Investigations

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There are many investigations that doctors and physiotherapists utilize to help determine a patient’s diagnosis. They are usually used to help confirm or eliminate a suspected diagnosis following clinical examination.

The most common investigations utilized in sports medicine and musculoskeletal physiotherapy include:

  • X-ray
  • MRI
  • CT Scan
  • Bone Scan
  • Ultrasound

Investigations - X-ray of the Knee

Figure 1 – Investigations (X-ray of the Knee)


When are investigations indicated?

Investigations are frequently indicated in the following scenarios:

  • Severe or traumatic injury
  • Suspicion of serious pathology
  • Unusual clinical presentations
  • Unknown diagnosis following examination
  • Injuries that are unresponsive to treatment

As a general rule, investigations are usually only indicated if the outcome is likely to change treatment and should be discussed on an individual basis with your doctor or physiotherapist. It is usually unnecessary to perform expensive investigations to confirm an already obvious clinical diagnosis.

In addition, there are many instances when a thorough examination from a qualified professional is more accurate in determining a diagnosis than an investigation. This is due to the fact that many investigations are not 100% reliable or have inaccuracies due to a variety of factors.

Nonetheless, investigations do have an important place in the clinical setting and can provide valuable information when used appropriately and at the astute discretion of the treating physiotherapist or doctor.


Which investigation for which injury?

If an investigation is indicated, it is important that your physiotherapist or doctor refers you for the most appropriate investigation(s) for your particular injury. It is also important that the investigation undertaken occurs at the appropriate time, is taken using the most appropriate view(s) and is taken with the patient in the most appropriate position for a suspected diagnosis. In addition, it is imperative that any contraindications are identified to ensure the patient does not undertake an investigation that is going to harm them.

A description of the most commonly used investigations in sports medicine and musculoskeletal physiotherapy, and their clinical application, are outlined below.


What is an X-ray?

An X-ray (also known as a Plain X-ray) is a form of medical imaging that uses electromagnetic radiation to produce images of the dense tissues inside the body, such as bone.


When is an X-ray used?

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What is an MRI?

MRI stands for Magnetic Resonance Imaging. An MRI is a scan that uses a magnetic field and radio waves to create images of the bone and soft tissues of the body. One of the benefits of an MRI over other investigations (such as an X-ray or CT scan) is that it does not use ionizing radiation and is, therefore, potentially less harmful to the patient.


When is an MRI used?

An MRI is commonly used to assess for bone abnormalities, joint abnormalities, soft tissue abnormalities, and nerve root compression as well as various medical conditions (such as tumours or diseases of internal organs). In sports medicine and musculoskeletal physiotherapy it is often used to assess for the following conditions:

  • Bone Fractures
  • Joint Pathologies
  • Cartilage Tears / Meniscal Tears / Labral Tears
  • Disc Injuries
  • Acute Nerve Root Compression (Sciatica)
  • Muscle Tears or Ruptures
  • Tendinopathy
  • Tendon Tears or Ruptures
  • Ligament Sprains or Ruptures
  • Bursitis
  • Bone Disease
  • Tumors

It is important to be aware, that there are a few contraindications to MRI, such as certain brain aneurysm clips, neurostimulators, cardiac pacemakers etc.


What is a CT Scan?

CT Scan stands for Computed Tomographic Scanning. It is a type of medical imaging that uses X-ray beams and a computer to produce cross sectional images of bone and soft tissues.


When is a CT Scan used?

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What is a Bone Scan?

A bone scan (also known as radioisotopic bone scan or bone scintigraphy) is a nuclear scanning test used to detect areas of increased bone turnover, such as bone growth or damage (e.g. stress fractures). It involves the injection of a radioactive substance into the body followed by the taking of a series of images using a special camera to detect the radioactive substance (which concentrates in areas where there is increased blood flow and bone turnover, such as at fracture sites).


When is a Bone Scan used?

A bone scan is particularly useful for identifying:

  • Bone Stress Reactions
  • Bone Stress Fractures (e.g. navicular, pelvic, pars interarticularis)
  • Osteochondral Lesions (e.g. osteochondral fracture of the talar dome)
  • Other Bony Medical Conditions (such as bone cancers or bone infections)

A positive finding on a bone scan may then be accompanied by a CT scan to assess the severity of the ‘hot spot’ and to provide a more accurate diagnosis (i.e. confirm a fracture).


What is an Ultrasound?

An investigative ultrasound scan is a painless method of imaging that uses high frequency sound waves. A probe is usually applied to the skin with the help of a conductive medium (typically ultrasound gel) to transmit the sound waves and assess the soft tissues underneath the skin. Ultrasound is a relatively safe imaging technique as it does not expose the patient to any radiation.


When is an Ultrasound used?

Ultrasound is commonly used to assess tendons, muscles and other soft tissues. In medical practice, it is often used in the assessment of organs and to assess and visualize fetuses in prenatal care. Ultrasound is particularly useful in the assessment of the following musculoskeletal conditions:

  • Tendinopathy (e.g. Achilles, Patellar, Rotator Cuff)
  • Tendon Tears
  • Tendon Ruptures
  • Bursitis
  • Calcification
  • Muscle Tears
  • Muscle Haematomas (e.g. contusions)

It is important to note that ultrasound is largely dependent on the skills and expertise of the operator in order to provide accurate information. Ultrasound also, unfortunately, does not provide information on the deeper structures, such as joints or bones.


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