Ultrasonography of the Lower Extremity: Sport-Related Injuries

By Ferdinando Draghi

This book provides a detailed overview of ultrasound imaging of sport-related injuries of the lower extremity. The available literature focuses mainly on either clinical aspects or all imaging modalities and clinical aspects of sport-related pathologies, with little relevance on ultrasound. Indeed, recent advances in ultrasound technology, including high resolution, electronic, broadband transducers, have led to improved assessment of the musculoskeletal system, and ultrasound is now considered an optimal imaging technique to evaluate musculoskeletal sport-related injuries. Its advantages include the ability to perform dynamic examinations essential for many diagnoses, such as intrasheath instability of the peroneal tendons.

Drawing on the author’s over 30 years of experience in clinical praxis, this book highlights the great potential of the ultrasonographic evaluation of sports-related injuries and is entirely devoted to this technique. Similar to the twoprevious monographs by the same author, the book has the form of an atlas-text, with a wealth of high-quality ultrasound images and schemes – a structure that has proved particularly effective for learning, especially for younger physicians.

Ultrasonography of the lower extremity: sport-related injuries combines the interests of various specialists, including radiologists, physiatrists, orthopedists, rheumatologists, and ultrasound technicians.

• Language: English
• Publisher: Springer
• Release date: Jun 28, 2019
• ISBN: 9783030149918

Book preview

© Springer Nature Switzerland AG 2019

Ferdinando DraghiUltrasonography of the Lower Extremityhttps://doi.org/10.1007/978-3-030-14991-8_1

1. Introduction

Ferdinando Draghi¹ 

(1)

Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

Content Overview

Football

Cycling

Ballet

Ski

Tennis

Basketball

Volleyball

Rugby

Baseball

Pediatric athlete

In recent years, due to the popularity of sports and training intensity, sports-related injuries have greatly increased in both amateur and professional athletes [1]. Some sports, due to their biomechanical characteristics, cause specific injuries, but the majority of injuries are common to many sports [2, 3], and most often affect joints, tendons [4], muscles [5], and bones of the lower extremity (Tables 1.1, 1.2, and 1.3). These sports-related injuries can be acute or chronic; acute injuries follow traumatic events, while chronic lesions may result from local repetitive microtrauma or the sequelae of an acute injury. History and clinical examination are essential to obtain a diagnosis. Nevertheless, an imaging modality is usually necessary to confirm the clinical suspicion, assess the extent of tissue damage, and help choose treatment. Ultrasound certainly has advantages; it is a cheap, noninvasive, and dynamic modality that allows accurate evaluation of the para-articular soft tissues, such as tendons and muscles, and can be considered the choice exam in many sports-related injuries.

Table 1.1

Sports-related injuries of muscles and tendons around the pelvis

Table 1.2

Sports-related injuries of muscles and tendons around the knee

Table 1.3

Sports-related injuries of muscles and tendons around the ankle

Soccer is the world’s most popular sports, and since it is a contact sports, injuries occur rather frequently and range from low-grade muscle strains to potentially career-ending ligamentous injuries. The lesions that are most often evaluated with ultrasound are those of the tendon [6, 7], myotendinous junction, and muscle. Muscle injuries in soccer generally affect the lower extremities, and the most frequent locations are hamstrings and quadriceps muscles [8–11]. Adductor muscle and tendon injuries are also frequents and result in groin pain [12–15]. Ultrasound is then of primary importance in the evaluation of the lateral ligamentous complex of ankle injuries.

Cycling accounts for the highest number of sports-related pathologies, which are quite varied, but the knee is most frequently affected (patellofemoral syndrome, patellar tendinopathy, quadriceps tendinopathy, iliotibial band syndrome, pes anserine tendinitis, biceps femoris tendinopathy, and bursitis) [16, 17]. Achilles tendinopathy is also frequent in cyclists; however, it is less frequent than tendinopathies of the knee. Ultrasonography is useful in these diseases for screening and treatment.

Musculoskeletal injuries are very common in ballet dancers, and the majority involve the hip, foot, or ankle [18, 19]. Assessment with dynamic ultrasound is recommended in most cases, including peroneal tendon subluxation [20, 21] and snapping hip [22, 23]. In other injuries, such as metatarsal stress fractures, the most common midfoot lesions encountered in ballet dancers, the role of ultrasound is limited and the final diagnosis is with magnetic resonance imaging (MRI).

Lower extremity injuries account for 54–57% of reported alpine skiing injuries [24], and medial collateral and anterior cruciate ligament sprains are the most common skiing-related injuries. MRI assessment provides very high sensitivity and specificity in the diagnosis of these injuries. The role of ultrasound is, instead, for the evaluation of chronic lesions, particularly of the tendons such as in jumper’s knee [25].

Tennis players have a higher prevalence of musculoskeletal injuries. Acute injuries are more common in the lower extremities [26], whereas chronic injuries are more often seen in the upper extremities. Ultrasound is the technique of choice to confirm clinically suspected lesions, including proximal adductor-gracilis syndrome, disorders of the hamstrings, asymmetric hypertrophy of the iliopsoas and gluteus muscles, lesions of the extensor mechanism of the knee, tennis leg, and overuse and traumatic injuries of the Achilles tendon.

Basketball is characterized by stopping and starting, sprints, and jumping. Thus, lower extremity injuries also predominate in this sports, particularly at the knee, foot, and ankle. Sonography is well suited for evaluation of overuse injuries and ankle sprains in basketball players [27, 28].

Volleyball is a noncontact game and injuries often result from blocking and spiking actions; most injuries involve lower extremities, primarily the ankle and the knee. Ultrasound is a powerful imaging tool to assess the tendons around the knee [29] and tendons and ligaments around the ankle joint.

Rugby players are particularly susceptible to chest injuries and injuries of vital internal organs, such as the heart, lungs, trachea, liver, and scrotum and large blood vessels that lie in close proximity to bony structures. Musculotendinous strains and tears, ankle/heel injuries, and groin/hip/buttock injuries are also very common [30]. Ultrasound may allow the simultaneous evaluation of muscles, tendons, articulations, parenchymatous organs, and scrotal injuries, while computed tomography (CT) and MRI are second-level examinations.

Baseball has one of the lowest injury rates in all of sports; upper extremity injuries are more common than those of the lower extremities. Lower extremity injuries, however, do occur [31] and range from sprains to fractures. They have the same characteristics as seen in other sports.

The spectrum of injuries incurred by the pediatric athlete is unique, but nearly 50% of them are overuse injuries [32]. In general, overuse occurs when training exceeds the body’s physiologic ability to compensate. Jumper’s knee, Osgood–Schlatter disease, and Sinding–Larsen–Johansson syndrome are the most common in the pediatric lower extremity. History and clinical examination are sufficient to obtain a diagnosis.

Ultrasonography is usually useful to confirm the clinical suspicion and assess the extent of damage.

Although sports can result in a wide spectrum of injuries, we should not make the mistake of not practicing it, because the alternative, a sedentary lifestyle, is the second leading cause of death in industrialized countries (after cigarette smoking).

Implication for Patient Care

Although sports can result in a wide spectrum of injuries, we should not make the mistake of not practicing it, because the alternative, a sedentary lifestyle, is the second leading cause of death in industrialized countries (after cigarette smoking).

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