BEWARE OF THE NORMAL X-RAY in athletes
What are the shortcomings of x-rays?
There are a lot of cases in sports where patients tell a history that suggest a bone injury and have been discharged with a diagnosis of No Bone Injury or NBI. Even after months from the trauma, there is still pain and swelling in the area. These patients are unable to return to their sporting activity as expected. Some patients are simply told that they have merely sprained some ligaments.
Athletes must keep in mind that if they are given an x-ray during the time of the injury, the x-ray will usually miss fractures especially if the injury happened in a joint like an ankle. If an athlete is still limping one week after the injury because of an ankle pain then there is likely to be an injury. Moreover, if the ankle is still swelling then there is a very big chance that there is a fracture. The athlete should assume that there is a fracture unless there is solid proof of no fracture at all.
What are some of the other investigations that can be done?
Bone scans are used nowadays so that a diagnosis of the bone injury is better. Some X-rays will return a normal result even after all the examinations and the history say that there is something wrong with your bones. In a bone scan, a radio isotope dye is injected into the arm. This is then taken all over the body and the blood stream in search of hot spots. These hot spots indicate increased bone activity where healing occurs. Healing fractures, bone infections, and other types of bone disorders will show up on this scan. This will make the diagnosis of a bony injury very comprehensive. You can localize the bone that is injured and then treat it accordingly.
In order to assess the extent of the damage to the bone, a CAT or MRI scan can be made. This will show any damage to the bony areas or the cartilaginous areas. This will also reveal any more bone fractures that have become unstable and that have resulted in loose bodies long ago. An arthroscope will be used to remove this matter. An arthroscope is a small telescope that can be inserted into the spaces between joints so that the joint surfaces can be assessed. Using the arthroscope, any bony, cartilaginous, or chronically inflamed join lining or chronic synovitis can be extracted or treated properly.
When you repetitively overuse your bones over a long time frame, you can get stress fractures. Instead of getting one time big time acute injuries which are more common in sports, you will get an injury that has progressed over time. These progressive injuries usually do not show up on the normal x-rays. If these progressive injuries appear on the x-rays then they do so usually after a month. Bone scans can identify the fracture within twenty four hours only. It will be able to identify the stress fracture and localize the bone that is at risk. When the stress fractures are diagnosed as early as possible, they can be treated and can save you from further damage. What is usually done in this case is that the athlete is removed from the sport. Afterwards, the athlete is put on a rehabilitation programme so that the stress crack does not develop into something serious.
Sometimes ultrasound scans are used to identify injuries in soft tissues. Ultrasound is important so that injuries in the Achilles or the bottom of the calf, the patella or the front of the knee, the tendon, and rotator cuff tears in the shoulder can be identified. Ultrasounds are relatively cheap but at the same time, they provide very valuable information. They are able to diagnose the injury and analyze its severity. The accuracy and the quality of the diagnosis are dependent on the operator. If the operator is knowledgeable and skilled then the quality of the diagnosis will be very good. The radiographer must be trained and experienced in order to have the best diagnosis possible.
The most expensive and the most advanced of all the imaging used in sports is the MRI scan. MRI stands for magnetic resonance imaging and it will provide you with the best pictures of soft tissues. With an MRI, you will be able to see the exact anatomy of your muscles, tendons, blood vessels, nerves, the overall bony architecture, and even the amount of fluids in your joints. With the MRI scans, you can even see bruising in the bones which can not be seen in other types of imaging. With MRI, you won’t even have to worry about radiation.
All in all, if you are still limping around with a sore ankle, pain, and swelling after one week from your injury then it is very likely that an ankle fracture has occurred. You may have gotten an x-ray but this does not guarantee that you are free from injury. Other tissues that can not be seen in an x-ray like the tendons, ligaments, and cartilage may have been damaged. There are more tools available nowadays which are better than the x-ray. Proper diagnosis can be made with better examinations. With the better imagine technologies available today, you will be able to manage your injuries early on and be able to return to your normal sporting activities as soon as possible.