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ULTRASOUND VS. MRI: DIAGNOSING MUSCLE AND JOINT SYMPTOMS

Pain or other joint symptoms can be challenging to diagnose and often depend on many factors. For example, pain that seems to be coming from a joint could by caused by many structures within or surrounding the joint, such as ligaments, tendons, muscles, nerves, bursae, and bones.

Often the first step in diagnosing musculoskeletal injuries and symptoms is medical imaging, such as ultrasound, X-ray, and MRI.

WHEN ARE ULTRASOUND AND X-RAY ORDERED?

A musculoskeletal (MSK) ultrasound is a specialized exam that looks specifically at your muscles and other structures close to the skin. It has a limited role in examining the joints; typically limited to assessment of fluid or inflammation around a joint. It is frequently ordered with an X-ray to allow the radiologist to have a more complete evaluation of the joint and surrounding bones.

Ultrasound imaging uses high frequency sound waves transmitted through a handheld device to examine your organs, tissues, and blood vessels. In this way ultrasound focuses on the soft tissues of your body.  X-ray imaging uses a small amount of radiation, passing through a body part, to provide a more detailed look at your bones and joints. Ultrasound and X-ray are used together to help diagnose a musculoskeletal problem.

It’s very common for doctors to order MSK ultrasound first when trying to diagnose muscle and joint symptoms since it’s versatile, portable, relatively inexpensive, non-invasive and can provide real-time information about the area of concern.

WHEN IS MRI ORDERED?

Magnetic resonance imaging (MRI) is often ordered when more detail is needed based on results of other studies or ultrasound and X-ray results, or when the cause of symptoms is unclear during a physical exam. It’s a powerful tool for diagnosis and detecting diseases in their earliest, most treatable stage. Using a strong magnetic field and radiofrequency waves, this technology can examine the soft tissues of the body along with the bones.

WHAT CAN MSK ULTRASOUND DIAGNOSE?

An MSK ultrasound may help determine the source of your muscle or joint symptoms. Ultrasound can allow the technologist and radiologist to watch your anatomy move in real time, such as examining how tendons move around joints, and if a joint separates when stressed. Plus, as the patient, you can show us exactly where you feel your symptoms, so we can pinpoint your area of concern at the time of imaging.

If an injury to your tendon or muscle is suspected, we can see if it’s intact or torn. Ultrasound can help determine the extent of the injury, sometimes clarify if surgery is indicated, and assess how well these injuries are healing.

Some common diagnoses that may be evaluated by an MSK ultrasound include:

  • Bursitis
  • Carpal tunnel syndrome
  • Rotator cuff tears
  • Sprained ankle

WHAT CAN MRI DIAGNOSE?

When using MRI to diagnose joint and muscle symptoms, your doctor might order an MRI arthrogram. This scan includes the use of an injectable dye called contrast that is administered directly into a joint. Targeted joints will absorb and be enhanced by the contrast dye, allowing for a more detailed image.

An MRI arthrogram might be requested to inspect the elements of the joint that may have been injured during physical activity or from wear and tear. It can provide detailed images of various sections of the joint, such as bones, cartilage, tendons, muscles, and ligaments.

Most often this type of exam is used to help diagnose the cause of symptoms, such as persistent and unexplained pain, discomfort, loss of motion, or changes in the way the joint works. Your health care practitioner may request this scan to help diagnose and treat many types of conditions, including:

  • Bone fractures
  • Damaged cartilage, ligaments, tendons, or meniscus
  • Fluid buildup
  • Inflammation or infection
  • Osteoarthritis and other degenerative joint disorders
  • Osteonecrosis – when blood flow to part of a bone is reduced causing death of bone tissue
  • Post-dislocation of the joint
  • Sports- or trauma-related injury
  • Tumors

This scan may also be ordered before or after arthroscopic surgery. Your doctor may request other imaging tests, such as an X-ray or ultrasound, along with your MRI arthrogram.

ARE THESE EXAMS SAFE?

Ultrasound has been around for over sixty years and is considered safe since there are no known risks and it doesn’t use radiation.

MRI images are created using a magnetic field, which can attract metal objects or may cause metal in your body to move. This means that before an MRI can be performed all patients will need to be screened to exclude internal metal objects or hardware that are not safe in the MRI. The inside of the MRI scanner can feel small to some people and there are noises caused by changes in the magnetic field, which require ear protection.

When using MRI contrast, an injectable gadolinium dye, there is a small risk of allergic reaction. However, you will be asked about your allergies and other medical conditions when booking your exam.

HOW DO I GET MEDICAL IMAGING?

Your personal medical history will help determine which type of imaging is best suited to diagnose your concern. In determining appropriateness, there are a number of questions you could discuss with your doctor. What are your treatment options? What outcomes could be expected for each option? How do the different types of imaging work? What are the risks? What happens if you don’t have imaging? What happens after your exam?

Once your doctor has identified the need for an exam, you will be given a requisition form. For ultrasound exams, your doctor may book your exam for you, or you may be given the number for our Contact Centre to book an appointment. Ultrasound exams are covered under your provincial health care plan.

For MRI exams, your doctor will send us your requisition (for both public or private exams) and we will call you to schedule your exam and provide you with detailed information to prepare for it.

In Alberta, we offer MRI services as private pay exams, for when patients may be unable to wait to receive an exam through the public health system. An MRI’s magnetic field strength is measured in tesla (T) and Mayfair operates both 1.5T and 3T MRI services at our Mayfair Place location in Calgary. The highly sensitive images from the 3T machine allows enhanced imaging of many areas of the body, including musculoskeletal imaging of joints and soft tissues.

In Saskatchewan, we offer MRIs as a publicly funded, community-based service under contract with the Saskatchewan Health Authority and as a private pay exam. Private MRI services in Saskatchewan are provided in accordance with and under the legislation of the Province of Saskatchewan.

Once your exam is completed, your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor. Mayfair Diagnostics is owned and operated by over 50 radiologists who are sub-specialty trained, which guarantees an expert opinion of your imaging.

Mayfair Diagnostics has 12 locations across Calgary which provide ultrasound services, as well as one in Cochrane and one in Regina. Mayfair Diagnostics offers MRI imaging as a private pay service at our Mayfair Place location in Calgary, and as both public and private pay exams at our Regina and Saskatoon locations in Saskatchewan.

For more information, please visit our services page or call our toll-free number 1-866-611-2665.

 

REFERENCES

Healthwise Staff (2019) “Arthrogram (Joint X-Ray).”  www.myhealth.alberta.ca. Accessed September 28, 2022.

Johns Hopkins Medicine (2021) “Magnetic Resonance Imaging (MRI) of the Bones, Joints, and Soft Tissues.” www.hopkinsmedicine.org. Accessed September 28, 2022.

Krans, B. (2017) “Knee MRI Scan.” www.healthline.com. Accessed September 28, 2022.

Petscavage-Thomas, J. (2014) “Clinical applications of dynamic functional musculoskeletal ultrasound.” www.dovepress.com. Accessed September 28, 2022.

Villa-Forte, A. (2021) “Musculoskeletal Pain.” www.merckmanuals.com. Accessed September 28, 2022.

Wang, Q. et al. (2017) “Quantitative Analysis of Musculoskeletal Ultrasound: Techniques and Clinical Applications.” Biomed Research International. Accessed September 28, 2022.

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