Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?

OBJECTIVE: Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. RESULTS: Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. CONCLUSIONS: Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.

Use of computed tomography and magnetic resonance imaging for occult neck of femur fractures: A single-centre study.

OBJECTIVE: Neck of femur (NOF) fractures are common and serious injuries in the elderly. When a NOF fracture is suspected but is not clearly visible on radiographs, guidelines recommend magnetic resonance imaging (MRI), or computed tomography (CT) if MRI is not available/contraindicated. The aim of our study was to review the use of CT and subsequent MRI for suspected NOF fractures in patients with negative or equivocal radiographs. METHODS: A retrospective review of adult patients with negative or equivocal plain radiographs with suspected NOF fractures presenting between 1 July 2015 and 30 June 2017 was performed. Review of CT and subsequent MRI studies was performed with documentation of reported findings, time intervals from plain radiographs to CT and MRI and final outcomes. RESULTS: A total of 184 CT studies in 181 patients were reviewed; median age was 82 years (interquartile range 71-89 years) with 110 (60.8%) female patients. CT reported 20 occult fractures; all proceeded to surgery. MRI was performed in 23 patients and revealed additional four NOF fractures missed by CT. An additional fifth fracture missed by CT was confirmed by follow-up radiographs. Median time was approximately 4 h from radiographs to CT and approximately 56 h from radiographs to MRI. CONCLUSION: Access to CT for evaluation of suspected occult NOF fractures is much quicker compared to MRI. When CT results are negative with on-going clinical suspicion of an occult fracture, MRI should be performed in a time efficient manner.

MRI does not effectively diagnose ulnar-sided wrist pain in elite tennis players.

OBJECTIVES: Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players using a double-handed backhand technique. This study investigated the radiological changes of the non-dominant wrist in elite symptomatic and asymptomatic players using this technique as well as healthy controls. We compared clinical findings to radiological abnormalities. DESIGN: Cross-sectional design with blinded radiological assessment, and contemporaneous clinical assessment of symptomatic players. METHODS: Magnetic resonance images (MRI) of wrists related to non-dominant ulnar-sided pain, were taken in 14 symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls which were then independently reviewed for abnormalities by blinded radiologists. Total abnormalities and global between-group differences in the triangular fibrocartilage complex (TFC), ulnar collateral ligament (UCL), extensor carpi ulnaris (ECU) and supporting structures, osseous-articular lesions and ganglia were assessed. These were then compared to clinical examinations of the symptomatic players to assess agreement. RESULTS: Symptomatic players reported a mean 3.64 abnormalities, being exactly 1 abnormality greater than asymptomatic players (2.64) and controls (2.50), suggesting similar asymptomatic lesions in all three groups. Players with pain reported significantly more osseous-articular lesions, ECU tendon and dorsal radio-ulnar ligament abnormalities, while changes to the UCL may reflect an isolated problem in specific wrists. There were no between-group differences in the presence of ganglia, most TFC structures nor ECU subsheath tear and subluxation. CONCLUSIONS: Clinicians should carefully consider radiological changes alongside their clinical diagnosis of non-dominant wrist pain in tennis players due to possible tennis-related changes and/or asymptomatic findings.

Lumbar spine abnormalities and facet joint angles in asymptomatic elite junior tennis players.

BACKGROUND: Lumbar spine abnormalities, in particular stress fractures to the pars interarticularis, are common in elite junior tennis players, though the difference in prevalence between males and females remains unclear. Further, facet joint orientation appears to be a possible option for recognizing which players might go on to present with a pars stress fracture. Given the link between pars stress fractures and low back pain in tennis players, it appears logical to explore the link between facet joint angle and pars abnormalities. Thus, the purpose of this study was to describe the prevalence of lumbar spine abnormalities and explore the relationship between facet joint orientation and pars abnormalities in elite adolescent tennis players. METHODOLOGY: Lumbar spine MRI images of 25 elite junior tennis players were obtained and distributed between five radiologists for analysis. Descriptive comparisons and confidence intervals were used to describe the prevalence of the abnormalities. A generalized linear regression model was conducted to investigate the relationship between lumbar pars abnormalities and lumbar facet joint angles. RESULTS: Sixteen (64%) of 25 players were found to have at least one lumbar spine abnormality. Pars abnormalities affected 36% of players while bone marrow edema was found in 24% of players. Disc herniation, disc degeneration, and facet joint degeneration were diagnosed in 20%, 44%, and 24% of players respectively. Lastly, one player (4%) was diagnosed with spondylolisthesis. Females had significantly larger facet joint angles across L3/4 L5/S1 compared to males (p < 0.01). Further, those who had pars abnormalities had larger facet joint angles compared to those who did not (p < 0.001). CONCLUSION: Disc degeneration, pars abnormalities, including bone marrow edema, and facet joint degeneration were common findings among elite adolescent tennis players. Additionally, this study is the first to discover that pars abnormalities are linked to facet joint angle in elite adolescent tennis players. This finding might assist in identifying tennis players at a greater risk of developing lumbar spine pars abnormalities in the future.

Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy.

BACKGROUND: Diagnosis of patellar tendinopathy is based primarily on clinical examination; however, it is commonplace to image the patellar tendon for diagnosis confirmation, with the imaging modalities of choice being magnetic resonance imaging (MRI) and ultrasonography (US). The comparative accuracy of these modalities has not been established. HYPOTHESIS: Magnetic resonance imaging and US have good (>80%) accuracy and show substantial agreement in confirming clinically diagnosed patellar tendinopathy. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Magnetic resonance imaging and US (gray scale [GS-US] and color Doppler [CD-US]) features of 30 participants with clinically diagnosed patellar tendinopathy and 33 activity-matched, asymptomatic participants were prospectively compared. Accuracy, sensitivity, specificity, positive and negative predictive values, and the likelihood of positive and negative test results were determined for each technique. RESULTS: The accuracy of MRI, GS-US, and CD-US was 70%, 83%, and 83%, respectively (P = .04; MRI vs GS-US). The likelihood of positive MRI, GS-US, and CD-US was 3.1, 4.8, and 11.6, respectively. The MRI and GS-US had equivalent specificity (82% vs 82%; P = 1.00); however, the sensitivity of GS-US was greater than MRI (87% vs 57%; P = .01). Sensitivity (70% vs 87%; P = .06) and specificity (94% vs 82%; P = .10) did not differ between CD-US and GS-US. CONCLUSIONS: Ultrasonography was more accurate than MRI in confirming clinically diagnosed patellar tendinopathy. GS-US and CD-US may represent the best combination for confirming clinically diagnosed patellar tendinopathy because GS-US had the greatest sensitivity, while a positive CD-US test result indicated a strong likelihood an individual was symptomatic.

MRI of stress reaction of the distal humerus in elite tennis players.

OBJECTIVE: The purpose of this study was to describe the MRI appearance of stress reaction in the distal humerus in 12 elite tennis players. In addition, we aimed to determine whether any MRI findings were associated with changes in recovery times. CONCLUSION: Stress injury to the distal humerus is a cause of chronic arm pain among elite tennis players and may be exacerbated during full competition. The degree of marrow edema on STIR MRI may be predictive of time to return to competition.

MRI findings of femoroacetabular impingement.

OBJECTIVE: The purpose of our study was to evaluate MRI in the identification of labral and articular cartilage lesions in patients with a clinical suspicion of femoroacetabular impingement. MATERIALS AND METHODS: Preoperative MRI was performed in 46 consecutive patients (26 men, 20 women; age range, 21-45 years; mean age, 32.3 years) for whom femoroacetabular impingement was clinically suspected. Two musculoskeletal radiologists independently assessed the MR images for the presence and anatomic site of labral disorders, labral-chondral transitional zone disorders, femoral cartilage lesions, and acetabular cartilage lesions. Surgical correlation was obtained in all cases by two surgeons who were experienced in hip arthroscopy. RESULTS: Seven patients showed labral tears on MRI that were confirmed surgically in all cases. Thirty-seven patients (97%) of the 38 surgically confirmed cases had lesions of the labral-chondral transitional zone on MRI. The sites of labral-chondral transitional zone abnormalities at arthroscopy were 50% anterosuperior, 36% anterosuperior and superolateral, 11% superolateral, and 3% superolateral and posterosuperior. The site was identified correctly in 92% (reviewer 1) and 95% (reviewer 2) of cases on MRI. Separate acetabular cartilage abnormality was surgically identified in 39% of cases, and femoral cartilage lesions were found in 20%. The acetabular chondral lesions were correctly identified in 89-94% of cases. CONCLUSION: MRI provides a useful assessment of patients in whom a femoroacetabular impingement is clinically suspected. A high-resolution, nonarthrographic technique can provide preoperative information regarding the presence and anatomic site of labral and cartilage abnormalities.

MR imaging findings of acetabular dysplasia in adults.

OBJECTIVE: To evaluate the diagnostic accuracy of MR imaging in the identification of labral and articular cartilage lesions in patients with acetabular dysplasia. DESIGN AND PATIENTS: Pre-operative MR imaging was performed on 27 hips in 25 consecutive patients (16 males, 9 females, age range 19-52 years, mean age 31.2 years) with radiographic evidence of acetabular dysplasia (centre-edge angle of Wiberg <20 degrees). The average duration of symptoms was 16.2 months. Two musculoskeletal radiologists assessed MR images in consensus for the presence of abnormality involving the acetabular labrum and adjacent acetabular articular cartilage. A high resolution, non-arthrographic technique was used to assess the labrum and labral chondral transitional zone. Surgical correlation was obtained in all cases by a single surgeon experienced in hip arthroscopy and ten patients with normal hip MRI were included to provide a control group. RESULTS: The acetabular labra in the dysplastic hips demonstrated abnormal signal intensity, and had an elongated appearance when compared with the control group (mean length 10.9 mm vs 6.4 mm). Morphological appearances in the labra included surface irregularity, fissures and cleft formation. MR imaging correctly identified the severity of chondral abnormality in 24 of 27 hips (89%) when compared with arthroscopic findings. CONCLUSIONS: MR imaging demonstrates an elongated labrum, focal intra-substance signal change and irregularity and fissuring of the margins in patients with acetabular dysplasia. Abnormality is also identified at the labral chondral transitional zone, where fissuring, focal clefts, chondral deficiency and subchondral cyst formation may be apparent. A high-resolution, non-arthrographic technique can provide an accurate preoperative assessment and evaluate the presence of premature osteoarthritis.

Painful diabetic mastopathy as a reason for mastectomy.

A 34 year old woman with longstanding insulin-dependent diabetes mellitus experienced disabling bilateral breast pain and tenderness associated with the benign breast lesions of diabetic mastopathy. Diabetic mastopathy is typically associated with nontender lesions, however we present a case where disabling pain and tenderness lead to bilateral mastectomy, as requested by the patient. This relieved the patient of her symptoms.

False-positive breast screening due to fat necrosis following mammography.

Traumatic fat necrosis can result in a spectrum of imaging appearances that range from characteristically benign to those indistinguishable from malignancy. In such cases, biopsy might be required for diagnosis. The present case demonstrates a suspicious mammographic mass lesion appearing following a haematoma caused by a previous screening mammogram.

Fourteen-gauge needle core biopsy of mammographically evident radial scars: is excision necessary?

BACKGROUND: Radial scars are benign lesions that may mimic breast carcinoma on mammography and usually are managed by excision biopsy. The authors report their experience with stereotactic needle core biopsy (SNCB) in sampling these lesions. METHODS: A prospective study examined a consecutive series of 75 mammographically detected radial scars from a population-based screening program. In patients who were sampled by SNCB followed by surgical biopsy, the histologic findings of core biopsy and the gold standard of excision biopsy were compared. RESULTS: Sixty-three patients were sampled by core biopsy: SNCB was used in 55 patients (87.0%), and ultrasound-guided needle core biopsy (UNCB) was used in 8 patients (13%). One patient who underwent SNCB did not undergo a follow-up excision biopsy. Radial scars were diagnosed preoperatively by core biopsy in 51 of 62 patients who underwent excision (82%; 95% confidence interval [95%CI], 70-91%). The sensitivity for SNCB was 85% (95%CI, 73-94%), and the sensitivity for UNCB was 63% (95%CI, 24-91%). Of 54 patients who underwent SNCB and excision, 4 patients had coexistent ductal carcinoma in situ (DCIS) at the time they underwent surgical excision: SNCB identified DCIS in 1 patient and identified atypical ductal hyperplasia (ADH) in 3 patients. In the entire group of 75 radial scars, 5 scars were associated with DCIS (7%), and there were no invasive carcinomas. ADH was present in association with 42 of 74 radial scars that were excised surgically (57%). Twenty-nine of those radial scars were sampled preoperatively by SNCB. ADH was found in 21 patients (72%; 95CI, 53-87%). CONCLUSIONS: The sensitivity of SNCB in the identification of radial scars was 85%. In four patients with associated DCIS, SNCB revealed either ADH or DCIS, both of which required excision. These findings suggest that patients with SNCB-proven radial scars among a screened population can be managed safely by mammographic follow-up, provided there is no associated DCIS, ADH, or lobular carcinoma in situ. Spiculated abnormalities with discordant SNCB results require surgical biopsy.

Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries.

OBJECTIVE: We compared sonography and MRI for assessing hamstring injuries in professional football players (Australian football) 3 days, 2 weeks, and 6 weeks after an injury and identified imaging characteristics at baseline that may be useful in predicting the time needed for return to competition. MATERIALS AND METHODS: Sixty men who are professional football players presented with suspected acute hamstring strain underwent sonography and MRI within 3 days of injury; those who were injured returned 2 and 6 weeks later for follow-up MRI and sonography. Two radiologists interpreted either the MR images or the sonograms and were blinded to the results of the other technique. The following six parameters were measured at each assessment: the muscle injured, the site of injury within the muscle, the longitudinal injury length (expressed in millimeters), the cross-sectional injured area (expressed as a percentage), and the presence of interand intramuscular hematoma. RESULTS: At baseline, MRI identified abnormalities in 42 (70.0%) of 60 patients, whereas sonography found abnormalities in 45 (75%) of 60. At 2 weeks, 29 (59.2%) of 49 scans showed abnormalities on MRI and 25 (51.0%) of 49 showed abnormalities on sonograms. Of those players who were injured at baseline, 15 (35.7%) of 42 and 10 (22.2%) of 45 still showed abnormal results on scans at 6 weeks on MRI and sonography, respectively. However, all but one player had returned to competition. The biceps femoris was the most commonly injured muscle and the musculotendinous junction was the most common site of injury. Injuries appeared significantly larger on MRI than on sonography at all time points. Our analysis showed that at baseline, the longitudinal length of hamstring tear on MRI had the highest statistical correlation with recovery (r = 0.58, p < 0.0001) and was the best radiologic predictor for return to competition. CONCLUSION: Sonography is as useful as MRI in depicting acute hamstring injuries and because of lower costs may be the preferred imaging technique. However, MRI is more sensitive for follow-up imaging of healing injuries. The longitudinal length of the strain as measured on MRI is a strong predictor for the amount of time needed until an athlete can return to competition.