Sports Imaging of Team Handball Injuries

Abstract

Team handball is a fast high-scoring indoor contact sport with > 20 million registered players who are organized in > 150 federations worldwide. The combination of complex and unique biomechanics of handball throwing, permitted body tackles and blocks, and illegal fouls contribute to team handball ranging among the four athletic sports that carry the highest risks of injury. The categories include a broad range of acute and overuse injuries that most commonly occur in the shoulder, knee, and ankle. In concert with sports medicine, physicians, surgeons, physical therapists, and radiologists consult in the care of handball players through the appropriate use and expert interpretations of radiography, ultrasonography, CT, and MRI studies to facilitate diagnosis, characterization, and healing of a broad spectrum of acute, complex, concomitant, chronic, and overuse injuries. This article is based on published data and the author team's cumulative experience in playing and caring for handball players in Denmark, Sweden, Norway, Germany, Switzerland, and Spain. The article reviews and illustrates the spectrum of common handball injuries and highlights the contributions of sports imaging for diagnosis and management.

Keywords

handball - magnetic resonance imaging - computed tomography - radiography - ultrasonography

Publication History

Article published online:
28 September 2020

• References

• 1 Schad T. Olympics 2012: Team handball, an exciting sport mostly unknown to America. The Washington Times; 2020 . Available at: https://www.washingtontimes.com/news/2012/jul/26/london-olympics-2012-team-handball-an-exciting-spo/. Accessed February 1, 2020
• 2 Filip Taleski has the fastest shot of men's EHF EURO 2020: Handball Planet; 2020 Available at: http://www.handball-planet.com/filip-taleski-has-the-fastest-shot-of-mens-ehf-euro-2020/. Accessed February 1, 2020
• 3 Nikolaidis PT, Ingebrigtsen J. Physical and physiological characteristics of elite male handball players from teams with a different ranking. J Hum Kinet 2013; 38: 115-124
• 4 Faszination Handball. Deutscher Handballbund; 2020 Available at: https://www.dhb.de/de/verband/ueber-uns/faszination-handball/. Accessed February 1, 2020
• 5 Handballer vs. Fußballer!: Antenne Thueringen; 2018 Available at: https://www.antennethueringen.de/blog/handballer-vs.-fussballer-371885. Accessed February 1, 2020
• 6 Fast zwölf Millionen Zuschauer sehen Halbfinale von Deutschland gegen Norwegen: Handball World; 2019 Available at: https://www.handball-world.news/o.red.r/news-1-1-25-111898.html. Accessed February 1, 2020
• 7 Handball schlägt Fußball im TV-Sportjahr 2019: Frankfurter Allgemeine Zeitung; 2019 Available at: https://www.faz.net/aktuell/sport/mehr-sport/handball-schlaegt-fussball-in-tv-quoten-ranking-im-sportjahr-2019-16540028.html. Accessed February 1, 2020
• 8 Fans tune into the global handball showcase: International Handball Federation; 2019 Available at: https://www.ihf.info/node/735. Accessed February 1, 2020
• 9 Plummer HA, Oliver GD. The effects of localised fatigue on upper extremity jump shot kinematics and kinetics in team handball. J Sports Sci 2017; 35 (02) 182-188
• 10 Skejø SD, Møller M, Bencke J, Sørensen H. Shoulder kinematics and kinetics of team handball throwing: a scoping review. Hum Mov Sci 2019; 64: 203-212
• 11 Lin DJ, Wong TT, Kazam JK. Shoulder injuries in the overhead-throwing athlete: epidemiology, mechanisms of injury, and imaging findings. Radiology 2018; 286 (02) 370-387
• 12 Weber AE, Kontaxis A, O'Brien SJ, Bedi A. The biomechanics of throwing: simplified and cogent. Sports Med Arthrosc Rev 2014; 22 (02) 72-79
• 13 Rose MB, Noonan T. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med 2018; 9: 69-78
• 14 Ouellette H, Kassarjian A, Tétreault P, Palmer W. Imaging of the overhead throwing athlete. Semin Musculoskelet Radiol 2005; 9 (04) 316-333
• 15 Wagner H, Buchecker M, von Duvillard SP, Müller E. Kinematic description of elite vs. low level players in team-handball jump throw. J Sports Sci Med 2010; 9 (01) 15-23
• 16 Almeida GP, Silveira PF, Rosseto NP, Barbosa G, Ejnisman B, Cohen M. Glenohumeral range of motion in handball players with and without throwing-related shoulder pain. J Shoulder Elbow Surg 2013; 22 (05) 602-607
• 17 Luck PG. Sportmedizinische Aspekte des Handballsports K. Federal Institute of Sport Science of Germany. 1996 Available at: https://www.bisp-surf.de/Record/PU199908401416 . Accessed February 1, 2020
• 18 Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports 2006; 16 (06) 426-432
• 19 Bere T, Alonso JM, Wangensteen A. , et al. Injury and illness surveillance during the 24th Men's Handball World Championship 2015 in Qatar. Br J Sports Med 2015; 49 (17) 1151-1156
• 20 Rafnsson ET, Valdimarsson Ö, Sveinsson T, Árnason Á. Injury pattern in Icelandic elite male handball players. Clin J Sport Med 2019; 29 (03) 232-237
• 21 Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports 1997; 7 (06) 342-347
• 22 Renstrom P, Ljungqvist A, Arendt E. , et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008; 42 (06) 394-412
• 23 Myklebust G, Maehlum S, Engebretsen L, Strand T, Solheim E. Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons. Scand J Med Sci Sports 1997; 7 (05) 289-292
• 24 Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R. Relationship between floor type and risk of ACL injury in team handball. Scand J Med Sci Sports 2003; 13 (05) 299-304
• 25 Pieper HG. Humeral torsion in the throwing arm of handball players. Am J Sports Med 1998; 26 (02) 247-253
• 26 Jost B, Zumstein M, Pfirrmann CW, Zanetti M, Gerber C. MRI findings in throwing shoulders: abnormalities in professional handball players. Clin Orthop Relat Res 2005; (434) 130-137
• 27 Lubiatowski P, Kaczmarek P, Cisowski P. , et al. Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players. Knee Surg Sports Traumatol Arthrosc 2018; 26 (01) 67-75
• 28 Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg 1992; 1 (05) 238-245
• 29 Antoniou J, Duckworth DT, Harryman II DT. Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000; 82 (09) 1220-1230
• 30 Schär MO, Dellenbach S, Pfirrmann CW, Raniga S, Jost B, Zumstein MA. Many shoulder MRI findings in elite professional throwing athletes resolve after retirement: a clinical and radiographic study. Clin Orthop Relat Res 2018; 476 (03) 620-631
• 31 Ramkumar PN, Frangiamore SJ, Navarro SM. , et al. Interobserver and intraobserver reliability of an MRI-based classification system for injuries to the ulnar collateral ligament. Am J Sports Med 2018; 46 (11) 2755-2760
• 32 Tyrdal S, Bahr R. High prevalence of elbow problems among goalkeepers in European team handball—'handball goalie's elbow.'. Scand J Med Sci Sports 1996; 6 (05) 297-302
• 33 Akgun U, Karahan M, Tiryaki C, Erol B, Engebretsen L. Direction of the load on the elbow of the ball blocking handball goalie. Knee Surg Sports Traumatol Arthrosc 2008; 16 (05) 522-530
• 34 Popovic N, Lemaire R. Hyperextension trauma to the elbow: radiological and ultrasonographic evaluation in handball goalkeepers. Br J Sports Med 2002; 36 (06) 452-456
• 35 Popovic N, Ferrara MA, Daenen B, Georis P, Lemaire R. Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound, and magnetic resonance imaging. Int J Sports Med 2001; 22 (01) 60-67
• 36 Del Grande F, Aro M, Farahani SJ, Wilckens J, Cosgarea A, Carrino JA. Three-Tesla MR imaging of the elbow in non-symptomatic professional baseball pitchers. Skeletal Radiol 2015; 44 (01) 115-123
• 37 National Council on Nutrition and Physical Activity in Norway. Extract from the Norwegian National Report on Physical Activity and Health. Scand J Med Sci Sports 2001; 11 (04) 255-257
• 38 Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A one-year prospective study of sixteen men's senior teams of a superior nonprofessional level. Am J Sports Med 1998; 26 (05) 681-687
• 39 Bono CM. Low-back pain in athletes. J Bone Joint Surg Am 2004; 86 (02) 382-396
• 40 Baranto A, Hellström M, Cederlund CG, Nyman R, Swärd L. Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1125-1134
• 41 Nadler SF, Wu KD, Galski T, Feinberg JH. Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain. Spine 1998; 23 (07) 828-833
• 42 Samanta J, Kendall J, Samanta A. 10-minute consultation: chronic low back pain. BMJ 2003; 326 (7388): 535
• 43 Cyron BM, Hutton WC. The fatigue strength of the lumbar neural arch in spondylolysis. J Bone Joint Surg Br 1978; 60-B [phone]
• 44 Hollenberg GM, Beattie PF, Meyers SP, Weinberg EP, Adams MJ. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 2002; 27 (02) 181-186
• 45 Moller M, Attermann J, Myklebust G, Wedderkopp N. Injury risk in Danish youth and senior elite handball using a new SMS text messages approach. Br J Sports Med 2012; 46 (07) 531-537
• 46 Weir A, Brukner P, Delahunt E. , et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2015; 49 (12) 768-774
• 47 Zoga AC, Kavanagh EC, Omar IM. , et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology 2008; 247 (03) 797-807
• 48 Myklebust G, Maehlum S, Holm I, Bahr R. A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball. Scand J Med Sci Sports 1998; 8 (03) 149-153
• 49 van der List JP, Mintz DN, DiFelice GS. The location of anterior cruciate ligament tears: a prevalence study using magnetic resonance imaging. Orthop J Sports Med 2017; 5 (06) 2325967117709966
• 50 DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy 2015; 31 (11) 2162-2171
• 51 Daniels SP, van der List JP, Kazam JJ, DiFelice GS. Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol 2018; 47 (05) 619-629
• 52 Del Grande F, Delcogliano M, Guglielmi R. , et al. Fully automated 10-minute 3D CAIPIRINHA SPACE TSE MRI of the knee in adults: a multicenter, multireader, multifield-strength validation study. Invest Radiol 2018; 53 (11) 689-697
• 53 Fritz B, Bensler S, Thawait GK, Raithel E, Stern SE, Fritz J. CAIPIRINHA-accelerated 10-min 3D TSE MRI of the ankle for the diagnosis of painful ankle conditions: performance evaluation in 70 patients. Eur Radiol 2019; 29 (02) 609-619
• 54 Fritz J, Fritz B, Thawait GG, Meyer H, Gilson WD, Raithel E. Three-dimensional CAIPIRINHA SPACE TSE for 5-minute high-resolution MRI of the knee. Invest Radiol 2016; 51 (10) 609-617
• 55 Janssen RP, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 2102-2108
• 56 Filli L, Rosskopf AB, Sutter R, Fucentese SF, Pfirrmann CWA. MRI predictors of posterolateral corner instability: a decision tree analysis of patients with acute anterior cruciate ligament tear. Radiology 2018; 289 (01) 170-180
• 57 DePhillipo NN, Moatshe G, Chahla J. , et al. Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med 2019; 47 (02) 372-378
• 58 Bollen SR. Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br 2010; 92 (02) 222-223
• 59 Chahla J, Dean CS, Moatshe G. , et al. Meniscal ramp lesions: anatomy, incidence, diagnosis, and treatment. Orthop J Sports Med 2016; 4 (07) 2325967116657815
• 60 Lian OB, Engebretsen L, Bahr R. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med 2005; 33 (04) 561-567
• 61 Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper's knee. Orthop Clin North Am 1973; 4 (03) 665-678
• 62 Davies SG, Baudouin CJ, King JB, Perry JD. Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis. Clin Radiol 1991; 43 (01) 52-56
• 63 Richardson ML, Amini B, Richards TL. Some new angles on the magic angle: what MSK radiologists know and don't know about this phenomenon. Skeletal Radiol 2018; 47 (12) 1673-1681
• 64 Yun SJ, Jin W, Park YK. , et al. Increased signal intensity at the proximal patellar tendon: correlation between MR imaging and histology in eight cadavers and clinical MR imaging studies. Eur Radiol 2015; 25 (10) 2976-2983
• 65 Chung CB, Skaf A, Roger B, Campos J, Stump X, Resnick D. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients. Skeletal Radiol 2001; 30 (12) 694-697
• 66 Brostroem L. Sprained ankles. I. Anatomic lesions in recent sprains. Acta Chir Scand 1964; 128: 483-495
• 67 McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc 2013; 21 (06) 1328-1337
• 68 van Dijk CN, Longo UG, Loppini M. , et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 1200-1216
• 69 Calder JD, Bamford R, Petrie A, McCollum GA. Stable versus unstable grade II high ankle sprains: a prospective study predicting the need for surgical stabilization and time to return to sports. Arthroscopy 2016; 32 (04) 634-642
• 70 Kijowski R, Choi J, Shinki K, Del Rio AM, De Smet A. Validation of MRI classification system for tibial stress injuries. AJR Am J Roentgenol 2012; 198 (04) 878-884
• 71 Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959; 41-A: 988-1020
• 72 Hannon CP, Smyth NA, Murawski CD. , et al. Osteochondral lesions of the talus: aspects of current management. Bone Joint J 2014; 96-B [phone]
• 73 Mintz DN, Tashjian GS, Connell DA, Deland JT, O'Malley M, Potter HG. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy 2003; 19 (04) 353-359
• 74 Gribble PA, Bleakley CM, Caulfield BM. , et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016; 50 (24) 1496-1505
• 75 Bowers Jr KD, Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports 1976; 8 (02) 81-83
• 76 Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle 1986; 7 (03) 162-176
• 77 Sims AL, Kurup HV. Painful sesamoid of the great toe. World J Orthop 2014; 5 (02) 146-150
• 78 Schweitzer ME, Maheshwari S, Shabshin N. Hallux valgus and hallux rigidus: MRI findings. Clin Imaging 1999; 23 (06) 397-402
• 79 Guermazi A, Roemer FW, Robinson P, Tol JL, Regatte RR, Crema MD. Imaging of muscle injuries in sports medicine: sports imaging series. Radiology 2017; 282 (03) 646-663
• 80 Mueller-Wohlfahrt HW, Haensel L, Mithoefer K. , et al. Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 2013; 47 (06) 342-350
• 81 Finch CF. An overview of some definitional issues for sports injury surveillance. Sports Med 1997; 24 (03) 157-163
• 82 Peetrons P. Ultrasound of muscles. Eur Radiol 2002; 12 (01) 35-43
• 83 Ekstrand J, Askling C, Magnusson H, Mithoefer K. Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med 2013; 47 (12) 769-774
• 84 Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 2007; 35 (02) 197-206
• 85 Conder RL, Conder AA. Sports-related concussions. N C Med J 2015; 76 (02) 89-95
• 86 Herring SA, Cantu RC, Guskiewicz KM. , et al; American College of Sports Medicine. Concussion (mild traumatic brain injury) and the team physician: a consensus statement—2011 update. Med Sci Sports Exerc 2011; 43 (12) 2412-2422
• 87 Asken BM, Sullan MJ, DeKosky ST, Jaffee MS, Bauer RM. Research gaps and controversies in chronic traumatic encephalopathy: a review. JAMA Neurol 2017; 74 (10) 1255-1262