Seminars in Musculoskeletal Radiology最新文献

Hyperextension of the first metatarsophalangeal joint can lead to a turf toe injury of the plantar plate complex, resulting in significant morbidity for athletes. This article reviews the anatomy, pathophysiology, classification, and imaging findings of turf toe injuries. In turf toe trauma, many different structures can be injured, with the sesamoid-phalangeal ligaments the most common. Diagnosis, classification, and treatment options rely on clinical evaluation and specific magnetic resonance imaging findings. It is vital for radiologists to understand the anatomy, pathophysiology, and imaging findings of turf toe injuries to ensure an accurate diagnosis and appropriate management.

The management of any injury in elite athletes poses unique challenges distinct from the general population because the goal is rapid recovery and return to play (RTP) while simultaneously managing residual symptoms and minimizing risk of reinjury. The time required for treatment, recovery, and return to peak performance can have consequences for both the athlete and his or her team: financial implications, psychological stressors, team dynamics, and future performance. RTP after an injury in the professional athlete requires a complex decision-making process with many stakeholders. Several factors influence this decision, not the least of which is the type and mechanism of injury. This article provides an overview of the RTP process including nonmedical factors that may influence this decision, common injuries seen in professional athletes, injury patterns particular to certain popular sports, and imaging guidelines for such injuries.

We review the spectrum of acute osseous injuries in athletes, ranging from osseous contusion (bone bruise) injuries to nondisplaced cortical fractures. The basic biomechanical concepts, underlying histopathologic changes, and characteristic magnetic resonance imaging (MRI) features of acute osseous injuries are presented. Bone bruise injuries of varying severity are highlighted to showcase the breadth of imaging findings on MRI and methods for characterizing such lesions. We emphasize the importance of accurately assessing patterns of injury on MRI to communicate more effectively with team medical staff and recognize the implications on return to play. This article offers the foundational tools for approaching bone bruise injuries in elite athletes to add value to the diagnosis and treatment of this unique patient population.

For nonsurgical musculoskeletal (MSK) injuries in athletes, image-guided percutaneous intervention may aid in recovery and decrease return to play (RTP) time. These interventions fall into two major categories: to reduce inflammation (and therefore alleviate pain) or to promote healing. This review describes the risks and benefits of the various percutaneous interventions in MSK athletic injury and surveys the literature regarding the implication of these interventions on RTP.

This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.

Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.

Radiologists are frequently called on for guidance regarding return to play (RTP) for athletes and active individuals after sustaining a musculoskeletal injury. Avoidance of reinjury is of particular importance throughout the rehabilitative process and following resumption of competitive activity. Understanding reinjury risk estimation, imaging patterns, and correlation of clinical and surgical findings will help prepare the radiologist to identify reinjuries correctly on diagnostic imaging studies and optimize management for a safe RTP.

Artificial intelligence (AI) has shown tremendous growth over the last decade, with the more recent development of clinical applications in health care. The ability of AI to synthesize large amounts of complex data automatically allows health care providers to access previously unavailable metrics and thus enhance and personalize patient care. These innovations include AI-assisted diagnostic tools, prediction models for each treatment pathway, and various tools for workflow optimization. The extension of AI into sports medicine is still early, but numerous AI-driven algorithms, devices, and research initiatives have delved into predicting and preventing athlete injury, aiding in injury assessment, optimizing recovery plans, monitoring rehabilitation progress, and predicting return to play.