Update on sports imaging

Abstract

Sports Imaging has dramatically increased in the past decade with increasing number of adolescents, young and middle-aged adults participating in non-competitive/hobby sports. Therefore, sports injuries are no longer confined to elite athletes. Furthermore, newer forms of sports such as mountain climbing, pickle ball and curling etc. are gaining popularity. Majority of the injuries in sports medicine are from musculoskeletal trauma. Therefore, it is imperative that the musculoskeletal radiologist becomes familiar with various sports related injury patterns as these are commonly encountered in daily practice. This update aims to briefly encapsulate the major aspects of sports imaging. It includes the imaging manifestations of various types of musculoskeletal injuries on different modalities (commonly US and MRI) and briefly mentions the various image guided interventions, performed both on the sports field and in the hospital setting.

Keywords: Image guided injections; Imaging; MRI; Musculoskeletal; Sports injuries; US.

Fig. 1

Spectrum of sports injuries with commonly injured parts of the body.

Fig. 2

Skeletal distribution of sports injuries.

Fig. 3

Diagram showing unipennate, bipennate and multipennate muscles depicting the varying direction of their muscle fibres (red) and varying characteristics of the myotendons (white).

Fig. 4

Coronal T2W MR image showing an acute pectoralis major tendon avulsion injury in a professional weightlifter. The sternal head is retracted with diffuse muscle edema (yellow arrow) and a large haematoma (red arrow) between the retracted torn end of the tendon and its humeral attachment.

Fig. 5

US long axis image of the right medial elbow in a patient with non- professional Golfer’s elbow. There is common flexor tendinosis (with loss of the normal fibrillary appearance, focal hypoechogenicity and thickening of the tendon). An intrasubstance partial-thickness tear (red arrow) is seen as a anechoic area within the zone of tendinosis. ME- medial epicondyle.

Fig. 6

Longitudinal axis US image of left elbow joint depicting an acute triceps tendon rupture in a soccer player. The triceps tendon is retracted with an avulsed bone fragment attached to it (yellow arrow). An intervening haematoma (red arrow) is noted between the retracted torn end of the tendon and the olecranon. O-olecranon process.

Fig. 7

Coronal Proton Density fat-saturated MR image in a football player showing marrow edema in the medial femoral condyle (yellow arrow) and partial tear of the medial collateral ligament (red arrow).

Fig. 8

Axial T1-weighted fat-saturated hip MR arthrogram image showing a partial thickness tear of the anterosuperior acetabular labrum (red arrow) in a varsity soccer player. Also noted is a femoral neck small anterior bump (yellow arrow), possibly an early CAM type of femoroacetabular impingement.

Fig. 9

Coronal T1-weighted fat-saturated wrist MR arthrogram image showing a peripheral tear of the triangular fibrocartilage including styloid attachment (red arrow) and partial thickness tear of the scapholunate ligament (yellow arrow) following an acute skiing injury in a young non-professional skier.

Fig. 10

Longitudinal axis (a) and transverse axis (b) US images of the median nerve in a badminton player with carpal tunnel syndrome showing thickened hypoechoic median nerve with loss of the fascicular appearance (red arrow), perineural echogenicity and mild doppler hyperemia (yellow arrow).