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Review
. 2023 Nov 1;13(11):7552-7571.
doi: 10.21037/qims-22-1294. Epub 2023 Apr 14.

Top 15 musculoskeletal lesions in the aging recreational sporter: a pictorial review

Filip M Vanhoenacker  1
Affiliations
Review

Top 15 musculoskeletal lesions in the aging recreational sporter: a pictorial review

Filip M Vanhoenacker. Quant Imaging Med Surg. .

Abstract

Because of the increased life expectancy, the aging population can participate in recreational sports activities. The fact that activity is promoted as having a positive effect on mental and physical health is another factor that may contribute to a trend of increased participation in sports activities by middle-aged and older patients. Due to age-related degeneration of tendons, muscles, joints and decreasing Bone Mineral Density, the musculoskeletal (MSK) system in the aging patient is more vulnerable to trauma. Therefore, sports-related lesions are commonly encountered in the daily routine of most imaging departments. In our radiological practice, we have seen a trend for an increase in sport-related injury referrals particularly in a population aged 40 years and over. Currently, 10% of referrals for imaging studies for sport injuries are in patients older than 40-year-old. This article consists of a pictorial review of the imaging appearance of the most encountered MSK lesions in aging recreational sporters in a radiological practice according to their anatomical location. We have chosen the 15 most encountered acute and overuse sports-related lesions involving the lower and upper extremity that are referred to our department of medical imaging. We especially focus on the most characteristic imaging findings on ultrasound and magnetic resonance imaging (MRI). Because of the high prevalence of MSK lesions in older asymptomatic patients, imaging findings must be interpreted in conjunction with the clinical presentation.

Keywords: Musculoskeletal imaging (MSK imaging); magnetic resonance imaging (MRI); radiology; sports injuries; ultrasound.

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Conflict of interest statement

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-1294/coif). The special issue “Imaging of Aging and Age-Related Disorders” was commissioned by the editorial office without any funding or sponsorship. The author has no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Almost complete avulsion of the right hamstrings in a 51-year-old female presenting with acute pain during golf. (A) Coronal FS T2-WI showing complete avulsion of the right conjoint tendon (white arrow). There is minor residual remnant of the superolateral aspect of proximal attachment of the semimembranosus tendon. (B) Axial FS T2-WI showing absence of the proximal hamstring tendons (white arrows) on the right side compared to the left side. Note the normal hypointense aspect of the semimembranosus tendon (open green arrow) anteriorly and the conjoint tendon (open red arrow) on the left side. (C) Enlarged axial FS T2-WI of the right side demonstrates a fluid-filled gap between the ischial tuberosity and the semimembranosus tendon (anterior open green arrow) and between the ischial tuberosity the conjoint tendon (posterior open red arrow). FS, fat suppressed; WI, weighted image.
Figure 2
Figure 2
Complex medial meniscus tear in a 52-year-old male skier. (A) Coronal FS T2-WI at the posterior horn and (B) coronal FS T2-WI at the corpus of the medial meniscus of the right knee. There is a horizontal tear of the posterior and corpus of the medial meniscus and a radial tear at the intercondylar part of the posterior horn (arrow in A) and an extrusion of the corpus relative to the medial tibia (B). The high signal in the meniscus tear is due to joint fluid filling the meniscus defect. FS, fat suppressed; WI, weighted image.
Figure 3
Figure 3
Complete ACL tear a 40-year-old male skier. (A) Midsagittal FS T2-WI shows discontinuity of the femoral portion of the ACL (green open arrow). (B) Sagittal FS T2-WI at lateral compartment shows bone marrow edema at the posterolateral tibia and the middle portion of the lateral femur condyle due to anterior translation of the tibia and impaction of the posterlateral tibia and the lateral femur condyle. (C) Midsagittal FS T2-WI shows a hypointense signal of the femoral portion of a normal ACL (green open arrow) for comparison. The striated aspect of the tibial portion of the ACL is a normal finding. ACL, anterior cruciate ligaments; FS, fat suppressed; WI, weighted image.
Figure 4
Figure 4
Subchondral insufficiency fracture of the medial femoral condyle of the left knee in a 60-year-old female following long distance walking. (A) Sagittal T1-WI showing a hypointense fracture line paralleling the subchondral bone plate (white arrow). (B) Enlarged sagittal T1-WI showing a hypointense fracture line paralleling the subchondral bone plate (arrow). (C) Coronal FS T2-WI shows extensive surrounding bone marrow edema in the medial femoral condyle (white asterisk). The overlying articular cartilage is intact. FS, fat suppressed; WI, weighted image.
Figure 5
Figure 5
Stress fracture of the left distal tibia in a middle-aged female runner, presenting with pain during a start-to-run program. (A) Coronal T1-WI of the ankle showing an oblique hypointense fracture line within the cancellous bone extending to the medial cortex of the tibia and subtle surrounding periosteal reaction (arrow). (B) Detailed coronal T1-WI shows better the fracture line (open green arrow). (C) Axial FS T2-WI shows a subtle hyperintense fracture line in the medial cortex of the tibia with adjacent bone marrow edema and periosteal edema (arrow). (D) Bone scintigraphy reveals increased tracer uptake in the left distal tibia. WI, weighted image; FS, fat suppressed.
Figure 6
Figure 6
Tennis leg of the right calf in a 61-year-old tennis player. (A) Longitudinal US and (B) panoramic view shows an anechoic fluid collection deep to the medial gastrocnemius and superficial to the soleus muscle. There is disruption of the muscle fibers of the distal medial gastrocnemius. US, ultrasound.
Figure 7
Figure 7
Tennis leg of the right calf in a 52-year-old badminton player presenting with a sudden painful snap in the left calf. (A) Sagittal FS T2-WI reveals a hyperintense fluid collection between the medial head of the gastrocnemius and soleus. Note retraction of the distal gastrocnemius (black arrow). (B) Axial FS T2-WI shows a hyperintense fluid collection adjacent to the distal medial gastrocnemius (stars). There is also feathery oedema in the gastrocnemius and soleus muscles. FS, fat suppressed; WI, weighted image.
Figure 8
Figure 8
Complete achilles tendon tear in a 52-year-old female badminton player presenting with a sudden painful snap in the left calf. (A) Longitudinal ultrasound with plantar flexion of the foot shows an anechoic gap in the achilles tendon. (B) On a longitudinal ultrasound with dorsiflexion of the foot, the size of the gap increases. (C) Panoramic longitudinal view shows better the proximal and distal tendon gap. (D) Partial Achilles tendon tear in another 67-year-old male. Sagittal FS T2-WI reveals an intratendinous focus of high signal (green arrow). There is pre-existent tendinosis with fusiform swelling of the Achilles tendon. Note also linear high signal adjacent to the anterior and posterior aspect of the tendon indicating paratenonitis (red arrows). FS, fat suppressed; WI, weighted image.
Figure 9
Figure 9
Snowboard fracture in a middle-aged snowboarder. (A) Coronal FS T2-WI shows bone marrow edema at the lateral process of the talus (asterisks). (B) Coronal Proton density image without fat suppression shows a hypointense fracture line at the lateral process of the talus (arrows). (C) Magnification view of the coronal proton density image without fat suppression shows better the fracture line (green arrows). FS, fat suppressed; WI, weighted image.
Figure 10
Figure 10
Morel-Lavallée lesion in a 77-year-old recreational female cyclist presenting with a compressible prepatellar soft tissue swelling following a fall. Axial ultrasound shows an anechoic collection with subtle intralesional septations (asterisks) separating the subcutaneous fat and the patellar retinaculum. LAT, lateral; PAT, patella.
Figure 11
Figure 11
Morel-Lavallée lesion in another 62-year-old recreational female cyclist presenting with a soft tissue swelling at the knee following a fall. Typically, Morel-Lavallée lesion at the knee joints extends more medially and laterally along with the patellar retinacula, compared to a prepatellar bursa which has a median location. Axial FS T2-WI shows a fluid-filled collection separating the subcutaneous fat and the patellar retinacula (asterisks). Small areas of isointense signal to fat consistent with the presence of fat globules are seen anteriorly in the collection (red arrows). FS, fat suppressed; WI, weighted image.
Figure 12
Figure 12
Morton’s fibroma in a 49-year-old female long-distance walker. (A) Short axis T1-WI shows an hour-glass shaped lesion in the third web space (red arrows). (B) On short axis FS T2-WI, the lesion is a mixed signal intensity with hypointense and intermediate signal (red asterisk). There is associated fluid (green arrows) within the intermetatarsal bursa. WI, weighted image; FS, fat suppressed.
Figure 13
Figure 13
Traumatic rotator cuff tear in a 55-year-old male presenting with a painful shoulder and loss of muscle strength following bench pressing. (A) Longitudinal US loss a fibrillar structure (compare to panel D) of the supraspinatus tendon. Note instead an area of structureless heterogeneous echotexture adjacent to the greater tuberosity (between callipers). There is fluid and debris within the subacromial bursa adjacent to the greater tuberosity (red asterisk). These findings are highly suspicious for a full-thickness rotator cuff tear. (B) Oblique coronal and (C) oblique sagittal MR arthrogram shows leakage of contrast into a gap within the supraspinatus and infraspinatus tendon (red asterisks). MR arthrography is superior to US to demonstrate the size, extent (supraspinatus and infraspinatus are involved in this case) and degree of retraction of the tear. There is also communication of the full-thickness tear with the acromioclavicular joint which is a negative prognostic parameter for surgical repair. (D) Longitudinal US in a volunteer showing a normal fibrillar structure of the supraspinatus tendon. (E) Oblique sagittal MR arthrogram shows a normal delineation of the articular side of the supraspinatus in another patient (red arrows). MR, magnetic resonance; US, ultrasound.
Figure 14
Figure 14
Distal clavicular osteolysis at the right clavicle in a middle-aged weightlifter. (A) Radiograph of the right AC joint shows irregular delineation and tapering of the right clavicle and widening of the AC joint. (B) Normal radiograph of the left AC joint for comparison. AC, acromioclavicular.
Figure 15
Figure 15
Distal clavicular osteolysis at the right clavicle in a 49-year-old weightlifter. (A) Ultrasound of the right AC joint shows irregular delineation of the right clavicle (red arrows), joint effusion and widening of the AC joint. (B) Ultrasound of a normal right AC joint for comparison. Note regular delineation of the articular side of the acromion and clavicle (red arrows). AC, acromioclavicular.
Figure 16
Figure 16
Distal clavicular osteolysis at the left clavicle in middle-aged body builder. (A) Coronal FS T2-WI shows bone marrow edema at the clavicle (asterisks), joint effusion (thick black arrow) and widening of the AC joint and focal irregular delineation of the lateral clavicle (small arrow). (B) Axial FS-T1-WI better shows the irregular delineation of the lateral clavicle (small arrows). Note also a small subchondral cyst anteriorly. FS, fat suppressed; WI, weighted image; AC, acromioclavicular.
Figure 17
Figure 17
Partial tear of the long head of the distal biceps brachii in a 53-year-old recreational javelin thrower. (A) Longitudinal ultrasound showing irregular delineation of the deep portion of the long head of the biceps brachii (white arrows). There is still continuity of the superficial part and the short head (white arrow with black contour). There is fluid surrounding the distal biceps tendon. (B) Axial FS-T2-WI and (C) coronal FS-T2-WI in FABS position shows irregular delineation and thinning of the long head of the biceps brachii (white arrows with black contour). Note fluid adjacent to the distal biceps tendon. FS, fat suppressed; WI, weighted image; FABS, Flexed, shoulder ABducted and forearm Supinated.
Figure 18
Figure 18
Complete tear of the long head of the distal biceps brachii in a 50-year-old male presenting with a sudden popping sensation during bench pressing. (A) Longitudinal ultrasound showing complete discontinuity and proximal retraction of the biceps brachii (red arrows showing retracted tendon stump). (B) Sagittal and (C) Coronal FS-T2-WI in FABS position shows discontinuity and proximal retraction of the biceps brachii (arrows). (D) Axial FS-T2-WI shows discontinuity of the biceps tendon (white arrow with black contour) and lacertus fibrosus (white arrow). The latter is responsible for tendon retraction. (E) Longitudinal ultrasound showing normal continuity and fibrillar structure of the biceps brachii (red arrows) in a normal individual for comparison with panel A. FS, fat suppressed; WI, weighted image; FABS, Flexed, shoulder ABducted and forearm Supinated.
Figure 19
Figure 19
Tennis elbow with proximal extensor tendinopathy in a middle-aged tennis player. (A) Longitudinal gray scale ultrasound showing thickening and hypoechogenicity of the proximal extensor tendon. (B) Longitudinal ultrasound with power doppler shows hypervascularity of the affected tendon. (C) Longitudinal gray scale ultrasound showing a normal fibrillar structure of the extensor tendons (red arrows) in a normal individual for comparison with (A). No increased power doppler was seen (not shown).
Figure 20
Figure 20
Tennis elbow with partial tear of the proximal extensor tendon in a 58-year-old tennis player. (A) Longitudinal ultrasound showing an anechoic defect at the deep side of the extensor tendon with subtle sparing of the superficial tendon fibers. (B) Axial. (C) Sagittal and (D) coronal FS T2-WI showing a fluid-filled defect in the proximal extensor tendons (arrows). FS, fat suppressed; WI, weighted image.
Figure 21
Figure 21
Stener lesion. (A) Longitudinal ultrasound in a 57-year-old female skier showing a yoyo (circle) on string (small arrows) corresponding to the retracted UCL and adductor aponeurosis respectively. (B) Coronal FS-T2-WI in another middle-aged skier shows a retracted and entrapped UCL (red arrows) proximal to the adductor aponeurosis (small arrows). Also note bone marrow edema at the ulnar side of the proximal phalanx. UCL, ulnar collateral ligament; FS, fat suppressed; WI, weighted image.
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