Magnetic Resonance Imaging Abnormalities in the Shoulder and Wrist Joints of Asymptomatic Elite Athletes

Fredericson, Michael; Ho, Charles P.; Waite, Brandee; Jennings, Fábio; Peterson, Jeffrey J.; Williams, Christina; Mathesonn, Gordon O.

doi:10.1016/j.pmrj.2008.09.004

Cited by 39 publications

(42 citation statements)

References 13 publications

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“…In one such study comparing MRI to arthroscopy reports, Ben-Galim et al found a false-positive rate of 47.2% for ACL tears in healthy subjects [100]. In another study, MRIs of wrists showed mild to moderate ligament injury in every case although all subjects (elite gymnasts) were asymptomatic [101].…”

Section: Mri -Not Always the Best Tools Of The Tradementioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

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Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injures create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structures in and around the joint. The long-term consequence of nonhealed ligament injury is osteoarthritis, the most common joint disorder in the world today.Ligaments heal through a distinct sequence of cellular events that take place in three consecutive stages: an acute inflammatory phase, a proliferative or regenerative phase, and a tissue remodeling phase. The process can take months to resolve itself, and despite advances in therapeutics, many ligaments do not regain their normal tensile strength.Various diagnostic procedures have been used to determine and assess ligament injury. Traditionally, MRI and X-rays have been the most utilized techniques; however, because ligaments do not show up clearly with these devices, there have been many false positives and negatives reported due to inconclusive or inaccurate readings. Newer technologies, such as ultrasound and digital motion X-ray, are able to provide a more detailed image of a ligament's structure and function.Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue's response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal antiinflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all.Regenerative medicine techniques, such as prolotherapy, have been shown, in both case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints. More research and additional studies are needed to better assess ligament injuries and healing properties.

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Section: Mri -Not Always the Best Tools Of The Tradementioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

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“…As a consequence, MRI risks inappropriate diagnoses and unnecessary treatments [9]. Wrist pain is common, and it is often difficult to identify discrete, objective pathophysiology that accounts for the symptoms.…”

Section: Introductionmentioning

confidence: 99%

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Kuntz

Janssen

Ring

2015

Hand (New York, N,Y.)

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Background Magnetic resonance imaging (MRI) commonly finds musculoskeletal abnormalities incidental to the reason for ordering the test. The purpose of this study was to determine if the prevalence of extensor carpi ulnaris (ECU) signal changes on MRI varies between patients undergoing upper extremity MRI for assessment of clinically suspected ECU tendinopathy and those undergoing upper extremity MRI for other indications. Our secondary null hypotheses were that the prevalence of ECU signal changes on MRI does not vary based on patient age or sex and that the prevalence of ECU signal changes on MRI does not vary among other indications for MRI. Methods We searched MRI reports of all patients undergoing MRI of the hand, wrist, or arm at our institution between 2001 and 2014 for signal changes in the ECU. The medical record was reviewed to determine the indication for the MRI and the presence of clinically suspected ECU tendinopathy. Results ECU signal changes (overall prevalence of 13 %) were more common in patients undergoing MRI for a working clinical diagnosis of ECU tendinopathy or ulnar-sided wrist pain compared to patients evaluated for nonspecific pain and other indications. Age was independently associated with ECU signal changes on MRI. MRI signal changes are uncommonly associated with symptomatic tendinopathy (low positive predictive value). Conclusions ECU signal changes on MRI are common and often asymptomatic.

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“…Although asymptomatic structural changes have been reported in a variety of body regions, to our knowledge, no prior investigation has systematically evaluated the plantar heel region in asymptomatic runners, a group at risk for developing heel abnormalities. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Consequently, the primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. On the basis of our preliminary observations, we hypothesized that more than 50% of asymptomatic runners would have at least 1 structural abnormality in 1 heel, as defined by the following: (1) presence of vascularization on power Doppler sonography, (2) nonuniform heterogeneous echo texture of the plantar heel pad, (3) abnormal plantar heel pad thickness (uncompressed heel pad thickness <12 or > 28 mm), 15,36 (4) abnormal plantar heel pad compressibility (heel pad compressibility index <0.45 or >0.75), 15 (5) abnormal plantar fascia thickness (>4 mm), 1 and (6) abnormal plantar fascia echo texture.…”

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confidence: 99%

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

Hall

Finnoff

Sayeed

et al. 2015

J of Ultrasound Medicine

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lantar heel pain is a common condition affecting endurance runners and accounts for approximately 8% of all runningrelated injuries. 1 Although plantar fasciitis is the most common cause of heel pain in the athletic population, 2,3 the differential diagnosis of heel pain is broad and includes plantar heel pad syndrome (also referred to as fat pad syndrome), calcaneal fractures, regional nerve entrapments (eg, Baxter nerve), and referred pain syndromes. 2 The role of musculoskeletal sonography in the evaluation of plantar heel pain has been well established with respect to the plantar fascia. [3][4][5][6][7][8][9][10][11][12][13][14][15] More specifically, plantar fascia thickening (>4 mm), hypoecho genicity, heterogeneity, and neovascularization are considered reliable markers of symptomatic plantar fasciitis, whereas a normalappearing plantar fascia warrants consideration of alternative causes of heel pain. 1,3,4,9,[12][13][14] On the contrary, the role of sonography Mederic M. Hall, MD, Jonathan T. Finnoff, DO, Yusef A. Sayeed, MD, MPH, MEng, Jay Smith, MD Received December 31, 2014, ORIGINAL RESEARCHObjectives-The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain.Methods-Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. Conclusions-At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners. Results-Doppler

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Magnetic Resonance Imaging Abnormalities in the Shoulder and Wrist Joints of Asymptomatic Elite Athletes

Cited by 39 publications

References 13 publications

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

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