Sports Injuries of the Upper Extremity
09 October 2012 (online)
Over the past 30 years, the development of MRI has coincided with a boom in health consciousness and physical fitness. Weekend warriors, competitive amateurs, and professional athletes take their positions on starting lines, ski slopes, squash courts, golf courses, and football fields to challenge themselves and their aging spines and joints. As they are breaking in their new running shoes, baseball gloves, and mountain bikes, they are often breaking bones, tearing ligaments, and damaging cartilage. When injuries occur, athletes at all levels have come to expect accurate diagnosis and a quick return to activity. In sports medicine, a critical goal is minimizing down time. These athletes, as well as the orthopedists, physiatrists, and internists caring for them, rely on imaging to confirm the clinical impression, determine the extent of tissue damage, institute appropriate management, guide rehabilitation, and limit permanent disability.
MRI remains the most valuable diagnostic tool in the assessment of musculoskeletal disorders, especially sports injuries. As radiofrequency gradients, surface coils, and pulse sequences have all improved, radiologists and MRI have matched orthopedists and arthroscopy in the assessment of intra-articular disorders while maintaining advantages in the evaluation of extra-articular abnormalities and bone marrow lesions. With continued progress in magnet design and field strength, diagnostic capabilities have surpassed surgical advances. Exquisite anatomical resolution demands expertise from radiologists who interpret musculoskeletal studies. To grow and sustain referrals, larger group practices have recruited radiologists with specialized interest and training in musculoskeletal imaging. These specialists are valuable because they understand the structural nuances of joints, the mechanisms and patterns of traumatic injury, and the rationales behind operative treatments. They can communicate skillfully with orthopedists.
Over the past 3 decades, the imaging literature has burgeoned with publications on sports injuries. Most of these publications have focused on MRI due to its soft tissue contrast resolution, multiplanar capabilities, and standardized, easily replicated protocols. More recently, the literature has shifted toward ultrasound as an accurate, cost-effective tool when the diagnostic question is limited in scope and the relevant structures are sonographically accessible. Ultrasound is increasingly accepted by the orthopedic community. As the number of sports-related articles has grown, so has the sophistication of their content. Musculoskeletal radiologists involved in clinical investigations, cadaveric studies, or basic research have all kept pace with orthopedic knowledge, operative innovations, and preoperative imaging demands.
In this issue of Seminars in Musculoskeletal Radiology, entitled “Sports Injuries of the Upper Extremity,” the authors have shared their expertise on various topics and also expressed their opinions. The articles review current literature, offering practical advice on some problems that are commonly observed as well as others rarely encountered.
In the opening article, Kirkland Davis and Kara Gill focus on the pediatric population, illustrating the spectrum of sports-related soft tissue and osseous injuries that occur in the shoulder, elbow, and wrist. David Wilson and Gina Allen then highlight the advantages and specific roles of ultrasonography in the evaluation and characterization of upper extremity disorders. On the shoulder, Jenny Bencardino, Soterios Gyftopoulos, and I collaborate in an article that compares acute dislocation with chronic glenohumeral instability, contrasting their clinical presentations and unique imaging findings. In a tour de force, Kate Stevens et al explore the length of the biceps brachii from shoulder to elbow, including pulley lesions and myotendinous strains in athletes.
David Rubin and Jennifer Demertzis write a comprehensive article on neurovascular injuries of the upper extremity, addressing the imaging strategies and diagnostic difficulties involved in this challenging topic. In the wrist, Hiroshi Yoshioka et al share their experience with high-resolution imaging of the ulnar-sided wrist, emphasizing subtle anatomical relationships while distinguishing asymptomatic degenerative phenomena from symptomatic sports injuries. The issue concludes with the article written by Christine Chung et al, who review the delicate structures of the fingers and elucidate the traumatic mechanisms that lead to instability and disability.
My sincere thanks go to all of the contributors to this issue. Their diligence and expertise made my job a pleasurable learning experience. I also thank Larry White and Marco Zanetti for the invitation to edit this issue of Seminars in Musculoskeletal Radiology. I have appreciated the patience of Anita Kaufman, production editor for Thieme Medical Publishers. I am grateful for the opportunity to become involved with an internationally recognized publication that serves all radiologists interested in musculoskeletal disorders.