Sesamoid Injury: Why do we MRI?

      There are so many reasons to get MRI images when you suspect a sesamoid fracture. I think it is important enough to have my patients self pay if there is any issues with their health insurance. I always think of an MRI for sesamoid injuries as the first MRI with another needed in 6 months if something is found positive. In this MRI, the medial or tibial sesamoid is white (signifying an inflammatory reaction) when it should be black on this T2 image. T2 imaging is hypersensitive for water (or inflammation) within structures when it should not be. All we know by this one image, and no other information, that something is going on which can be healing. This swelling within the tibial sesamoid is also called bone edema (bone swelling). Typically bone swelling when you have to walk on it is very sore. 

     After getting my first MRI, and finding a positive finding, I tell the patient that typically we will be repeating this MRI in 6 months to check for progress. I hope to initiate various treatments to get the pain level within 0-2 and allow for healing to occur. There are times that the patient is doing so much better that another MRI is not done. There are also times that the injury is too bad, complete healing does not occur, and the patient will either have surgery or is put on the 2 year wait and see plan. You always have to treat the patient and not the image, you always have to strive to make treatment changes when a subpar plateau occurs. And, since this is a bone, where bone health is crucial, consider Vitamin D levels and bone density testing. I hope this helps.