AMSSM - American Medical Society for Sports Medicine

AMSSM LIBRARY OF SPORTS ULTRASOUND PATHOLOGY
Objective An educational resource of high-quality, de-identified images and videos displaying common and unique sports ultrasound pathology in case format. Anyone is welcome to submit cases. Please review the submission guidelines attached below. US Pathology Studies Submission Guidelines Current Library Master Spreadsheet QUESTIONS? Send an email to Kersten Schwanz, MD and Matthew Waldrop, MD.



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Acute-Subacute Ulnar Collateral Ligament Tear A 16-year-old right-hand dominant male high school wrestler presented with 2 weeks of right elbow pain, stiffness, and instability after a wrestling injury. His exam was notable for anteromedial swelling, medial epicondyle tenderness, pain with valgus stress, and decreased elbow range of motion and strength with intact neurovascular function.

Sternoclavicular Joint CPPD Arthropathy A 72-year-old female was referred for 5 months of a "lump" at the base of the anterior neck. She initially had pain in the shoulder, which then migrated to the medial clavicle and sternoclavicular region. Prior work-up included a recent thyroid ultrasound, which was normal.

Partial Proximal Ulnar Collateral Ligament Tear of the Elbow A 28-year-old right-hand-dominant competetive male tennis player presented with persistent right medial elbow pain after increasing the volume of his serving practice. Symptoms worsened gradually over the prior two weeks and failed to resolve with rest. Examination was 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 presented to the emergency department with acute right shoulder pain that began during a sparring session approximately one hour prior to presentation. He reported feeling immediate pain during sparring and was unable to continue due to pain. On examination, he held his right arm in adduction and internal rotation. There was 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.

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 presented with complaints of persistent numbness and tingling in his left 4th and 5th fingers ongoing for the prior two months. He also complained 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 presented with atraumatic right elbow pain for 2 weeks which began after starting an intense tennis training regimen. He had developed acute worsening of pain with new limitation in elbow extension prompting visit for evaluation. He denied previous injuries to the elbow, and denied history of inflammatory arthropathy. Ultrasound-guided arthrocentesis was performed which yielded 12mL of purulent material. He was eventually diagnosed with septic arthritis of the elbow.

Traumatic Knee Lipohemarthrosis A 77-year-old female presented to the Emergency Department after sustaining a mechanical ground-level fall with subsequent right knee pain. She was unable to stand or extend her right knee due to pain. Physical exam showed a right knee effusion, inability to perform straight leg raise, limited knee extension due to pain, and tenderness of the patellar tendon and medial and lateral joint lines.

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 presented 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 revealed bilateral pes planus. There was limited left plantarflexion and dorsiflexion with both active and passive range of motion. Left sided limitation in active and passive dorsiflexion was noted. He had 5/5 strength with ankle plantarflexion and dorsiflexion, and severe pain with resisted ankle dorsiflexion.

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