What are the commonly performed investigations in Sports and Musculoskeletal Medicine

 

1. X-ray

X-rays are extremely valuable and easily available method of investigation to assess joints and bones. This provides information about arthritis, bone injury (e.g., fractures), bone quality (osteoporosis) and calcifications of soft tissue structures  (e.g., calcific tendinopathy). There is some level of radiation associated with x-rays but the risk is very small. 

X-rays are not usually recommended during pregnancy.

 

2. Magnetic resonance imaging (MRI)

 

MRI uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. MRI: very useful to study  the anatomy of joints, tendons, muscles and soft tissue structures as well as inflammation and soft tissue and bone tumours. There is no radiation associated with MRI.

MRI is also not usually recommended during pregnancy.

https://www.nhs.uk/conditions/mri-scan/ 

3. Magnetic resonance arthrogram (MRA) 

This is a special MRI scan produced by using a dye in the joint to enable an even a better understanding of the deep anatomy of any joint. This is particularly useful when conventional  MRI does not provide the necessary information or in preparation prior to surgery. MRA is especially used in large and deep joints like the hips, knees and shoulders.

4. Computerised tomography (CT) scan

CT scan is a detailed X-ray using a computer to create detailed images of bones and joints. CT scan are usually performed prior to surgery or in suspected bone tumours. These are sometimes used to reproduce 3-D image of the bony anatomy. There is more radiation involved compared to a conventional X-ray and is also not recommended during pregnancy.

https://www.nhs.uk/conditions/ct-scan/

5. Contrast MRI and CT

Contrast MRI and CT scans are used to analyse a soft tissue structure in more detail. A dye is injected into the vein and after a few minutes an MRI or CT scan is performed. This modality is particularly used when soft tissue tumours or cysts need to be visualised for diagnosis. 

6. Electrophysiological studies

 

Nerve conduction studies and electromyography (EMG) are used to assess for any disruption to the sensation or power of a particular nerve in a limb. This can help localise where the nerve is affected.

Electrodes are placed on the body and a low electrical current is passed to stimulate the nerve which innervates the particular muscle group and skin. The velocity and amplitude are compared between the left and right side. 

It is useful in conditions like shoulder winging, carpal tunnel syndrome, foot drop, meralgia paraesthetica and ulnar nerve neuropathies. 

7. Blood tests

 

Blood tests can identify infection and inflammation in the body. Specific inflammatory markers are checked to identify auto-immune conditions (thyroid disorders, rheumatoid arthritis, spondyloathropathy and gout) and deficiencies (anaemia, iron, Vitamin D & B12) 

 

 

8. Joint aspirations

 

When there is severe pain, swelling or redness is present in a joint or cyst then using an Ultrasound scan and needle, samples can be drained and sent for analysis to exclude infection or inflammation  (gout).