmond, and reads musculoskeletal cases for Tyson’s Corner Diagnostic Imaging and Vienna Diagnostic Imaging in northern Virginia. Website

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