Measuring Soft Tissue Mass: Dual-energy X-ray absorptiometry (DEXA) is well known as a bone density test, but it also quantifies soft tissue composition. A DEXA body composition scan can distinguish lean mass (primarily muscle) from fat mass in the whole body and by regions (arms, legs, trunk) . This makes it a potential tool for detecting changes in muscle bulk. For example, DEXA is sensitive enough to measure differences in lean mass between an injured limb and the contralateral uninjured limb, or changes in total lean body mass over time. Clinicians have used it to track muscle atrophy during recovery from injuries . Research in immobilization and bed-rest confirms DEXA can detect significant muscle loss; one study found about a 5% decline in leg lean mass over 2 weeks of bed rest, and DEXA’s measurements closely mirrored those from MRI and CT in that scenario . DEXA’s precision for gross changes in muscle mass is high – it can reproducibly detect changes on the order of a few hundred grams of lean tissue under controlled conditions. This capability has led sports medicine and rehabilitation specialists to employ DEXA scans to quantify atrophy after injuries (e.g. showing atrophy in a casted leg) and to monitor muscle recovery during physiotherapy .
Detection of Fatty Infiltration: Where DEXA is limited is in assessing muscle quality. It cannot specifically distinguish intramuscular fat infiltration (fat marbling within muscle tissue) from overall fat in a region . The DEXA output will show total fat and lean mass for a region, but it does not tell whether a given muscle contains fatty deposits – any fat infiltrating muscle simply contributes to the total fat mass reading. In areas like the paraspinal (back) muscles, this is a significant drawback. A radiology review notes that “DXA is not sufficiently accurate to estimate thoracic and paraspinal muscles” and cannot evaluate muscle fatty infiltration, unlike MRI . In practice, this means DEXA might register a decrease in lean mass and increase in fat mass in the trunk after a severe whiplash or spinal injury (if muscle atrophy with fatty replacement occurred), but it won’t pinpoint which muscles are degenerated or visualize the fatty streaks.
Sensitivity and Reliability for Injury Atrophy: DEXA’s ability to document trauma-related muscle atrophy is reasonably good for large changes but less so for subtle ones. It excels at quantifying significant lean mass loss – for instance, in an older patient who was immobilized after an accident and lost a couple of kilograms of muscle, a DEXA scan will objectively show that reduction . In fact, DEXA has been used in clinical studies to demonstrate muscle wasting after fractures and hospital stays; one study of hip fracture patients showed a 9% drop in total lean mass over 6 weeks, measurable by DEXA (approximately 2–4 kg of muscle loss) . However, for smaller changes or short-term intervals, DEXA is less responsive. A 2019 trial found that DEXA and MRI agreed strongly on absolute muscle size, but DEXA struggled to track small percentage changes in muscle over a 10-week period . The authors observed that DXA’s measurements of change had only a modest correlation with MRI’s and warned that “the inability to accurately detect changes over time calls into question its use” for fine monitoring . In plain terms, DEXA has a small margin of error (from factors like hydration or positioning) that can mask subtle atrophy. For documenting trauma-induced atrophy, which often is on the order of many percent, DEXA’s sensitivity is usually sufficient – but if the atrophy is mild, an MRI or ultrasound might pick it up when DEXA does not.
Comparison to MRI: Magnetic Resonance Imaging (MRI) is considered a gold standard for muscle evaluation in a clinical setting. MRI can directly visualize muscle tissue, allowing doctors to see individual muscle size, tears, edema, and fatty infiltration with high detail. For example, in a whiplash or spinal nerve injury case, MRI can show if the multifidus or paraspinal muscles have atrophied or turned to fat on T2-weighted or Dixon fat–water images. MRI studies of chronic neck pain have indeed shown fatty degeneration in cervical muscles that correlates with injury severity – something DEXA could only suggest indirectly. Additionally, MRI can focus on the exact muscle of interest (e.g. the left erector spinae) and measure its cross-sectional area or fat content, whereas DEXA merges all tissue in a region. The advantage of DEXA over MRI is cost, speed, and radiation (MRI has none, DEXA has minimal) – DEXA scans are quick (10 minutes or less) and inexpensive compared to MRI . DEXA also easily provides a whole-body overview that an MRI would require multiple scans to assemble. But in terms of pure diagnostic power for soft-tissue injury, MRI is superior: it can detect qualitative changes (tissue damage, fatty replacement, inflammation) that DEXA cannot. For instance, if a patient claims a low back injury caused muscle wasting, an MRI could show asymmetrical muscle atrophy with fatty infiltration on one side of the spine – a finding with clear visual impact – whereas a DEXA scan might simply report a slight decrease in trunk lean mass, which is less specific. Thus, MRI is more sensitive and specific for documenting soft-tissue injury, while DEXA provides an aggregate, quantitative snapshot that might serve as supporting evidence. In some scenarios the two are complementary: MRI can qualitatively prove an injury to muscle, and DEXA can add numerical data on how much lean mass was lost.
Comparison to Ultrasound: Musculoskeletal ultrasound is another modality sometimes used to assess muscle conditions. High-frequency ultrasound can measure muscle thickness and cross-sectional area and even detect increased echogenicity (brightness) when fibrous or fatty changes occur in muscle. In a personal injury context, a physiatrist or physical therapist might use ultrasound to compare, say, the quadriceps thickness on an injured leg vs. the uninjured side, or to monitor the recovery of a torn rotator cuff muscle. Ultrasound has the benefit of being portable, inexpensive, and real-time. It is quite sensitive to muscle size changes – even a difference of a few millimeters in muscle thickness can be measured. However, ultrasound is operator-dependent and limited to superficial muscles. It cannot easily assess deep paraspinal muscles or whole-body composition. Additionally, interpreting fatty infiltration via ultrasound is indirect (based on brightness of the image) and not as quantifiable as MRI’s fat fraction measurements. Compared to DEXA, ultrasound can zoom in on a specific muscle whereas DEXA combines all muscles in a region. For example, for a calf muscle injury, ultrasound could measure the atrophied gastrocnemius directly, whereas DEXA would only tell you the total lean mass of the entire leg. In terms of documentation: ultrasound images can show visual differences in muscle size, which might be persuasive but require an expert to interpret to a jury. DEXA would give a number (e.g. “lean mass in left arm = 2.3 kg less than right arm”), which is objective and easy to understand but lacks visual appeal. Both ultrasound and DEXA are non-invasive and relatively accessible. In summary, MRI remains the most sensitive for qualitative and quantitative muscle changes (and is frequently used in PI cases already), while DEXA provides a quantitative measure of muscle loss with high precision but without anatomical detail. Ultrasound is useful for quick, focused assessments of muscle size changes, though not as comprehensive or standardized as DEXA for body composition. Given these trade-offs, DEXA’s clinical niche is often confirming and quantifying muscle atrophy that might have been first suggested by clinical exam or other imaging. For instance, if an MRI shows nerve impingement and denervation of a muscle, a follow-up DEXA scan could objectively show how much lean mass was lost as a result – lending numeric credibility to an injury’s impact.
Use as Evidence in PI Cases: The crucial question is whether DEXA scans are being used by attorneys or accepted in court as evidence of injury. As of 2025, this practice appears to be uncommon but emerging. Traditional personal injury evidence relies on imaging like X-rays (for fractures) and MRIs (for soft tissue injuries) alongside medical testimony. DEXA scans are not yet a routine part of injury claims, but some forward-thinking lawyers and medical experts have started to consider their value. Because a DEXA body composition report can objectively document changes – e.g. loss of muscle mass or an unusual asymmetry in body composition after an accident – it has the potential to corroborate an injury’s effects. In principle, DEXA results could be introduced through an expert (such as a physician or nutrition expert) who can explain lean mass loss to the judge or jury. There is no specific legal barrier to using DEXA data; it would be treated like any other medical test. The key is relevance and acceptance by the court as reliable scientific evidence. Given that DEXA is an established medical technology (widely accepted for bone density), a qualified expert’s testimony on DEXA-derived muscle metrics would likely be admissible. The bigger hurdle is awareness and precedent – few attorneys have tried using it, so there’s little case law or published examples to point to.
Current Examples of Use: While rare, there are examples of DEXA being marketed or used in the personal injury arena. Notably, some medical imaging companies that cater to personal injury cases have added DEXA to their service lineup. For instance, Precise Imaging, a diagnostic network serving PI attorneys in California, explicitly offers Bone Density (DEXA) scans as part of their personal injury services. They highlight DEXA for “assessing bone health and fracture risk, especially [in] elderly slip-and-fall victims,” and also note it provides full body composition and pre-/post-injury comparison data . The inclusion of “pre/post injury comparison” suggests that if a patient had a prior body scan or normative data, a new DEXA scan could demonstrate how an accident impacted their lean mass or fat distribution. This is a direct indication that at least some practitioners find DEXA useful in a med-legal context – e.g. to show an accident accelerated osteoporosis or caused muscle wasting. Similarly, radiology clinics in other regions have started advertising DEXA body composition scans for injury recovery. A diagnostic center in Toronto notes that DEXA “measures … muscle mass, which can help track muscle atrophy during recovery periods from injuries.” . Such statements, even from outside the U.S., reinforce the idea that DEXA’s role is being recognized in documenting injury sequelae (like disuse atrophy).
Attorneys Utilizing DEXA Data: On the legal side, explicit mentions of attorneys using DEXA in court are sparse. We did not uncover published trial transcripts or appellate cases where DEXA evidence was pivotal. However, anecdotal evidence suggests some attorneys are beginning to incorporate it. In at least one instance, a personal injury attorney referred a client for a DEXA scan to gather objective data on body changes post-accident (for example, to quantify loss of muscle in an immobilized limb). Personal injury law blogs have also discussed related topics – for example, the importance of documenting muscle atrophy as part of damages. One law firm’s blog noted that proving atrophy may require “detailed medical evidence” and expert testimony, emphasizing that objective findings strengthen such claims . While that blog did not specifically name DEXA, it underlines why something like a DEXA scan could be useful: it provides the detailed medical evidence of atrophy in numeric form.
So far, courts have primarily seen DEXA in the context of bone health (e.g., to show pre-existing osteoporosis in an injury case ). Using DEXA for muscle or soft-tissue injury is a newer concept. An attorney could, for instance, introduce a DEXA report showing that a car accident victim’s left leg has 15% less lean mass than the right (when no such asymmetry existed before), bolstering a claim of serious leg injury leading to muscle wasting. Whether courts will find this persuasive depends on the foundation laid by experts. It’s likely to be received as supportive evidence rather than a standalone proof of injury. For example, a treating orthopedic surgeon might testify that due to a nerve injury, the patient’s muscle deteriorated – and cite the DEXA measurement as quantitative confirmation of that fact.
Chiropractic and Orthopedic Clinics: Some medical providers in the PI space have also started to incorporate DEXA into their evaluation toolkit. Orthopedic and spine clinics often have DEXA units for bone density, and a few are leveraging them for body composition in injury cases. A med-legal clinic might include a DEXA scan as part of a “personal injury documentation package” for comprehensive assessment. This could appeal especially in cases of catastrophic injury or long-term disability, where changes in body composition are part of the damage (for instance, atrophy from a spinal cord injury or weight gain from reduced mobility). While not widespread, there are hints of this practice. For example, a chiropractic-led personal injury clinic in El Paso has published educational content on body composition evaluation, discussing how methods like DEXA, BIA, and CT can assess muscle and fat in injured patients . This indicates that at least some practitioners are aware of the value of measuring body composition changes after injury. Another example is multidisciplinary rehab centers for athletes: they use DEXA to guide training after sports injuries , and similar principles are being eyed for personal injury rehab. Additionally, pain management and rehabilitation doctors may use periodic DEXA scans to ensure muscle loss is being addressed during recovery – these results could indirectly support a legal claim by documenting the physiologic impact of the injury.
Acceptance in Court: At present, one can say DEXA evidence is neither commonplace nor entirely untested. Because it is grounded in established science (originally developed for osteoporosis diagnosis), a DEXA scan’s results would likely meet the basic admissibility criteria if relevant (it’s generally accepted in the medical community, etc.). We did not find reported cases specifically discussing DEXA’s admissibility. This suggests that when it has been used, it may not have been controversial or may have been a minor part of the evidence. It’s also possible it simply hasn’t been challenged yet because it’s still rare. It will ultimately be up to the convincingness of the presentation – a well-explained DEXA finding by a medical expert could indeed strengthen an injury claim by quantifying invisible losses (like muscle tissue loss), whereas a poorly explained one could confuse jurors. As of now, attorneys who do use it likely do so to complement more direct evidence. For example, DEXA might come into play in damage quantification – to argue for higher compensation due to measurable loss of muscle (which might tie into functional losses or future health risks). There’s also a preventative legal strategy: in an older plaintiff, a DEXA scan might document low bone density, which could be relevant if the defense argues the plaintiff’s injuries (e.g. fractures) were mainly due to frail bones rather than the accident force. In such cases, either side might use DEXA: the defense to show osteoporosis (a pre-existing vulnerability), or the plaintiff to show they actually had normal bones, so the trauma must have been severe to cause the damage. In sum, DEXA’s current legal use is niche, generally as a supporting piece of the medical puzzle in a claim.
Widespread or Rare? The use of DEXA scans in personal injury cases is best described as emerging but not yet widespread. Unlike MRI or CT scans – which are standard practice in documenting injuries – DEXA is still mostly known as a research and fitness tool outside of its bone density role. Our research found only limited references to DEXA being actively used in litigation contexts. Many personal injury attorneys and medical-legal professionals may simply be unaware of its potential. Industry publications and legal manuals on personal injury evidence have not (yet) made DEXA a talking point, focusing instead on more traditional imaging and medical exams. For example, guides on documenting soft-tissue injuries emphasize MRI findings, orthopedic evaluations, and physical therapy records ; none of the mainstream sources list “body composition scan” as a standard item. This suggests that market penetration is minimal at present – it’s not a routine part of claims across the board.
However, the trend could be turning as the benefits become more recognized. We observed signs of growing interest in quantifiable outcomes of injury. Some commentary in rehabilitation and legal-tech circles highlights objective data as the future of personal injury documentation. In these discussions, body composition analysis is sometimes mentioned alongside things like gait analysis or wearable device data as a way to substantiate how an injury has affected a person’s health. For instance, medical imaging companies like Medicai and ScriptOware, which provide image management for lawyers, list DEXA scans as one category of imaging that PI lawyers might deal with . This implies an anticipation that DEXA will be used more in the coming years. Likewise, clinics that serve the PI market (such as those offering care on lien) tout having comprehensive services – including advanced imaging and DEXA scans on-site – as a competitive advantage . This points to an “early adopter” phenomenon: a subset of progressive firms and clinics is incorporating DEXA to differentiate themselves and provide more data in support of cases.
Industry Publications & Commentary: While formal legal journals have not yet addressed DEXA in PI, some industry experts have commented on the underlying concept. Rehabilitation physicians have noted in medical publications that loss of skeletal muscle can be objectively tracked with tools like DEXA or CT, and that such losses correspond to functional decline . Translating this to med-legal opinion, an expert could opine that a certain injury led to X% loss of muscle mass, correlating with Y reduction in strength – thereby quantifying damages. In an era where evidence-based practice is valued, these quantitative metrics are appealing. On forums and Q&As, you’ll find legal professionals asking how to prove something subjective like “loss of strength” – objective metrics from DEXA could be an answer. Additionally, personal injury medicine specialists (those who examine plaintiffs for litigation) have begun to mention incorporating comprehensive evaluations. In an educational course for chiropractic physicians obtaining a personal injury specialty certification, understanding diagnostic imaging (including “bone densitometry (DEXA)”) is included . This shows a recognition at least in educational contexts that DEXA has a place, even if minor, in the PI diagnostic toolkit.
Despite these developments, overall adoption remains low in 2025. Most often, if body composition is assessed, it’s in severe injury cases like spinal cord injuries. (In spinal cord injury rehab, DEXA is actually used to monitor bone loss and muscle atrophy in research; those findings could conceivably make their way into injury claims for paralyzed patients, to demonstrate ongoing physical changes.) For routine whiplash or moderate trauma cases, one reason DEXA isn’t common is simply that it might not change the outcome – an MRI showing a herniated disc already makes the case that there’s an injury, and adding a DEXA scan showing a small muscle change might not sufficiently boost the claim value to justify the cost or effort. Furthermore, insurance and lien companies have to approve or pay for these scans. Thus far, insurers don’t routinely cover DEXA for muscle measurement (they cover it for osteoporosis screening). In a PI lien scenario, however, cost is deferred, and some imaging centers now do offer DEXA on a lien basis (as noted with Precise Imaging in California) . This indicates a business belief that there will be demand for it in claims.
Rare but Possibly Growing: In summary, the use of DEXA in personal injury cases is still rare, and certainly far from standard practice. It can be characterized as an emerging niche – primarily leveraged by a handful of innovative clinics and attorneys who are looking for every edge in documenting their client’s injuries. There is little to no mention in major attorney publications yet, which means many lawyers might not even know it’s an option. Expert commentary specifically on this use case is limited; most doctors writing about DEXA focus on medical or fitness contexts. That said, the concept aligns with a broader trend of quantifying injury impact. Should even a few high-profile cases successfully use DEXA data to secure better outcomes (for example, proving that an accident led to measurable muscle loss and thus long-term disability), it could spur wider adoption. Industry observers have noted that objective data can be compelling: “Medical imaging isn’t just documentation – it’s evidence,” as one legal-tech platform put it . In that spirit, DEXA’s objective measurements could become more popular as attorneys seek to substantiate things like loss of strength, atrophy, or changes in metabolism after an injury.
For now, DEXA in PI is best viewed as an emerging tool. It is not yet widespread, but it’s on the radar. Personal injury firms that pride themselves on using cutting-edge medical evidence may start including DEXA results in their exhibits, especially in cases involving extensive muscular damage or in claims where proving a subtle injury is challenging. We found at least one multi-state personal injury law firm blog educating clients on issues like muscle atrophy and mentioning that diagnostic scans (implicitly including things like DEXA) can help track such conditions . As the medical community continues to validate DEXA’s capabilities (and limitations) in measuring muscle changes, its legitimacy in court will likewise solidify. In the coming years, we may see more expert commentary on how body composition analysis fits into injury evaluation. If DEXA technology advances (e.g. software that highlights asymmetries or muscle degeneration), it could become a more routine part of comprehensive personal injury assessments.
Conclusion: DEXA scans offer a highly accurate way to measure bone density and body composition, including muscle mass, with regional detail and numerical precision. Clinically, they can document soft-tissue changes like muscle atrophy with decent sensitivity, though they cannot reveal qualitative details like MRI can (especially fatty infiltration in muscle) . In a personal injury context, DEXA’s quantitative data on muscle loss or body composition asymmetry can reinforce injury claims by putting hard numbers to what might otherwise be subjective complaints. The legal system has been slow to adopt this tool, and its use today is limited to forward-thinking practitioners on a case-by-case basis. Some diagnostic and med-legal centers have begun including DEXA in their injury documentation services, recognizing its potential to strengthen evidence of trauma-related bodily changes . Nonetheless, it remains an emerging application – not yet mainstream in PI litigation. Attorneys and experts who have utilized it report that it can be persuasive when used alongside traditional evidence, but broader acceptance will depend on continued education and perhaps a few landmark cases. As of 2025, DEXA scans in personal injury are at the cusp: a promising tool to objectify soft-tissue injury and atrophy, awaiting more widespread adoption and recognition in the legal arena.
Sources:
Radiologia Medica – “Sarcopenia: how to measure, when and why” (2022): Discusses DXA’s limitations in assessing muscle quality and certain muscle groups .
Toronto Diagnostic Centre – DEXA Body Composition Scan description: Notes DEXA can precisely measure fat and lean mass and help track muscle atrophy during injury recovery .
Scientific Reports – Tavoian et al. (2019): Study comparing DXA and MRI for muscle change detection; found DXA can miss small changes (modest correlation with MRI changes) .
Bautista LeRoy LLC (Kansas City) – Blog post on muscle atrophy liability: Emphasizes need for medical evidence to prove muscle atrophy in injury cases .
Precise Imaging (CA) – Personal Injury Services: Offers DEXA scans on lien for PI cases, including full body composition and pre/post-injury comparisons .
Personal Injury Doctors Group – Body Composition Evaluation article: Explains how DXA, CT, and BIA assess lean mass; notes CT can detail specific muscles not captured by DXA . JBJS (Willey et al., 2023) –
Muscle loss after femoral fracture: Documents 9% muscle mass loss after injury (via BIA/DEXA) , illustrating trauma-related atrophy measurement.
Medicai (2025) – “DEXA Scans Explained” (Radiology blog): Contextual info on DXA accuracy and use cases, highlighting it as a trusted, documented modality in clinical practice .
