Application of Ultrasound in Sports Injury

Ultrasound Diagnosis Technology for Sports Injury Detection and Prevention: A Mini Review

Ultrasound as a medical diagnosis tool, comprising the strengths of noninvasive, portable and cost-saving, and it allows the evaluation of soft tissue pathology. In sports medicine field, sonography technology is used for the detection and prevention of injuries of upper and lower limbs, mainly including elbow, shoulder, knee and ankle joints. The implement of ultrasound diagnosis technology was discussed in this narrative literature review. Sonographic images of elbows could provide a dynamic assessment of medial joint laxity. Due to the importance of ultrasound assessment in lower-limb muscles, tendons, and ligaments, this technology has been applied extensively for many types of extra-articular injuries in the lower limb. Most muscle injuries can be assessed and graded using the ultrasound apparatus. Overall, sonographic image evaluation is a reliable and handy method for the initial examination of acute or chronic sports injuries.

The application of musculoskeletal ultrasonography in sports injuries of lower limbs in Chongqing Marathon competition

BACKGROUND

High incidence of sports injury occurring during marathon competitions urges a pressing demand for a convenient and accurate diagnostic tool of such injuries. However, contemporary information on the application of musculoskeletal ultrasonography (MSUS) in sports injury is not sufficient.

METHODS

A repeated measures study was used to describe the distribution of lower limb injuries in the Chongqing marathon and the application of MSUS in assessing these sports injuries. To verify the diagnostic accuracy of MSUS for sports injury, participants were assigned to group A (MSUS group) or group B (Sports medicine physician, i.e. SMP group), each group had an independent procedure of making a diagnosis. That is, ultrasound physicians in group A made a diagnosis from the ultrasonographic images while sports medicine physicians in group B synthesizing symptoms and signs of patients to identify the exact injury.

RESULTS

No statistically significant difference was found in the participants of the baseline characteristics between the two groups (P>0.05). In both groups, the knee was accounted as the vast majority of running injury sites, followed by the ankle (P=0.152). Tendons and ligaments injuries (χ2=48.437 and P=0.000) were the most common types of injury. Visual Analog Scale (VAS), a higher score of which indicates severer pain (0 to 10), was used to evaluate the severity of pain from injuries. VAS scores decreased significantly (P<0.05) in both groups after immediate treatment and the decrease in group A was significantly greater than group B (P=0.007). For athletes with pain sustained or exacerbated, further MRI exam showed a concordance rate of approximately 100% between MSUS and MRI diagnosis.

CONCLUSIONS

Musculoskeletal ultrasonography could be applied as an efficient method for the diagnosis of sports injuries in the athletic competition field.

State-of-the-art ultrasonographic findings in lower extremity sports injuries

Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.

Evaluation of MRI-US Fusion Technology in Sports-Related Musculoskeletal Injuries

INTRODUCTION

A combination of magnetic resonance imaging (MRI) with real-time high-resolution ultrasound (US) known as fusion imaging may improve visualization of musculoskeletal (MSK) sports medicine injuries. The aim of this study was to evaluate the applicability of MRI-US fusion technology in MSK sports medicine.

METHODS

This study was conducted by the medical services of the FC Barcelona. The participants included volunteers and referred athletes with symptomatic and asymptomatic MSK injuries. All cases underwent MRI which was loaded into the US system for manual registration on the live US image and fusion imaging examination. After every test, an evaluation form was completed in terms of advantages, disadvantages, and anatomic fusion landmarks.

RESULTS

From November 2014 to March 2015, we evaluated 20 subjects who underwent fusion imaging, 5 non-injured volunteers and 15 injured athletes, 11 symptomatic and 4 asymptomatic, age range 16-50 years, mean 22. We describe some of the anatomic landmarks used to guide fusion in different regions. This technology allowed us to examine muscle and tendon injuries simultaneously in US and MRI, and the correlation of both techniques, especially low-grade muscular injuries. This has also helped compensate for the limited field of view with US. It improves spatial orientation of cartilage, labrum and meniscal injuries. However, a high-quality MRI image is essential in achieving an adequate fusion image, and 3D sequences need to be added in MRI protocols to improve navigation.

CONCLUSION

The combination of real-time MRI and US image fusion and navigation is relatively easy to perform and is helping to improve understanding of MSK injuries. However, it requires specific skills in MSK imaging and still needs further research in sports-related injuries.

FUNDING

Toshiba Medical Systems Corporation.