Skilled Sports Medicine relies on careful history-taking, examination and, often, radiology investigations. These latter commonly include x- rays, ultrasound, computed tomography (CT) scanning, magnetic resonance imaging (MRI) and bone scan.
X-rays are used especially for fracture detection; assessment of arthritis; bony spurs and anatomical variations in a population that may predispose to injury. X-rays deliver a small, but detectable, radiation to the patient.
Ultrasound has a role in soft tissue diagnosis. It is user- dependent, meaning that the person performing the test must be experienced and appreciate musculoskeletal conditions. Ultrasound uses sound waves and the relative reflection off tissues of different densities. There is no radiation and is considered completely safe. Ultrasound can detect muscle and tendon tears, although this is usually evident clinically (e.g. acute Achilles tendon rupture). In addition, MRI is almost always a better option for detection of the extent of rotator cuff (shoulder tendon) tears.
MRI detects water content in the body tissues by use of a powerful magnet. This creates a detailed image of all tissues, especially tendons, ligaments, muscle and the spine. It can detect fractures, but often CT scan is a superior test. MRI can also show cartilage injuries, such as meniscus tears in the knee and labral tears in the shoulder or hip. MRI does not involve radiation. However, it is a lengthy procedure and quite noisy. Individuals must lie in a tunnel, and especially when the scan is for the upper body this can be daunting for some patients who are prone to claustrophobia.
CT scan, involving more radiation than x-ray, is extremely useful for fracture detection and tumour identification.
Bone scan is a nuclear medicine test. An injection into the blood stream is taken up by the bone and highlights increased turnover. This means that fractures will be shown at very high sensitivity. It can also detect tumours and infection, but often another test such as CT or MRI is needed to definitively make the diagnosis.