Diagnostic tests
1st tests to order
1st tests to ordertable-forMusculoskeletal sprains and strains
| Test | Result |
- x-rays
-
Should be ordered initially if the clinical suspicion for fracture is very high, to rule out bony injuries.
Can be repeated in 2 weeks if symptoms do not improve with initial treatment (e.g., in wrist injury to rule out scaphoid fracture).
| negative |
- MRI
-
Can differentiate between complete and incomplete tear with reasonable certainty.
| grade 1 muscle strain: focal hyperintensity in T2 sequence; grade 2 muscle strain: hyperintensity in T2 in acute phase with muscle fibre retraction; grade 3 muscle strain: hyperintensity in T2 with bell clappers sign due to muscle fibres floating in the haematoma; grade 1 ligament sprain: focal hyperintensity in T2 sequence; grade 2 ligament sprain: hyperintensity in T2 in acute phase; grade 3 ligament sprain: hyperintensity in T2 with loss of integrity of the ligament |
- ultrasound for non-ligament injuries
-
Initial investigation in groin area or if close to musculotendinous junction.
In situations of non-availability of MRI, ultrasound can be helpful.
Confirms muscle sprain and grades it. Ultrasound is not useful for ligament sprains.
The diagnostic reliability of ultrasound is observer-dependent and requires a skilled practitioner.
| grade 1: generalised or focal hyperechogenicity; grade 2: interruption of fibres in the echogenic perimysial striae; grade 3: muscle stump appears rounded and hyperechogenic |
Tests to consider
Tests to considertable-forMusculoskeletal sprains and strains
| Test | Result |
- diagnostic arthroscopy
-
More useful in ankle and wrist injuries. Used to differentiate between incomplete and complete ligament sprain.
| torn ligament invaginated into the joint |
Last updated: Oct 25, 2012
