Rectus abdominus tear in a collegiate cheerleader.

Acute muscle injuries can occur at all skill levels across multiple different sports. Imaging is often used for diagnosis and is necessary for recognizing the extent of injury, complications, and overall prognosis. Ultrasound can be used in diagnosing muscle tears. However, there are less than a dozen documented cases that use ultrasound in the evaluation and diagnosis of a rectus abdominus tear, though the actual number of cases are most likely underreported in the literature. This case discusses an 18-year-old college athlete that suffered a distal rectus abdominus tear after performing a stunt as a cheerleader and her subsequent treatment.

Isolated distal semitendinosus tendon tear in a collegiate athlete.

Complete distal semitendinosus tendon tears are rare hamstring injuries. They often present with a "pop" followed by delayed pain and swelling. We describe the case of a collegiate athlete with an isolated distal semitendinosus tendon tear diagnosed by MRI and ultrasound after being treated for a stress fracture of the anterior tibial shaft with an intramedullary nail. The tear progressed from partial to complete after 2 weeks of rehabilitation and return to practice. The patient was ultimately successfully treated with semitendinosus tenodesis.

Mommy's thumb: De Quervain's tenosynovitis in a new mother with cardiomyopathy.

Mommy's thumb is a lay term for de Quervain's tenosynovitis in mothers of newborn to young children. It is most commonly the result of carrying the child, leading to overuse of the wrist. Less commonly, it can also result from fluid retention resulting from lactational changes. We present a case report of a first-time mother presenting with bilateral de Quirvain's tenosynovitis which may be attributed to a previously undiagnosed cardiomyopathy leading to fluid retention.

Slipping rib syndrome presentation in a young woman.

Slipping rib syndrome (SRS) disorder is the hypermobility of the costal cartilages attached to the floating ribs. Causes include weakness of the interchondral ligaments, and less commonly congenital rib deformities or direct trauma. Due to its location (right upper quadrant) and symptomatic presentation, the differential for this syndrome is especially broad, and as a result, even though this syndrome may make up to 5% of visits for lower chest/upper abdominal pain, it is frequently underdiagnosed, and patients often undergo excessive workup. Treatment includes conservative management, physical therapy, intercostal nerve blocks and for refractory cases, surgical intervention. We describe a case of a 43-year-old female presenting with Slipping Rib Syndrome (SRS) that was confirmed with an ultrasound. In this case report, we discuss presentation of SRS, diagnostic maneuvers and image finding of SRS, and the treatment of SRS.

Imaging findings of a biopsy-proven desmoid tumor of the axilla in a young female.

Desmoid tumors (fibromatoses) are rare but locally aggressive tumors that do not metastasize. They are non-encapsulated, well-differentiated lesions made of fibroblasts and collagen, which mainly appear in the mesentery and abdominal wall. Rarely, these tumors can also occur in breasts, making up approximately 0.2% of all breast neoplasms. Treatment typically includes surgical excision and/or medical management. We describe a case of a 31-year-old female presenting with a mass in her left axilla that was biopsy proven to be a desmoid tumor. In this case report, we discuss the various imaging findings present on ultrasound, mammography, computed tomography, and magnetic resonance imaging.

Bilateral popliteal entrapment syndrome in a young athlete diagnosed with ultrasound.

Popliteal artery entrapment syndrome (PAES) occurs when the popliteal artery is compressed by abnormally developed or hypertrophied muscles adjacent to the popliteal fossa. When symptomatic, it most frequently presents with leg cramping while walking or running. We describe the case of an 18-year-old female runner presenting with claudication and exercise intolerance. After MRI was non-diagnostic, diagnostic ultrasound demonstrated that she had functional (Type VI) PAES. She subsequently underwent popliteal artery release surgery. Type VI PAES should be considered in young, healthy patients who present with claudication, particularly athletes.

Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear?

BACKGROUND: Patient-reported measures guide physicians in clinical decision making and therefore it is critical to determine what clinical factors are associated with these scores. Psychological and physical factors are commonly studied separately in patients with rotator cuff tears to determine their influence on outcomes. It is well established that psychological distress and scapular motion change in the presence of a symptomatic rotator cuff tear. However, these factors have not been studied simultaneously in a clinical setting to determine their association with shoulder outcome scores. QUESTION/PURPOSE: After controlling for relevant confounding variables, what physical and psychological factors are associated with better (1) American Shoulder and Elbow Surgeons (ASES) scores for function, (2) ASES pain scores, and (3) total ASES scores? METHODS: Fifty-nine patients with a potential symptomatic rotator cuff tear were recruited and agreed to participate in this cross-sectional study. Of those, 85% (50 of 59) met eligibility criteria for a primary diagnosis of an MRI-confirmed symptomatic partial-thickness or full-thickness rotator cuff tear without a history of shoulder surgery. Demographics, rotator cuff tear size, arm flexion, and clinical scapular motion during active arm flexion were evaluated by experienced examiners using standardized procedures. Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment form, which measures 11 different pain-related psychological distress symptoms. Three separate stepwise multiple linear regression analyses were performed for ASES pain, function, and total scores, with significance set at p < 0.05. RESULTS: This model found that ASES function scores were associated with four factors: older age, increased arm flexion, increased percentage of scapular external rotation during arm flexion, and increased scores for acceptance of chronic pain (adjusted r2 = 0.67; p = 0.01). Those four factors appear to explain 67% of the observed variance in ASES function scores in patients with rotator cuff tears. Furthermore, increased percentage of scapular external rotation during arm flexion and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.36; p < 0.01) were associated with better ASES pain scores. And finally, better ASES total scores were associated with four factors: increased arm flexion, increased percentage of scapular upward rotation, increased scapular external rotation during arm flexion, and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.65; p < 0.001). CONCLUSION: Our results favor adopting a comprehensive biopsychological clinical assessment for patients with rotator cuff tears that specifically includes humeral and scapular motion, fear-avoidance behaviors, and pain coping behaviors along with demographics. These particular physical and psychological variables were found to be associated with the ASES and, therefore, should be clinically examined simultaneously and targeted as part of a tailored treatment plan. LEVEL OF EVIDENCE: Level II, prognostic study.

FDG PET of alveolar soft part sarcoma.

Alveolar soft part sarcoma (ASPS) is a very rare, but distinctive type of soft tissue sarcoma, whose name is derived from the pseudoalveolar appearance of its histology. In this report, the FDG PET/CT findings of ASPS are described in a 17-year-old asthmatic female who presented with worsening respiratory symptoms and a pelvic mass. The staging PET showed heterogeneous intense incorporation of FDG within the mass and variable FDG incorporation within the multiple lung nodules. In concordance with other soft tissue sarcomas, PET/CT helped to confirm the anatomic origin of the ASPS, to direct its biopsy, and to assess the distribution of disease.