Preliminary Diagnosis: Tendonitis
I. What imaging technique is first-line for this diagnosis
MR imaging
II. Describe the advantages and disadvantages of this technique for diagnosis of tendonitis.
Advantages
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Able to detect other causes of pain or weakness in the joint such as tenosynovitis or tears of the tendons.
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Does not use ionizing radiation.
Disadvantages
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Expensive
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Time-consuming imaging modality
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Requires marked patient cooperation to limit motion artifact.
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MR imaging with intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR > 30 and < 60.
III. What are the contraindications for the first-line imaging technique?
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Contraindicated in patients with non-MR compatible metallic hardware and foreign bodies.
IV. What alternative imaging techniques are available?
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Radiography
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Ultrasound
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CT with or without contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tendonitis.
Radiography
Advantages
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Inexpensive and easy to perform
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Requires minimal patient cooperation.
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Can detect calcific tendinopathy and heterotopic calcifications in chronic cases.
Disadvantages
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Low sensitivity, radiographs usually normal.
Ultrasound
Advantages
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Able to detect disruption of normal tendon architecture and areas of tear.
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Color Doppler can aid diagnosis without the potential complications of contrast administration.
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Relatively inexpensive and portable imaging modality
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Does not use ionizing radiation.
Disadvantages
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Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology.
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Limited evaluation in obese patients.
CT with or without contrast
Advantages
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Can detect calcific tendinopathy and heterotopic calcifications in chronic cases better than radiography.
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Further detail of bone to assess for fracture and degenerative changes.
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Relatively quick imaging procedure
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Requires little patient cooperation and is associated with less motion artifact.
Disadvantages
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Soft tissue structures and tendons are better evaluated with MRI.
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Exposes patient to intravenous contrast
VI. What are the contraindications for the alternative imaging techniques?
Radiography
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No significant contraindications exist.
Ultrasound
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No significant contraindications exist.
CT with or without contrast
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Contraindicated in a pregnant patient, especially within the first two trimesters.
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