Ultrasound of the Upper Limb: When to Use It in Athletes

Abstract

Ultrasound is a powerful screening examination for athletes with upper limb injuries. It is very effective in demonstrating injuries to muscle, tendon, ligament, and nerves. The technique is particularly useful in excluding joint effusion and in detecting soft tissue foreign bodies. Dynamic ultrasound examination is especially useful in detecting subluxation of tendon and nerves; it may be the only means of demonstrating the cause of snapping. Detailed anatomical knowledge is mandatory, and the examination should be structured and systematic. Ultrasound may overlook disorders of the deep structures in joints and bone disease. Those employing the technique must understand the strengths of ultrasound examination compared with and in combination with MRI.

Keywords

ultrasound - upper limb - shoulder - elbow - wrist - muscle - nerve - tendon - ligament - Doppler - snapping syndromes - foreign bodies

• References

• 1 Alonso JM, Edouard P, Fischetto G, Adams B, Depiesse F, Mountjoy M. Determination of future prevention strategies in elite track and field: analysis of Daegu 2011 IAAF Championships injuries and illnesses surveillance. Br J Sports Med 2012; 46 (7) 505-514
• 2 Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc 2012; 20 (1) 16-21
• 3 Mariscalco MW, Saluan P. Upper extremity injuries in the adolescent athlete. Sports Med Arthrosc 2011; 19 (1) 17-26
• 4 Sivan M, Brown J, Brennan S, Bhakta B. A one-stop approach to the management of soft tissue and degenerative musculoskeletal conditions using clinic-based ultrasonography. Musculoskelet Care 2011; 9 (2) 63-68
• 5 Allen G, Wilson D. Current role for ultrasonography. In: Karantanas AH, , ed. Sports Injuries in Children and Adolescents. Heidelberg, Germany: Springer; 2011: 83-93
• 6 Allen GM, Wilson DJ. Ultrasound in sports medicine—a critical evaluation. Eur J Radiol 2007; 62 (1) 79-85
• 7 Klauser AS, Tagliafico A, Allen GM , et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 2012; 22 (5) 1140-1148
• 8 Hopper MA, Tirman P, Robinson P. Muscle injury of the chest wall and upper extremity. Semin Musculoskelet Radiol 2010; 14 (2) 122-130
• 9 Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol 2012; 81 (6) 1207-1210
• 10 Allen GM, Wilson DJ. Ultrasound of the shoulder. Eur J Ultrasound 2001; 14 (1) 3-9
• 11 Klauser A, Frauscher F, Bodner G , et al. Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology 2002; 222 (3) 755-761
• 12 Watts AC, McEachan J, Reid J, Rymaszewski L. The snapping elbow: a diagnostic pitfall. J Shoulder Elbow Surg 2009; 18 (1) e9-e10
• 13 Lazović D, Wegner U, Peters G, Gossé F. Ultrasound for diagnosis of apophyseal injuries. Knee Surg Sports Traumatol Arthrosc 1996; 3 (4) 234-237
• 14 Radunovic G, Vlad V, Micu MC , et al. Ultrasound assessment of the elbow. Med Ultrasound 2012; 14 (2) 141-146
• 15 Bradley M. Image-guided soft-tissue foreign body extraction—success and pitfalls. Clin Radiol 2012; 67 (6) 531-534
• 16 Jacobson JA, Miller BS, Morag Y. Golf and racquet sports injuries. Semin Musculoskelet Radiol 2005; 9 (4) 346-359
• 17 Fradkin AJ, Cameron PA, Gabbe BJ. Golf injuries—common and potentially avoidable. J Sci Med Sport 2005; 8 (2) 163-170
• 18 Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Med 2005; 35 (6) 537-555
• 19 Browne J, Helms CA. Intersection syndrome of the forearm. Arthritis Rheum 2006; 54 (6) 2038
• 20 McNally E, Wilson D, Seiler S. Rowing injuries. Semin Musculoskelet Radiol 2005; 9 (4) 379-396
• 21 Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol 2009; 38 (2) 157-163
• 22 Yoon JS, Walker FO, Cartwright MS. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 2008; 38 (4) 1231-1235
• 23 Yoon JS, Hong SJ, Kim BJ , et al. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2008; 89 (5) 887-889
• 24 Chalidis BE, Sachinis NC, Dimitriou CG. Ulnar nerve penetration by a volar ganglion in the Guyon canal. Plast Reconstr Surg 2009; 124 (5) 264e-266e
• 25 Hughes DG, Wilson DJ. Ultrasound appearances of peripheral nerve tumours. Br J Radiol 1986; 59 (706) 1041-1043
• 26 Cooke R, Lawson I. Use of Doppler in the diagnosis of hypothenar hammer syndrome. Occup Med (Lond) 2009; 59 (3) 185-190