Role of Musculoskeletal Radiology in Modern Sports Medicine

John P. Hynes; John Walsh; T.P. Farrell; Aoife S. Murray; Stephen J. Eustace

doi:10.1055/s-0038-1672191

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2018; 22(05): 582-591
DOI: 10.1055/s-0038-1672191

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of Musculoskeletal Radiology in Modern Sports Medicine

John P. Hynes

¹Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland

,

John Walsh

¹Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland

²Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Republic of Ireland

,

T.P. Farrell

¹Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland

²Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Republic of Ireland

,

Aoife S. Murray

¹Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland

,

Stephen J. Eustace

¹Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland

²Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Republic of Ireland

› Author Affiliations

Abstract

Musculoskeletal radiology's role in the recent and continued evolution of sports medicine is an exciting and expanding one. In this article we explore a variety of the ways that musculoskeletal radiology contributes to current practices in modern sports medicine, discussing advances across a variety of imaging modalities in the care of both elite athletes and so-called weekend warriors. We describe the technical and ethical factors pertaining to image-guided therapeutic intervention in athletes and speculate on the potential for future developments in the role of imaging in deciding when an athlete may return to participation. We also explore the recent shift to the delivery of imaging facilities at sporting events and in stadiums.

Keywords

sports medicine - return to play - pitch-side radiology - image-guided intervention

Full Text

References

References
1 Parker L, Nazarian LN, Carrino JA. , et al. Musculoskeletal imaging: medicare use, costs, and potential for cost substitution. J Am Coll Radiol 2008; 5 (03) 182-188
2 Coris EE, Zwygart K, Fletcher M, Pescasio M. Imaging in sports medicine: an overview. Sports Med Arthrosc Rev 2009; 17 (01) 2-12
3 Hughes RJ, Houlihan-Burne DG. Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol 2011; 15 (01) 69-88
4 Dijkstra HP, Pollock N, Chakraverty R, Alonso JM. Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med 2014; 48 (07) 523-531
5 Dijkstra HP, Pollock N. The role of the specialist sports medicine physician in elite sport. Managing athlete health while optimising performance—a track and field perspective. Aspetar Sports Med J 2014; 3: 24-31
6 Tok F, Özçakar L, De Muynck M, Kara M, Vanderstraeten G. Musculoskeletal ultrasound for sports injuries. Eur J Phys Rehabil Med 2012; 48 (04) 651-663 ; quiz 707
7 Levin DC, Rao VM. Turf wars in radiology: challenges leveled at our specialty and how to respond to them. J Am Coll Radiol 2007; 4 (07) 492-493
8 Bethapudi S, Budgett R, Engebretsen L, O'Connor P. Imaging at London 2012 summer Olympic Games: analysis of demand and distribution of workload. Br J Sports Med 2013; 47 (13) 850-856
9 Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 2015; 49 (16) 1042-1049
10 Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med 2016; 50 (07) 392-396
11 Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: a systematic review and meta-analysis. Semin Arthritis Rheum 2015; 45 (03) 374-378
12 Finnoff JT. The evolution of diagnostic and interventional ultrasound in sports medicine. PM R 2016; 8 (3, Suppl): S133-S138
13 Finnoff JT, Hall MM, Adams E. , et al. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med 2015; 49: 151
14 Finnoff J, Lavallee ME, Smith J. Musculoskeletal ultrasound education for sports medicine fellows: a suggested/potential curriculum by the American Medical Society for Sports Medicine. Br J Sports Med 2010; 44 (16) 1144-1148
15 Fritz J, Niemeyer T, Clasen S. , et al. Management of chronic low back pain: rationales, principles, and targets of imaging-guided spinal injections. Radiographics 2007; 27 (06) 1751-1771
16 Granhed H, Morelli B. Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med 1988; 16 (05) 530-533
17 Swärd L, Hellström M, Jacobsson B, Nyman R, Peterson L. Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine 1991; 16 (04) 437-443
18 Fett D, Trompeter K, Platen P. Back pain in elite sports: a cross-sectional study on 1114 athletes. PLoS One 2017; 12 (06) e0180130
19 Hainline B. Low back injury. Clin Sports Med 1995; 14 (01) 241-265
20 McCarroll JR, Miller JM, Ritter MA. Lumbar spondylolysis and spondylolisthesis in college football players. A prospective study. Am J Sports Med 1986; 14 (05) 404-406
21 Newlands C, Reid D, Parmar P. The prevalence, incidence and severity of low back pain among international-level rowers. Br J Sports Med 2015; 49 (14) 951-956
22 van Hilst J, Hilgersom NF, Kuilman MC, Kuijer PP, Frings-Dresen MH. Low back pain in young elite field hockey players, football players and speed skaters: prevalence and risk factors. J Back Musculoskeletal Rehabil 2015; 28 (01) 67-73
23 Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain 1997; 13 (04) 285-302
24 Gangi A, Dietemann JL, Mortazavi R, Pfleger D, Kauff C, Roy C. CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics 1998; 18 (03) 621-633
25 Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 1996; 21 (16) 1889-1892
26 Rosenberg JM, Quint TJ, de Rosayro AM. Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 2000; 16 (01) 18-21
27 Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002; 27 (01) 11-16
28 Riew KD, Park JB, Cho YS. , et al. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am 2006; 88 (08) 1722-1725
29 Bethapudi S, Ritchie D, Bongale S, Gordon J, MacLean J, Mendl L. Data analysis and review of radiology services at Glasgow 2014 Commonwealth Games. Skeletal Radiol 2015; 44 (10) 1477-1483
30 Jacobson JA, Bedi A, Sekiya JK, Blankenbaker DG. Evaluation of the painful athletic hip: imaging options and imaging-guided injections. AJR Am J Roentgenol 2012; 199 (03) 516-524
31 Siragusa DA, Cardella JF, Hieb RA. , et al; Society of Interventional Radiology. Requirements for training in interventional radiology. J Vasc Interv Radiol 2013; 24 (11) 1609-1612
32 Van der Wall H, Lee A, Magee M, Frater C, Wijesinghe H, Kannangara S. Radionuclide bone scintigraphy in sports injuries. Semin Nucl Med 2010; 40 (01) 16-30
33 Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF. Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc Rev 2011; 19 (02) 174-181
34 Matesan M, Behnia F, Bermo M, Vesselle H. SPECT/CT bone scintigraphy to evaluate low back pain in young athletes: common and uncommon etiologies. J Orthop Surg 2016; 11 (01) 76
35 Pelletier-Galarneau M, Martineau P, Gaudreault M, Pham X. Review of running injuries of the foot and ankle: clinical presentation and SPECT-CT imaging patterns. Am J Nucl Med Mol Imaging 2015; 5 (04) 305-316
36 Orenstein B. Imaging in the NFL. Radiology Today 2015;16(10):12. Available at: http://www.radiologytoday.net/archive/rt1015p12.shtml . Accessed March 25, 2018
37 Versey NG, Halson SL, Dawson BT. Water immersion recovery for athletes: effect on exercise performance and practical recommendations. Sports Med 2013; 43 (11) 1101-1130
38 Guermazi A, Hayashi D, Jarraya M. , et al. Sports injuries at the Rio de Janeiro 2016 Summer Olympics: use of diagnostic imaging services. Radiology 2018; 287 (03) 922-932
39 Your guide to medical imaging equipment. Available at: https://info.blockimaging.com/bid/92623/mri-machine-cost-and-price-guide
40 Orchard JW. The use of match day imaging in professional sport. Br J Sports Med 2010; 44 (16) 1134
41 Orchard J. The use of local anaesthetic injections in professional football. Br J Sports Med 2001; 35 (04) 212-213
42 World Rugby. Player welfare: putting players first. Available at: http://playerwelfare.worldrugby.org/?subsection=53
43 Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North America 2000; 18 (02) 217-233 , v
44 Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog 2012; 59 (02) 90-101 ; quiz 102–103
45 Reynolds F. Adverse effects of local anaesthetics. Br J Anaesth 1987; 59 (01) 78-95
46 Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol 2003; 91 (04) 342-345
47 Ekman EF, Koman LA. Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management. Instr Course Lect 2005; 54 (06) 21-33
48 Nepple JJ, Matava MJ. Soft tissue injections in the athlete. Sports Health 2009; 1 (05) 396-404
49 Orchard JW. Benefits and risks of using local anaesthetic for pain relief to allow early return to play in professional football. Br J Sports Med 2002; 36 (03) 209-213
50 Orchard JW, Steet E, Massey A, Dan S, Gardiner B, Ibrahim A. Long-term safety of using local anesthetic injections in professional rugby league. Am J Sports Med 2010; 38 (11) 2259-2266
51 Nelson C. Anesthetic injections in football: an ethical dilemma. Sports Med Dig 2001; 23: 133
52 Arliani GG, Astur DC, Yamada RKF. , et al. Early osteoarthritis and reduced quality of life after retirement in former professional soccer players. Clinics (Sao Paulo) 2014; 69 (09) 589-594
53 Kuijt MT, Inklaar H, Gouttebarge V, Frings-Dresen MH. Knee and ankle osteoarthritis in former elite soccer players: a systematic review of the recent literature. J Sci Med Sport 2012; 15 (06) 480-487
54 Iosifidis MI, Tsarouhas A, Fylaktou A. Lower limb clinical and radiographic osteoarthritis in former elite male athletes. Knee Surg Sports Traumatol Arthrosc 2015; 23 (09) 2528-2535
55 Vigdorchik JM, Nepple JJ, Eftekhary N, Leunig M, Clohisy JC. What is the association of elite sporting activities with the development of hip osteoarthritis?. Am J Sports Med 2017; 45 (04) 961-964
56 Orchard JW. Is it safe to use local anaesthetic painkilling injections in professional football?. Sports Med 2004; 34 (04) 209-219
57 Houston JM, Carter D, Smither RD. Competitiveness in elite professional athletes. Perceptual Motor Skills 1997; 84 (03) 1447-1454
58 The World Anti-Doping Code: International Standard. Available at: https://www.wada-ama.org/sites/default/files/prohibited_list_2018_en.pdf
59 Union Cycliste Internationale. Available at: http://www.uci.ch/clean-sport/therapeutic-use-exemptions
60 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (02) CD005328
61 Minetto M, Rainoldi A, Gazzoni M. , et al. Differential responses of serum and salivary interleukin-6 to acute strenuous exercise. Eur J Appl Physiol 2005; 93 (5-6): 679-686
62 Piazza PV, Rougé-Pont F, Deroche V, Maccari S, Simon H, Le Moal M. Glucocorticoids have state-dependent stimulant effects on the mesencephalic dopaminergic transmission. Proc Natl Acad Sci U S A 1996; 93 (16) 8716-8720
63 Soetens E, De Meirleir K, Hueting JE. No influence of ACTH on maximal performance. Psychopharmacology (Berl) 1995; 118 (03) 260-266
64 Duclos M. Glucocorticoids: a doping agent?. Endocrinol Metab Clin North Am 2010; 39 (01) 107-126 , ix–x
65 Armstrong RD, English J, Gibson T, Chakraborty J, Marks V. Serum methylprednisolone levels following intra-articular injection of methylprednisolone acetate. Ann Rheum Dis 1981; 40 (06) 571-574
66 Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018; 6 (02) 2325967118756576
67 Jüni P, Hari R, Rutjes AW. , et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev 2015; (10) CD005328
68 Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5 (03) 351-361
69 Lavelle W, Lavelle ED, Lavelle L. Intra-articular injections. Anesthesiol Clin 2007; 25 (04) 853-862 , viii
70 Pal B, Morris J. Perceived risks of joint infection following intra-articular corticosteroid injections: a survey of rheumatologists. Clin Rheumatol 1999; 18 (03) 264-265
71 Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med 2015; 3 (05) 2325967115581163
72 Uthman I, Raynauld JP, Haraoui B. Intra-articular therapy in osteoarthritis. Postgrad Med J 2003; 79 (934) 449-453
73 Dvorak J, Feddermann N, Grimm K. Glucocorticosteroids in football: use and misuse. Br J Sports Med 2006; 40 (Suppl. 01) i48-i54
74 Keagy RD, Keim HA. Intra-articular steroid therapy: repeated use in patients with chronic arthritis. Am J Med Sci 1967; 253 (01) 45-51
75 Nichols AW. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med 2005; 15 (05) 370-375
76 Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994; 309 (6948): 184-188
77 Whitney SN, McGuire AL, McCullough LB. A typology of shared decision making, informed consent, and simple consent. Ann Intern Med 2004; 140 (01) 54-59
78 Dunn WR, George MS, Churchill L, Spindler KP. Ethics in sports medicine. Am J Sports Med 2007; 35 (05) 840-844
79 Fredberg U. Local corticosteroid injection in sport: review of literature and guidelines for treatment. Scand J Med Sci Sports 1997; 7 (03) 131-139
80 Available at: https://www.wada-ama.org/sites/default/files/resources/files/wada_anti-doping_code_2018_english_final.pdf . Accessed September 21, 2018
81 Caldwell JR. Intra-articular corticosteroids. Guide to selection and indications for use. Drugs 1996; 52 (04) 507-514
82 Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, Austin SB. Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion. J Athl Train 2015; 50 (09) 944-951
83 Testoni D, Hornik CP, Smith PB, Benjamin Jr DK, McKinney Jr RE. Sports medicine and ethics. Am J Bioeth 2013; 13 (10) 4-12
84 Shah VM, Andrews JR, Fleisig GS, McMichael CS, Lemak LJ. Return to play after anterior cruciate ligament reconstruction in National Football League athletes. Am J Sports Med 2010; 38 (11) 2233-2239
85 Casagranda BU, Thurlow PC. The role of imaging in determining return to play. Radiol Clin North Am 2016; 54 (05) 979-988
86 Dijkstra HP, Pollock N, Chakraverty R, Ardern CL. Return to play in elite sport: a shared decision-making process. Br J Sports Med 2017; 51 (05) 419-420
87 Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355 (9216): 1670-1674
88 Rosenkrantz AB, Kim S, Lim RP. , et al. Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. Radiology 2013; 269 (02) 482-492
89 Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15 (04) 827-832
90 Fournier-Farley C, Lamontagne M, Gendron P, Gagnon DH. Determinants of return to play after the nonoperative management of hamstring injuries in athletes: a systematic review. Am J Sports Med 2016; 44 (08) 2166-2172
91 Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39 (06) 1226-1232
92 Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med 2005; 15 (06) 436-441
93 Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol 2002; 179 (06) 1621-1628
94 Connell DA, Schneider-Kolsky ME, Hoving JL. , et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 2004; 183 (04) 975-984
95 Schneider-Kolsky ME, Hoving JL, Warren P, Connell DA. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med 2006; 34 (06) 1008-1015
96 Cohen SB, Towers JD, Zoga A. , et al. Hamstring injuries in professional football players: magnetic resonance imaging correlation with return to play. Sports Health 2011; 3 (05) 423-430
97 Reurink G, Brilman EG, de Vos RJ. , et al. Magnetic resonance imaging in acute hamstring injury: can we provide a return to play prognosis?. Sports Med 2015; 45 (01) 133-146
98 Bowman Jr KF, Cohen SB, Bradley JP. Operative management of partial-thickness tears of the proximal hamstring muscles in athletes. Am J Sports Med 2013; 41 (06) 1363-1371
99 Ward R, Caruthers S, Yablon C, Blake M, DiMasi M, Eustace S. Analysis of diffusion changes in posttraumatic bone marrow using navigator-corrected diffusion gradients. AJR Am J Roentgenol 2000; 174 (03) 731-734
100 Eustace S. General principles. In: Eustace S. , ed. Magnetic Resonance Imaging of Orthopedic Trauma. Philadelphia, PA: Lippincott Williams & Wilkins; 1999: 60-65
101 Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi M. MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol 2001; 56 (01) 4-12