Medicine 4 Qustions - Assignment Example

1.0 Femoroacetabular Impingement (FAI) can be an indication for Magnetic Resonance Imaging of the hip. Define and discuss this condition? 1.1 Define: Femoroacetabular impingement (FAI) is a medical condition in which the hip bones are unusually shaped (Kaschka, 2012). Because the bones do not fit flawlessly together, the hipbones have a tendency of rubbing against each other hence resulting into damage to the joint tissues (Kaplan, 2010, April 1). This condition mostly occurs in young and middle aged adults. The hip joint damage may occur on the labral cartilage or the articular cartilage. There are various types of impingement; the main distinguishing factor between these types of impingement depends on the point of disease manifestation as well as the pinched part of the hipbones (Keck, 2012). Three types of Femoroacetabular Impingement (FAI) are common, these are the cam-type impingement, the pincer-type impingement (commonly occurs in women) and the combined type impingement. 1.2 Discussion 1.2.1 The anatomy of the hip Similar to the shoulder, the hip has a ball and socket joint. The hips are more stable as compared to other joints in the body. Acetabulum forms the socket, which is the major part of the pelvic bone. The femoral head is ball shaped, and is also the upper end of thighbone (femur) (Balderston, 2011). A slippery tissue known as articular cartilage covers the ball and socket surface. The articular cartilage provides a smooth and low friction surface where bones glide and slide easily across one another (Pacifici, 2013). Strong fibrocartilage tissues called the labrum cover the socket joint. Labrum forms a strong gasket on the socket resulting to a tight seal, which makes the joint more stable (Stein et al., 2011). In Femoroacetabular impingement (FAI), there is the development of bone spurs around femoral head and along the acetabulum. This overgrowth of bones makes the hipbones hit against each other instead of smooth movement (Hayter, Koff & Potter, 2012). With time, this condition can result into collapse of the articular cartilage as well as tear on the labrum. Image on the anatomy of the hip 1.2.2 Types of Femoroacetabular impingement (FAI) As mentioned above, there are three common types of Femoroacetabular impingement (FAI); these are the cam-type impingement, the pincer-type impingement, and a combined impingement. -The cam-type impingement: this is where the femoral head does not have the round shape hence cannot rotate freely inside the acetabulum. Normally there is the formation of a lump on the femoral head hence resulting to grinding of the cartilage on the acetabulum. -The pincer-type impingement on the other hand occurs when extra bones widen out over the acetabulum rim. As a result, the labrum can easily be crashed under the acetabulum rim. -The combined impingement is a case where an individual suffers from both the cam type impingement and the pincer type impingement. 1.2.3 Symptoms The most common and noticeable symptom of Femoroacetabular impingement (FAI) is always deep pain on the thigh when performing activities that strain the hip motion. During this time, the affected person may face difficulty in prolonged walking. The condition normally occurs on both sides but the signs are felt only on one side (Dubois & Omar, 2010). In other instances, the pain on the thigh is not felt if the person has been sitting down and then begins to stand up. The victim may also limp partially due to the limited motion and pain that comes with the condition. In addition, the thigh pain brought about by Femoroacetabular impingement may be accompanied locking, clicking, or catching after labral tear has occurred. In the presence of both labral tear and the Femoroacetabular impingement, the symptoms become extreme especially when the victim stands, sits, or walks for longer periods of time (Chakraverty et al.2013). At the same time, pivoting on the affected leg results in pain. 1.2.4 Aetiology of the disease The disease aetiology has for a long time been a topic of discussion, with many health professionals presenting their views regarding the illness. However, with new imaging studies, it is evident that slight changes on the femoral head shape may be the major cause of Femoroacetabular impingement (Peña, 2012). Similarly, anatomical changes that occur on the bones are likely to contribute to this condition. In regards to the Femoroacetabular Impingement (FAI) pathology, most instances of this disease are caused by acute changes in the femoral head shape. Relatively, most health professionals have argued that genetic linage of individuals could also cause the disease (Dubois & Omar, 2010). 2.0 Discuss coils selection in MRI examination and describe how you would position a patient for MRI of hips. 2.1 Coils Magnetic Resonance Imaging (MRI) examination often involves the use of coils. Coils are part of MRI machines hardware, and their function is to detect or create a magnetic field by electric voltage passing through the wire (Jiao & Jin, 2009). Coils have antennas, which captures the signal waves. Perfect coil often produce uniform magnetic field even without considerable variations. The main reason for using the MRI coils is to increase the image quality of the region under study. There are various types of coils that have been developed, depending on the part of the body examine. For the FAI examination the body coil and surface coil are using . The surface coil center will be on the femoral head region .While the body coil surround the pelvic area and the center of leaser beam will be on pubic symphysis. Coil selection is equally of great importance, for Magnetic Resonance Imaging (MRI) examination, it is advisable to select a dedicated phased-array hip coil. Suppose the signal to noise ratio is not satisfactory with the body coil then a surface coil can be used (Campe & Palmer, 2013). The field of view provided here should be sufficient to determine the femoral head articular cartilage and the acetabular roof. According to Daniel and Rush (1995) found the image quality that have been provided by surface coil was better than body coil images. So, they have been recommended using surface coil for optimal visualization in the MRI hip examination. The surface coil has several recommend than body coil such as higher filling factor, better signal –to noise rate and decreased field –of –view (FOV) as well as it placed on the area of interest so is very close to the signal source. This reduces signal loss due to the distance between the sample and coil, which they improve the image spatial resolution (Daniel and Rush 1995). Fig ( ): Surface coil fixed on the anterior superior iliac spine (femeral head region) (Daniel and Rush 1995). Fig (2): shown the center of body coil (Source: http://mrimaster.com) Fig ( ): shows the surface coil (Source: Siemens: www.dotmid.com). Fig( ): shows the body coil (Source: Siemens: www.dotmid.com). 2.2 Patient position for hip MRI During magnetic resonance imaging, the patient would be asked to put on clothes without metallic fasteners, or simply the hospital gown; this is to prevent distortion of images during the scan. Metallic substances have a tendency of interfering with the magnetic shield formed by the MRI machine. Their presence therefore can lead to poor image translation (Georges, 2009). The patient is then requested to lie on the back in the supine position, the head of patient towards the magnet and the feet forward the magnetic. The coil is normally placed around the hip area to help in sending and reception of radio waves hence improving the image quality (Erlichman, 2010). Relatively, the coil must be placed throughout the session until the images are taken, this is normally 30 minutes. The table then slides to the center of the MRI machine. When performing an MRI on a child, the child need special care, in cases where the child cannot lie still, a strap may be used to gently hold the child on the table. Caution should be observed to ensure the child lay still to prevent distortion of images in any way. Fig( ) : shows the patient position during MRI hip examination (Source: http://mrimaster.com ). The traditional MRI scanner often require the patient to go in with the head first, however, there are some obese patients who may develop a lot of tension and anxiety when inside the machine. To minimize this, the patients may use the open MRI. Relatively, an obese patient may require coils to be placed around their hip joints (Campe & Palmer, 2013). This will enhance the quality of imaging. 3.0 "Tennis Elbow" is a common indication for elbow MRI. Define and discuss this condition. 3.1 Define: Tennis elbow, also known as lateral epicondylitis refers to a painful medical condition on the elbow due to overuse (Berlins, 2007). As the name suggest, games such as tennis, which involves overuse of arms, can cause this medical condition. The pain comes because of inflammation on the tendons joining the muscles of the forearm on the outside (Tegner, 2010). The muscles and tendons on the forearm often experience damage due to overworking, by making similar motion every now and then. This condition is often likened to another known as golfer’s elbow mostly affecting the tendons inside the elbow (Drez, 2008). Fig ( ): Shows the Tennis Elbow image in T2-weighted axial (E) (Tegner, 2010). 3.2 Discusion 3.2.1 Anatomy of elbow The elbow bone joint comprises of three bones, these include the humeros (upper arm bone) and two bones on the forearm (the ulna and the radius). Lower of the humeros are bony bumps called epicondyles. The bump on the exterior side of the elbow is called lateral epicondyle (Nirschi, 2010). Tennis elbows normally involve the tendons and muscles of the forearm. The forearm muscles often extend to the wrists and fingers. The forearm tendons, also called extensors connect the muscles to the bone. The tendons that are normally involved in the tennis elbow are known as Extensor Carpi Radialis Brevis (ECRB) (Nirschi, 2010). 3.2.2 Symptoms: Symptoms of tennis elbow often develop slowly. The symptoms often begin as mild pain, which worsens slowly over weeks and months (Maunder, 2013). There is however, no exact injury associated with the initial symptoms. Some of the most common indications of tennis elbow include weak grip strength, burning sensation or pain is felt on the external part of the elbow. These symptoms often get worse with increased activity on the forearm. The dominant arm, i.e. the arm performing most tasks is always the most vulnerable; however, tennis elbow can affect both arms. Similarly, the victims may experience a lot of pain when performing activities like handshaking, raising the hands, straightening the wrists, lifting something or when griping an object such as a racket (Stalker, 2009). 3.2.3 Aetiology of the disease: The origin of this disease mostly revolves around overworking of the arm through vigorous activities. The effects of this health condition is not always felt by tennis players alone, but also by people playing related games such as racquets, badminton etc (Maunder, 2013) . Relatively, the prevalence of this disease has also been witnessed among members of a given occupation. People with jobs that involve recurring movement of the wrist and arm stand a chance of contacting Tennis Elbow, such occupations may include paining, plumbing, carpentry, butchers, and cooks among others (Chung & Steinbach, 2010). The early experiments performed on this disease implied that overexertion was primarily the major cause of this condition. According to Cyriax, microscopic tears occur on the radial nerve during contraction of the elbow hence resulting into the condition (Drez, 2008). Chances of contacting the disease are equally increased by the presence of certain disorders such as rotator cuff and carpal tunnel syndrome (Chung & Steinbach, 2010). 3.2.4 Pathology of the disease: In one of the reviews of the lateral epicondylitis, tennis elbow was considered a degenerative process since there were no acute cells; rather it was viewed as more of a failed reparative process. Surgical explorations of the fibers normally reveal a small circular region, always dull, friable, grayish in color, and edematous. Such an area should be removed during surgery (Hodler, Schulthess & Zollikofer, 2010). Relatively, the early experiments revealed that the tennis elbow disease was majorly caused by overexertion; however, current studies have revealed that traumatic instances such as abrupt forceful pull, direct blow to the epicondyle or even a forceful extension of the arm can cause nearly half of the related injuries. Consequently, incorrect playing of tennis may result to this since the player would be mis-hitting the ball hence causing elbow shock (Edelson, 2009). As well, certain medical disorders such as bicipital tendinitis, rotator cuff, and carpal tunnel syndrome are likely to increase the chances of acquiring the tennis elbow disease. 4.0 Discuss coil selection and describe how you would position a patient for MRI of an elbow. 4.1 Coil Diagnosis of tennis elbow often involves the use of Magnetic Resonance Imaging (MRI) to establish the main cause of the problem. To obtain the best and high quality images, it is often recommended to use coils. Just like in the case of Femoroacetabular Impingement (FAI), coil selection is vital to achieving the desired quality (Chung & Steinbach, 2010). Thus, prior to performing the MRI test, the machine operator needs to make a selection of the right and most appropriate coil. Therefore, there are two types of coils can be use for imaging elbow; these are the Surface flex coil and the cylindrical local coil. 4.1.1 Surface flex coil The surface flex coil has a dual surface and often used for spectroscopic applications. Some of its advantages are that it is multipurpose, can be used for skeletal muscles, kidneys or the liver; ensures maximum comfort to the patient, ensures optimum SNR and proper penetration depths (Erlichman, 2010). The only disadvantage to this is that it expensive and not every patient can afford it. Image of a surface flex coil http://www.rapidbiomed.com 4.1.2 cylindrical local coil Cylindrical local coil is a type of MRI coil comprising of one or more groups of coils arranged circumferentially in a cylindrical form. There is an overlapping between the multiple coil groups so as to bring electrical isolation in the coil groups, hence preserving the SNR in the local coil and at the same time increasing the field of view of the entire coil group. The advantages of this are that, a greater field of view is provided as well ensures reduction in the SNR (Georges, 2009). Between the two types of coils, Surface flex coil is ideal since it can be used for multiple purposes, provides high quality images, and ensures comfort of patient (Jiao & Jin, 2009). In this perspective, it can lead to higher quality images since the patient’s arm will be comfortable and well placed. https://www.inkling.com 4.2 Position: When performing the magnetic resonance imaging (MRI) on the elbow, the patient is normally images while at prone or supine position, placing the arm in the supine position at the patient side, which is the comfortable position for the patient. While in the prone position patient need to extend the arm overhead with slight flexed. Moreover, in some cases, prone position is useful for patients whom they are not able to fully extend the elbow . Therefore, patients usually feel uncomfortable in prone position during the examination. In general , to avoid any motion artifact , patient need to be in the comfortable position . In supine position, when the arm beside the patients usually motion artifact is not a problem so, it is useful position for children and adult .The imaging is often done approximately 10 cm above elbow joint; the scan is often extended to bicipital tuberosity. The images are thus obtained in the coronal, axial and the sagittal planes. Fig ( ): shows the patient positioning of MRI elbow . References Balderston, R. A. (2011). The Hip. Philadelphia: Lea & Febiger. Berlins, T. (2007). Tennis Elbow. The Lancet, 302(7843), 1426. Campe, C. B., & Palmer, W. E. (2013). MR Imaging of Metal-on-Metal Hip Prostheses. Magnetic resonance imaging clinics of North America, 21(1), 155-168. Chakraverty, J. K., Sullivan, C., Gan, C., Narayanaswamy, S., & Kamath, S. (2013). Cam and Pincer Femoroacetabular Impingement: CT Findings of Features Resembling Femoroacetabular Impingement in a Young Population Without Symptoms. American Journal of Roentgenology, 200(2), 389-395. Chung, C. B., & Steinbach, L. S. 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