JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
or fat-suppressed T2-weighted sequences enable detection of edematous changes in the musculotendinous unit and are the imaging modality of choice for muscle strains. 1,5 A normal quadriceps tendon will have a laminated appearance. A T1 weighted image of a strain will show discontinuous hypointense fibers surrounded by decreased signal intensity from edema and hemorrhage. The T2 weighted images will show hyperintense fluid and hemorrhage near the tear site. Partial tears (grade I and II) will show variable thickening, increased signal intensity, and continuity of fibers near the tear site. The edema in a 1st degree strainmay track along themuscle and create a“feathery”margin. 2 A 2nd degree strain is often accompanied by a hematoma at the myotendinous junction and perifascial fluid collections. 1,5 T2 weighted images of a 3rd degree strain show increased signal intensity with discontinuous fibers. 3 Conservative treatment of partial tears consistsof immobilization and range of motion exercises. Surgical intervention should be completed within 48 hours for end-to-end tendon repair. 3 Several studies have shown that significant morbidity exists in delaying surgical treatment. In one study by Siwek and Rao, six patients undergoing delayed surgical treatment fared far worse than thirty patients receiving prompt treatment. 6
REFERENCES
David Aamodt is a fourth year medical student at Tulane University School of Medicine in New Orleans, Louisiana. Dr. Serou is musculoskeletal radiologist at Tulane University Health Sciences Center in New Orleans, Louisiana. Dr. Neitzschman , now deceased, was a professor of Radiology and the Chairman of the Department of Radiology at Tulane University Health Sciences Center in New Orleans, Louisiana. Donald Olivares is the Digital Imaging Specialist and Graphic Designer for the Department of Radiology at Tulane University Health Sciences Center in New Orleans, Louisiana. Sonin AH, Fitzgerald SW, Bresler ME, Kirsch MD, Hoff FL, Friedman H.MR imaging appearance of the extensor mechanism of the knee: functional anatomy and injury patterns. RadioGraphics 1995; 15:367-382. 5. Palmer WE, Kuong SJ, Elmadbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol 1999; 173:703-709. 6. Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am . 1981;63:932–937. 1. Steinbach LS, Fleckenstein JL, Mink J. Magnetic resonance imaging of muscle injuries. Orthopedics 1994; 17:991-999. 2. Resnick, Donald, andMark Kransdorf. Bone and Joint Imaging. Philadelphia: Saunders , 2004. 3. Stoller, DavidW. Diagnostic imaging. Salt Lake City, Utah: Amirsys , 2004. 4.
100 J La State Med Soc VOL 169 JULY/AUGUST 2017
Made with FlippingBook Digital Publishing Software