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Semin Musculoskelet Radiol 2004; 8(1): 17-27
DOI: 10.1055/s-2004-823012
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound in Sports Medicine

Carolyn M. Sofka1 , 2
  • 1Department of Radiology, Weill Medical College of Cornell University
  • 2Department of Radiology, Hospital for Special Surgery, New York, NY
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Publication History

Publication Date:
13 April 2004 (online)

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The accuracy of sonography in evaluating various conditions of the musculoskeletal system has been demonstrated and its utility as a primary diagnostic imaging modality in the musculoskeletal system in the United States has been increasing in frequency. Sonography is universally tolerated across a broad patient population, including pediatric and pregnant patients and those in whom traditional magnetic resonance (MR) imaging is not an option, due either to absolute or relative contraindications. Sonographic examinations are relatively quick compared with an MR or computed tomographic study, and delays in scheduling are therefore minimal, an advantage for those patients who have traveled a long distance or who are in a considerable amount of discomfort at the time of their visit to the orthopedic surgeon. With portable ultrasound units, examinations can be performed on the playing field, immediately at the time of the acute injury, for rapid diagnosis. Lastly, ultrasound can be used to guide for therapeutic procedures at the same time the diagnostic exam is performed.

KEYWORDS

Ultrasound - musculoskeletal imaging - therapeutic interventions

REFERENCES

  • 1 Jacobson J A. Ultrasound in sports medicine.  Radiol Clin North Am. 2002;  40 363-386
    CrossrefPubMedGoogle Scholar
  • 2 Erickson S J. High-resolution imaging of the musculoskeletal system.  Radiology. 1997;  205 593-618
    PubMedGoogle Scholar
  • 3 Entrekin R R, Porter B A, Sillesen H H, Wong A D, Cooperberg P L, Fix C H. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound.  Semin Ultrasound CT MR. 2001;  22 50-64
    PubMedGoogle Scholar
  • 4 Crass J R, van de Vegte G L, Harkavy L A. Tendon echogenicity: ex vivo study.  Radiology. 1988;  167 499-501
    PubMedGoogle Scholar
  • 5 Martinoli C, Derchi L E, Pastorino C, Bertolotti M, Silvestri E. Analysis of echotexture of tendons with ultrasound.  Radiology. 1993;  186 839-843
    PubMedGoogle Scholar
  • 6 Lin E C, Middleton W D, Teefey S A. Extended field of view sonography in musculoskeletal imaging.  J Ultrasound Med. 1999;  18 147-152
    PubMedGoogle Scholar
  • 7 Barberie J E, Wong A D, Cooperberg P L, Carson B W. Extended field-of-view sonography in musculoskeletal disorders.  AJR Am J Roentgenol. 1998;  171 751-757
    PubMedGoogle Scholar
  • 8 Newman J S, Adler R S. Power Doppler sonography: applications in musculoskeletal imaging.  Semin Musculoskelet Radiol. 1998;  2 331-339
    PubMedGoogle Scholar
  • 9 Newman J S, Adler R S, Bude R O, Rubin J M. Detection of soft-tissue hyperemia: value of power Doppler sonography.  AJR Am J Roentgenol. 1994;  163 385-389
    CrossrefPubMedGoogle Scholar
  • 10 Martinoli C, Pretolesi F, Crespi G et al.. Power Doppler sonography: clinical applications.  Eur J Radiol. 1998;  28(Suppl 2) S133-S140
    CrossrefPubMedGoogle Scholar
  • 11 Teefey S A, Hasan S A, Middleton W D, Patel M, Wright R W, Yamaguchi K. Ultrasonography of the rotator cuff: a comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases.  J Bone Joint Surg. 2000;  82A 498-504
    PubMedGoogle Scholar
  • 12 Van Holsbeeck M T, Kolowich P A, Eyler W R et al.. Ultrasound depiction of partial-thickness tear of the rotator cuff.  Radiology. 1995;  197 443-446
    PubMedGoogle Scholar
  • 13 Crass J R, Craig E V, Feinberg S B. The hyperextended internal rotation view in rotator cuff ultrasonography.  J Clin Ultrasound. 1987;  15 416-420
    CrossrefPubMedGoogle Scholar
  • 14 Middleton W D, Teefey S A, Yamaguchi K. Sonography of the shoulder.  Semin Musculoskelet Radiol. 1998;  2 211-221
    PubMedGoogle Scholar
  • 15 Lin J, Jacobson J A, Fessell D P, Weadock W J, Hayes C W. An illustrated tutorial of musculoskeletal sonography: part 2, upper extremity.  AJR Am J Roentgenol. 2000;  175 1071-1079
    PubMedGoogle Scholar
  • 16 Jiang Y, Zhao J, van Holsbeeck M T, Flynn M J, Ouyang X, Genant H K. Trabecular microstructure and surface changes in the greater tuberosity in rotator cuff tears.  Skeletal Radiol. 2002;  31 522-528
    CrossrefPubMedGoogle Scholar
  • 17 Teefey S A, Middleton W D, Bauer G S, Hildebolt C F, Yamaguchi K. Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears.  J Ultrasound Med. 2000;  19 377-381
    PubMedGoogle Scholar
  • 18 Bouffard J A, Lee S M, Dhanju J. Ultrasound of the shoulder.  Semin Ultrasound CT MR. 2000;  21 164-191
    CrossrefPubMedGoogle Scholar
  • 19 Jacobson J A, van Holsbeeck M T. Musculoskeletal ultrasonography.  Orthop Clin North Am. 1998;  29 135-167
    CrossrefPubMedGoogle Scholar
  • 20 Van Holsbeeck M T, Introcaso J H. Musculoskeletal Ultrasound, 2nd ed. St Louis, MO; Mosby, Inc 2001: 207
    Google Scholar
  • 21 Winter T C, Teefey S A, Middleton W D. Musculoskeletal ultrasound: an update.  Radiol Clin North Am. 2001;  39 465-483
    CrossrefPubMedGoogle Scholar
  • 22 Farin P U, Jaroma H, Harju A, Soimakallio S. Medial displacement of the biceps brachii tendon: evaluation with dynamic sonography during maximal external shoulder rotation.  Radiology. 1995;  195 845-848
    PubMedGoogle Scholar
  • 23 Ryu K N, Lee S W, Rhee Y G, Lim J H. Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography.  J Ultrasound Med. 1993;  12 445-449
    PubMedGoogle Scholar
  • 24 Taljanovic M S, Carlson K L, Kuhn J E, Jacobson J A, Delaney-Sathy L O, Adler R S. Sonography of the glenoid labrum: a cadaveric study with arthroscopic correlation.  AJR Am J Roentgenol. 2000;  174 1717-1722
    PubMedGoogle Scholar
  • 25 Schydlowsky P, Standberg C, Galatius S, Gam A. Ultrasonographic examination of the glenoid labrum of healthy volunteers.  Eur J Ultrasound. 1998;  8 85-89
    CrossrefPubMedGoogle Scholar
  • 26 Peetrons P, Rasmussen O S, Creteur V, Chhem R K. Ultrasound of the shoulder joint: non-“rotator cuff” lesions.  Eur J Ultrasound. 2001;  14 11-19
    CrossrefPubMedGoogle Scholar
  • 27 Hamar M V, Wintzell G B, Astrom K GO, Larsson S, Elvin A. Role of ultrasound in the preoperative evaluation of patients with anterior shoulder instability.  Radiology. 2001;  219 29-34
    PubMedGoogle Scholar
  • 28 Vanderschueren G, Prasad A, van Holsbeeck M. Ultrasound of the elbow.  Semin Musculoskelet Radiol. 1998;  2 223-235
    PubMedGoogle Scholar
  • 29 Connell D, Burke F, Coombes P et al.. Sonographic examination of lateral epicondylitis.  Am J Roentgenol. 2001;  176 777-782
    PubMedGoogle Scholar
  • 30 Falchook F S, Zlatkin M B, Erbacher G E, Moulton J S, Bisset G S, Murphy B J. Rupture of the distal tendon of the biceps tendon: evaluation with MR imaging.  Radiology. 1994;  190 659-663
    PubMedGoogle Scholar
  • 31 Fitzgerald S W, Curry D R, Erickson S J, Quinn S F, Friedman H. Distal biceps tendon injury: MR imaging diagnosis.  Radiology. 1994;  191 203-206
    PubMedGoogle Scholar
  • 32 D'Alessandro D F, Shields Jr C L, Tibone J E, Chandler R W. Repair of distal tendon ruptures in athletes.  Am J Sports Med. 1993;  21 114-119
    PubMedGoogle Scholar
  • 33 Miller T T, Adler R S. Sonography of tears of the distal biceps tendon.  Am J Roentgenol. 2000;  175 1081-1086
    PubMedGoogle Scholar
  • 34 Belli P, Costantini M, Mirk P, Leone A, Pastore G, Marano P. Sonographic diagnosis of distal biceps tendon rupture: a prospective study of 25 cases.  J Ultrasound Med. 2001;  20 587-595
    CrossrefPubMedGoogle Scholar
  • 35 Lozano V, Alonso P. Sonographic detection of the distal biceps tendon rupture.  J Ultrasound Med. 1995;  14 389-391
    PubMedGoogle Scholar
  • 36 De Smet A A, Winter T C, Best T M, Bernhardt D T. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.  Skeletal Radiol. 2002;  31 671-676
    CrossrefPubMedGoogle Scholar
  • 37 Markowitz R I, Davidson R S, Harty M P, Bellah R D, Hubbard A M, Rosenberg H K. Sonography of the elbow in infants and children.  Am J Roentgenol. 1992;  159 829-833
    PubMedGoogle Scholar
  • 38 Roberts C S, Beck Jr D J, Heinsen J, Seligson D. Diagnostic ultrasonography: applications in orthopaedic surgery.  Clin Orthop. 2002;  401 248-264
    CrossrefPubMedGoogle Scholar
  • 39 May D A, Disler D G, Jones E A, Pearce D A. Using sonography to diagnose an unossified medial epicondyle avulsion in a child.  Am J Roentgenol. 2000;  174 1115-1117
    PubMedGoogle Scholar
  • 40 Takahara M, Ogino T, Tsuchida H, Takagi M, Kashiwa H, Nambu T. Sonographic assessment of osteochondral dissecans of the humeral capitellum.  Am J Roentgenol. 2000;  174 411-415
    PubMedGoogle Scholar
  • 41 Lazar R D, Waters P M, Jaramillo D. The use of ultrasonography in the diagnosis of occult fracture of the radial neck.  J Bone Joint Surg. 1998;  80A 1361-1364
    PubMedGoogle Scholar
  • 42 Jacobson J A, Jebson P JL, Jeffers A W, Fessell D P, Hayes C W. Ulnar nerve dislocation and snapping triceps syndrome: diagnosis with dynamic sonography-report of three cases.  Radiology. 2001;  220 601-605
    CrossrefPubMedGoogle Scholar
  • 43 Teefey S A, Middleton W D, Boyer M I. Sonography of the hand and wrist.  Semin Ultrasound CT MR. 2000;  21 192-204
    CrossrefPubMedGoogle Scholar
  • 44 Jacobson J A, Oh E, Propeck T, Jebson P JL, Jamadar D A, Hayes C W. Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy.  Am J Roentgenol. 2002;  179 523-527
    PubMedGoogle Scholar
  • 45 Herneth A M, Siegmeth A, Bader T R et al.. Scaphoid fractures: evaluation with high-spatial-resolution ultrasound: initial results.  Radiology. 2001;  220 231-235
    CrossrefPubMedGoogle Scholar
  • 46 Chiou H J, Chang C Y, Chou Y H et al.. Triangular fibrocartilage of wrist: presentation on high resolution ultrasonography.  J Ultrasound Med. 1998;  17 41-48
    PubMedGoogle Scholar
  • 47 Moschilla G, Breidahl W. Sonography of the finger.  Am J Roentgenol. 2002;  178 1451-1457
    PubMedGoogle Scholar
  • 48 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings.  Am J Roentgenol. 2001;  176 67-73
    CrossrefPubMedGoogle Scholar
  • 49 Choi Y S, Lee S M, Song B Y, Paik S H, Yoon Y K. Dynamic sonography of external snapping hip syndrome.  J Ultrasound Med. 2002;  21 753-758
    PubMedGoogle Scholar
  • 50 Bass C J, Connell D A. Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain.  Skeletal Radiol. 2002;  31 143-148
    CrossrefPubMedGoogle Scholar
  • 51 Bianchi S, Martinoli C, Waser N P, Bianchi-Zamorani M P, Federici E, Fasel J. Central aponeurosis tears of the rectus femoris: sonographic findings.  Skeletal Radiol. 2002;  31 581-586
    CrossrefPubMedGoogle Scholar
  • 52 Kim S M, Shin M J, Kim K S et al.. Imaging features of ischial bursitis with an emphasis on ultrasonography.  Skeletal Radiol. 2002;  31 631-636
    CrossrefPubMedGoogle Scholar
  • 53 Carr J C, Hanly S, Griffin J, Gibney R. Sonography of the patellar tendon and adjacent structures in pediatric and adult patients.  Am J Roentgenol. 2001;  176 1535-1539
    PubMedGoogle Scholar
  • 54 Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation.  Am J Roentgenol. 1997;  168 1493-1499
    PubMedGoogle Scholar
  • 55 Fuchs S, Chylarecki C. Sonographic evaluation of ACL rupture signs compared to arthroscopic findings in acutely injured knees.  Ultrasound Med Biol. 2002;  28 149-154
    CrossrefPubMedGoogle Scholar
  • 56 Miller T T. Sonography of the posterior cruciate ligament of the knee.  Skeletal Radiol. 2002;  31 149-154
    CrossrefPubMedGoogle Scholar
  • 57 Cho K H, Lee D C, Chhem R K et al.. Normal and acutely torn posterior cruciate ligament of the knee at ultrasound evaluation: preliminary experience.  Radiology. 2001;  219 375-380
    CrossrefPubMedGoogle Scholar
  • 58 De Maeseneer M, Vanderdood K, Marcelis S, Shabana W, Osteaux M. Sonography of the medial and lateral tendons and ligaments of the knee: the use of bony landmarks as an easy method for identification.  AJR Am J Roentgenol. 2002;  178 1437-1444
    PubMedGoogle Scholar
  • 59 Sekiya J K, Jacobson J A, Wojtys E M. Sonographic imaging of the posterolateral structures of the knee: findings in human cadavers.  Arthroscopy. 2002;  18 872-881
    CrossrefPubMedGoogle Scholar
  • 60 Van Holsbeeck M T, Introcaso J H. Sonography of large synovial joints. In: van Holsbeeck MT, Introcaso JH Musculoskeletal Ultrasound. St Louis, MO; Mosby, Inc 2001: 251-263
    Google Scholar
  • 61 Jamadar D A, Jacobson J A, Theisen S E et al.. Sonography of the painful calf: differential considerations.  AJR Am J Roentgenol. 2002;  179 709-716
    PubMedGoogle Scholar
  • 62 Fessell D P, van Holsbeeck M T. Foot and ankle sonography.  Radiol Clin North Am. 1999;  37 831-858
    CrossrefPubMedGoogle Scholar
  • 63 Muller M, Kalebo P, Tidebrant G, Movin T, Karlsson J. The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment, with comparisons to MRI appearance.  Knee Surg, Sports Tramatol Arthrosc. 2002;  10 49-56
    PubMedGoogle Scholar
  • 64 Fessell D P, Vanderschueren G M, Jacobson J A et al.. Ultrasound of the ankle: technique, anatomy, and diagnosis of pathologic conditions.  Radiographics. 1998;  18 325-340
    PubMedGoogle Scholar
  • 65 Premkumar A, Perry M B, Dwyer A J et al.. Sonography and MR imaging of posterior tibial tendinopathy.  AJR Am J Roentgenol. 2002;  178 223-232
    PubMedGoogle Scholar
  • 66 Patel S, Fessell D P, Jacobson J A, Hayes C W, van Holsbeeck M T. Artifacts, anatomic variants, and pitfalls in sonography of the foot and ankle.  AJR Am J Roentgenol. 2002;  178 1247-1254
    PubMedGoogle Scholar
  • 67 McConkey J P, Favero K J. Subluxation of the peroneal tendons within the peroneal tendon sheath: a case report.  Am J Sports Med. 1987;  15 511-513
    CrossrefPubMedGoogle Scholar
  • 68 Milz P, Milz S, Putz R, Reiser M. 13 MHz high-frequency sonography of the lateral ankle joint ligaments and the tibiofibular syndesmosis in anatomic specimens.  J Ultrasound Med. 1996;  15 277-284
    PubMedGoogle Scholar
  • 69 Campbell D G, Menz A, Isaacs J. Dynamic ankle ultrasonography: a new imaging technique for acute ankle ligament injuries.  Am J Sports Med. 1994;  22 855-858
    PubMedGoogle Scholar
  • 70 Iagnocco A M, Coari G, Palombi G, Valesini G. Sonography in the study of metatarsalgia.  J Rheumatol. 2001;  28 1338-1340
    PubMedGoogle Scholar
  • 71 Miller S D. Forefoot pain: diagnosing metatarsophalangeal joint synovitis from interdigital neuroma.  Foot Ankle Int. 2001;  22 914-915
    PubMedGoogle Scholar
  • 72 Ortega R, Fessell D P, Jacobson J A, Lin J, van Holsbeeck M T, Hayes C W. Sonography of ankle ganglia with pathologic correlation in 10 pediatric and adult patients.  AJR Am J Roentgenol. 2002;  178 1445-1449
    CrossrefPubMedGoogle Scholar
  • 73 Grassi W, Lamanna G, Farina A, Cervini C. Sonographic imaging of normal and osteoarthritic cartilage.  Semin Arthritis Rheum. 1999;  28 398-403
    CrossrefPubMedGoogle Scholar
  • 74 Disler D G, Raymond E, May D A, Wayne J S, McCauley T R. Articular cartilage defects: in vitro evaluation of accuracy and interobserver reliability for detection and grading with ultrasound.  Radiology. 2000;  215 846-851
    Google Scholar
  • 75 Nieminen H J, Toyras J, Rieppo J et al.. Real- time ultrasound analysis of articular cartilage degradation in vitro.  Ultrasound Med Biol. 2002;  28 519-525
    CrossrefPubMedGoogle Scholar
  • 76 Yao J Q, Seedhom B B. Ultrasonic measurement of the thickness of human articular cartilage in situ.  Rheumatology (Oxford). 1999;  38 1269-1271
    CrossrefPubMedGoogle Scholar
  • 77 Takebayashi S, Takasawa H, Banzai Y et al.. Sonographic findings in muscle strain injury: clinical and MR imaging correlation.  J Ultrasound Med. 1995;  14 899-905
    CrossrefPubMedGoogle Scholar
  • 78 Delgado G J, Chung C B, Lektrakul N et al.. Tennis leg: clinical ultrasound study of 141 patients and anatomic investigation of four cadavers with MR imaging and ultrasound.  Radiology. 2002;  224 112-119
    CrossrefPubMedGoogle Scholar
  • 79 Bianchi S, Martinoli C, Abdelwahab I F, Derchi L E, Damiani S. Sonographic evaluation of tears of the gastrocnemius medial head (“tennis leg”).  J Ultrasound Med. 1998;  17 157-162
    PubMedGoogle Scholar
  • 80 Sofka C M, Collins A J, Adler R S. Use of ultrasonographic guidance in interventional musculoskeletal procedures: a review from a single institution.  J Ultrasound Med. 2001;  20 21-26
    PubMedGoogle Scholar
  • 81 Breidahl W H, Adler R S. Ultrasound-guided injection of ganglia with corticosteroids.  Skeletal Radiol. 1996;  25 635-638
    CrossrefPubMedGoogle Scholar
  • 82 Chiou H J, Chou Y H, Wu J J et al.. Alternative and effective treatment of shoulder ganglion cyst: ultrasonographically guided aspiration.  J Ultrasound Med. 1999;  18 531-535
    PubMedGoogle Scholar
  • 83 Farin P U, Rasanen H, Jaroma H, Harju A. Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage.  Skeletal Radiol. 1996;  25 551-554
    CrossrefPubMedGoogle Scholar
  • 84 Farin P U, Jaroma H, Soimakallio S. Rotator cuff calcifications: treatment with ultrasound-guided technique.  Radiology. 1995;  195 841-843
    PubMedGoogle Scholar

Carolyn M SofkaM.D. 

Assistant Attending Radiologist, Hospital for Special Surgery

535 East 70th Street

New York, New York 10021

Email: sofkac@hss.edu

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