Imaging of Orthopedic Sports Injuries (eBook)

Vanhoenacker F.M., president of the musculoskeletal section of the Royal Belgian Society of Radiology, section editor musculoskeletal European Radiology, reviewer of different journals, incl. Skeletal Radiology, authors or co-author of more than 112 scientific papers. Gielen J. president VVS (Flemish society of sports medicine) Maas M., Vice president of the subcommittee on Sports Imaging of the European Society of Musculoskeletal radiology. Chair of the musculoskeletal section of the Dutch Society of Radiology. Vice-chair of the board of medical education University of Amsterdam. Radiology consultant for various national Sports societies. Reviewer of various journals

Foreword 7
Preface 8
Introduction 10
Contents 12
Relevant Basic Science and General Imaging Principles 15
The Clinician’s Point of View 17
Imaging Techniques and Procedures in Sports Injuries 21
Muscle Injuries 29
Cartilage Trauma 55
Tendon and Ligamentous Trauma 75
Bone Marrow Edema in Sports Injuries: 87
General Concept 87
Overuse Bone Trauma and Stress Fractures 99
Pseudotumors in Sports 117
Topographic Discussion 133
Shoulder Instability 135
Rotator Cuff and Impingement 163
Scapular, Clavicular, Acromioclavicular and 183
Sternoclavicular Joint Injuries 183
Imaging of Wrist Injuries 215
Finger and Hand 239
Pelvis, Hip and Groin 249
Sports-related Meniscal Injury 279
Knee: Ligaments 297
Imaging of Anterior Knee Pain and Maltracking 321
Injuries of the Ligaments and Tendons in the Ankle and Foot 335
Ankle and Foot: Osteochondral Injuries 351
Acute and Overuse Lesions of the Leg and Calf 365
The Spine in Sports Injuries: Cervical Spine 391
The Spine in Sports Injuries: Thoracic and Lumbar Spine 405
Maxillofacial Injuries in Sports 415
Thoracic and Abdominal Wall Injuries in Sports 429
Special Considerations in the Immature Skeleton 447
The Aging Athlete 463
Monitoring of Sports Injury Repair 482
Natural History and Monitoring of Fractures and Microfractures 483
Monitoring of Muscle, Tendon and Ligament Repair 503
Addendum 518
Sport- Specific Injuries 519
Subject Index 533
List of Contributors 543

The Clinician’s Point of View (p. 3-4)

Babette M. Pluim

C O N T E N T S
1.1 Introduction 3
1.2 Role of Imaging 3
1.3 What is Expected from the Radiologist? 4
1.4 What is Expected from the Radiology Department? 4
1.5 What is Expected from the Sports Physician? 4
1.6 Risks of Over-Imaging 5
1.7 The Travelling Athlete 5
1.8 Conclusions 6
Things to Remember 6
References 6

1.1 Introduction

Over the last ten, years imaging techniques have become increasingly important as a diagnostic tool for sports injuries without replacing the traditional methods of management (Geertsma and Maas 2002, De March et al. 2005). An accurate diagnosis can often be made based on a history and physical examination alone but imaging techniques can be very helpful if there is doubt about the diagnosis. In patients who do not respond to conservative management, imaging can be especially useful to acquire a better understanding of the extent of the lesion. However, over-imaging can cause problems in high-level athletes, who have easy access to imaging modalities when travelling abroad. This is particularly so when there is lack of communication between the various treating physicians and when an understanding of the mechanism of injury is essential in order to establish the correct diagnosis.

This chapter will review a number of situations where good communication between the radiologist and sports physician can result in the correct choice of imaging technique and a greater chance of establishing the correct diagnosis. The speci. c demands that elite athletes and sports physicians may place on the radiologist and the radiology department are also discussed.

1.2 Role of Imaging

It should be noted that the patient population of the sports physician differs slightly from the normal population. In general, athletes tend to be highly motivated and are keen to resume sport as soon as possible. The majority of their injuries are caused by training overload yet they . nd it very diffdcult to reduce this load. There is always another match, another race, another goal to achieve. So in a situation where a ‘normal’ patient may be content to give his/her ankle sprain or stress fracture the required three to six weeks rest, an athlete will want to know if he/she can participate in next week’s tournament. When working with athletes, time is always a pressure. This is where imaging can play an important role for both the sports physician and the athlete. First, by establishing the correct diagnosis at the start, the correct treatment procedures can be initiated immediately with no unnecessary time lag. Second, it is often very helpful to provide the athlete with visual evidence that a significant injury is present (e.g. stress fracture, muscle rupture or meniscal lesion) and thereby to convince him/her that rest is indeed essential. Hopefully this will also obviate the inclination of the athlete to get multiple opinions ("medical shopping"). Finally, it may clarify whether surgery is necessary. In cases where conservative management is indicated, imaging may also help determine the appropriate form of treatment, for example, if calcifications are present, use of Dolorclast (shock wave therapy) may be indicated. Despite the fact that corticosteroid injections are used less and less in sports medicine, there are still instances when this type of treatment is indicated and imaging can help in this choice, e.g. a tenosynovitis (trigger . nger), ganglion cyst, bursitis or iliotibial tract syndrome. Ultrasound may also be used to guide the injection needle (Jacob et al. 2005).