What medical scan is for muscles?

*be. Sigh.

From what I remember CT is usually the scan of choice for muscles and MRI for ligaments and tendons. Having said that it is possible to see muscle tears on an MRI and if that’s what you radiologist suggest I’d go with that as he’s the one that will be interpreting the pictures.

For “muscle pain” they usually do a test where they poke each muscle, I don’t remember exactly. There is one that a small needle (doesn’t hurt) is stuck barely in your skin and they send a mini shock. That’s actually a nerve test. Another is they lay something on your skin on all the different muscle groups and measure something with a machine. Both take just a few minutes.

An MRI of the brain is usually done by a neurologist if a patient complains of muscle pain. When I had muscle problems they never scanned the muscle. I’m not sure if they can do some sort of scan to see a tear, hopefully other jellies will know. I’ve had X-rays done where the doctor tells me I have a muscle injury, but I think they deduced that because there was not bone break or no disc bulging, etc.

I can’t tell you how much I want you to just try getting your vitamin D up to at least 40 to see if your symptoms improve. It’s a fact you’re deficient; the dose you are at is not working. It has nothing to do with a pill or dose I think you should take, I am going by the lab work you have shared with us. If it doesn’t help you, you can always go back to taking less. Neurologists are going to give you much more serious drugs to try than a vitamin pill.

Here are studies on the government website. NIH pubmed is what researchers use as one of the sources to find and publish studies. It is not people wanting to sell vitamin pills. You can just skim the first few pages of each and see some information on D sufficiency causing muscle problems, balance problems in lab rats in a study, lower production of particular muscle fibers that are needed for anaerobic movement, and more. I didn’t read the documents all the way through.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725481/#!po=17.8571

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319727/

I think the MRI is more for soft tissues, the CAT is more for brain stuff, although they can do an MRI for the brain.

I broke an ankle and tore ligaments in it, and as a result I had both MRI and CAT scan. From what I was told, MRI is more of a 3D image of the bones, CAT scan was for the ligaments.

There is a lot of misinformation around, so I’d like to qualify this by saying I am a Radiographer of 5 years experience, having worked with CT for 4.5 years, and am part way through a Masters in MRI.

CT scans for musculo-skeletal (MSK) indications are primarily for bony abnormalities. CT can often detect acute and/or larger muscular abnormalities, but it is somewhat dependent on the body fat content of the patient. CT images on patients with some fat layers between their muscles are easier to read. However while CT is the gold standard imaging modality for bony abnormalities, if there is no bony involvement, and no highly vascular structures such as a tumour or arterio-venous malformation (AVM), I would not recommend it.

The first option for muscular injuries, depending on location, should be Ultrasound (US). US is usually cheaper than MRI, it is faster, and in many cases it is just as sensitive. It is limited for deep muscles, as a lower frequency probe with lower resolution must be used. US is also limited when structures are hidden behind bone, because unlike CT and MRI, it cannot penetrate bone. For example in the shoulder, US is fantastic for imaging the muscles you can directly feel with your fingers, but can’t image the muscles that sit between the shoulder blade and the rib cage.

MRI is, when correctly performed, the gold standard for MSK imaging (bony abnormalities aside). It is generally the most expensive form of imaging, and the scans can take quite some time. But the general rule with MRI, is that it is good at imaging anything with a lot of water or fat, provided there is a difference in the water or fat contents between tissues. MRI is however highly dependent on the operator. There are dozens of different sequences an MRI can use, and the selection of the correct sequences is vital. Some centres will limit their protocol to simple series, so the scan is shorter and they can get the next patient in sooner. More scans equal more money. But if the correct sequences are chosen, MRI will generally provide more information on muscular injuries and abnormalities than any other form of investigation.

Summary
I would recommend you get an Ultrasound first. If it is enough to diagnose your situation, then you’ve saved a lot of time and money. If you aren’t able to have an MRI (many people aren’t, for safety reasons), Ultrasound is still a very good option for most muscular issues. However MRI is the gold standard for most muscular issues, if it is correctly performed. If the Ultrasound doesn’t yield enough information to inform your recovery, then an MRI is an excellent next step.

@FireMadeFlesh Thank you very much! I’m dealing with a rib injury that I’ve had for at least 3 years now and it’s just not going back to normal. I still get a lot of pain and I just want to know what exactly is going on with it so I can heal. It pops out of place quite a bit, because my doctor thought there was muscle scarring or tearing, but even when it’s popped back in by my chiro, there’s still a lot of muscle pain, numbness, feels like my muscles are squeezing my ribs in so I can’t breathe as well, and my shoulder blade was fused to my back before they started working pulling it away. I just want to know, once and for all, how bad the damage might be and what I can do to make it better.

It’s been a long road and I’m sick of it.

When you feel the squeezing, is it after you have been lifting things for a while? Like if you spent the day moving boxes, or even just cleaning the house and making the beds for an hour or more? Basically, using your upper body strength?

@JLeslie It’s completely random. It’s been happening ever since my rib injury in general, which was about 3 years ago. I heard something snap in my rib area about a day after my neighbor hit me and a friend head on, and everything was downhill from there. The muscles also spasm all the time (not in a painful way – it actually feels better when it happens, because they fatigue and let go). My doctor thought there was scarring and that my muscles healed incorrectly and started holding everything in the wrong place. Which I could easily see, because I could tell my muscles were different and I knew before they did that my shoulder blade was fused to my back. I couldn’t lift my left shoulder blade off of my back at all, even if I pushed it out. So they had to work on pulling it away over time and it pops out more now, but it’s an ongoing process.

But yes, any activity at all can make my rib worse. It’s why I’ve been going to the chiro and now, in combination, a physical therapist. But my doctor brought up an MRI or CT Scan, just to make sure once again that there’s nothing they missed. So I wanted to know what might show scarring or tearing, because I think it’s more likely to be that than anything bone-related.

I see. Well, @FireMadeFlesh gave a great answer about scans obviously.

I get tightness in my chest after I use chest muscles. I don’t realize until afterwards. If I lift a lot of stuff continuously or use my upper body a lot for an hour or more, I would get that feeling. I have no idea if it feels similar to what you feel though. I finally decided it was the same thing that was happening to all if my muscles, and as I have mentioned the vitamin D has greatly reduced my problems along those lines.

I also have used magnesium spray where I have an I hurt from an accident on my shoulder and neck and it seems to help. My husband uses it on his foot, because he developed plantars fasciitis, and he feels it helped significantly, plus I’ve been loading him up with D. He really believes in the magnesium magic more than anything.

If they will do the MRI I think go ahead and do it if your curious. I personally wouldn’t do a CT (just my own fear of the radiation) unless knowing will mean a change in treatment.

Edit: also, I thought I would mention, I just thought if it, when I really exhaust my muscles with exercise or physical work, about 3 hours later my anxiety gets really bad. The physical “shaky” feeling is ramped up. I have no idea if that happens to other people. I especially notice it if I’m sitting or lying down relaxing.

@DrasticDreamer Thanks for the extra information. Considering the problem seems to be under your shoulder blade and around the rib cage, ultrasound may be of limited usefulness. In that case MRI would be your best option. I’m highly sceptical that CT would yield any useful information in this case. However of course these are things you should discuss with your doctor also – I’m not qualified in clinical assessment, even if I was able to see you in person.

If I can hazard a guess though, it sounds like you need to work on some mobility drills. Although your chiropractor may be able to help by putting the rib back in place, you need to learn why it is popping out in the first place. The most likely reason is that, following the injury, your muscles tightened up to protect an unstable region. Sometimes these muscles “forget” their normal activation patterns, and the tension exhibited following the injury becomes the new normal for you. If you try to move in novel and organic ways, they will learn how to activate in a more functional manner.

Start by reaching both arms as high as you can without pain. Then breathe as deeply as you can, in a slow and controlled manner, focussing the breath in your chest. Then try some of these movements, obviously with very light resistance at first(be careful with the final movement). Focus on moving your shoulder blades as you do each exercise. It doesn’t matter if they don’t move far at first, just do what you can. I would also add some yoga side bends.

When it comes to the scans though, you must ask your doctor how the results may inform your recovery. If the muscle is scarred or torn, as far as I understand there’s not a whole lot you would do differently. You still need to get it moving, and allow the body to adapt to these new movements.

@FireMadeFlesh Thank you, all of that was really useful information. I bookmarked your links and I’ll include them (without pushing myself too far) in the exercises that the physical therapist showed me. But I would absolutely love to retrain my muscles, because the worst part about it is that they healed in such a way that, when tight, they make it harder for me to breathe on my left side since it doesn’t seem like my ribcage is expanding as much as it should be. It’s been a very difficult, painful and long journey so far. But I have made progress (pain was so bad in the beginning that I had trouble walking) and hope to continue to do so, so again, thank you for the information and the links.