Musculoskeletal radiology is a subspecialized field of radiology uses imaging techniques to diagnose & treat disorders associated with the bones, joints, muscles, tendons, ligaments & Musculoskeletal issues range from accidental injuries and chronic ailments to genetic predispositions. To give an accurate diagnosis of such diverse conditions, a specialized section of radiology is needed.
Musculoskeletal Reporting is the process used to analyse & interpret the medical images (MRI, CT & X-ray) of the bones, joints, muscles, tendons, ligaments, etc. to create a diagnostic report to help doctors diagnose and treat musculoskeletal conditions such as fractures, traumas, ligament & more. It employs several radiological techniques like MRI, CT, and X-ray imaging. Common issues highlighted by musculoskeletal radiology consist of fractures, traumas, ligament ruptures, arthritis, and even tumors and infections.
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A radiological examination of the musculoskeletal system covers certain connective tissues and other parts, listed down below:
Contrary to common perception, bones aren’t a homogenous solid mass. They have distinct anatomical sections susceptible to various types of injuries. The three main sections of the bone include cortex, trabecular bone, and epiphysis/metaphysis/diaphysis. Depending on the clinical history, an appropriate musculoskeletal examination method must be selected. This method of radiology is effective in capturing fractures, osteomyelitis (bone infection), tumors (e.g., osteosarcoma, metastases), and bone islands/enostoses.
There are three main types of joints in the human body—synovial, cartilaginous, and fibrous joints. Out of the three, the synovial, i.e., freely movable joints such as shoulders, elbows, hips, wrists, knees, and ankle joints, are most commonly analyzed by musculoskeletal analysis. For joints, the clinical findings determine the appropriate radiology method. For e.g., MRI is considered the gold standard for cartilage, labrum, effusions, and synovitis. X-rays are optimum for capturing narrow joint spaces due to arthritis.
Muscles are primary tissues connected to the bone and are essential for body structure and movement. An MRI can detect muscle injury by checking for tears and strains in the muscle fibers. Conversely, using an ultrasound, the real-time movement and injuries can be observed. Myotendinous junctions are the sites where the muscle fibers transition into tendon fibers. These sites are the most susceptible to injuries. Musculoskeletal examination can be used to observe wounds in these sites as well.
These are collagen bundles that connect muscles to the bones. As tendons are collagen-based, an MRI can accurately assess any abnormalities in these regions. Commonly, rotator cuff (shoulder), Achilles (heel), and flexor/extensor tendons (wrist/hand) are analyzed using musculoskeletal imaging.
Other tissues that are typically observed using musculoskeletal imaging include ligaments, cartilages, bursae & synovial sheaths, and neurovascular tissues and soft tissue envelopes.
Musculoskeletal Radiology is a diagnostic radiology subspeciality used to interpret the medical images (MRI, CT & X-ray) to treat injury / disease associated with the bones, joints, muscles, tendons, ligaments etc.
A number of methods are used to inspect the tissues and structures in the musculoskeletal system, as given below:
X-ray imaging is a basic technique used to create 2D images of the area of interest. It consists of exposing the body parts to ionizing radiation, which are then captured by the detectors. High-density tissues like bones appear darker, and soft tissues appear lighter in the final image. This is an effective, inexpensive technique that is ideal for the initial evaluation of fractures, dislocations, bone lesions, arthritis, and hardware position.
MRI maps the hydrogen proton behavior in the water molecules inside the tissues. Using this method, the tissue/body part is placed under a magnetic field, which aligns the water and fat molecules, and exposed to radiofrequency pulses. These pulses disturb the water molecules and fat placements. As these molecules return to their original position, they emit energy, which is then trapped by the sensors. Using this principle, a high-resolution image is obtained, which is excellent for soft tissue imaging.
Similar to an X-ray image, a CT initially creates 2D images of the body part. The beam rotates around the patients, creating multiple 2D images from several angles. A computed algorithm then rearranges these 2D images to create a high quality 3D image. This method is effective to examine the complex bone structure, fractures, and cortical detail.
An ultrasound employs high-frequency sonic waves to determine the internal structure of the tissues. The returning echoes are then converted to images in real time. This method is ideal to observe the dynamic movements of superficial soft tissues, tendons, and guidance of interventions.
Under musculoskeletal radiology, the conditions are distinguished based on the nature of the abnormality. These conditions are listed below:
1. Sesamoid bones
2. Accessory ossicles
3. Multipartite patella
1. Coalitions (fusion of bones, e.g., wrist or foot)
2. Osteogenesis Imperfecta (fragile bone syndrome)
3. Polydactyly (extra digits)
4. Absence or malformation of bones
5. Hip disorders like Environmental Dysplasia of the Hip (DDH) and slipped capital femoral epiphysis (SCFE)
1. Scaphoid fractures
2. Colles fractures
3. Greenstick and torus (buckle) fractures in children
4. Fracture healing
5. Soft tissue injury
1. Osteoarthritis
2. Rheumatoid arthritis—typically polyarticular
3. Psoriatic arthritis
4. Gout & pseudogout
5. Hemophilic arthritis
6. Neuropathic joints (e.g., Charcot joints)
1. Benign bone tumors
2. Malignant neoplasms
1. Paget's Disease
2. Osteoporosis & Osteomalacia
3. Rickets
1. Osteomyelitis
2. Septic arthritis
The duties of a musculoskeletal radiologist go beyond the technical image capturing. They must ensure accurate diagnosis supported by anatomical evidence.
Musculoskeletal radiology is a subcategory of radiology itself. Based on the practices of MSK radiology, it can be further divided into:
This category falls under those MSK imaging methods that are performed pre- or post-orthopedic interventions. It focuses on the alignment, stability, and complications, which are crucial aspects for an orthopedic surgeon.
This kind of imaging is useful to assess intra-articular abnormalities. An intra-articular examination is crucial in detecting early signs of bone damage, thus preventing further complications.
Growing bones and surrounding tissues exhibit distinct behaviors and complications compared to adult tissues. Pediatric MSK imaging is beneficial in tracking the development of tissues using different techniques.
This category focuses on the osseous and soft tissue structure of the vertical column. The method is frequently used to detect the etiology of chronic pain and aging in patients.
Rheumatoid disorders are a result of inflammation at the affected site. It may occur due to autoimmunity, trauma, or infections. MSK radiology is crucial to assess the internal damage to the tissues.
