Transcript KNEE MRI - NTUMCAA-NA-GNY

MRI EVALUATION OF
TENNIS INJURIES
TENNIS ELBOW AND BEYOND
Peter P. Chow, M.D., M.P.H.
Pacific Medical Imaging & Oncology Center,
Alhambra, CA
Valley Imaging Partnership,
West Covina, CA
Tennis Injuries Overview
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Extremely high demands on structural integrity
of the body’s joints.
Repetitive, asymmetrical and technically
challenging movements at high speed in
dynamic settings.
Testing the limits of players’ physical and mental
endurance
Top 5 Tennis Injuries
Tennis Injuries Facts
-in ATP professional Players
35-50% to lower extremities
 20% to upper limb
 20% to lower back
 Chronic overuse conditions more likely to
occur in upper body
 Acute injuries more likely to occur in the
lower limbs.
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Sprain vs. Partial tear
93 y/o F, lat. Ankle pain
Muscle Injuries in Tennis
Hamstring muscles
Calf muscles
Middle-aged male pushing a stalled car
and felt a pop in the calf
Rupture of Plantaris Tendon
(Tennis Leg)
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Middle-aged patients
Forced dorsiflection of the ankle with the knee
in extention
Audible “pop” in the calf, with subsequent pain
and swelling, and frequently with a palpable
mass caused by hematoma
Often associated with ACL tear and
posterolateral corner injuries
Calf Injury
Tommy Haas
Injuries to Med. Gastronemius muscle
(Tennis Leg)
23 y/o F semi-pro athlete, training tennis
>6h/day
Medial Tibial Stress Syndrome
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Also known as shin splints
Characterized by hyperintense signal along the
anterior tibial border
Related to periosteal avulsion and periostitis at
the medial soleus insertional site
Grade I (periosteal edema)thru grade IV (stress
fracture)
Shin Splints -- periostitis
Medial Tibial Stress Syndrome
BONE BRUISE-26 y/o M MR Tech
4 wk
7wk
9 wk after injury
Patellar tendinosis Jumper’s knee
Patellar Chondromalacia
No. 1 USC player turned professional
30 y/o male, anterior knee pain
Hamstring Injury
M. Sharapova at Pan Pacific Open, Feb. 2007
Partial Tear of Biceps Femoris
Hamstring Injuries
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MR depicts the location and extent of injuries
MR useful in grading of muscular injuries:
Grade I – limited muscle fiber disruption
 Grade II – partial tears at musculotendinous
junction without retraction of muscle
 Grade III – complete disruption of the
musculotendinous junction, often with retraction
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Treatment options depend on the location and
severity of the injury
Melbourne, Australia 01/06
Kim Clijsters
The combined rotation and extension of the back
during serving places high demands on the back
Pars Stress Fracture
30% of adolescents involved in
sports will have an episode of
low back pain.
Lumbar spondylolysis is one
of the causes of LBP
in this age group of athletes.
Athletes involved in sports
requiring repetitive bending
and straightening of the spine
are most commonly affected
Most patients have excellent
clinical outcomes with
conservative measures, and
surgery is rarely necessary
Spondylolysis
R. Nadal at Queens Club, June 2006
Shoulder Pain in Athletes
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AC joint sprain
Calcific rotator cuff tendinopathy
Clavicle fracture
Dislocated shoulder
Adhesive capsulitis
Rotator cuff tear
Subacromial bursitis
Subacromial Impingement
Shoulder Impingement Syndrome
Adequate subacromial space
Narrowed subacromial space
Articular sided partial tear
High school varsity baseball pitcher-shoulder pain before end of the season games
Ulnar Sided Wrist Pain
Extensor Carpi Ulnaris(ECU) Tendinitis
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Related to racquet sports with repetitive wrist motion
 Squash
 Badminton
 Raquetball
 Tennis
 Rowing
Tennis player with two-handed backhand
using excessive ulnar deviation in
nondominant wrist
Players who hit with a lot of topspin are at
increased risk for extensor carpi ulnaris tendon injury
ECU Tendinitis – Tennis Wrist
Ganglion cyst + Carpal tunnel syndrome
Tennis Elbow
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Middle-aged female with a single-handed
backhand who leads with elbow
Straightens elbow and extends wrist on contact
Placing the wrist extensors under excessive
tension
Correct form – swinging from the shoulder with
a straight arm and using the entire body to
execute the stroke
TENNIS ELBOW
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A painful condition caused by
inflammation or small tears of
the wrist extensors and
tendons, esp. extensor carpi
radialis brevis rubbing over the
lateral epicondyle and the radial
head
Most experts believe that tennis
elbow is caused by overloading
of the forearm muscles due to
faulty backhand technique
LATERAL EPICONDILITIS
Lateral Epicondylitis
Lateral Epicondylitis - Mild
The backhand is generally found to be the prime
cause of tennis elbow in non-professionals due to
the complexity of this stroke. A bent elbow or
"swinging" just at the elbow and not the entire arm,
causes excess torques and forces in the elbow
region.
Other causes of tennis elbow are:
Late backhand stroke with hyper-extended wrist.
Too tight of grip.
Excessive wrist "pop" on overhand serve.
Forehand stroke with excessive wrist movement.
Using too many “topspin” shots.
Single vs. double-handed backhand
Electromyographic and cinematographic analysis
of elbow function in tennis players using singleand double-handed backhand strokes
It is generally believed that tennis players using a
double-handed backhand rarely develop lateral
epicondylitis since the helping arm appears to absorb
more energy and changes the mechanics of the swing.
Giangarra CE, et al, American Journal of Sports Medicine,
Vol 21, Issue 3 394-399.
Vania King (金久慈)
Racquet Selection to Avoid
Tennis Elbow
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Use a more flexible racquet made of graphite,
fiberglass, etc.
Use an oversized racquet with bigger “sweet
spot”
Use a heavier but comfortable racquet
Lower string tension by 10%
Correct grip size. Add a cushioned over grip.
Do not use extra-long racquet
If you followed all those tips that I gave you:
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There is no guarantee that you
will become a better tennis
player.
There is a good chance that
you will have a pain-free
elbow.
You will enjoy tennis better
and live your life happily after.
CONCLUSION
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Because of its superior soft tissue discrimination,
multiplanar capability, non-invasive, and nonradioactive nature, MR is well-suited for imaging
in sport medicine.
Understanding of mechanism of injuries would
enable better diagnosis and facilitate
management of sport injuries.
Patient education can be better achieved by
providing visual evidence of disease processes.