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Ravi S, Dopke K, Richardson M, Vatsia S, Lynch S. Guide to Muscular Injuries and Common Ligamentous Injuries Among Soccer Players. Sports Med Arthrosc Rev 2024; 32:131-137. [PMID: 39087702 DOI: 10.1097/jsa.0000000000000411] [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: 08/02/2024]
Abstract
With over 250 million players worldwide, soccer is the most popular sport in the world. The overall number of players at professional, amateur, and recreational levels has increased along with an increase in player diversity, including age and sex. These increases in player numbers, as well as a variety of demographics, have resulted in an increase in soccer-related injuries. Injury in the professional setting can lead to time off the field and an effect on team results and earnings. Injury at the amateur and recreational levels can lead to time off work, away from other activities, and change in activities of daily living. We provide an extensive list of common injuries sustained by soccer players, their pathophysiology, diagnosis, treatment, and general guidelines on return to play.
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Affiliation(s)
- Sreeram Ravi
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
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Zhang B, Lowrance D, Sarma MK, Bartlett M, Zaha D, Nelson MD, Henning A. 3T 31P/ 1H calf muscle coil for 1H and 31P MRI/MRS integrated with NIRS data acquisition. Magn Reson Med 2024; 91:2638-2651. [PMID: 38263948 DOI: 10.1002/mrm.30025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Our aim was to design and build a 3T 31P/1H calf coil that is capable of providing both good 31P and 1H transmit and receive performance, as well as being capable of accommodating a near-infrared spectroscopy (NIRS) device for simultaneous NIRS data and MRI/MRS acquisition. METHOD In this work, we propose a new 3T 31P/1H birdcage combination design consisting of two co-centrically positioned birdcages on the same surface to maximize transmit efficiency and sensitivity for both nuclei. The 31P birdcage is a high-pass birdcage, whereas the 1H birdcage is a low-pass one to minimize coupling. The diameter of the 31P/1H birdcage combination was designed to be large enough to accommodate a NIRS device for simultaneous NIRS data and MRI/MRS acquisition. RESULTS The one-layer coil structure of the birdcage combination significantly streamlines the mechanical design and coil assembly process. Full-wave simulation results show that the 31P and 1H are very well decoupled with each other, and the 1H and 31P SNR surpasses that of their standalone counterparts in the central area. Experiment results show that the inclusion of a NIRS device does not significantly affect the performance of the coil, thus enabling simultaneous NIRS and MRI readouts during exercise. CONCLUSION Our findings demonstrate the feasibility and effectiveness of this dual-tuned coil design for combined NIRS and MRS measurements, offering potential benefits for studying metabolic and functional changes in the skeletal muscle in vivo.
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Affiliation(s)
- Bei Zhang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel Lowrance
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manoj Kumar Sarma
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - David Zaha
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Anke Henning
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Vidal L, Vila I, Venegas V, Sacristán A, Contreras-Muñoz P, Lopez-Garzon M, Giné C, Rodas G, Marotta M. A Novel Minimally Invasive Surgically Induced Skeletal Muscle Injury Model in Sheep. Int J Mol Sci 2024; 25:5612. [PMID: 38891800 PMCID: PMC11171619 DOI: 10.3390/ijms25115612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Sports-related muscle injuries account for 10-55% of all injuries, which is a growing concern, especially given the aging world population. To evaluate the process of skeletal muscle injury and compare it with muscle lesions observed in humans, we developed a novel in vivo model in sheep. In this model, muscle injury was induced by an ultrasound-guided transverse biopsy at the myotendinous junction of the medial gastrocnemius muscle. Twelve male sheep were examined at 3, 7, 14, and 28 days post-injury. Histological, immunofluorescence, and MRI analyses indicate that our sheep model could resemble key human clinicopathological features. Statistically significant differences (p < 0.05) were observed in collagen I, dMHC, α-SMA, and CD68 immunohistochemical detection when comparing injured and healthy muscles. The injured gastrocnemius muscle exhibited elevated levels of type I collagen, infiltration of CD68(+) macrophages, angiogenesis, and the emergence of newly regenerated dMHC(+) myofibers, which persisted for up to 4 weeks post-injury. Similarly, the progression of muscle injury in the sheep model was assessed using advanced clinical 3 T MRI and compared with MRI scans from human patients. The data indicate that the sheep muscle injury model presents features similar to those observed in human skeletal muscle injuries. This makes it a valuable large animal model for studying muscle injuries and developing novel therapeutic strategies.
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Affiliation(s)
- Laura Vidal
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Ingrid Vila
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Vanesa Venegas
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Anabel Sacristán
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Paola Contreras-Muñoz
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Maria Lopez-Garzon
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Carles Giné
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Gil Rodas
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation, 08970 Sant Joan Despí, Spain
- Sports Medicine Unit, Hospital Clínic and Sant Joan de Déu, 08950 Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Mario Marotta
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
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Heiss R, Tol JL, Pogarell T, Roemer FW, Reurink G, Renoux J, Crema MD, Guermazi A. Imaging of muscle injuries in soccer. Skeletal Radiol 2023:10.1007/s00256-023-04514-1. [PMID: 37991553 DOI: 10.1007/s00256-023-04514-1] [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: 08/18/2023] [Revised: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tobias Pogarell
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - Guus Reurink
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jerome Renoux
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Michel D Crema
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA.
- VA Boston Healthcare System, West Roxbury, MA, USA.
- Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B106, West Roxbury, MA, 02132, USA.
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Heiss R, Janka R, Uder M, Hotfiel T, Gast L, Nagel AM, Roemer FW. [Imaging of muscle injuries in sports medicine]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:249-258. [PMID: 36797330 DOI: 10.1007/s00117-023-01118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Early diagnosis of muscle injuries is indispensable in order to initiate appropriate treatment and to facilitate optimal healing. PURPOSE The aim of this review is to provide an update on imaging of muscle injuries in sports medicine with a focus on ultrasound and magnetic resonance imaging (MRI) and to present experimental approaches in addition to routine diagnostic procedures. MATERIALS AND METHODS A PubMed literature search for the years 2012-2022 using the following keywords was performed: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes. RESULTS Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help establishing treatment decisions, which directly affect the prognosis. This is of importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. In addition to established methods such as B‑mode ultrasound and 1H‑MRI, individual studies show promising approaches to further improve the imaging of muscle injuries in the future. Prior to the integration of contrast-enhanced ultrasound and X‑nuclei into clinical routine, additional studies are needed to validate these techniques further. CONCLUSION B‑mode ultrasound represents an easily available, cost-effective modality for the initial diagnosis of muscle injuries. MRI is still considered the reference standard and enables an accurate morphological assessment of the extent of the injury. There are still no imaging approaches available for the objective determination of the optimal point of return to play.
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Affiliation(s)
- Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.
| | - Rolf Janka
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Thilo Hotfiel
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.,Osnabrücker Zentrum für Muskuloskelettale Chirurgie (OZMC), Klinikum Osnabrück, Osnabrück, Deutschland
| | - Lena Gast
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Abteilung Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Frank W Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Quantitative Imaging Center (QIC), Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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6
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Bordalo M, Arnaiz J, Yamashiro E, Al-Naimi MR. Imaging of Muscle Injuries. Magn Reson Imaging Clin N Am 2023; 31:163-179. [PMID: 37019544 DOI: 10.1016/j.mric.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Ultrasound (US) and MR imaging are the most common imaging modalities used to assess sports muscle injuries. The site of the muscle injury can be located at the peripheral aspect of the muscle (myofascial), within the muscle belly (musculotendinous), and with tendon involvement (intratendinous). Tears that affect the intramuscular tendon have a worse prognosis in terms of recovery time. US is an excellent method to evaluate muscle injuries, with high spatial and contrast resolution. MR imaging can be reserved for evaluation of professional athletes, surgical planning, differential diagnosis, and assessment of deep located and proximal muscle groups.
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Friedman JM, Diaz LE, Roemer FW, Guermazi A. Imaging of common hip pathologies in runners. Jpn J Radiol 2023; 41:488-499. [PMID: 36607548 DOI: 10.1007/s11604-022-01381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.
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Affiliation(s)
- Jonathan M Friedman
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
| | - Luis E Diaz
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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Barnes MJ, Lomiwes D, Parry DAD, Mackintosh S. An experimental model of contusion injury in humans. PLoS One 2022; 17:e0277765. [PMID: 36395119 PMCID: PMC9671306 DOI: 10.1371/journal.pone.0277765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Contusion injuries are common in sport, but our knowledge of the responses to injury primarily come from animal studies and research using eccentric exercise. Therefore, the aim of this study was to develop a model of contusion injury in human participants and, additionally, investigate and compare physiological responses to four impact loads. METHODS Thirty-two males were exposed to a single impact of either 4.2, 5.2, 6.2 or 7.2kg, dropped from 67 cm, on to the vastus lateralis of one leg. Maximum voluntary and electrically induced quadriceps force, and pressure pain threshold were measured, and blood sampling carried out, prior to and 30min, 24, 48 and 72h post-impact. Magnetic resonance imaging was carried out 24h post-impact to quantify oedema. RESULTS Despite impact force with 7.2kg (1681.4 ± 235.6 N) not being different to 6.2kg (1690.7 ± 117.6 N), 7.2kg resulted in greater volume of oedema, voluntary force loss, pain and elevations in creatine kinase than the other loads. Although electrically induced force changed over time, post-hoc analysis failed to identify any changes. Interleukin-6 and prostaglandin-E2 did not change over time for any of the loads. Significant correlations were found between oedema volume, pressure pain threshold and maximum voluntary contraction force. CONCLUSIONS This is the first experimental study to investigate traumatic loading of skeletal muscle and the subsequent physiological responses associated with contusion injuries in humans. The absence of immediate elevations in creatine kinase and changes in electrically induced force suggest impact, with forces similar to those experienced in contact sport, does not cause significant, direct damage to skeletal muscle. However, the relationship between oedema volume, changes in pressure pain threshold and maximum voluntary contraction force suggests central inhibition plays a role in contusion-related muscle dysfunction.
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Affiliation(s)
- Matthew J. Barnes
- School of Sport, Exercise & Nutrition, Massey University, Palmerston North, New Zealand
- * E-mail:
| | - Dominic Lomiwes
- The New Zealand Institute for Plant and Food Research Ltd, Palmerston North, New Zealand
| | - David A. D. Parry
- School of Natural Sciences, Massey University, Palmerston North, New Zealand
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Meek WM, Kucharik MP, Eberlin CT, Naessig SA, Rudisill SS, Martin SD. Calf Strain in Athletes. JBJS Rev 2022; 10:01874474-202203000-00015. [PMID: 35316243 DOI: 10.2106/jbjs.rvw.21.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Calf strain is a common condition. In high-performance athletes, calf strain contributes to a substantial absence from competition. » Player age and history of a calf strain or other leg injury are the strongest risk factors for calf strain injury and reinjury. » Although the diagnosis is often clinical, magnetic resonance imaging and ultrasound are valuable to confirm the location of the strain and the grade of injury. » Nonoperative treatment is effective for most calf strain injuries. Operative management, although rarely indicated, may be appropriate for severe cases with grade-III rupture or complications. » Further investigation is necessary to elucidate the benefits of blood flow restriction therapy, deep water running, lower-body positive pressure therapy, platelet-rich plasma, and stem cell therapy for calf strain rehabilitation.
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10
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Go YI, Kim GW. Bilateral multifocal muscular hemorrhage in the triceps surae during antiplatelet therapy: a case report. J Int Med Res 2021; 49:3000605211064391. [PMID: 34936520 PMCID: PMC8721707 DOI: 10.1177/03000605211064391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hemorrhagic complications are often reported following antiplatelet therapy; however, simultaneous multifocal hemorrhages in both legs are uncommon. The patient was a 75-year-old man diagnosed with ST elevation myocardial infarction who underwent percutaneous coronary intervention in the right coronary artery. He was prescribed oral acetylsalicylic acid and ticagrelor. Three days after initial drug treatment, he complained of bilateral leg pain that was aggravated by walking and moving his ankle across a broad range of motion. No deep vein thrombosis was detected on Doppler ultrasonography; however, muscular hemorrhage was suspected according to musculoskeletal ultrasonography. Multifocal muscular hemorrhage was confirmed in the soleus and gastrocnemius muscles on magnetic resonance imaging. To reduce the risk of bleeding, we changed the medication from ticagrelor to clopidogrel. The patient performed leg elevation exercises, compression, and applied an ice pack. He also performed range of motion exercises and gait training in addition to receiving drug treatment. With these therapies, his pain score improved from 5 to 3 on a visual analog scale, without further complications. Multifocal muscular hemorrhage rarely occurs bilaterally; however, when it does occur, an appropriate treatment plan can be developed based on musculoskeletal ultrasonography.
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Affiliation(s)
- Young-In Go
- Department of Physical Medicine & Rehabilitation, 90158Jeonbuk National University Medical School, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, 90158Jeonbuk National University Medical School, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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11
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Pipitone F, Miller JM, DeLancey J. Injury-associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study. BJOG 2021; 128:2046-2053. [PMID: 34013655 PMCID: PMC8497388 DOI: 10.1111/1471-0528.16760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether all three components of the levator ani muscle (pubovisceral [= pubococcygeal], puborectal and iliococcygeal) and the external anal sphincter are equally affected by oedema associated with muscle injury after vaginal birth. DESIGN Observational cross-sectional study. SETTING Michigan Medicine, University of Michigan. POPULATION Primiparous women classified as high risk for levator ani muscle injury during childbirth. METHOD MRI scans obtained 6-8 weeks postpartum were analysed. Muscle oedema was assessed on axial and coronal fluid-sensitive magnetic resonance (MRI) scans. Presence of oedema was separately determined in each levator ani muscle component and in the external anal sphincter for all subjects. Descriptive statistics and correlation with obstetric variables were obtained. MAIN OUTCOME MEASURES Oedema score on fluid-sensitive MRI scans. RESULTS Of the 78 women included in this cohort, 51.3% (n = 40/78) showed muscle oedema in the pubovisceral (one bilateral avulsion excluded), 5.1% (n = 4/78) in the puborectal and 5.1% (n = 4/78) in the iliococcygeal muscle. No subject showed definite oedema on external anal sphincter. Incidence of oedema on the pubovisceral muscle was seven times higher than on any of the other analysed muscles (all paired comparisons, P < 0.001). CONCLUSIONS Even in the absence of muscle tearing, the pubovisceral muscle shows by far the highest incidence of injury, establishing that levator components are not equally affected by childbirth. External anal sphincter did not show oedema-even in women with sphincter laceration- suggesting a different injury mechanism. Developing a databased map of injured areas helps understand injury mechanisms that can guide us in honing research on treatment and prevention. TWEETABLE ABSTRACT Injury-associated levator ani muscle and anal sphincter oedema mapping on MRI reveals vulnerable muscle components after childbirth.
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Affiliation(s)
- F Pipitone
- Pelvic Floor Research Group, Michigan Medicine, University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - J M Miller
- University of Michigan School of Nursing and Medical School Department of Obstetrics and Gynecology, 426 N Ingalls St, Ann Arbor, MI, 48104, USA
| | - Jol DeLancey
- Pelvic Floor Research Group, Michigan Medicine, University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
- Obstetrics and Gynecology Department, Michigan Medicine, University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
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12
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Miyamoto N, Kimura N, Hirata K. Non-uniform distribution of passive muscle stiffness within hamstring. Scand J Med Sci Sports 2020; 30:1729-1738. [PMID: 32490549 DOI: 10.1111/sms.13732] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/09/2020] [Accepted: 05/21/2020] [Indexed: 01/09/2023]
Abstract
Limited information is available on whether stiffness is different within and between the constituents of the hamstring, that is, the biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM). Therefore, understanding of hamstring injuries and stretching effect on hamstring stiffness is difficult. The present study primarily aimed to identify whether passive muscle stiffness differs between the BFlh, ST, and SM and between the proximal, middle, and distal sites within each muscle. Secondly, the effect of stretching exercise on the heterogeneity in passive muscle stiffness was examined. In the lengthened hamstring positions by extending the knee joint or flexing the hip joint, passive muscle shear modulus (a measure of stiffness) at the proximal, middle, and distal sites of the BFlh, ST, and SM was measured by using ultrasound shear wave elastography. Furthermore, before and after five repetitions of 90-seconds static stretching for the hamstring, passive muscle shear modulus at the proximal and distal sites of the SM was measured. The shear modulus was significantly higher in the SM than in the BFlh and ST and higher at the distal site than the proximal site in all muscles. After the stretching, the higher shear modulus at the distal site of the SM compared to the proximal site was still observed (pre-stretching: +80%, post-stretching: +81%). These findings indicate that passive muscle stiffness varies within the hamstring regardless of performing stretching exercise and that passive muscle stiffness is not highest at the proximal site of the SM where a stretching-type hamstring strain typically occurs.
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Affiliation(s)
- Naokazu Miyamoto
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Japan.,National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan
| | - Noriko Kimura
- National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan.,Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
| | - Kosuke Hirata
- National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan.,Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama, Japan.,Research Fellow of Japanese Society for the Promotion of Science, Tokyo, Japan
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Yoshida K, Itoigawa Y, Maruyama Y, Kaneko K. Healing Process of Gastrocnemius Muscle Injury on Ultrasonography Using B-Mode Imaging, Power Doppler Imaging, and Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3239-3246. [PMID: 31165497 DOI: 10.1002/jum.15035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Muscle injury often occurs in sports activity. To avoid reinjury, it is important to determine the appropriate period until return to play after injury. The purpose of this study was to evaluate characteristics of the healing process for gastrocnemius muscle injury by B-mode imaging, power Doppler (PD) imaging, and shear wave elastography (SWE). METHODS Twenty patients with acute calf musculotendinous injury were enrolled. Scar thickness on B-mode imaging, new vessels according to PD grades, and SWE values in the muscle, musculotendinous junction, and tendon of the medial head of gastrocnemius were measured at 4, 8, and 12 weeks after injury. RESULTS Scar thickness was significantly larger at 8 and 12 weeks compared with 4 weeks (P < .01 for both). Power Doppler grades at 4 and 8 weeks were significantly higher compared with 12 weeks (P < .01 for both). Shear wave elastographic values in the muscle on the injury side were significantly higher at 8 and 12 weeks compared with 4 weeks (P < .01 for both), whereas those in the musculotendinous junction on the injury side were significantly higher at 12 weeks compared with 4 and 8 weeks (P < .01; P = .01, respectively). CONCLUSIONS B-mode imaging, PD imaging, and SWE can measure the healing process after musculotendinous injury of the gastrocnemius medial head.
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Macdonald B, McAleer S, Kelly S, Chakraverty R, Johnston M, Pollock N. Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice. Br J Sports Med 2019; 53:1464-1473. [DOI: 10.1136/bjsports-2017-098971] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
RationaleHamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.ObjectiveWe present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.
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Thierfelder KM, Gerhardt JS, Gemescu IN, Notohamiprodjo S, Rehnitz C, Weber MA. Imaging of hip and thigh muscle injury: a pictorial review. Insights Imaging 2019; 10:20. [PMID: 30771029 PMCID: PMC6377690 DOI: 10.1186/s13244-019-0702-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/25/2018] [Indexed: 01/28/2023] Open
Abstract
Muscle injuries of the hip and thigh are a highly relevant issue in competitive sports imaging. The gold standard in diagnostic imaging of muscle injuries is magnetic resonance imaging (MRI). Radiologists need to be familiar with typical MRI findings in order to accurately detect and classify muscle injuries. Proper interpretation of the findings is crucial, especially in elite athletes. In soccer players, muscle injuries of the hip and thigh are the most common reason for missing a game.The present pictorial review deals with the diagnostic assessment, especially MRI, of muscle injuries of the hip and thigh. Typical MR findings in muscle injuries include edema, hematoma, and tendinous avulsion as well as partial or complete muscle tear. To estimate the time to return to play, a grading into three groups-muscle strain, partial tear, complete tear-has traditionally been used. Taking into account the most recent literature, there are other prognostic factors such as the longitudinal length of a tear, the tendon's intramuscular component, or persisting edema.
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Affiliation(s)
- Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Judith S Gerhardt
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ioan N Gemescu
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, Bucharest, Romania
| | | | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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16
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Kumaravel M, Bawa P, Murai N. Magnetic resonance imaging of muscle injury in elite American football players: Predictors for return to play and performance. Eur J Radiol 2018; 108:155-164. [PMID: 30396649 DOI: 10.1016/j.ejrad.2018.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
Muscle injury accounts for about one-third of total sports-related injuries. The lower limb muscles have one of the highest predisposition for injury in high-level professional athletic sports, such as the National Football League. The commonest group of muscles injured among football players include the hamstrings, followed by the quadriceps. Muscle injuries lead to significant time, off the field and affect return to play. Sports physicians and teams have been keen on assessing such injuries and also relying on multiple tools to safely return the player back to the field. MRI plays a key role in evaluation, follow-up, and assessment for return to play (RTP). In this review, we will discuss details of muscle anatomy, incidence of muscle injuries, injury mechanisms, and use of MRI in assessment, grading, follow-up and in predicting the natural course of muscle injuries in the high-end athletic players. While the use of MRI is clear in diagnosis, and for follow up of muscle injuries, there is some limitation in its ability to predict RTP, based on current MRI classification systems. Footballers who have clinical injuries without MRI evidence of significant muscle injury (grade 0 and 1) have a shorter period of RTP. Injuries classified as high grade (3 and 4) on MRI do not correlate well with time to RTP. Further trials are required to improve the capability of MRI in its prediction of RTP.
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Affiliation(s)
- Manickam Kumaravel
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA.
| | - Pritish Bawa
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA
| | - Naoki Murai
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin street MSB 2.130B, Houston, TX 77030 USA
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Abstract
BACKGROUND Muscular and apophyseal injuries in the inguinal region are a common cause of groin pain in athletes. PURPOSE Frequently occurring muscular and apophyseal injuries in the groin region are described. MATERIAL AND METHODS Fundamental studies and expert recommendations are discussed. Examination protocols for routine clinical practice are presented. RESULTS The exact diagnosis and classification of muscular or apophyseal injuries in the inguinal region are the basic prerequisites for the initiation of a targeted treatment and thus crucial for the return to sport time. These injuries are occurring with increasing frequency in both professional and recreational sports. CONCLUSION In addition to the clinical examination and the history of the course of the injury, MRI plays an important role in the evaluation of muscular and apophyseal injuries in the inguinal region.
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Affiliation(s)
- M G Mack
- Radiologie München, Burgstraße 7, 80331, München, Deutschland.
| | - M Regier
- Radiologie München, Burgstraße 7, 80331, München, Deutschland
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18
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Perdikakis E, Tsifountoudis I, Kalaitzoglou I, Rountas C, Malliaropoulos N, Maffulli N. Soft tissue pseudotumours: a pictorial review with emphasis on MRI. Muscles Ligaments Tendons J 2017; 7:353-375. [PMID: 29264349 DOI: 10.11138/mltj/2017.7.2.353] [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: 11/17/2022]
Abstract
Background Several tumour-like conditions of the soft tissues may be encountered in clinical practice, or when patients undergo radiologic examinations. Al-though advances in cross sectional imaging (ultra-sound, MDCT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis. Clinical history, physical examination and anatomic location are of paramount importance. Methods In this pictorial essay we review some of the most frequent benign soft tissue conditions which may be mistaken for malignancy and thus lead to need-less referrals, unnecessary biopsies and great anxiety to the patients and their carers. Level of evidence IV.
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Affiliation(s)
| | | | | | | | - Nikos Malliaropoulos
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece; Centre for Sports & Exercise Medicine, Queen Mary, University of London, London, UK
| | - Nicola Maffulli
- Centre for Sports & Exercise Medicine, Queen Mary, University of London, Barts And The London School of Medicine and Dentistry, Mile end Hospital, London, UK; Department of Physical and Rehabilitation Medicine, University of Salerno, Italy
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19
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Flores DV, Mejía Gómez C, Estrada-Castrillón M, Smitaman E, Pathria MN. MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance. Radiographics 2017; 38:124-148. [PMID: 29220207 DOI: 10.1148/rg.2018170072] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Muscle is an important component of the muscle-tendon-bone unit, driving skeletal motion through contractions that alter the length of the muscle. The muscle and myotendinous junction (MTJ) are most commonly injured in the young adult, as a result of indirect mechanisms such as overuse or stretching, direct impact (penetrating or nonpenetrating), or dysfunction of the supporting connective tissues. Magnetic resonance (MR) imaging is widely used for assessment of muscle injuries. This review illustrates the MR imaging appearance of a broad spectrum of acute, subacute, and chronic traumatic lesions of muscle, highlighting the pathophysiology, biomechanics, and anatomic considerations underlying these lesions. Concentric (shortening) contractions are more powerful, but it is eccentric (lengthening) contractions that produce the greatest muscle tension, leading to indirect injuries such as delayed-onset muscle soreness (DOMS) and muscle strain. Strain is the most commonly encountered muscle injury and is characteristically located at the MTJ, where maximal stress accumulates during eccentric exercise. The risk of strain varies among muscles based on their fiber composition, size, length, and architecture, with pennate muscles being at highest risk. Direct impact to muscle results in laceration or contusion, often accompanied by intramuscular interstitial hemorrhage and hematoma. Disorders related to the muscle's collagen framework include compartment syndrome, which is related to acute or episodic increases in pressure, and muscle herniation through anatomic defects in the overlying fascia. The healing response after muscle trauma can result in regeneration, degeneration with fibrosis and fatty replacement, or disordered tissue proliferation as seen in myositis ossificans. In athletes, accurate grading of the severity and precise location of injury is necessary to guide rehabilitation planning to prevent reinjury and ensure adequate healing. In elite athletes, MR imaging grading of muscle trauma plays an increasingly important role in recently developed comprehensive grading systems that are replacing the imprecise three-grade injury classification system currently used. ©RSNA, 2017.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Philippine Orthopedic Center, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G., M.E.C.); and Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.)
| | - Catalina Mejía Gómez
- From the Department of Radiology, Philippine Orthopedic Center, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G., M.E.C.); and Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.)
| | - Mauricio Estrada-Castrillón
- From the Department of Radiology, Philippine Orthopedic Center, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G., M.E.C.); and Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.)
| | - Edward Smitaman
- From the Department of Radiology, Philippine Orthopedic Center, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G., M.E.C.); and Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.)
| | - Mini N Pathria
- From the Department of Radiology, Philippine Orthopedic Center, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G., M.E.C.); and Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.)
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20
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Crema MD, Godoy IRB, Abdalla RJ, de Aquino JS, Ingham SJM, Skaf AY. Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play. Sports Health 2017; 10:75-79. [PMID: 29116884 PMCID: PMC5753969 DOI: 10.1177/1941738117741471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times. Hypothesis: MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP). Study Design: Retrospective cohort study. Level of Evidence: Level 4. Methods: Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors. Results: The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP. Conclusion: The extent of MRI edema in hamstring injuries does not have prognostic value. Clinical Relevance: Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.
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Affiliation(s)
- Michel D Crema
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.,Department of Radiology, Hôpital Saint-Antoine, University Paris VI, Paris, France.,Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ivan R B Godoy
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - Rene J Abdalla
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.,Knee Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil
| | | | - Sheila J McNeill Ingham
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.,Knee Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil
| | - Abdalla Y Skaf
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
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21
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Pezzotta G, Querques G, Pecorelli A, Nani R, Sironi S. MRI detection of soleus muscle injuries in professional football players. Skeletal Radiol 2017; 46:1513-1520. [PMID: 28770309 DOI: 10.1007/s00256-017-2729-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/27/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe magnetic resonance imaging (MRI) characteristics of soleus muscle injuries in symptomatic professional football players stratified according to both the Munich consensus statement and the British Athletics Muscle Injury Classification (BAMIC), and to investigate the association between specific MRI features and the "return to play" (RTP). MATERIALS AND METHODS Professional football players with an episode of acute posterior calf pain and impaired function, subsequent to sports activity, underwent ultrasound followed by MRI examination reviewed by two different radiologists with more than 10 years of experience in the musculoskeletal system. MRI features and RTP outcome were evaluated for all types of injuries. RESULTS During a 36-month period, a total of 20 professional football players were evaluated. According to the Munich consensus, 11 were type 3A, 8 were type 3B, and 1 was type 4, whereas according to the BAMIC, 11 lesions were considered grade 1, 4 grade 2, 4 grade 3, and 1 grade 4. RTP data were available for all patients (mean 3.3 ± 1.6 weeks). Both the Munich consensus and the BAMIC correlated with RTP (Spearman correlation = 0.982 and p < 0.0001 and 0.886 and p < 0.0001 respectively). Extension of edema was an independent prognostic factor for RTP in two different models of multivariate regression analysis (p = 0.044 model A; p = 0.031 model B). CONCLUSIONS The Munich consensus and BAMIC grading systems are useful tools for defining the patient's prognosis and proper rehabilitation time after injury. The MRI feature that we should carefully look for is the extension of edema, as it seems to significantly affect the RTP.
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Affiliation(s)
- G Pezzotta
- Department of Radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Piazza OMS 1, Bergamo, Italy.
| | - G Querques
- Department of Radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Piazza OMS 1, Bergamo, Italy
| | - A Pecorelli
- Department of Radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Piazza OMS 1, Bergamo, Italy
| | - R Nani
- Department of Radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Piazza OMS 1, Bergamo, Italy
| | - S Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Piazza OMS 1, Bergamo, Italy
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Prakash A, Entwisle T, Schneider M, Brukner P, Connell D. Connective tissue injury in calf muscle tears and return to play: MRI correlation. Br J Sports Med 2017; 52:929-933. [DOI: 10.1136/bjsports-2017-098362] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Abstract
ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.
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23
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Rubin DA. MRI of Sports Injuries in the Leg. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MRI of the Hip: What the Surgeon Wants to Know. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kim GW, Kang C, Oh YB, Ko MH, Seo JH, Lee D. Ultrasonographic Imaging and Anti-inflammatory Therapy of Muscle and Tendon Injuries Using Polymer Nanoparticles. Theranostics 2017; 7:2463-2476. [PMID: 28744328 PMCID: PMC5525750 DOI: 10.7150/thno.18922] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/17/2017] [Indexed: 12/23/2022] Open
Abstract
Ultrasonography is a reliable diagnostic modality for muscle and tendon injuries, but it has been challenging to find right diagnosis of minor musculoskeletal injuries by conventional ultrasonographic imaging. A large amount of hydrogen peroxide (H2O2) are known to be generated during tissue damages such as mechanical injury and therefore H2O2 holds great potential as a diagnostic and therapeutic marker for mechanical injuries in the musculoskeletal system. We previously developed poly(vanillyl alcohol-co-oxalate) (PVAX), which rapidly scavenges H2O2 and exerts antioxidant and anti-inflammatory activity in H2O2-associated diseases. Based on the notion that PVAX nanoparticles generate CO2 bubbles through H2O2-triggered hydrolysis, we postulated that PVAX nanoparticles could serve as ultrasonographic contrast agents and therapeutic agents for musculoskeletal injuries associated with overproduction of H2O2. In the agarose gel phantom study, PVAX nanoparticles continuously generated CO2 bubbles to enhance ultrasonographic echogenicity significantly. Contusion injury significantly elevated the level of H2O2 in skeletal muscles and Achilles tendons. Upon intramuscular injection, PVAX nanoparticles significantly elevated the ultrasound contrast and suppressed inflammation and apoptosis in the contusion injury of musculoskeletal systems. We anticipate that PVAX nanoparticles hold great translational potential as theranostic agents for musculoskeletal injuries.
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Affiliation(s)
- Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Changsun Kang
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
| | - Young-Bin Oh
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Chonbuk, 561-756, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
- Translational Research & Clinical Trial Center for Medical Device, Chonbuk National University Hospital, Chonbuk, 561-756, Republic of Korea
| | - Dongwon Lee
- Department of BIN Convergence Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
- Department of Polymer•Nano Science and Technology, Chonbuk National University, Chonbuk, 561-756, Republic of Korea
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Guermazi A, Roemer FW, Robinson P, Tol JL, Regatte RR, Crema MD. Imaging of Muscle Injuries in Sports Medicine: Sports Imaging Series. Radiology 2017; 282:646-663. [PMID: 28218878 DOI: 10.1148/radiol.2017160267] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In sports-related muscle injuries, the main goal of the sports medicine physician is to return the athlete to competition-balanced against the need to prevent the injury from worsening or recurring. Prognosis based on the available clinical and imaging information is crucial. Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help to guide management, which directly affects the prognosis. This is especially important when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. Several imaging techniques are widely available, with ultrasonography and magnetic resonance imaging currently the most frequently applied in sports medicine. This state of the art review will discuss the main imaging modalities for the assessment of sports-related muscle injuries, including advanced imaging techniques, with the focus on the clinical relevance of imaging features of muscle injuries. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ali Guermazi
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
| | - Frank W Roemer
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
| | - Philip Robinson
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
| | - Johannes L Tol
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
| | - Ravindar R Regatte
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
| | - Michel D Crema
- From the Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.G., F.W.R., M.D.C.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, England (P.R.); Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England (P.R.); Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (J.L.T.); The Sports Physician Group, OLVG, Amsterdam, the Netherlands (J.L.T.); Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, the Netherlands (J.L.T.); New York University Langone Medical Center, New York, NY (R.R.R.); and Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France (M.D.C.)
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Yamada AF, Godoy IRB, Pecci Neto L, Taneja AK, Hernandez Filho G, Skaf AY. Diagnostic Imaging of Muscle Injuries in Sports Medicine: New Concepts and Radiological Approach. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0223-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aurora A, Corona BT, Walters TJ. A Porcine Urinary Bladder Matrix Does Not Recapitulate the Spatiotemporal Macrophage Response of Muscle Regeneration after Volumetric Muscle Loss Injury. Cells Tissues Organs 2016; 202:189-201. [PMID: 27825152 DOI: 10.1159/000447582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/19/2022] Open
Abstract
Volumetric muscle loss (VML) results in irrecoverable loss of muscle tissue making its repair challenging. VML repair with acellular extracellular matrix (ECM) scaffolds devoid of exogenous cells has shown improved muscle function, but limited de novo muscle fiber regeneration. On the other hand, studies using minced autologous and free autologous muscle grafts have reported appreciable muscle regeneration. This raises the fundamental question whether an acellular ECM scaffold can orchestrate the spatiotemporal cellular events necessary for appreciable muscle fiber regeneration. This study compares the macrophage and angiogenic responses including the remodeling outcomes of a commercially available porcine urinary bladder matrix, MatriStem™, and autologous muscle grafts. The early heightened and protracted M1 response of the scaffold indicates that the scaffold does not recapitulate the spatiotemporal macrophage response of the autograft tissue. Additionally, the scaffold only supports limited de novo muscle fiber formation and regressing vessel density. Furthermore, scaffold remodeling is accompanied by increased presence of transforming growth factor and α-smooth muscle actin, which is consistent with remodeling of the scaffold into a fibrotic scar-like tissue. The limited muscle formation and scaffold-mediated fibrosis noted in this study corroborates the findings of recent studies that investigated acellular ECM scaffolds (devoid of myogenic cells) for VML repair. Taken together, acellular ECM scaffolds when used for VML repair will likely remodel into a fibrotic scar-like tissue and support limited de novo muscle fiber regeneration primarily in the proximity of the injured musculature. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel.
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Yoshida K, Itoigawa Y, Maruyama Y, Saita Y, Takazawa Y, Ikeda H, Kaneko K, Sakai T, Okuwaki T. Application of shear wave elastography for the gastrocnemius medial head to tennis leg. Clin Anat 2016; 30:114-119. [DOI: 10.1002/ca.22788] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yoshitomo Saita
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Yuji Takazawa
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Hiroshi Ikeda
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery; Juntendo University; Tokyo Japan
| | - Tatsuo Sakai
- Department of Anatomy; Juntendo University; Tokyo Japan
| | - Toru Okuwaki
- Department of Sports Medicine; Japan Institute of Sports Science; Tokyo Japan
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Wangensteen A, Tol JL, Witvrouw E, Van Linschoten R, Almusa E, Hamilton B, Bahr R. Hamstring Reinjuries Occur at the Same Location and Early After Return to Sport: A Descriptive Study of MRI-Confirmed Reinjuries. Am J Sports Med 2016; 44:2112-21. [PMID: 27184543 DOI: 10.1177/0363546516646086] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite relatively high reinjury rates after acute hamstring injuries, there is a lack of detailed knowledge about where and when hamstring reinjuries occur, and studies including imaging-confirmed reinjuries are scarce. PURPOSE To investigate the location, radiological severity, and timing of reinjuries on magnetic resonance imaging (MRI) compared with the index injury. STUDY DESIGN Case series; Level of evidence, 4. METHODS A MRI scan was obtained ≤5 days after an acute hamstring index injury in 180 athletes, and time to return to sport (RTS) was registered. Athletes with an MRI-confirmed reinjury in the same leg ≤365 days after RTS were included. Categorical grading and standardized MRI parameters of the index injury and reinjury were scored by a single radiologist (with excellent intraobserver reliability). To determine the location of the reinjury, axial and coronal views of the index injury and reinjury were directly compared on proton density-weighted fat-suppressed images. RESULTS In the 19 athletes included with reinjury, 79% of these reinjuries occurred in the same location within the muscle as the index injury. The median time to RTS after the index injury was 19 days (range, 5-37 days; interquartile range [IQR], 15 days). The median time between the index injury and reinjury was 60 days (range, 20-316 days; IQR, 131 days) and the median time between RTS after the index injury and the reinjury was 24 days (range, 4-311 days; IQR, 140 days). More than 50% of reinjuries occurred within 25 days (4 weeks) after RTS from the index injury and 50% occurred within 50 days after the index injury. All reinjuries with more severe radiological grading occurred in the same location as the index injury. CONCLUSION The majority of the hamstring reinjuries occurred in the same location as the index injury, early after RTS and with a radiologically greater extent, suggesting incomplete biological and/or functional healing of the index injury. Specific exercise programs focusing on reinjury prevention initiated after RTS from the index injury are highly recommended.
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Affiliation(s)
- Arnlaug Wangensteen
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Center for Evidence Based Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department Rehabilitation Science and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Emad Almusa
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bruce Hamilton
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar High Performance Sport NZ, Sport Research Institute of New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Svensson K, Alricsson M, Eckerman M, Magounakis T, Werner S. The correlation between the imaging characteristics of hamstring injury and time required before returning to sports: a literature review. J Exerc Rehabil 2016; 12:134-42. [PMID: 27419106 PMCID: PMC4934955 DOI: 10.12965/jer.1632558.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
Injuries to the hamstring muscles are common in athletes. Track and field, Australian football, American football and soccer are examples of sports where hamstring injuries are the most common. The purpose of this study was to investigate whether there is a correlation between a hamstring injury prognosis and its characteristics of imaging parameters. The literature search was performed in the databases PubMed and CINAHL, and eleven articles were included. Seven out of the 11 articles showed a correlation between the size of the hamstring injury and length of time required before returning to sports. Different authors have reported contrasting results about length of time required before returning to sports due to location of injury within specific muscle. Majority of the articles found hamstring strain correlated to an extended amount of time required before returning to sports.
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Affiliation(s)
- Kjell Svensson
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marie Alricsson
- Swedish Winter Sport Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden; Department of Sports Science, Linnaeus University, Kalmar, Sweden
| | - Mattias Eckerman
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Suzanne Werner
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, Stockholm, Sweden
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Role of Imaging in Musculoskeletal Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jawahar A, Lu Y, Okur G, Kliethermes S, Lomasney L. Gastrocnemius tendinosis--A frequent finding on MRI knee examination. Eur J Radiol 2015; 84:2579-85. [PMID: 26456309 DOI: 10.1016/j.ejrad.2015.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/13/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Gastrocnemius tendinosis (GT) is one potential cause for posterior knee pain, commonly overlooked on clinical examinations and imaging. This study assesses the frequency of GT on MR imaging in a convenience sample based on a database search and associations with other articular pathologies and clinical findings. SUBJECTS AND METHODS With IRB approval, retrospective review was completed on 300 randomly selected MR knee exams performed from February 2009 to June 2010. Following de-identification, axial T2 and sagittal PD images, with or without fat suppression, were reviewed by 2 radiologists. The gastrocnemius tendon femoral attachments were graded as normal, mild (few cysts, thickening, intermediate signal) or severe GT (multiple cysts, marrow edema, tear). Select associated MR findings of internal derangement were documented. Clinical charts were reviewed for clinical presentation, physical exam findings, and select demographics. RESULTS The inter-observer reliability for presence/grading of GT was very high (kappa statistic=0.97). Frequency of GT was 50.33%, most frequently involving medial head of gastrocnemius (63.6%). Grades of GT were 41.7% and 17.2% for mild and severe respectively. Univariate analysis showed statistically significant relationship between grade of GT with arthrosis (p=0.05) and clinical joint effusion (p=0.02). Multivariate analysis showed higher odds of severe GT for individuals with medial plus lateral GT. Statistical significance was noted for presence of both GT and ACL tear (13.9%; p=0.02). CONCLUSION Significant findings of our analysis included GT presented with predominant involvement of medial head of gastrocnemius tendon, mild in severity, strong association with ACL tear, presented frequently as posterior knee pain, limited joint motion and clinical joint effusion. However, there was no statistically significant association between demographic features and medical comorbidities in the patients. Increased understanding of frequency of GT allows more accurate reporting of MR knee exam and systematic search for associated abnormalities.
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Affiliation(s)
- Anugayathri Jawahar
- Department of Radiology, Loyola University Medical Center, 2160, South 1st Avenue, Maywood, IL 60153, United States.
| | - Yanan Lu
- Department of Radiology, Loyola University Medical Center, 2160, South 1st Avenue, Maywood, IL 60153, United States
| | - Gokcan Okur
- Department of Radiology, Loyola University Medical Center, 2160, South 1st Avenue, Maywood, IL 60153, United States
| | - Stephanie Kliethermes
- Department of Radiology, Loyola University Medical Center, 2160, South 1st Avenue, Maywood, IL 60153, United States
| | - Laurie Lomasney
- Department of Radiology, Loyola University Medical Center, 2160, South 1st Avenue, Maywood, IL 60153, United States
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Crema MD, Yamada AF, Guermazi A, Roemer FW, Skaf AY. Imaging techniques for muscle injury in sports medicine and clinical relevance. Curr Rev Musculoskelet Med 2015; 8:154-61. [PMID: 25708212 DOI: 10.1007/s12178-015-9260-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) and ultrasound are the imaging modalities of choice to assess muscle injuries in athletes. Most authors consider MRI as the reference standard for evaluation of muscle injuries, since it superiorly depicts the extent of injuries independently of its temporal evolution, and due to the fact that MRI seems to be more sensitive for the detection of minimal injuries. Furthermore, MRI may potentially allow sports medicine physicians to more accurately estimate recovery times of athletes sustaining muscle injuries in the lower limbs, as well as the risk of re-injury. However, based on data available, the specific utility of imaging (including MRI) regarding its prognostic value remains limited and controversial. Although high-quality imaging is systematically performed in professional athletes and data extracted from it may potentially help to plan and guide management of muscle injuries, clinical (and functional) assessment is still the most valuable tool to guide return to competition decisions.
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Affiliation(s)
- Michel D Crema
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil,
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Abstract
Skeletal muscle injuries are among the most common sports-related injuries that result in time lost from practice and competition. The cellular response to muscle injury can often result in changes made to the muscle fibers as well as the surrounding extracellular matrix during repair. This can negatively affect the force and range of the injured muscle even after the patient's return to play. Diagnosis of skeletal muscle injury involves both history and physical examinations; imaging modalities including ultrasound and magnetic resonance imaging (MRI) can also be used to assess the extent of injury. Current research is investigating potential methods, including clinical factors and MRI, by which to predict a patient's return to sports. Overall, function of acutely injured muscles seems to improve with time. Current treatment methods for skeletal muscle injuries include injections of steroids, anesthetics, and platelet-rich plasma (PRP). Other proposed methods involve inhibitors of key players in fibrotic pathways, such as transforming growth factor (TGF)-ß and angiotensin II, as well as muscle-derived stem cells.
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Affiliation(s)
- Stephanie Wong
- Department of Orthopaedic Surgery, University of California, 1500 Owens Ave, Box 3004, San Francisco, CA, 94127, USA
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37
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Margraf NG, Rohr A, Granert O, Hampel J, Drews A, Deuschl G. MRI of lumbar trunk muscles in patients with Parkinson’s disease and camptocormia. J Neurol 2015; 262:1655-64. [DOI: 10.1007/s00415-015-7726-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Reurink G, Almusa E, Goudswaard GJ, Tol JL, Hamilton B, Moen MH, Weir A, Verhaar JAN, Maas M. No association between fibrosis on magnetic resonance imaging at return to play and hamstring reinjury risk. Am J Sports Med 2015; 43:1228-34. [PMID: 25748473 DOI: 10.1177/0363546515572603] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Connective tissue scar (fibrosis) is a common finding on magnetic resonance imaging (MRI) after recovery from acute hamstring injuries. Fibrosis has been suggested as a predisposing factor for reinjury, but evidence from clinical studies is lacking. PURPOSE/HYPOTHESIS The aim of this study was to examine the association between the presence of fibrosis on MRI at return to play after an acute hamstring injury and the risk of reinjury. The hypothesis was that fibrous tissue on MRI was associated with an increased reinjury risk. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Magnetic resonance images were obtained from 108 consecutive athletes with modified Peetrons classification grade 1 or 2 hamstring injuries within 5 days of injury and within 7 days of return to play. The presence and extent of abnormally low signal intensity in the intramuscular tissue on MRI, suggestive of fibrosis, were assessed on both T1- and T2-weighted images. Reinjuries were recorded over a 1-year follow-up period. The association between fibrosis and reinjury risk was analyzed with a Cox proportional hazards model. RESULTS The MRIs of the initial injury showed 45 (43%) grade 1 and 63 (57%) grade 2 injuries. Median time of return to play was 30 days (interquartile range [IQR], 22-42 days). At return to play, 41 athletes (38%) had fibrosis on MRI with a median longitudinal length of 5.8 cm (IQR, 3.3-12.5 cm) and a median volume of 1.5 cm3 (IQR, 1.5-3.9 cm3). In athletes with fibrosis, 24% (10/41) sustained a reinjury, and in the subjects without fibrosis, 24% (16/67) had a reinjury, resulting in a hazard ratio of 0.95 (95% CI, 0.43-2.1; P=.898). CONCLUSION Fibrosis is commonly seen on MRI at return to play after grade 1 or 2 hamstring injuries but is not associated with reinjury risk.
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Affiliation(s)
- Gustaaf Reurink
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, the Netherlands Department of Sports Medicine, The Sports Physicians Group, St Lucas Andreas Hospital, Amsterdam, the Netherlands
| | - Emad Almusa
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gert Jan Goudswaard
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bruce Hamilton
- High Performance Sport New Zealand, Millennium Institute of Sport and Health, Mairangi Bay, Auckland, New Zealand
| | - Maarten H Moen
- Department of Sports Medicine, The Sports Physicians Group, St Lucas Andreas Hospital, Amsterdam, the Netherlands Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands
| | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Centre University of Amsterdam, Amsterdam, the Netherlands
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Inage K, Sakuma Y, Yamauchi K, Suganami A, Orita S, Kubota G, Oikawa Y, Sainoh T, Sato J, Fujimoto K, Shiga Y, Takahashi K, Ohtori S, Tamura Y. Effect of photodynamic therapy on local muscle treatment in a rat muscle injury model: a controlled trial. J Orthop Surg Res 2015; 10:50. [PMID: 25900267 PMCID: PMC4406025 DOI: 10.1186/s13018-015-0193-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/09/2015] [Indexed: 12/15/2022] Open
Abstract
Background Muscle injury is common and is thought to account for 10%–50% of all sports-related injuries. The use of rest, ice, compression, and elevation is common in clinical practice, but many treatments over a long period are required to produce a therapeutic effect. We evaluated the utility of photodynamic therapy as a new treatment option for the acute stage of muscle injury. Methods Twenty 8-week-old Sprague-Dawley male rats underwent experimental injury of the right gastrocnemius muscle with a drop-mass method. After muscle injury was induced, a liposomally formulated indocyanine green derivative (7 mg/kg) near-infrared laser irradiation was performed at 18 h after injury. Local time-dependent changes in the treatment (n = 14) and no treatment (n = 14) groups were evaluated with in vivo imaging, histologic examination, and enzyme-linked immunosorbent assay methods. Results In vivo imaging fluorescence values were significantly higher in the no treatment group, whereas interleukin-6 and tumor necrosis factor-α levels were significantly higher in the treatment group at 18 h after injury. Histologic examination results revealed that the treatment group had less bleeding and more degeneration repair processes than the no treatment group at 24 h and 1 week after muscle injury. Conclusions These findings suggest that photodynamic therapy promotes a tissue-repairing effect during the early stage of muscle injury.
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Affiliation(s)
- Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Yoshihiro Sakuma
- Department of Orthopaedic Surgery, National Hospital Organization Chiba Medical Center, 4 Chome-1-2 Tsubakimori, Chiba City, Chiba, Japan.
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Akiko Suganami
- Department of Bioinformatics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Go Kubota
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba City, Chiba, Japan.
| | - Takeshi Sainoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Jun Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Yutaka Tamura
- Department of Bioinformatics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba City, Chiba, Japan.
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Abstract
OBJECTIVE The purpose of this article is to describe the MRI features of rotator cuff myotendinous junction injuries. MATERIALS AND METHODS We retrospectively identified MRI cases with myotendinous junction injury of the rotator cuff muscles and reviewed clinical, imaging, and surgical records. MR images were reviewed independently by two musculoskeletal radiologists to grade myotendinous junction injuries (strain, partial tear, or complete tear) and to assess for concurrent tendon tears (partial or full thickness) and bone changes (fracture or contusion). RESULTS The final study group comprised 16 subjects. The mean age was 38 years, with a majority of men (56%). The left shoulder was affected in 56% of subjects, with the dominant upper limb affected in 50%. The mean time between symptoms and MRI was 19 days. Subjects reported heavy lifting (19%), landing on the arm after a fall (19%), or prior shoulder therapeutic injection (25%). Myotendinous junction injuries affected the infraspinatus muscle (50%), followed by the supraspinatus (31%), subscapularis (25%), and teres minor (19%) muscles. About one fifth of subjects presented with more than one muscle affected, and 94% did not present with tears of the corresponding tendons. Most myotendinous junction injuries were strains (80%), followed by partial tears (20%). No complete tears were identified. There was no correlation between myotendinous junction injury and the presence of bone changes or the presence of tendon tears (p > 0.05). CONCLUSION Rotator cuff myotendinous junction injuries affect mostly the infra-spinatus and supraspinatus muscles, usually in a strain pattern and without tear of the corresponding tendon attachment.
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Artul S, Khazin F, Hakim J, Habib G. Ultrasonographic findings in a large series of patients with knee pain. J Clin Imaging Sci 2014; 4:45. [PMID: 25250194 PMCID: PMC4168644 DOI: 10.4103/2156-7514.139735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/06/2014] [Indexed: 01/20/2023] Open
Abstract
Background: Musculoskeletal ultrasound (MSKUS) is becoming more and more popular in the evaluation of different musculoskeletal abnormalities. The aim of this retrospective study was to document the prevalence and spectrum of MSKUS findings at the painful knee. Materials and Methods: All the studies of MSKUS that were performed for the evaluation of knee pain during the previous 2 years at the Department of Radiology in Nazareth hospital were reviewed. Demographic and clinical parameters including age, gender, side, and MSKUS findings were documented. Results: Two hundred and seventy-six patients were included in the review. In 21 of them, both knees were evaluated at the same setting (total number of knees evaluated was 297). One hundred and forty-four knees were of the left side. Thirty-three pathologies were identified. 34% of the studies were negative. The most common MSKUS findings were medial meniscal tear (MMT) (20%), Baker's cyst (BC) (16%), and osteoarthritis (OA) (11%). Only one knee of all the knees evaluated in our study showed synovitis. Fifty-three knees (18% of all the knees evaluated) had more than one imaging finding, mosty two and while some had three findings. The most common combination of findings was MMT and BC (8 knees), MMT with OA (8 knees), and MMT with fluid (6 knee). In 67% of the patients who had simultaneous bilateral knee evaluation, at least one knee had no abnormal findings and in 43%, both knees were negative. Conclusions: MSKUS has the potential for revealing huge spectrum of abnormalities. In nearly 90% of the positive studies, degenerative/mechanical abnormalities were reported, with MMT, BC, and osteoarthritic changes being the most common.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, Faculty of Medicine, Nazareth Hospital, Bar Ilan University, Nazareth, Zfat, Israel
| | - Fadi Khazin
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
| | - Jeries Hakim
- Department of Orthopedics, EMMS Hospital, Nazareth, Zfat, Israel
| | - George Habib
- Rheumatology Clinic, Nazareth Hospital and Department of Medicine, Faculty of Medicine, Carmel Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
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Artul S, Habib G. Ultrasound findings of the painful ankle and foot. J Clin Imaging Sci 2014; 4:25. [PMID: 24991476 PMCID: PMC4078419 DOI: 10.4103/2156-7514.133257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/08/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To document the prevalence and spectrum of musculoskeletal ultrasound (MSKUS) findings at different parts of the foot. MATERIALS AND METHODS All MSKUS studies conducted on the foot during a 2-year period (2012-2013) at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. RESULTS Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. CONCLUSIONS MSKUS has the potential for revealing a huge spectrum of abnormalities. The most common finding was collection/hematoma and foreign bodies at the foot, tenosynovitis at the ankle, and Achilles tendinitis at the heel.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, EMMS Nazareth Hospital, Nazareth, Israel ; Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - George Habib
- Rheumatology Clinic, EMMS Nazareth Hospital, Nazareth, Israel
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Nsitem V. Diagnosis and rehabilitation of gastrocnemius muscle tear: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:327-333. [PMID: 24302780 PMCID: PMC3845475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This case study presents the epidemiology, etiology, diagnostic criteria, and therapeutic interventions for a common clinical condition - gastrocnemius injury. CLINICAL FEATURES A 44-year old male presented with acute calf pain with a palpable defect, loss of range of motion, and loss of strength after sustaining a soft tissue injury to the lower leg. The differential diagnosis of tear of the medial head of the gastrocnemius was confirmed by physical examination and diagnostic ultrasound imaging. INTERVENTION AND OUTCOME The patient was treated over a 6 week period. Initially, rehabilitation was approached using the PRICE principles for symptomatic relief, followed by stretching, strengthening, proprioception, and conditioning exercises. At 9-month follow-up post injury, there was no residual impairment in the gastrocnemius muscle function. SUMMARY This case demonstrates the importance of epidemiology, clinical assessment, and the use of diagnostic ultrasound and MRI imaging in the diagnosis of a tear of the medial head of the gastrocnemius muscle. With an accurate diagnosis and comprehension of classification of muscle injuries, management of gastrocnemius tears is straightforward.
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Affiliation(s)
- Virginia Nsitem
- Total Health & Family Care Centre, 1090 Dundas Street East, Suite, L-105, Mississauga, Ontario, L4Y 2B8, Tel: 905-275-4993
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Hayashi D, Roemer FW, Kohler R, Guermazi A, Gebers C, De Villiers R. Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics. Br J Sports Med 2013; 48:1097-101. [PMID: 23962879 DOI: 10.1136/bjsports-2013-092681] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Professional rugby players are prone to traumatic thoracic injuries due to the use of minimal protective gear to cover the torso. In the 2007 Rugby World Cup, thoracic injuries occurred at a rate of 8.3 cases/1000 player-hours. CT and MRI play an important role in the diagnosis of these injuries. Vital internal organs, such as the heart, lungs, trachea, liver and large blood vessels lie within close proximity to the bony structures and what seems to be a simple rib fracture or clavicular dislocation can have potentially life-threatening complications that are not detected by conventional radiography. Cross-sectional imaging helps to determine the choice of treatment. Ultrasound offers a quick and dynamic imaging examination and allows high-resolution assessment of superficial tissues that complements conventional imaging. In this review article, we (1) presented data on incidence of thoracic injuries in professional rugby players; (2) described the anatomy of the joints comprising the thoracic cage and major muscles attached to the rib cage; (3) discussed indications and relevance for MRI and presented an optimised MRI protocol for assessment of suspected thoracic injury; and (4) illustrated various types of thoracic injuries seen in professional rugby players, including sternal contusion, retrosternal haematoma, manubriosternal disruption, sternoclavicular dislocation, rib fractures and injuries of the pectoralis major muscle.
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Affiliation(s)
- Daichi Hayashi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Radiology, University of Erlangen, Erlangen, Germany
| | - Ryan Kohler
- Australian Sports Commission, Bruce, Australia
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Chris Gebers
- Drs Van Wageningen and Partners, Somerset West, South Africa
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