The woman referred to Dr. Martin Lazarus at the University of Illinois at Chicago Medical Center felt her kneecap popping in and out of place when she bent her leg. But her doctors couldn't tell what was wrong because x-rays and scans showed only a picture of the knee at rest.
Lazarus, a musculoskeletal radiologist, used a new kind of MRI (magnetic resonance imaging) scan to observe the knee in motion and immediately diagnosed the problem. As the patient flexed her knee inside the scanner, he could see the kneecap pop out of place and move to one side.
"That was completely unexpected," Lazarus said. Not only did the kneecap move in the opposite direction from where it was expected to move, but the motion could not be detected by physical examination or x-rays, CT scans or static MRIs.
Lazarus uses dynamic kinematic MRI imaging, which reproduces in the scan the motion causing the patient problems. He can pinpoint the exact point in the range of motion at which the problem occurs.
In addition to knees, the technology also diagnoses ankle and temporomandibular joint (jaw) problems. Armed with that information, doctors can determine what kind of surgery or therapy to do.
This type of MRI technology has been available for just three or four years, according to Lazarus, one of a handful of musculoskeletal radiologists, or sports radiologists, in the Chicago area, who most often uses the scans on athletes.
"I see everything from recreational athletes to Olympic athletes," said Lazarus, who admits to being "a big sports fan." He has diagnosed runners, professional basketball and hockey players, an Olympic heptathlete and Olympic gymnast, among many other patients.
He enjoys the sense of urgency in diagnosing competitive athletes. "You have to have an answer now: Is this just a bruise or is he out for the season? With every competitive athlete you're going to determine their season or their career."
And for the rest of us, the ability to see a joint in motion can mean an end to pain and maybe a chance to win the next volleyball tournament.