DOI: 10.5124/jkma.2010.53.7.615 pissn: 1975-8456 eissn: 2093-5951 http://jkma.org Continuing Education Column Imaging Diagnosis of Sports Injury Young Cheol Yoon, MD Department of Radiology, Samsung medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Corresponding author: Young Cheol Yoon E-mail: ycyoon@skku.edu Received pril 6, 2010 ccepted pril 20, 2010 bstract Increased number of population participating in sports results in unavoidably increase of incidence of sports injury. It also causes a rise of total healthcare expenditure. ecause the technology of a variety of imaging modalities and treatment for sports injury is rapidly developed, an up-to-date knowledge on technology is critical for the sports physician. dvances in areas of nuclear medicine, magnetic resonance imaging, ultrasonography, and multi-detector computed tomography, provides a variety of options to physician in the process of patient evaluation. Therefore, they should be aware of strength, limitation, indications, contraindications, and diagnostic accuracy of diagnostic tools. Keywords: Sports medicine; Radiology; Magnetic resonance imaging; Computed tomography; Ultrasound c Korean Medical ssociation This is an Open-ccess article distributed under the terms of the Creative Commons ttribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 615
Young CY RT RT DORSL PLNTR RT RT MEDIL LTERL NTERIOR POSTERIOR Figure 1. patient with calcaneal stress fracture. () lateral foot plain radiograph shows no definite fracture line on calcaneus. () Whole body bone scintigraphy shows increased uptake at right hind foot area. 616
Imaging Diagnosis of Sports Injury C Figure 2. patient with intra-articular calcaneal fracture. () lateral foot plain radiograph shows suspicious vertical radiolucent fracture line at calcaneal body. () Sagittal reformatted CT image clearly shows the fracture line extending to subtalar joint. (C) Three-dimensional (3D) image with surface shaded technique (SSD) shows multiple fracture lines at a glance. Figure 3. patient with full-thickness tears of supraspinatus tendon. Oblique sagittal reformatted () and oblique coronal reformatted () image of shoulder CT arthrography show contrast material which injected into glenohumeral joint traverse (arrow) the supraspinatus tendon (asterisk) and reach to subacromial-subdeltoid bursa (arrowheads). 617
Young CY Figure 4. patient with complete tear of extensor pollicis longus tendon (EPL). Transverse sonography at the level of distal radius shows empty right third extensor compartment (arrows).. extended field of view image shows swollen distal part of EPL which disrupted at scaphoid level. Figure 5. US guided subacromial injection procedure. Needle tip is located between mildly thickened subdeltoid bursal wall (arrowheads). 618
Imaging Diagnosis of Sports Injury Figure 6. patient with transient patellar lateral subluxation. () Patellar skyline view of right knee shows linear increased opacity parallel to medial patellar facet (arrow) representing osteochondral fracture fragment. () Transaxial image of saturated proton density weighted MR image shows subchondral bone marrow contusion at medial patellar facet and lateral femoral condyle (arrows) and osteochondral fracture fragment from medial patellar facet (arrowheads). 619
Young CY C Figure 7. patient of medial meniscus horizontal tear. Proton density weighted coronal (), sagittal (), and transaxial (C) images show intrameniscal linear high signal intensity area which extend to inferior articular surface (arrows in and, arrowheads in C), and multilocular fluid-like high signal intensity area representing parameniscal cysts (arrow in C). 620
Imaging Diagnosis of Sports Injury REFERENCES 11. Coris EE, Zwygart K, Fletcher M, Pescasio M. Imaging in sports medicine: an overview. Sports Med rthrosc 2009; 17: 2-12. 12. errington de Gonzalez, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363: 345-351. 13. Orchard JW, Read JW, nderson IJ. The use of diagnostic imaging in sports medicine. Med J ust 2005; 183: 482-486. 14. Leffers D, Collins L. n overview of the use of bone scintigraphy in sports medicine. Sports Med rthrosc 2009; 17: 21-24. 15. Coris EE, Higgins HW, 2nd. First rib stress fractures in throwing athletes. m J Sports Med 2005; 33: 1400-1404. 16. Humphreys SC, Eck JC, Hodges SD. Neuroimaging in low back pain. m Fam Physician 2002; 65: 2299-2306. 17. Sanderlin W, Raspa RF. Common stress fractures. m Fam Physician 2003; 68: 1527-1532. 18. Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment. Curr Opin Pediatr 2004; 16: 37-46. 19. Carek PJ, Dickerson LM, Sack JL. Diagnosis and manage-ment of osteomyelitis. m Fam Physician 2001; 63: 2413-2420. 10. uckwalter K. Current concepts and advances: computerized tomography in sports medicine. Sports Med rthrosc 2009; 17: 13-20. 11. Munshi M, Davidson M, MacDonald P, Froese W, Sutherland K. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med 2000; 10: 34-39. 12. Megliola, Eutropi F, Scorzelli, Gambacorta D, De Marchi, De Filippo M, Faletti C, Ferrari FS. Ultrasound and magnetic resonance imaging in sports-related muscle injuries. Radiol Med 2006; 111: 836-845. 13. Campbell RS, Grainger J. Current concepts in imaging of tendinopathy. Clin Radiol 2001; 56: 253-267. 14. llen GM, Wilson DJ. Ultrasound in sports medicine-a critical evaluation. Eur J Radiol 2007; 62: 79-85. 15. Khan KM, Forster, Robinson J, et al. re ultrasound and 621
Young CY magnetic resonance imaging of value in assessment of chilles tendon disorders? two year prospective study. r J Sports Med 2003; 37: 149-153. 16. Kijowski R, De Smet. The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med 2006; 25: 569-590, viii. 17. hn JM, El-Khoury GY. Role of magnetic resonance imaging in musculoskeletal trauma. Top Magn Reson Imaging 2007; 18: 155-168. 18. Gold GE, Hargreaves, eaulieu CF. Protocols in sports magnetic resonance imaging. Top Magn Reson Imaging 2003; 14: 3-23. Peer Reviewers Commentary 622