JOINTS, LIMBS, SPINE MRI GALLERY
M/45 Severe neck pain and bilateral upper limb numbness and weakness.
Ossification of posterior longitudinal ligament (OPLL) typically occurs in Asian population especially in Japanese patient. Patient might present with radiculopathy or even myelopathy like this patient. There is already focal cord atrophy at C4-5 level due to long term compression. The characteristic “mushroom-like” hypertrophy of the PLL at axial image readily confirms the diagnosis.
Sciatica. To rule out lumbar disc prolapse.
There is a growing trend of lumbar disc herniation in Hong Kong people. The predisposing factors include occupation, lack of stretching exercise and sports, and improper sitting posture. Very often the herniation is triggered by minor trauma or sudden blow like lifting heavy object. MRI assesses the lumbar spine from multiple angles and tissue aspects, including the disc, marrow, spinal canal and the facet joints. Indeed, most sciatica is caused by disc herniation like the photo at right, but one must not forget the potential culprit from degenerated facet joint and even synovial cyst formation like the photo at left.
Knee injury after skiing holiday. To rule out ACL or MCL tear.
A good deal of Hong Kong people love skiing or snowboarding. Tremendous number of amateur are referred to orthopaedic surgeons for knee injury after each skiing season. MRI knee provides valuable information to assess the ligamentous condition, such as tear of the anterior cruciate ligament (ACL) at left, and medial collateral ligament (MCL) at right. Careful grading of the ligamentous injury, meniscal tear and cartilage fracture are essential for guiding the treatment.
Chronic hip pain. To rule out pathology.
Dual-coil MRI technique provides a comprehensive and detailed assessment of the pelvic girdle, including the labrum and cartilage. High resolution image with good contrast ratio is essential in identifying labral tear such as the case at right hand side. Occasionally, MRI also picks up occult impacted hip fracture in old patient presenting with minor trauma, or some enthusiastic sport men or women like the photo at left.
Left shoulder pain. To rule out rotator cuff tear.
A dedicated “MR shoulder coil”, a special MRI device conforming to the contour of the shoulder joint, provides clear MRI image of the rotator cuff tendons, various ligaments, labrum and bone structures. Image at right side shows severe interstitial tear of the supraspinatus tendon of a 45-year-old nurse, whilst the image at left side shows a typical superior labral tear of a 30-year-old enthusiastic golfer. Both suffer from excruciating shoulder pain.