Search

Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.

Clinical assessment of the patient with shoulder symptoms can usually localize the cause to one of a few syndromes, each associated with specific imaging questions. MRI is used as the primary form of investigation for recurrent dislocation, SLAP lesions and PSI, as well as articular cartilage, synovial disease, tumours and infection. Ultrasound plays the leading role in impingement, acromioclavicular disease, dynamic assessment and guided therapy. Both techniques are reported to play a role in adhesive capsulitis. In our hospital, approximately four times as many shoulder ultrasound examinations as shoulder MRI are carried out, but elsewhere these proportions will vary according to the prevalence of clinical syndromes in the population being treated.