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Chapter 5: Musculoskeletal Diagnostic Techniques

INTRODUCTION

Multiple laboratory-based diagnostic techniques are referenced throughout this text. Although they typically are ordered and interpreted by physicians, it is important to know when these techniques are indicated, what conditions they are used to identify, and how to apply basic interpretation techniques. Table 5-1 presents an overview of the techniques discussed in this chapter and their most common uses.

Table 5-1Selected Musculoskeletal Diagnostic Techniques and Their Uses
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Table 5-1 Selected Musculoskeletal Diagnostic Techniques and Their Uses
Technique Best Use
Radiography

Standard: Identify bone lesions, joint surfaces, and joint spaces

Stress: Used to identify ligamentous injury

Fluoroscopy: Imaging of joint motion

Arthrogram: Identify capsular tissue tears and articular cartilage lesions

Angiogram:Visualize blood vessels

Myelogram: Identify pathologies within the spinal canal
Computed Tomography (CT)

Identify bony or articular cartilage lesions and some soft tissue lesions

Quantify bony lesions (e.g., size and location)

Identify tendinous and ligamentous injuries in varying joint positions

Angiography: Identify artery and/or vein pathologies, including stenosis, aneurysms, and thrombi (clots)
Magnetic Resonance Imaging (MRI)

Visualize soft tissue structures, especially ligamentous and meniscal injuries

Magnetic resonance arthrography (MRA):Visualize blood vessels

Functional magnetic resonance imaging (fMRI):Assess metabolic activity associated with brain function
Nuclear Medicine

Bone scan: Identify increased metabolic activity; can yield false-positive findings, especially in endurance athletes

Positron emission tomography (PET): Creates a three-dimensional image of physiological function in the body. Used to identify cancer, heart disease, or brain disorders.

Single photon emission computed tomography (SPECT): Produces three-dimensional images of internal structures and their function
Diagnostic Ultrasound

Detect joint and soft tissue disorders

Guide injections

Doppler ultrasound:Assess blood flow
Nerve Conduction Studies Assess the function of motor and sensory nerves to detect nerve pathology, including axonal degeneration and neurotmesis
Electromyography

Evaluate electrical activity of a muscle at rest and with activity

Identify pathology of muscle secondary to nerve supply dysfunction or change in the muscle itself

Used in conjunction with a nerve conduction study

DIAGNOSTIC IMAGING TECHNIQUES

Radiographs, computed tomography (CT), magnetic resonance images (MRI), nuclear medicine techniques, and diagnostic ultrasounds are collectively referred to as diagnostic imaging. They are obtained by exposing the body to electromagnetic energy or, in the case of diagnostic ultrasound, acoustical energy, and determining how much of that energy is absorbed by the body, is reflected, or passes through the tissues. Most imaging techniques use a source (i.e., generator) that transmits the energy to the body and a collector that captures energy that has not been absorbed or scattered. From this, two- and three-dimensional images are constructed.

To obtain the clearest images of the involved structure(s), the diagnostic energy must strike the body from a specific direction and angle. Energy may pass from the anterior through the posterior tissues (anteroposterior [AP]), posterior to anterior (posteroanterior [PA]) or from a left or right lateral projection. The patient and generator may be aligned ...

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