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Alidina S, Luxenburg D, Castro A, Subhawong TK, Ferreira de Souza F. Imaging Review of Different Subchondral Insufficiency Fractures. J Comput Assist Tomogr 2024:00004728-990000000-00327. [PMID: 38834938 DOI: 10.1097/rct.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT Subchondral fractures are a common cause of joint pain that may ultimately lead to articular collapse and the need for arthroplasty. This type of fracture has been reported at multiple joints throughout the body. While clinical and radiographic resolution can be achieved, progressive bone collapse can occur and lead to a variety of complications. Understanding the pertinent imaging findings can aid in the early evaluation of subchondral fractures and in the prevention of their associated complications.
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Affiliation(s)
- Sameer Alidina
- From the Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
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Kim AR, Covey CJ. Distal Clavicular Osteolysis Treated With Platelet-Rich Plasma: A Case Report. Clin J Sport Med 2024; 34:310-311. [PMID: 37921686 DOI: 10.1097/jsm.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
ABSTRACT Atraumatic distal clavicular osteolysis (DCO) is a cause of shoulder pain in younger athletes, often resulting from weightlifting and activities with repetitive pressing and overhead lifting. Athletes will present with shoulder pain localized to the acromioclavicular (AC) joint, with tenderness to palpation over the joint exacerbated by provocative testing on examination. Conservative management often includes activity modification, oral analgesics, physical therapy, and corticosteroid injection. Distal clavicular osteolysis can be refractory to conservative management and these athletes are often referred for surgical consultation. Platelet-rich plasma (PRP) injections have been used to treat a wide variety of musculoskeletal injuries, but there have been no published studies assessing the efficacy of PRP injections specifically for distal clavicle osteolysis. We present a case of refractory DCO successfully treated with an ultrasound-guided PRP injection of the AC joint.
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Affiliation(s)
- Alexander R Kim
- David Grant Medial Center, Travis Air Force Base, California
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3
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Singh M, Soo Hoo J. A Sports Medicine Clinician's Guide to the Diagnosis and Management of Distal Clavicular Osteolysis. Curr Sports Med Rep 2023; 22:230-237. [PMID: 37294199 DOI: 10.1249/jsr.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT Weightlifting associated shoulder injuries have seen a dramatic rise in the last 20 years. Distal clavicular osteolysis, coined weightlifter's shoulder, is one such condition caused by repetitive microtrauma to the distal clavicle with subsequent, painful development of bony erosions and resorption of the distal clavicle. Diagnosis, treatment, and prevention of this condition can be challenging. In this article, we highlight evidence-based clinical recommendations for the diagnosis and management of distal clavicular osteolysis, including specific considerations for atraumatic and posttraumatic etiologies, to help clinicians better care for their patients. Activity modification and rehabilitation are the mainstays of the initial treatment. Adjuvant treatments, such as injections or surgery, may be required in refractory cases or in certain patient populations. Early recognition and treatment of weightlifter's shoulder is essential to prevent progression to acromioclavicular joint pathology or instability and to allow for continued participation in sport-specific activities.
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Affiliation(s)
| | - Jennifer Soo Hoo
- Department of Rehabilitation, Weill Cornell Medical Center, NewYork-Presbyterian, New York, NY
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Restrepo R, Cervantes LF, Zahrah D, Schoenleber S, Lee EY. Pediatric Musculoskeletal Trauma: Upper Limb. Semin Musculoskelet Radiol 2021; 25:105-122. [PMID: 34020472 DOI: 10.1055/s-0041-1723963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. It also outlines a framework for imaging as it pertains to the pediatric upper extremity, with specific emphasis on acute and chronic injuries to the shoulder, elbow, forearm, and wrist.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | | | - David Zahrah
- School of Arts and Sciences, Washington University, St. Louis, Missouri
| | - Scott Schoenleber
- Department of Orthopaedic Surgery, Nicklaus Children's Hospital, Miami, Florida
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
Acromioclavicular joint (ACJ) pathology is a common source of shoulder girdle pain, frequently coexisting with and sharing overlapping clinical features of rotator cuff and glenohumeral articular lesions. ACJ trauma and osteoarthritis dominate clinical presentation; however, an array of pathologies can affect the joint. MR imaging of the ACJ is a powerful secondary diagnostic tool in early diagnosis of ACJ pathology and in accurate assessment of ACJ injuries, helping to resolve clinically challenging cases and allowing for individualized treatment planning. Knowledge of ACJ anatomy, biomechanics, and pathology is fundamental to interpreting and providing a clinically relevant ACJ MR imaging report.
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Affiliation(s)
- Terence Patrick Farrell
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, 10 Main, Philadelphia, PA 19107, USA.
| | - Adam Zoga
- Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical Center, 132 South 10th Street, Suite 1096, Philadelphia, PA 19107, USA
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Abstract
This article discusses the most common and important overuse injuries of the shoulder with attention to MR imaging and ultrasound findings. Pathologic conditions occurring in athletes and nonathletes are included, with review of relevant anatomy, predisposing factors, and treatment considerations. Specific overuse injuries involving the rotator cuff, long head of the biceps tendon, and subacromial-subdeltoid bursa are reviewed. Impingement syndromes of the shoulder, Little Leaguer's shoulder, and stress-induced distal clavicular osteolysis are also discussed.
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Affiliation(s)
- Hailey Allen
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
| | - Brian Y Chan
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA
| | - Kirkland W Davis
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Donna G Blankenbaker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA
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7
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Akromioklavikulargelenk. Radiologe 2019; 59:257-272. [DOI: 10.1007/s00117-019-0495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hegazi TM, Belair JA, McCarthy EJ, Roedl JB, Morrison WB. Sports Injuries about the Hip: What the Radiologist Should Know. Radiographics 2017; 36:1717-1745. [PMID: 27726744 DOI: 10.1148/rg.2016160012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. ©RSNA, 2016.
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Affiliation(s)
- Tarek M Hegazi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Jeffrey A Belair
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Eoghan J McCarthy
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Johannes B Roedl
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - William B Morrison
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
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Simpfendorfer CS, Schickendantz MS, Polster JM. The Shoulder: What is New and Evidence-Based in Orthopedic Sports Medicine. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies.
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Affiliation(s)
- Dilip R Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan 49008, USA
| | - Stephen Breisach
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan 49008, USA
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Distal clavicular osteolysis in adults: association with bench pressing intensity. Skeletal Radiol 2016; 45:1473-9. [PMID: 27550324 DOI: 10.1007/s00256-016-2446-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity. METHODS From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests. RESULTS The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1×/week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney). CONCLUSIONS High-intensity, but not low-intensity bench pressing is a risk factor for DCO.
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Braithwaite KA, Marshall KW. The Skeletally Immature and Newly Mature Throwing Athlete. Radiol Clin North Am 2016; 54:841-55. [DOI: 10.1016/j.rcl.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Casagranda BU, Thurlow PC. The Role of Imaging in Determining Return to Play. Radiol Clin North Am 2016; 54:979-88. [DOI: 10.1016/j.rcl.2016.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McCarthy E, Hegazi TM, Zoga AC, Morrison WB, Meyers WC, Poor AE, Nevalainen MT, Roedl JB. Ultrasound-guided Interventions for Core and Hip Injuries in Athletes. Radiol Clin North Am 2016; 54:875-92. [DOI: 10.1016/j.rcl.2016.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Repetitive, high-velocity overhead throwing can lead to several adaptive changes in the throwing shoulder, which over time lead to structural microtrauma and eventually overt injury. MR imaging is a useful imaging modality to evaluate these changes and to characterize their acuity and severity. Understanding the throwing motion and the effects of this motion on the structures of the shoulder can help radiologists to recognize these findings and provide useful information to referring physicians, which may affect the treatment of these athletes. This article reviews shoulder pathomechanics and MR imaging findings in overhead throwing athletes.
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Belair JA, Hegazi TM, Roedl JB, Zoga AC, Omar IM. Core Injuries Remote from the Pubic Symphysis. Radiol Clin North Am 2016; 54:893-911. [PMID: 27545427 DOI: 10.1016/j.rcl.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The core, or central musculoskeletal system of the torso, is essential for participating in sports and other physical activities. Core injuries are commonly encountered in athletes and active individuals. The importance of the midline pubic plate and rectus abdominis-adductor aponeurosis for core stability and function is discussed in the literature. This review article examines other important core injuries remote from the pubic symphysis, relevant clinical features, and preferred approaches to imaging. Several specific syndromes encountered in the core are reviewed. By protocoling imaging studies and identifying pathology, radiologists can add value to the clinical decision-making process and help guide therapeutic options.
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Affiliation(s)
- Jeffrey A Belair
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA.
| | - Tarek M Hegazi
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA; Department of Radiology, University of Dammam, PO Box 2114, Dammam 31451, Saudi Arabia
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
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Roedl JB, Gonzalez FM, Zoga AC, Morrison WB, Nevalainen MT, Ciccotti MG, Nazarian LN. Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players. Radiology 2016; 279:827-37. [DOI: 10.1148/radiol.2015151256] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Society of Skeletal Radiology 2015 annual meeting summary. Skeletal Radiol 2016; 45:3-7. [PMID: 26338070 DOI: 10.1007/s00256-015-2245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/20/2015] [Indexed: 02/02/2023]
Abstract
Peer-reviewed abstracts presented at the 2015 Society of Skeletal Radiology (SSR) 38th Annual Meeting were reviewed following oral presentation. Topics felt to be of potential interest to musculoskeletal (MSK) investigators and practicing clinicians are highlighted in this compilation and analysis of the meeting. New concepts regarding MSK imaging and intervention, MSK protocols and techniques, and quality improvement are included. ePoster highlights are also presented.
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