Table Of ContentI
Contents
MEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A. L. Baert, Leuven
M. Knauth, Göttingen
K. Sartor, Heidelberg
III
Contents
F. M. Vanhoenacker · M. Maas · J. L. Gielen (Eds.)
Imaging of
Orthopedic
Sports Injuries
With Contributions by
G. Allen · S. E. Anderson · J. Beltran · A. Bernaerts · P. Brys · K. Chapelle
A. M. Davies · M. de Jonge · M. De Maeseneer · A. Demeyere · F. Ebrahim · P. Ehlinger
D. G. Fransen-Franken · H. R. Galloway · E Geusens · W. Geyskens · W. Gibbon
J. L. Gielen · W. C. J. Huysse · F. Kainberger · A. Karantanas · A. Kelekis · D. Kelekis
N. L. Kelekis · E. Llopis · M. Maas · E. G. McNally · S. Ostlere · M. Padron
O. Papakonstantinou · P. M. Parizel · W. C. G. Peh · B. M. Pluim · P. Robinson
E. Schilders · J. Slavotinek · A. Suhardja · A. Van der Stappen · H.-J. Van der Woude
P. Van Dyck · F. M. Vanhoenacker · R. A. W. Verhagen · K. L. Verstraete · W. J. Willems
D. J. Wilson
Foreword by A. L. Baert
Introduction by C. Faletti
With 526 Figures in 914 Separate Illustrations, 62 in Color and 23 Tables
123
IV
Contents
Filip M. Vanhoenacker,
MD, PhD
Department of Radiology
University Hospital Antwerp
Wilrijkstraat, 10
2650 Edegem
Belgium
Mario Maas,
MD, PhD
Department of Radiology
Academic Medical Centre
Meibergdreef, 9, Suite C1-210
1105 AZ Amsterdam
The Netherlands
Jan L. Gielen,
MD, PhD
Department of Radiology
University Hospital Antwerp
Wilrijkstraat, 10
2650 Edegem
Belgium
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Knauth · M. Molls · K. Sartor
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
Library of Congress Control Number: 2006925524
ISBN 3-540-26014-5 Springer Berlin Heidelberg New York
ISBN 978-3-540-26014-1 Springer Berlin Heidelberg New York
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V
Contents
Foreword
Sports activity is an important part of our modern lifestyle, among both amateurs and
professionals. It makes an important contribution to our sense of well-being in today‘s
society. However, it has its price in terms of orthopedic injuries.
This volume therefore addresses an important issue of everyday life and medicine. Its
contents cover the entire imaging fi eld of all orthopedic sports injuries remarkably well
and in great detail.
The editors and contributing authors are all renowned experts in musculoskeletal
radiology.
I congratulate them on this up-to-date, well-researched and superbly illustrated
volume which covers modern radiological imaging of the whole spectrum of orthopedic
sports injuries comprehensively and thoroughly.
I am convinced that this book will be a great teaching tool for radiologists in training,
as well as for certifi ed radiologists. It will also constitute a highly informative reference
book for other medical disciplines.
I sincerely hope that this volume will meet with the same success as the numerous
other volumes already published in the series Medical Radiology – Diagnostic Imag-
ing.
Leuven Albert L. Baert
VII
Contents
Preface
Imaging of sports related injuries has always been a very popular topic and the interest
of radiologists in this domain has even increased in recent years.
Competitive athletes are vulnerable to a variety of injuries and they are often very
demanding in their expectations of a correct diagnosis, appropriate treatment and advice
on prognosis and estimated recovery period. Working in sports imaging means team
effort, whereby sports physicians, physical therapists, orthopaedic surgeons, radiologists
and technicians work closely together. Radiology plays a pivotal role in this process.
Since our society is more fi tness oriented than ever, a large percentage of the general
population is involved in recreational sports activities, and thus prone to injuries. This
underscores the impact of sports medicine in our daily practice.
Imaging of sports injuries has evolved dramatically since the introduction of MR
imaging, high resolution ultrasound and multi-detector computed tomography.
Indeed, whereas imaging evaluation was almost exclusively done by plain radiogra-
phy and scintigraphy in the early years, application of new techniques enables the radi-
ologist to make a more precise diagnosis.
Before 1988, the term “bone marrow edema” did not exist in the radiological literature,
but since the introduction of MR imaging in musculoskeletal imaging, more than 300
articles have been written on this specifi c item.
Several recent monographs and review articles on sports imaging concentrated on a
single imaging technique, such as ultrasound or MR imaging.
This book aims to provide a comprehensive overview of all imaging techniques used
in the evaluation of patients with sports injuries.
Therefore, we summarized the merit of each technique in the diagnostic setting of
these injuries in a concise table in each chapter of this book.
We have been very fortunate to work with talented and outstanding experts in the
fi eld of musculoskeletal imaging.
Furthermore, we are particularly grateful to Professor Albert L. Baert for giving us
the opportunity to edit this work, as well as to our previous mentors Professor Arthur
M. De Schepper and the late Dr. Piet F. Dijkstra for teaching us special aspects of mus-
culoskeletal radiology.
We are also deeply indebted to the technicians and co-workers in our respective
departments for providing us high quality images.
Last but not least, we want to thank our families for their constant support while we
were working on this amazing project.
We hope that this work becomes a valuable resource for those participating in the care
of patients who have sustained sports-related injuries.
Antwerp Filip M. Vanhoenacker
Amsterdam Mario Maas
Antwerp Jan L. Gielen
IX
Introduction
Introduction
Performing sports activities brings with it the possibility of producing alterations in
muscle-tendinous structures and joints through trauma or overuse.
Both these pathologies imply that the activities are to be suspended, which often leads
to the athlete, who is by defi nition an active individual, having to accept his/her condi-
tion, something which is not always easy to do. Therefore, the athlete and the entire
sports environment surrounding him/her expect the problem to be solved in the short-
est possible time.
The mandatory clinical examination, even if often able to provide precise informa-
tion, must also include a diagnostic study which confi rms or details the clinical data.
This means that diagnostic imaging is a fundamental step in orthopedic sports inju-
ries. It is essential, however, that the imaging technique/s chosen for the trauma be tai-
lored on the basis of the sensitivity and specifi city of each individual technique in rela-
tion to the type of injury. Moreover, the specialist must be well versed in this particular
fi eld of pathology.
Indeed, also on the basis of my personal experience as the radiologist responsible
for the diagnostic imaging of various National Italian Teams in several sports (soccer,
volley-ball, basket-ball, athletics etc.), as well as for the radiological coverage of the 2006
Winter Olympic Games, I have observed that it is very important on the one hand to
establish a good collaborative relationship with the clinician/s, while on the other, and
more particularly, to be aware of the limitations and possibilities of each technique.
Although it is not always easy to determine the precise technique capable of demon-
strating a lesion, with the aid of patient’s history and clinical experience it is possible to
choose the most appropriate imaging modality.
It is often diffi cult to differentiate the changes induced by the athletic movements
(typical for each individual sport), to be considered an asymptomatic para-physiological
adaptation, from the lesion itself, which lies at the basis of such alterations.
Consequently, in muscle-tendinous pathology, US and MRI are able to complement
one another, as long as they are used correctly on the basis of temporal and topographic
parameters. When a lesion is recent and superfi cial, US is able to offer a correct diagno-
sis, whilst MRI is more sensitive in the detection of the deeper lesion/s, or when a more
panoramic view is required.
When dealing with skeletal lesions, plain radiography is surely the fi rst examination
to be performed, complemented with the CT scan for multiplanar codifi cation and MRI
for bone marrow alterations.
MRI is often the fi rst examination for joint pathology to establish whether intra-
articular alterations are present. In some cases administration of intra-articular contrast
medium (MR-arthrography is required).
X
Introduction
Imaging in the follow-up phase of sports injuries is also fundamental, so as to moni-
tor the evolution of the lesion/s, both after surgical and/or conservative/re-educational
treatment, supplying useful data so as to forecast when the athlete may return to normal
sports activities again.
In conclusion, the radiologist responsible for this interesting fi eld of activity, i.e.
orthopedic sports injuries, must be able to apply his/her specialist technical knowledge
in radiology to the many and varied problems involved in sports injuries, thus identi-
fying not only the most suitable technique to be used, but also, and above all, to try to
propose diagnostic protocols for each individual pathology in collaboration with the
trauma team specialists. Indeed, the ultimate goal is to make a correct diagnosis, follow
the evolution of the lesion and re-integrate the athlete into sports activities in as short a
time as possible and in the best possible health.
Professor Carlo Faletti
Head of the Imaging Department and Interventional Radiology
Trauma Centre - Orthopaedic Hospital,
Consultant Professor Sports Medicine University Department
Turin, Italy.
XI
Contents
Contents
Relevant Basic Science and General Imaging Principles . . . . . . . . . . 1
1 The Clinician’s Point of View
Babette M. Pluim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Imaging Techniques and Procedures in Sports Injuries
Pieter Van Dyck, Jan L. Gielen, and Filip M. Vanhoenacker . . . . . . . . . . . . 7
3 Muscle Injuries
Jan L. Gielen, Philip Robinson, Pieter Van Dyck, Anja Van der Stappen,
and Filip M. Vanhoenacker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4 Cartilage Trauma
Wouter C. J. Huysse and Koenraad L. Verstraete . . . . . . . . . . . . . . . . . . 41
5 Tendon and Ligamentous Trauma
Gina Allen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
6 Bone Marrow Edema in Sports Injuries: General Concept
Filip M. Vanhoenacker, Pieter Van Dyck, Jan L. Gielen, and Wim Geyskens . . 73
7 Overuse Bone Trauma and Stress Fractures
Annick Demeyere and Filip M. Vanhoenacker . . . . . . . . . . . . . . . . . . . . 85
8 Pseudotumors in Sports
Suzanne E. Anderson and A. Mark Davies . . . . . . . . . . . . . . . . . . . . . . .103
Topografi c Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
9 Shoulder Instability
Javier Beltran and Augustinus Suhardja. . . . . . . . . . . . . . . . . . . . . . .121
10 Rotator Cuff and Impingement
Henk-Jan Van der Woude, Diana G. Franssen-Franken, and
W. Jaap Willems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
11 Scapular, Clavicular, Acromioclavicular and Sternoclavicaular Joint Injuries
Peter Brys and Eric Geusens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
12 Imaging of Sports Injuries of the Elbow
Milko de Jonge and Mario Maas. . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
XII
Contents
13 Imaging of Wrist Injuries
Wilfred C. G. Peh and Howard R. Galloway. . . . . . . . . . . . . . . . . . . . . .201
14 Finger and Hand
Michel De Maeseneer and Farhad Ebrahim . . . . . . . . . . . . . . . . . . . . .225
15 Pelvis, Hip and Groin
Wayne Gibbon and Ernest Schilders . . . . . . . . . . . . . . . . . . . . . . . . . .235
16 Sports-related Meniscal Injury
Pieter Van Dyck, Jan L. Gielen, and Filip M. Vanhoenacker. . . . . . . . . . . .265
17 Knee: Ligaments
Eugene G. McNally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283
18 Imaging of Anterior Knee Pain and Maltracking
Simon Ostlere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
19 Injuries of the Ligaments and Tendons in the Ankle and Foot
David J. Wilson. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .321
20 Ankle and Foot: Osteochondral Injuries
Mario Maas, Milko C. de Jonge, and Ronald A. W. Verhagen . . . . . . . . . . .337
21 Acute and Overuse Lesions of the Leg and Calf
Philip Robinson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351
22 The Spine in Sports Injuries: Cervical Spine
Paul M. Parizel, Jan L. Gielen, and Filip M. Vanhoenacker . . . . . . . . . . . .377
23 The Spine in Sports Injuries: Thoracic and Lumbar Spine
Franz Kainberger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391
24 Maxillofacial Injuries in Sports
Anja Bernaerts, Philippe Ehlinger, and Karen Chapelle . . . . . . . . . . . .401
25 Thoracic and Abdominal Wall Injuries in Sports Injuries
Jan L. Gielen, Filip M. Vanhoenacker, and Pieter Van Dyck. . . . . . . . . . . .415
26 Special Considerations in the Immature Skeleton
A. Mark Davies and Suzanne E. Anderson . . . . . . . . . . . . . . . . . . . . . . .433
27 The Aging Athlete
Eva Llopis and Mario Padrón. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .449
Monitoring of Sports Injury Repair . . . . . . . . . . . . . . . . . . . . . . . . .467
28 Natural History and Monitoring of Fractures and Microfractures
Apostolos H. Karantanas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469
