Musculoskeletal Injuries, Procedures and Treatments

Shoulder Scan - UCSF Medical

ACL Tear

The Anterior Cruciate Ligament (ACL) is one of four ligaments of the knee joint (ligaments connect bone to bone) that coordinate function and promote stability of the knee joint. The ACL runs in a notch at the end of the femur and originates at the back part of the femur and attaches to the front part of the tibia. In the knee, the ACL prevents excess forward movement of the tibia. It also provides roughly 90 percent of the stability within the knee joint. MRI allows to directly visualize the ACL ligament, to detect tears, and diagnose injuries of the surrounding tissues, which directly helps to decide on the best possible treatment.

Arthritis of the Shoulder

There are two joints that can be affected by arthritis in the shoulder. One is located where the collarbone meets the tip of the shoulder bone and is called the acromioclavicular or AC joint. The other is at the junction of the upper arm bone with the shoulder blade and is called the glenohumeral joint or scapulothoracic joint. Both joints may be affected and there are three major types of arthritis that generally affect the shoulder, osteoarthritis, rheumatoid and injury or post-trauma arthritis. The most common symptom of arthritis of the shoulder is pain. If the glenohumeral shoulder joint is most affected, the pain may be felt in the back of the shoulder, whereas the pain in the acromioclavicular joint may be felt in the front of the shoulder. With rheumatoid arthritis, the pain may be in both shoulder joints. Limited motion is a typical symptom. It may become more difficult to lift your arm, to wash your hair or reach up. You may hear a clicking or snapping noise (crepitus) as you move. There may be difficulties with pain at night while trying to sleep. X-rays and MRI can directly demonstrate which tissues are damaged in the shoulder joints. It helps to make a decision on what treatment may be best suited to help relief pain or dysfunction. For example there may be a tear of the rotator cuff or the labrum, which causes these problems which can be directly shown with MRI. MR-arthrography helps in particular to diagnose tears of the labrum. MRI also helps to decide whether enough muscle is available to perform a successful repair of the rotator cuff.

Bone and Soft Tissue Tumors

Bone tumors can occur as cancer which originates in bones (sarcoma) or when cancer has spread from another site in the body (i.e., breast, prostate, lung). Soft tissue tumors (sarcomas) refer to tumors in muscles, tendons, fat, blood vessels, lymph system, nerves, and around joints and are most common in the head, neck, arms, legs, trunk, and abdomen. X-rays, CT and MRI are performed to detect the tumors and to diagnose what tumor is present, whether it is benign or malignant and whether it is located in the bone, soft tissues or both. Imaging is also used to stage the tumors. In MSK radiology we also biopsy these tumors using CT guidance, which is a safe technique with minimal complications. After surgery x-rays and MRI are used to diagnose if there is a tumor recurrence.

Bone & Soft Tissue Pathology - UCSF MedicalThis text book, co-authored by UCSF's Dr. Thomas Link with Dr. Andrew Horvai, Bone and Soft Tissue Pathology: High-Yield Pathology presents the pathology of bone and soft tissue in a practical way with more than 1000 illustrations.  The book has 2 parts, one covers bones and the other covers soft tissues.  For the bone disease portion of the book, metabolic conditions, infectious and inflammatory diseases such as rheumatoid arthritis and osteoarthritis, cystic lesions, giant cell tumors, periosteal lesions, cartilage-forming lesions, bone-forming lesions, notochordal tumors, fibrous lesions, vascular lesions, hematopoietic lesions, lipomatous tumors, and carconoma are discussed and shown.  On the soft tissue side, the book shows diseases and diagnosis including myofibroblastic fasciitis, fibrosing lesions, myofibroblastic tumors, perivascular tumors, fibroblastic tumors, adipose tumors, smooth muscle tumors, genital stromal tumors, skelatal tumors, nerve and nerve sheath tumors, vasculor tumors, bone and cartilage tumors of the soft tissue, and rare tumors of uncertain origin.

Hip Labral Tear

The hip joint is a ball-and-socket joint enveloped in dense tissue. The labrum functions as a system of shock absorption, joint lubrication, pressure distribution, and aids in stability. Damage to the labrum can lead to or may be associated with osteoarthritis. Labral tears frequently go undiagnosed for a long time. Patients with hip or groin pain may have labral tears. MR-arthrography can directly show tears of the labrum and can also show signs of impingement of the hip joint, which is a common finding especially in younger people and can be a cause of hip pain. We inject anesthetics into the hip joint during MR-arthrography which helps to diagnose whether the pain comes from the hip. MRI of the hip can thus help to guide therapy. It also shows other findings near the hip, which may be a source of pain such as sports hernia or trochanteric insertion tendinopathy, which is particularly frequent in middle-aged and older women. For pain relief in osteoarthritis we perform fluoroscopically guided intraarticular injection with or without steroids. This may help to quiet an acute flare.

Joint Injections and Joint Lubrications

Joint injections are interventional treatments for people experiencing pain or swelling due to joint wear and tear or injury.  Joint lubrications are a cushioning and lubricating treatment to restore ease of movements in joints damaged by osteoarthritis.

Joint Replacement

Joint replacement may be necessary when natural joints wear out; the old joints are removed surgically, and new joints are inserted in their places.  The new joints for knees or hips may be made of special metal or polyethylene or are carbon-coated.  The new joints allow people to move again with little or no pain.

LCL Tear

The Lateral Collateral Ligament is the knee ligament that is located on the outside of the knee that links the thigh and shin bones. A ligament injury is sometimes called a sprain, and can occur if the knee is twisted or forced during sports or due to a fall. It is classified as first, second or third degree depending on the severity of the injury. MRI allows us to diagnose the severity of these injuries; it shows whether the sprain is complete or partial and thus helps to guide therapy. It also helps to diagnose associated injuries of the menisci, bone and cartilage.

MCL Tear

The medial collateral ligament (MCL) is a band of tissue in the inner part of the knee running from the thighbone to a point on the shinbone about five inches above the knee. The MCL's main function is to prevent the leg from extending too far inward, keep the knee stable and yet let it rotate. MRI shows whether the injury affects the deep and/or superficial fibers of the MCL and whether the sprain is complete or partial. It also helps to diagnose associated injuries of the menisci, bone and cartilage and thus helps the Orthopedic Surgeon to perform the best possible surgery.

MR Arthrography

This is a special MRI examination where before the MRI a diluted contrast agent is injected into the joint, distending the joint and allowing better detection of abnormalities at the labrum of the hip and shoulder, the cartilage, muscles, joint capsule and ligaments. It is mostly  done at the shoulder and hip but also at the elbow, the wrist and ankle joints.

Osteoarthritis

Osteoarthritis is degenerative joint disease that involves pain and stiffness in the joints caused when the protective cartilage in the joints wears down

Osteoarthritis of the Hand and Fingers

Osteoarthritis of the hand most commonly develops at three sites on the hand; the thumb, at joints that are closest to the fingertips, and in the middle joints of fingers. MRI scans show cartilage, bone, and ligaments. Radiographs directly show how severe the disease is, sometimes the pain may not be due to osteoarthritis but related to inflammation or injury of the ligaments and tendons. MRI can directly show whether there is such injury, which is found typically at the wrist.

Osteoarthritis of the Hip

Hips are at risk for osteoarthritis, due to "wear and tear" The covering called cartilage that is on the ends of your bones normally helps your hip joint to glide and this cartilage may wear out or thin out. As a result the hip joint gets stiff and inflamed. Bone spurs can build up at the edges of the joint. For pain relief in osteoarthritis we perform fluoroscopically guided intraarticular injection with or without steroids and viscosupplements to lubricate the hip joint.

Osteoarthritis of the Knee

Cartilage Deterioration is the main cause of knee osteoarthritis and can be caused by previous knee injury (especially meniscal injury), repetitive strain on the knee, ligament tears, fractures, stress on the joint due to overweight, and genetics. We have developed new techniques to better quantify degeneration of the cartilage, which helps in particular to identify the early stages. Using MRI we can directly quantify the collagen, proteoglycans and water content of the cartilage using T1 rho and T2 relaxation time techniques; collagen, proteoglycans and water content are essential to the function of the cartilage. At later stages of osteoarthritis we can perform fluoroscopically guided intraarticular injections with or without steroids and viscosupplements to lubricate the knee joint.

Osteoporosis

Osteoporosis is a disease, particularly found in post-menopausal women, which leads to loss of bone and makes the bones were fragile.  Loss of bone can be measured with bone mineral density.

PCL Tear

The PCL or Posterior Cruciate Ligament is the part of the knee joint that prevents the tibia, from dislocating backwards. A PCL injury can happen when someone falls onto the front of their knee or is in a car accident. In a PCL injury the knee has usually been in a flexed position. The knee receives a blow to the front and the tibia is driven back. It can result in a tear, a dislocation or ongoing instability in the knee. MRI can directly show these tears and associated soft tissue or bony injuries. MRI helps the Orthopedic Surgeon to guide the therapy.

Rotator Cuff Tear

The rotator cuff is actually a group of four tendons that stabilize the shoulder. The tendons connect to four muscles that move the shoulder in various directions. Rotator cuff injuries are caused by degeneration, aging or inflammation due to bursitis, tendinitis or arthritis in the shoulder and by falling and injuring the shoulder or by overuse, often in sports. MRI can directly demonstrate whether these tears are partial or complete and how big they are. It allows us to show the muscle size which is important for the prognosis of rotator cuff surgery.

MRI of the Upper Extremity: Shoulder, Elbow, Wrist and Hand

Christine B. Chung MD (Editor), Lynne S. Steinbach MD (Editor)

This highly illustrated text/atlas is a complete guide to MRI evaluation of shoulder, elbow, wrist, hand, and finger disorders. The editors present a practical approach to MRI interpretation, emphasizing the clinical correlations of imaging findings. More than 1,100 MRI scans show normal anatomy and pathologic findings, and a full-color cadaveric atlas familiarizes readers with anatomic structures seen on MR images.

Coverage of each joint begins with a review of MRI anatomy with cadaveric correlation and proceeds to technical MR imaging considerations and clinical assessment. Subsequent chapters thoroughly describe and illustrate MRI findings for specific disorders, including rotator cuff disease, nerve entrapment syndromes, osteochondral bodies, and triangular fibrocartilage disorders.

Rheumatologic Disorders

There are many chronic and sometimes debilitating diseases of tendons, joints, muscles, bones, nerves and connective tissue called Rheumatologic disorders. These can cause patients pain and limit their mobility.  Osteoarthritis, gout, fibromyalgia, juvenile rheumatoid arthritis, and rheumatoid arthritis are some of those which affect many in the USA.

Spine Disorders

Spine disorders include infections, injuries tumors, scoliosis, age related bone changes such as stenosis or hernaiated discs, or immune diseases such as ankylosing spondylitis.

Sports Hernia

Sports hernia does not occur in the area of the large, thick part of the muscle, rather the abdominal wall in a particular region is too thin, allowing a hernia to form.

Sports Medicine Injuries

Sports Injuries can commonly include sprains, fractures, dislocations, knee injuries, and Achilles tendon injuries.

Tennis Elbow

Tennis Elbow is an injury that can result from any overuse of the muscles and tendons of the elbow. Hitting a ball with a backhand motion is the most common way to get tennis elbow, and may be why it has come to be called by this name. Inflammation, tenderness, pain and small tears in the tendon are common. Radiographs and MRI can show findings associated with tennis elbow. If the pain is more severe and the function is limited this may be due to a tear of the tendon insertions, which may directly shown with MRI.