AMSSM - American Medical Society for Sports Medicine

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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.



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Midportion Achilles Tendinopathy and Partial Tear A 55-year-old male presented with a one-year history of insidious onset right posterior ankle pain. He is an avid runner, hiker, and rock climber but has been unable to engage in these activities in recent months due to worsening symptoms. On physical examination, the midportion of the right Achilles tendon is markedly thickened and tender to palpation. The patient is unable to perform a single-leg calf raise because of pain.

Insertional Achilles Tendinopathy and Haglund Syndrome A 54-year-old female runner presented with a two-year history of insidious onset posterior ankle pain that began while running. Over the past two months, the pain has intensified significantly, ultimately preventing her from continuing to run. On physical examination, there is tenderness over the superior aspect of the posterior calcaneus at the Achilles tendon insertion. She is able to perform single-leg calf raises and single-leg hops, both of which reproduce her symptoms.

Anterior Cruciate Ligament Cyst A 26-year-old female weightlifter with previous right tibial plateau fracture, sustained two years ago from dropping a barbell during a snatch attempt, presented with right knee pain and limited knee flexion. Pain was deep and worsened with squatting and lunging, limiting her return to sport.

Peripheral Nerve Sheath Tumor 77-year-old cyclist presented with acute right lower leg and ankle pain with an associated soft tissue mass just proximal to the lateral malleolus. The symptoms began gradually, without trauma, a few weeks prior to presentation. Exam of the right ankle was notable for pain with direct palpation over the area with radiating pain and numbness into the lateral ankle and foot. There was no weakness or skin changes. A right ankle x-ray demonstrated no osseous abnormalities.

Lateral Elbow Tendinopathy 48 yo M presents with 1 year history of lateral elbow pain that has persisted despite completing at least 6 months of physical therapy and home exercise program to include isometrics, eccentrics, modified activity and relative rest. Exam shows tenderness to palpation over the lateral common extensor tendon and pain with resisted wrist extension and middle finger extension.

Osteoarthritis of the Second Metatarsophalangeal Joint A 68-year-old male presented with pain in the right second toe. He has a remote history of a second toe fracture, and an x-ray revealed a questionable right second phalangeal loose body.

Extradigital Glomus Tumor of the Foot 54 y.o. male with complaints of chronic left anterior ankle pain that started 15 years ago without injury. His exam revealed tenderness to palpation over the extensor hallucis longus and tibialis anterior tendons just proximal to the ankle joint (most tender ~2cm proximal to the anterior distal tibiofibular joint). Strength intact, with normal sensation and range of motion.

Superficial Peroneal Neuropathy Young adult man with history of bilateral anterior and lateral compartment fasciotomies 12 years ago with insidious onset of right greater than left exertional loss of sensation on the dorsolateral/lateral aspect of the ankle and foot.

Insertional Achilles Tendinosis with Associated Retrocalcaneal Bursitis and Evidence of a Haglund Deformity 69 year old active male presents with left ankle pain that has persisted for the past month due to excessive walking in dress shoes. Physical examination revealed tenderness at posterior heel/calcaneus.

Deep Infrapatellar Bursopathy 77-year-old male presented to clinic with three months of insidious onset left infrapatellar knee pain without an obvious inciting event including any report of trauma. His pain was most notably provoked when descending stairs and located primarily at the distal patellar tendon region. He otherwise denied any swelling or instability of the knee. On examination, range of motion was full without audible crepitus. Tenderness to palpation was identified at the inferior patellar pole and distal patellar tendon region.

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