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
-
Able to detect other causes of pain or weakness in the joint such as tenosynovitis or tears of the tendons.
-
Does not use ionizing radiation.
Disadvantages
-
Expensive
-
Time-consuming imaging modality
-
Requires marked patient cooperation to limit motion artifact.
-
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?
-
Contraindicated in patients with non-MR compatible metallic hardware and foreign bodies.
IV. What alternative imaging techniques are available?
-
Radiography
-
Ultrasound
-
CT with or without contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tendonitis.
Radiography
Advantages
-
Inexpensive and easy to perform
-
Requires minimal patient cooperation.
-
Can detect calcific tendinopathy and heterotopic calcifications in chronic cases.
Disadvantages
-
Low sensitivity, radiographs usually normal.
Ultrasound
Advantages
-
Able to detect disruption of normal tendon architecture and areas of tear.
-
Color Doppler can aid diagnosis without the potential complications of contrast administration.
-
Relatively inexpensive and portable imaging modality
-
Does not use ionizing radiation.
Disadvantages
-
Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology.
-
Limited evaluation in obese patients.
CT with or without contrast
Advantages
-
Can detect calcific tendinopathy and heterotopic calcifications in chronic cases better than radiography.
-
Further detail of bone to assess for fracture and degenerative changes.
-
Relatively quick imaging procedure
-
Requires little patient cooperation and is associated with less motion artifact.
Disadvantages
-
Soft tissue structures and tendons are better evaluated with MRI.
-
Exposes patient to intravenous contrast
VI. What are the contraindications for the alternative imaging techniques?
Radiography
-
No significant contraindications exist.
Ultrasound
-
No significant contraindications exist.
CT with or without contrast
-
Contraindicated in a pregnant patient, especially within the first two trimesters.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
