Sports injury update: imaging features.
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Adolescent↗
Biomedical subjects
H Pavlov
Publications and source records attributed to H Pavlov.
Correlation of radiographic and arthroscopic findings with rotator cuff tears and degenerative joint disease.
The purpose of this study was to identify early signs of rotator cuff tear and glenohumeral articular cartilage degeneration by using conventional radiography. A non-weighted anteroposterior oblique and a weighted active abduction view were evaluated for superior humeral migration and matching degenerative changes at the inferolateral acromion and superior aspect of the greater tuberosity in 40 patients who underwent shoulder arthroscopy. Measurements of the glenohumeral distance were performed. Surgical reports were reviewed to determine rotator cuff and glenohumeral articular cartilage status. Matching degenerative changes correlate with complete rotator cuff tear (P =.04); superior migration does not. Severe glenohumeral cartilage loss correlates with narrowing of the superior joint space on the anteroposterior oblique radiograph (P =.02) and with narrowing of the mid joint space on the active abduction view (P =.05). Both glenohumeral articular cartilage degenerative change and rotator cuff injury, before formation of typical sequelae of chronic rotator cuff tear, can be detected with the use of conventional radiography.
Adult↗
Computer-assisted tomography of the knee.
The potential contributions and limitations of computer-assisted tomography of the knee have been analyzed. The knee was examined in the transaxial, sagittal, semi-sagittal and coronal planes. The positioning for obtaining intra-articular detail is outlined, and the indications are discussed. Delineation of the cruciate ligaments is remarkably clear and clinically applicable. The menisci can be demonstrated, but improvement in spacial resolution and changes in the physical construction of the scanner will be required to permit an adequate clinical evaluation.
Evaluation Studies as Topic↗
Stress fracture of the ipsilateral first rib in a pitcher.
This stress fracture of the left first rib in a 17-year-old, left-handed high school baseball pitcher represents the first of its type reported in the literature. Two similar cases have been reported in pitchers, but the fracture was on the nondominant side in both cases. In contrast to most cases of this rare lesion, the stress fracture we report occurred acutely and was documented roentgenographically from onset to complete healing 9 months later.
Adolescent↗
Axial loading injuries to the middle cervical spine segment. An analysis and classification of twenty-five cases.
Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamentous structures are rare. We present 25 cases of traumatic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5-C6-C7) cervical segments. Specifically, the C3-C4 lesions appear to be unique with regard to the infrequency of bony fracture, difficulty in effecting and maintaining reduction, and a more favorable recovery following early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc herniation (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation (N = 6), 4) bilateral facet dislocation (N = 7), and 5) fracture of vertebral body C4 (N = 4). Analysis of these 25 cases suggests that traumatic lesions of the cervical spine in general can be classified as involving the upper (C1-C2), middle (C3-C4), or lower (C4-C7) segments. This is based on our observations from this series that C3-C4 lesions 1) generally do not involve fracture of the bony elements; 2) acute intervertebral disc herniations are frequently associated with transient quadriplegia; 3) reduction of anterior subluxation of C3 on C4 is difficult to maintain; 4) reduction of unilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by closed manipulation and reduction under general anesthesia; and 5) reduction of bilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by open methods. The more favorable results observed in this series of immediate reduction of both unilateral and bilateral facet dislocations deserves emphasis. In two cases of unilateral facet dislocation reduced within 3 hours of injury and subsequently fused anteriorly, significant neurologic recovery occurred. The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic. In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.
Adolescent↗
The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis.
The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.
Biomechanical Phenomena↗
Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs.
We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that expose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgenograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormalities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990. All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus resulting from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quadriplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing techniques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.
Adolescent↗
Atypical clinical and magnetic resonance imaging manifestations of meniscal cysts. A report of two cases and review of the literature.
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Adult↗
Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain.
Osteoid osteoma, a benign osteoblastic tumour comprised of osteoid and atypical bone, is a well-known entity. However, clinical diagnosis may be delayed, especially when the pain is referred to a nearby joint. This paper reports a series of 11 cases occurring in physically active patients in whom the diagnosis was delayed because of pain referral to the knee. The mean duration from the onset of symptoms to diagnosis of osteoid osteoma was 20 months (range 3 to 48 months). Review of these 11 lesions indicates that they can be classified on the basis of their anatomical location: (a) distant to the knee; (b) periarticular; or (c) subarticular (intraarticular). It should be noted that initially only 5 of the 11 cases displayed characteristic x-ray findings; in the remaining 6 cases, diagnosis was dependent on positive 99mTc radionuclide bone scans, tomograms, and computerised tomography scans. Of the 9 patients who underwent surgical resection of their lesions, all had complete relief of symptoms and all continued to be asymptomatic at follow-up evaluations.
Adolescent↗
Stress fractures in 51 runners.
A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.
Adolescent↗
The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications.
Haglund syndrome, a common cause of pain in the posterior heel, consists of a painful swelling of the local soft tissues (the so-called pump bump) and prominence of the calcaneal bursal projection. The condition is caused by compression of the distal Achilles tendon and surrounding soft tissue between the os calcis and the posterior shoe counter. Osseous plantar projections appear to be a critical etiologic factor in Haglund syndrome. With an experimental model, it has been demonstrated that osseous projections on the plantar surface of the calcaneus adversely influence the bone-soft tissue relation of the posterior heel. Shoe heel elevation has been shown to be clinically effective in alleviating symptoms. It is demonstrated with an experimental model that elevation of the shoe heel decreases the pitch angle. This diminishes the prominence of the bursal projection and allows the foot to slip forward, displacing the posterior calcaneus away from the shoe counter.
Achilles Tendon↗
The radiographic diagnosis of the anterior cruciate ligament deficient knee.
Various radiologic procedures are used in the evaluation of the cruciate deficient knee, including routine roentgenography, arthrography, and computed tomography (CT). Routine roentgenograms can document a joint effusion, an avulsion fracture with or without complete anterior cruciate ligament (ACL) description, and other osseous abnormalities, e.g., degenerative joint changes. Double-contrast arthrography can determine the integrity f the ACL. When correctly performed and carefully interpreted, more than 90% accuracy is possible in diagnosing if the ligament is present and intact, torn, or absent. The condition of the medial and lateral menisci, the articular cartilages, and the synovium can be evaluated by the same arthrographic study. In those instances in which the arthrographic diagnosis is equivocal of the ACL has been repaired or can not be examined arthrographically, the CT examination may be useful. Unfortunately, because the CT examination is expensive and correct interpretations are sometimes difficult, its use is accordingly limited.
Humans↗