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AMSSM LIBRARY OF SPORTS ULTRASOUND PATHOLOGY


Objective
The Sports Ultrasound Committee looks to create an educational resource directed at residents, fellows, and other learners to review both common and unusual pathology within sports ultrasound using case examples. In exploring the library of sports ultrasound pathology, we intend for learners to gain an appreciation for the nuances of ultrasound imaging and increased confidence in recognition of abnormal findings.

Submission Guidelines

  • Current sports medicine fellows are particularly encouraged to submit, with faculty guidance.
  • If a trainee is preparing the submission, the content should be reviewed with a local attending to verify ultrasound image quality and image interpretation accuracy.
    • Following submission, a secondary review will be performed by an AMSSM subcommittee. Edits may be suggested or if images are of low quality, the case may be rejected. Thereafter, the accepted content will be posted and available for member review.
  • All content must be de-identified prior to submission.
  • High quality images and/or videos should be submitted. Low quality images will not be accepted.
  • US Pathology Studies Submission Guidelines – a quick reference guide to a successful submission.
 
 
   
(Login to access the Ultrasound Pathology Study Submission link)
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Popliteus Partial Tear and Tendinopathy
A 43-year-old male professional skydiver presented with left lateral knee pain after a hard landing. Pain was described as a burning sensation that started laterally and radiated towards his patella.
 
Partial Proximal Ulnar Collateral Ligament Tear in a Tennis Player
A 28-year-old right-hand-dominant competetive male tennis player presents with persistent right medial elbow pain after increasing the volume of his serving practice. Symptoms have worsened gradually over the past two weeks and failed to resolve with rest. Examination is notable for reproduction of pain with valgus stress testing and the milking maneuver, with mild tenderness to palpation over the medial elbow near the UCL origin. Initial imaging with a standard MRI of the right elbow without contrast was negative, and physical therapy did not provide relief. Repeat MRI with Flexed Elbow Valgus External Rotation (FEVER) view ultimately confirmed the diagnois visualized on ultrasound. The patient subsequently underwent ultrasound-guided platelet-rich plasma (PRP) injection of the partial UCL tear. At 4-month follow-up, repeat ultrasound demonstrated reconstitution of the UCL with restoration of the normal fibrillar echotexture, and the patient had returned to his prior level of play.
 
Snapping Triceps Syndrome & Ulnar Nerve Dislocation
A 39-year-old male presented with chronic medial elbow pain associated with a reproducible double snapping sensation during elbow flexion and extension. Symptoms were exacerbated by weight-bearing and pressing activities, including push-ups and bench press. Plain radiographs of the elbow were unremarkable. He denied numbness, tingling, or weakness in the ulnar nerve distribution.
 
Posterior Shoulder Dislocation
A 20-year-old male boxer presents to the emergency department with acute right shoulder pain that began during a sparring session approximately one hour prior to presentation. He reports feeling immediate pain during sparring and was unable to continue due to pain. On examination, he holds his right arm in adduction and internal rotation. There is significant pain with attempted motion, particularly external rotation. Point-of-care ultrasound was performed and demonstrated findings consistent with a posterior shoulder dislocation. The patient subsequently received an interscalene nerve block, followed by successful closed reduction without complication.
 
Left Ulnar Nerve Compression from Ganglion Cyst
An 86-year-old male with a past medical history of coronary artery disease, polymyalgia rheumatica, idiopathic gout involving the foot, CKD stage 3B, and pulmonary hypertension presents with complaints of persistent numbness and tingling in his left 4th and 5th fingers ongoing for the past two months. He also complains of feeling a small bump at the ulnar aspect of his left forearm slightly distal to his humeroulnar joint.
 
Non-Traumatic Elbow Joint Effusion
A previously healthy 35-year-old male presents with atraumatic right elbow pain for 2 weeks which began after starting an intense tennis training regimen. He has developed acute worsening of pain with new limitation in elbow extension prompting visit for evaluation. He denies previous injuries to the elbow, and denies history of inflammatory arthropathy. Ultrasound-guided arthrocentesis is performed which yields 12mL of purulent material. He was eventually diagnosed with septic arthritis of the elbow
 
Carpal Tunnel Syndrome Secondary to Transthyretin Amyloidosis
A 79-year-old male presented with progressive numbness and tingling in digits 1-3 of the right hand, along with wrist and hand pain. Physical exam demonstrated altered sensation in the median nerve distribution and thenar eminence atrophy. The atypical ultrasound findings during evaluation prompted further diagnostic workup, which ultimately led to a diagnosis of Transthyretin Amyloidosis (ATTR).
 
Tibialis Anterior Tenosynovitis
A 69-year-old man presents with acute left ankle pain following a hiking trip in the mountains. He walked up and downhill in flat boat shoes for several hours. On awakening the next day, he noticed swelling in the anterior aspect of his ankle along with severe pain with predominantly dorsiflexion of his ankle. Physical examination in the Sports Medicine office reveals bilateral pes planus. There is limited left plantarflexion and dorsiflexion with both active and passive range of motion.left sided limitation in active and passive dorsiflexion. He has 5/5 strength with ankle plantarflexion and dorsiflexion, and severe pain with resisted ankle dorsiflexion.
 
Adventitial Bursitis of the 1st MTP Joint
A 58-year-old woman presents with forefoot pain and swelling localized to the plantar aspect of the first metatarsophalangeal joint. She reports a longstanding history of daily high heel use as well as increased load on her feet from a half marathon training program. On physical exam, there is edema noted under the first metatarsal of the left foot as well as tenderness to palpation of the soft tissue over sesamoid and 1st MTP joint on the plantar aspect of the foot.
 
Rectus Abdominis Muscle Tear
A 48-year-old male presents with acute abdominal pain after a snowboarding injury. While going downhill, his snowboard "caught an edge" in the snow and his body continued forward causing a sudden hyperextension of the torso. The patient had immediate onset of pain, which persists and is exacerbated by maneuvers that increase intra-abdominal pressure, including sneezing, coughing, Valsalva maneuver. On physical exam, there is tenderness to palpation in the left lower quadrant and over the left lower abdominal muscles into the suprapubic region.
 
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