About Paolo Minafra

Musculoskeletal Radiologist - Sport Medicine Physician

A Thermographic Evaluation of Patellar​ Tendon Partial Tear

about the thermographic evaluation of patellar tendon degeneration

“Many pathological processes in humans manifest themselves as local changes in heat production and also as changes in blood flow pattern at affected organs or tissues”. Vainer BG. FPA-based infrared thermography as applied to the study of cutaneous perspiration and stimulated a vascular response in humans. Phys Med Biol. 2005 Dec 7;50(23): R63–94. 

Since I met the human thermography I always use this kind of evaluation for diagnosis and monitoring of musculoskeletal diseases, together with all the other imaging modalities.

Today I show you the case of a young athlete practicing long jump, with a chronic patellar tendon tendinopathy and partial tear at its proximal attachment.

I always start with clinical examination and thermographic study.

termography-knee

Thermographic study of the painful right knee

termography knee normal

The thermographic evaluation of the healthy left knee shows a difference of 1,5°C less than the right one

Mri Patellar tendon Tendinopathy

Sagittal T1w – Fusion – Stir Mri of the same patient (0.3 Tesla)

I perform the MRI examination to have also the clear depiction of the cortical patellar bone; as you probably know in many similar cases a bone marrow edema is associated at the inferior pole of the patella.

The study is completed with the dynamic ultrasound exam, both in supine and orthostatic position.

The elastosonography evaluation shows less adaptive changes during the dynamic study, as is usually seen in these pathologic conditions.

I believe in integrated imaging study for musculoskeletal pathologies; thermal cameras are user-friendly for anyone is involved in the diagnosis, monitoring, and treatment of these kinds of pathological conditions.

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Talus Osteochondral Bruises and Stress Injury

about monitoring stress injury of the talar dome with dynamic MRI and CBCT exam

Today I present you the clinical picture of a medial talar bone edema and spongious impaction of an elite runner; I’d like to remind you that a bone bruise is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema, so less indication for ultrasound imaging in this case. Yes, with ultrasound we can perfectly see the cortical irregularity but nothing about the definitive staging of the disease, so don’t forget: MRI is the method of choice (Stress Fracture in Runners).

Talus Injury MRI

Three months after the study was completed with Cone-Beam Ct scan; try to identify risk factors and training errors predisposing to stress fractures is mandatory.

Talus Injury Monitoring

Talar Injury CT

I always use the dynamic MRI-CBCT examination before the return to activity.

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