Special diagnostic procedures in sports medicine

In summary, there are a number of imaging procedures available to support the physician in his or her evaluation of sports injuries. Conventional radiographs remain the primary imaging examination. Specialized radiographic projections will often provide additional pertinent information. A fluoroscopic examination or conventional tomography may provide a cost-effective method of clarifying subtle post-traumatic changes. The use of the more sophisticated and costly imaging procedures should be reserved for those cases in which a diagnosis cannot be made with simpler technology. CT scanning, by virtue of its ability to image in the axial plane, has proved to be an effective method of documenting injuries particularly in complex bony anatomy such as the spine, wrist, elbow, and hips. CT arthrography provides diagnostic information about intra-articular structures. MRI is emerging as an excellent method of noninvasively imaging injuries to soft-tissue structures such as tendons, ligaments, and cartilage. The advancements in MRI technology that are projected for the future may expand the range of usefulness of this modality and decrease the current high cost of these procedures. Radionuclide scanning with Tc99m diphosphonate compounds has proved to be an efficient method of localizing subtle bone pathology and providing a "road map" for further analysis with additional imaging techniques. The cost-effective use of all of these imaging procedures is predicated on an understanding of their usefulness in the diagnosis of each clinical problem and the judicious use of each procedure to fit the needs of the individual patient.