Magnetic resonance imaging provides comprehensive information about the condition of the soft tissues of the body. When examining the knee (one of the most complex joints), the diagnostic procedure qualitatively complements the results of X-ray or CT. MRI images are used to evaluate the structure of cartilage, ligaments, muscles, and joint capsules. Information about soft tissue elements allows you to clarify the diagnosis and prescribe effective therapy. The key to successful treatment is a competent interpretation of the MRI of the knee joint.
MRI scan of the knee joint in T1 mode (arrow indicates bone swelling)
The structure of the joint includes many small elements. A radiology specialist with extensive practical experience will be able to read tomograms correctly. In controversial situations, MRI results are provided to several doctors for reading. A person without medical education and appropriate skills will not be able to decipher the images. Understanding a radiologist's report requires in-depth knowledge. For this reason, it is better to entrust the interpretation of the results of MR imaging to a doctor (traumatologist or orthopedist).
X-ray method
The easiest and most accurate way to diagnose arthrosis is with an X-ray. It will show signs characteristic of one or another stage of the disease:
- Stage 1. The image does not yet show bone growths, but the surface of the joint is uneven, sometimes with slightly ossified areas. The joint space is slightly narrowed, so external symptoms are not yet pronounced.
- Stage 2. Bone growths are already clearly visible, the gap is approximately 2-3 times narrower than normal. The specialist notes subchondral sclerosis - one of the signs of arthrosis, hardening and proliferation of bone tissue.
- Stage 3. The picture does not show the joint space at all. Most of the articular surface has ossified and increased due to marginal growths. One of the signs is a “joint mouse,” the movement of a fragment of the meniscus, cartilage or bone, which radically limits motor activity.
Only x-rays can accurately determine the degree of arthrosis
Stages of development of arthrosis
Arthrosis is a pathological chronic condition of the joints. There are several stages of this disease:
- At the initial stage, a barely noticeable narrowing of the joint space is observed. In this form of the disease, only the cartilage of the joints is affected.
- At the next, second, stage, pathological changes are already significantly pronounced. The narrowing of the joint gap is clearly visualized and has uneven contours. Cartilage begins to break down at the point of greatest stress. The images reveal subchondral osteosclerosis.
- At the third stage, clearly defined irreversible changes are visible. The cartilage becomes loose and almost completely destroyed. There is obvious dysfunction of the diseased joint. This stage is shown in the photo.
An X-ray of joints with arthrosis will help to diagnose the disease earlier, as a result of which it will be easier to relieve painful symptoms. The degrees of arthrosis on an X-ray are clearly visualized, and can be easily deciphered and described by an experienced radiologist.
- Is arthritis visible on an x-ray, and how to interpret the image?
Inflamed knee
Blood test for arthrosis
Since arthrosis has similar symptoms to other joint diseases, to distinguish it, for example, from infectious or rheumatoid arthritis, the following is prescribed:
- Clinical blood test. As a rule, arthrosis does not cause serious changes in blood counts, with the exception of a slight increase in ESR - up to a maximum of 25. With arthritis, ESR increases much more intensely - up to 40-80 units.
- Blood chemistry. The material is taken strictly on an empty stomach from a vein. With arthrosis, the indicators remain normal, but with arthritis, specific markers of inflammation appear - C-reactive protein, certain immunoglobulins, etc.
A blood test is needed to differentiate arthrosis from arthritis
In what cases are MRI and CT prescribed?
Sometimes, especially at an early stage of the disease, x-ray examination is not informative. In this case, magnetic resonance imaging is prescribed - an expensive but highly accurate method. It is based on the use of magnetic waves. With their help, it is possible to recognize even minor changes in cartilage, including at the initial stage. MRI is contraindicated in:
- an installed pacemaker, since changes in the magnetic field may affect the heart rhythm;
- the presence of electronic or ferromagnetic middle ear implants;
- large metal implants;
- pregnancy up to 12 weeks.
The study is not carried out in case of some relative contraindications, for example, in case of decompensated heart failure, claustrophobia, or other severe conditions of the patient.
If MRI is contraindicated, they resort to computed tomography, a modern analogue of X-ray. This method, which provides an image of all layers of the joint, is more accurate than radiography, but inferior to MRI.
MRI is a method that guarantees maximum accuracy and reliability of three-dimensional images. Unlike CT, MRI does not use radiation. A radiologist talks about these and other features of magnetic resonance therapy of joints:
Osteoarthritis of the knee joint
Arthrosis (Greek arthr) is a group of diseases that damage the joints of the human body.
( Photo No. 1 ) The left side of the picture of a healthy person. On the right, a person with severe arthrosis on the right hip joint. It can be seen that the channel has completely closed. Severe pain occurs and the patient cannot get to his feet.
There are more than 100 different forms of arthrosis. The most common form is osteoarthritis (damage to the articular ends of articulating bones) resulting from joint trauma.
, joint infections or age factors.
Other forms of arthrosis include rheumatoid arthrosis (rheumatism), gout, psoriatic arthrosis and related autoimmune diseases. Septic arthrosis occurs due to joint infection. All forms have one common symptom - joint pain
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Symptoms
All types of arthrosis are accompanied by pain, the nature of which determines its type. Characterized by redness of the skin, limited mobility in the knee joint, and changes in its shape. Disease-prone joints often crack unnaturally when stressed. The patient may experience difficulties in cases where it is necessary to undergo physical activity.
Elements of the medical history determine the diagnosis. Important elements are the time of onset and rate of development of the disease, the presence of morning immobility, pain, “locking” of the joint due to inactivity, etc. For a more accurate diagnosis, radiography and tomography are used.
Causes of arthrosis
Osteoarthritis pain occurs due to inflammation that occurs around the joint. Joint damage due to illness, daily chafing, muscle tension. Joint pain is often constant. The pain may be localized to the affected areas.
Classification of osteoarthritis
Osteoarthritis is divided into primary and secondary . There are 4 degrees of arthrosis:
- Arthrosis of the knee joint 1st degree - softening of the cartilage appears, can be felt on the surface of the knee. Not visible on x-ray.
- Osteoarthritis of the knee joint 2nd degree - the cartilage begins to wear away and a narrowing of the joint space can be seen in the picture.
- Arthrosis of the knee joint 3rd degree - osteophytes appear, treatment is more difficult. Difficult to distinguish from 2nd degree.
- Osteoarthritis of the knee joint 4 degrees - bones come into contact with each other, osteophytes increase, and distortion of the joint occurs.
Arthrosis of the patellofemoral joint
Patellofemoral osteoarthritis is damage to the cartilage between the kneecap and femur. Unlike other types of knee OA, which occur on the inside (medial) and outside (lateral) of the knee and cause difficulty walking on level surfaces, patellofemoral osteoarthritis causes pain in the front of the knee when squatting and rising from a sitting position. In this case, a knee brace helps a lot. Patients who wore the brace daily were observed to have significantly less joint damage on MRI and a decrease in knee pain.
Prevention and treatment of arthrosis of the knee joint
Osteoarthritis, like rheumatoid arthrosis, cannot be completely cured without surgery, but measures can be taken to prevent the condition from getting worse. Weight measurement is key to improving symptoms and preventing disease progression. For osteoarthritis, physical therapy is indicated to strengthen muscles and joints. In particular, ESMA equipment is effective for its treatment. Patients also require drug treatment. When the disease progresses rapidly and the pain is constant, surgery may be suggested. Unlike rheumatoid arthritis, osteoarthritis does benefit from joint replacement for many people. There are synovial injections - injections of intra-articular fluid. They allow the patient to be relieved of pain for 8 months, after which the procedure is repeated. Bee venom treatment is also effective in relieving pain.
( Photo No. 2 ) X-ray of a knee with an artificial prosthesis after joint replacement surgery.
Prevention of arthrosis
Includes a set of procedures: massage, hydrotherapy, physiotherapy, herbal preparations, dietary supplements, aromatherapy, heat and cold treatment, health exercises, diet.
According to statistics, today more than 43 million Americans experience pain when bending their knee. According to statistics, this is one of the main causes of disability in the country. About 1 in 7 Americans suffer from it. With age, the likelihood of developing arthrosis increases.
Professional medical equipment and devices for sports rehabilitation medicine ESMA.
The photo shows the following models of devices: Computer medical equipment - device - complex ESMA 12.48 FAVORITE Multifunctional portable device ESMA 12.04 MINIMAX
ESMA therapy devices ESMA devices sports medicine, fitness
Ultrasound in the diagnosis of arthrosis
Ultrasound diagnostics for suspected arthrosis is used infrequently, since it does not provide as accurate results as X-rays or MRIs. Using the method, you can see all the tissues and cartilage, evaluate their degree of wear, thinning, and quantitative changes in the synovial fluid. Efficiency largely depends on the qualifications of the specialist, since deciphering what is seen is often subjective.
Ultrasound of the knee determines the degree of preservation of the menisci, uric acid crystals, Baker's cyst
What is the difference between ultrasound, CT and MRI? In what cases is this or that study indicated? The expert answers these questions:
Synovial fluid examination
To perform the analysis, a joint puncture is performed. The main parameters of synovial fluid are subject to study:
- macroscopic indicators - color, volume, viscosity, turbidity and mucin clot;
- number of cells;
- cytology of the stained specimen;
- microscopy of the native preparation.
Normally, synovial fluid has a straw-yellow color and a transparent consistency. With arthrosis, its viscosity increases, the mucin clot is formed well, the number of cells is normal or slightly increased (maximum up to 5000/μl). Other indicators remain mostly normal. With reactive synovitis, the number of neutrophils is reduced by half.
A serious change is observed during inflammatory processes accompanying various forms of arthritis. One way or another, the interpretation of the results is carried out only by an experienced rheumatologist, taking into account the medical history, laboratory and instrumental studies.
Analysis of synovial fluid makes it possible to clearly distinguish arthrosis from arthritis
Additional instrumental methods
Sometimes other methods are prescribed to clarify the diagnosis. They have a number of contraindications due to their invasiveness, are quite expensive and are rarely practiced.
- Arthroscopy. An early diagnostic method that allows you to detect changes in cartilage tissue, even if they are not yet visible on an x-ray. It is performed under local anesthesia for 30-60 minutes. It has high diagnostic accuracy and minimal risks of complications.
- Chondroscopy. A type of arthroscopy, the purpose of which is to study the condition of the cartilage, namely the degree of its damage. Most often used to evaluate the effectiveness of treatment with chondroprotectors for arthrosis.
- Osteoscintigraphy. A type of radionuclide diagnostics that involves the introduction of a radiopharmaceutical into the body to detect bone pathology.
Arthroscopy is a highly informative visual diagnostic method using an arthroscope
Diagnosis of arthrosis is often difficult because external symptoms are not so obvious and overlap with signs of other joint diseases. There are a number of instrumental and laboratory methods that allow you to make an accurate diagnosis. You should not ignore the specialist’s recommendations regarding the examination, because the correct choice of treatment tactics, and therefore the result, depends on this.
Clinical picture of the development of arthrosis
The main feature of the development of arthrosis is significant pain syndromes, while morphological metamorphoses can be practically invisible on an X-ray image. The opposite clinical picture also occurs; the patient experiences virtually no unpleasant sensations, but numerous changes are visible on the image.
Osteoarthritis of the knee joint
The main reasons for such opposite clinical pictures are:
- The absence of vasculature and nerve endings in the articular cartilage explains the absence of symptoms until the disease spreads beyond the joint.
- The presence of nerve endings in the synovial membrane, joint capsule, as well as in tendons and muscles are not always damaged evenly.
- The rate of development of arthrosis is individual for each patient and the slower it affects the joints, the less pronounced the manifestations of the disease will be.
It should be noted that most often arthrosis affects the shoulder, hip, knee, and wrist joints. It is when the disease begins that it is important to monitor the condition of all joints in order to begin drug therapy on time.
Arthrosis on x-ray