Imaging of Orthopedic Sports Injuries

The Clinician’s Point of View (p. 3-4)

Babette M. Pluim

C O N T E N T S
1.1 Introduction 3
1.2 Role of Imaging 3
1.3 What is Expected from the Radiologist? 4
1.4 What is Expected from the Radiology Department? 4
1.5 What is Expected from the Sports Physician? 4
1.6 Risks of Over-Imaging 5
1.7 The Travelling Athlete 5
1.8 Conclusions 6
Things to Remember 6
References 6

1.1 Introduction

Over the last ten, years imaging techniques have become increasingly important as a diagnostic tool for sports injuries without replacing the traditional methods of management (Geertsma and Maas 2002, De March et al. 2005). An accurate diagnosis can often be made based on a history and physical examination alone but imaging techniques can be very helpful if there is doubt about the diagnosis. In patients who do not respond to conservative management, imaging can be especially useful to acquire a better understanding of the extent of the lesion. However, over-imaging can cause problems in high-level athletes, who have easy access to imaging modalities when travelling abroad. This is particularly so when there is lack of communication between the various treating physicians and when an understanding of the mechanism of injury is essential in order to establish the correct diagnosis.

This chapter will review a number of situations where good communication between the radiologist and sports physician can result in the correct choice of imaging technique and a greater chance of establishing the correct diagnosis. The speci. c demands that elite athletes and sports physicians may place on the radiologist and the radiology department are also discussed.

1.2 Role of Imaging

It should be noted that the patient population of the sports physician differs slightly from the normal population. In general, athletes tend to be highly motivated and are keen to resume sport as soon as possible. The majority of their injuries are caused by training overload yet they . nd it very diffdcult to reduce this load. There is always another match, another race, another goal to achieve. So in a situation where a ‘normal’ patient may be content to give his/her ankle sprain or stress fracture the required three to six weeks rest, an athlete will want to know if he/she can participate in next week’s tournament. When working with athletes, time is always a pressure. This is where imaging can play an important role for both the sports physician and the athlete. First, by establishing the correct diagnosis at the start, the correct treatment procedures can be initiated immediately with no unnecessary time lag. Second, it is often very helpful to provide the athlete with visual evidence that a significant injury is present (e.g. stress fracture, muscle rupture or meniscal lesion) and thereby to convince him/her that rest is indeed essential. Hopefully this will also obviate the inclination of the athlete to get multiple opinions ("medical shopping"). Finally, it may clarify whether surgery is necessary. In cases where conservative management is indicated, imaging may also help determine the appropriate form of treatment, for example, if calcifications are present, use of Dolorclast (shock wave therapy) may be indicated. Despite the fact that corticosteroid injections are used less and less in sports medicine, there are still instances when this type of treatment is indicated and imaging can help in this choice, e.g. a tenosynovitis (trigger . nger), ganglion cyst, bursitis or iliotibial tract syndrome. Ultrasound may also be used to guide the injection needle (Jacob et al. 2005).