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Stereological analysis of muscle morphology following exposure to repetitive stretch-shortening cycles in a rat model.

Repetitive motion is one risk factor associated with contraction-induced muscle injury, which leads to skeletal muscle degeneration, inflammation, and dysfunction. Since current methods are unable to quantify the acute degenerative and inflammatory responses of muscle tissue concurrently, the purpose of this study was to quantify the temporal myofiber response after exposure to injurious stretch-shortening cycles (SSCs) using a standardized stereological technique. Functional testing was performed on the ankle dorsiflexor muscles of Sprague-Dawley rats in vivo. Rats were anesthetized and exposed to 15 sets of 10 SSCs. Control rats were exposed to 15 sets of single isometric contractions of the same stimulation duration. Changes in muscle morphometry were assessed at 0.5, 24, 48, 72, and 240 h post-exposure to quantify the degree of myofiber degeneration and inflammation in the tibialis anterior muscle from each group. There was an increase in the volume density and average thickness of degenerating myofibers over time in the muscle collected from rats exposed to SSCs (p < 0.0001) that was significantly greater than in muscle exposed to isometric contractions at 24, 48, and 72 h post-exposure (p = 0.003). The volume density of degenerative myofibers was associated with functional deficits at 48 h. Stereological quantification of degenerative myofibers and interstitial space changes were associated with functional defects 48-72 h after SSC-induced injury, thus demonstrating stereology is an accurate measure of SSC-induced skeletal muscle injury.

Animals↗

Imaging features of avulsion injuries.

Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis. Chronic injuries (ie, those resulting from repetitive microtrauma or overuse) or old inactive injuries may be associated with a protuberant mass of bone and may bear a striking resemblance to a neoplastic or infectious process. Although not usually required, computed tomography is helpful in the diagnosis if radiographic findings are equivocal or if the injury is not in the acute phase. MR imaging is best suited for the evaluation of injuries to muscles, tendons, and ligaments. Recognition of characteristic imaging features and familiarity with musculotendinous anatomy will aid in accurate diagnosis of avulsion injuries.

Acute Disease↗

Finger pulley injuries in extreme rock climbers: depiction with dynamic US.

PURPOSE: To determine the ability of dynamic ultrasonography (US) to depict finger pulley injuries in extreme rock climbers. MATERIALS AND METHODS: Sixty-four extreme rock climbers (climbing levels 8-11 on a scale ranging from 1 to 11; Union Internationale des Associations d'Alpinisme) with finger injuries (75 symptomatic and 181 asymptomatic fingers) were examined by using US, with the transducer operating at 12 MHz. The distance between the flexor tendon and phalanx was evaluated in extension and forced flexion at the level of the A2 and A4 annular pulleys as an indicator of tendon bowstringing. A distance between the flexor tendon and phalanx greater than 1.0 mm was interpreted as positive for a pulley injury. US findings were compared with those of magnetic resonance imaging. Surgical correlation was available in seven cases. Statistical analysis was performed by using analysis of variance, the Student t test, and the Bonferroni method. RESULTS: US depicted 16 (100%) of 16 complete A2 pulley ruptures, nine (100%) of nine complete A4 pulley ruptures, six (86%) of seven surgically proved complete combined A2 and A3 pulley ruptures, and 15 (100%) of 15 incomplete A2 pulley ruptures. Measurement of distance between the flexor tendon and phalanx was significantly different among patient subsets without pulley ruptures and those with incomplete, complete, or complete combined pulley ruptures (P <.001). The sensitivity of US for depiction of finger pulley injuries was 98%, and specificity was 100%. CONCLUSION: Dynamic US allows excellent depiction of finger pulley injuries in extreme rock climbers.

Adolescent↗

Quadrilateral space syndrome: a rare cause of shoulder pain.

The authors report a case of quadrilateral space syndrome in a baseball pitcher. The diagnosis was made by means of subclavian arteriography performed with the arm in abduction and external rotation. This entity is a rare cause of shoulder pain caused by occlusion of the posterior humeral circumflex artery in the quadrilateral space.

Adult↗

Longitudinal stress fractures of the tibia: diagnosis with CT.

In most cases, the diagnosis of stress fracture is straightforward with a history of physical activity; characteristic pain in a specific site; and plain radiographs that show sclerosis, periosteal or endosteal reaction, no abnormalities, or, rarely, a fracture. However, when any of the features above are atypical, further study is warranted. Most stress fractures of the tibia are transverse or oblique and involve the mid or proximal shaft. Two cases are presented in which the fracture line was seen on computed tomography scans as coursing longitudinally down the shaft of the distal tibia, which, to my knowledge, is an orientation and location not previously described in the literature.

Cumulative Trauma Disorders↗

Stress fractures: MR imaging.

Five cases of stress fracture were studied with high-field-strength magnetic resonance (MR) imaging. In all cases, MR images showed bandlike areas of very low signal intensity in the intramedullary space, which were continuous with the cortex. These findings corresponded in location to the sites of fracture or new bone formation noted on radiographs. Surrounding areas of decreased signal intensity in the marrow space were also consistently seen on T1-weighted images. In three cases, prominent intramedullary areas of high signal intensity were noted on T2-weighted images obtained within 3 weeks of the onset of symptoms. Juxtacortical and/or subperiosteal areas of high signal intensity were also seen on T2-weighted images in two cases. Characteristic MR findings may distinguish stress fracture from occult intraosseous fracture.

Aged↗

Femoral stress abnormalities: improved scintigraphic detection with frog-leg view.

To identify a better scintigraphic imaging technique for detecting proximal femoral stress abnormalities, 51 consecutive patients with hip pain and the clinical suspicion of stress injury underwent three-phase bone scanning with technetium-99m methylene diphosphonate. Delayed scanning included anterior and frog-leg views of the hips. Fifteen patients had focal stress abnormalities of the femoral neck or lesser trochanter; all were detected with the frog-leg view, but only seven were detected with the standard anterior view. Stress abnormalities involving the lesser trochanter were depicted especially well on the frog-leg view.

Adolescent↗

Stress-related rib and vertebral changes.

In the course of routine chest examination, 80 asymptomatic patients were observed to have localized hyperostosis of the posterior ribs and articulating transverse processes. The authors studied the distributions of lesions in these 80 patients, and records were reviewed in the 50 cases in which they were available. The occupational histories, male-to-female ratio (5:1), and ratio of right-to-left rib involvement (9:1)--in addition to results of electromyographic and histologic studies and the principles of bone remodeling--suggest that this hyperostosis occurs at sites most stressed with bending and rotation of the thorax. The authors hypothesize that this stress-related change occurs due to the pull of the iliocostalis thoracis muscle and is of no clinical significance.

Adult↗

Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging.

Eccentric muscular actions involve the forced lengthening or stretching of muscles and tend to produce exertional injuries. This study used magnetic resonance (MR) imaging to serially evaluate muscles in five healthy, untrained subjects who performed exhaustive biceps exercise by doing isolated eccentric and concentric actions with a dumbbell. Symptoms were assessed, and T2-weighted images of the arms were obtained before exercise and 1, 3, 5, 10, 25, 40, 50, 60, and 80 days after exercise. Statistically significant increases in T2 relaxation times indicative of muscle injury occurred on each day of MR imaging evaluation in muscles performing eccentric actions, peaking on day 3 in two subjects; day 5, two subjects; and day 10, one subject. The pattern and extent of the abnormalities on MR images were variable. Pain, soreness, and joint stiffness were present on days 1, 3, and 5 in muscles that performed eccentric actions. MR imaging showed subclinical abnormalities that lasted as long as 75 days after the disappearance of symptoms (two subjects). Muscles that performed concentric actions had no changes in T2 relaxation times and were asymptomatic throughout the study.

Adult↗

Iliotibial band friction syndrome: MR imaging findings.

Six patients with clinical histories and physical examination results consistent with iliotibial band friction syndrome (ITBFS) were examined with magnetic resonance (MR) imaging. Ill-defined decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images was present deep to the iliotibial band, adjacent to the lateral femoral epicondyle. Axial fast imaging with steady-state precession (FISP) gradient-echo sequences were essential in differentiating the ill-defined signal intensity abnormality associated with ITBFS from fluid in the lateral knee joint. None of these patients were found to have lateral meniscal tears, and all responded to conservative measures directed at treating ITBFS. The authors conclude that MR imaging may be useful in confirming or establishing the diagnosis of ITBFS in patients with the appropriate clinical history and distal lateral thigh or lateral knee pain.

Adolescent↗

Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation.

The ulnar collateral ligament (UCL) provides stability to the medial aspect of the elbow during valgus stress. Trauma to this ligament may result from repetitive forceful throwing. Diagnosis of UCL injury has been based on clinical findings of medial joint pain and valgus instability, as direct imaging of this structure has not been available. Eleven baseball pitchers with clinical evidence of UCL injury were evaluated with magnetic resonance (MR) imaging. Surgical correlation was obtained in six patients, four of whom underwent UCL reconstruction. MR imaging findings in UCL injury included laxity, irregularity, poor definition, and increased signal intensity within and adjacent to the UCL. These findings reflect the presence of hemorrhage and/or edema within the UCL due to repeated microtears, which eventually lead to weakening and possible disruption of the UCL. Optimization of spatial resolution, signal-to-noise ratio, and other technical factors is critical for evaluation of the UCL due to its small size. MR imaging is useful in documenting the presence and severity of injury to the UCL and in distinguishing this entity from other causes of elbow pain.

Adolescent↗