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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Adventitial Bursitis of the 1st MTP Joint A 58-year-old woman presented with forefoot pain and swelling localized to the plantar aspect of the first metatarsophalangeal joint. She reported 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 was 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 presented 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 persisted and was exacerbated by maneuvers that increased intra-abdominal pressure, including sneezing, coughing, Valsalva maneuver. On physical exam, there was tenderness to palpation in the left lower quadrant and over the left lower abdominal muscles into the suprapubic region.

Partial Articular-sided Supraspinatus Tendon Tear/Avulsion (PASTA) A 39-year-old male presented with 3 years of left shoulder pain without a specific mechanism of injury or history of surgery. Pain was localized to the anterolateral aspect of the left shoulder and was exacerbated by overhead and reaching movements. His physical exam was significant for left shoulder abduction strength 5-/5 and a positive O'Brien test. Symptoms were refractory to formal therapy, guided home exercises, Tylenol, and NSAIDs. He had also received 2 prior subacromial bursa corticosteroid injections and one leukocyte-poor platelet rich plasma injection with only short-term symptom relief. He endorsed continued difficulty performing his work and activities of daily living.

Iatrogenic Brachial Plexopathy with Lateral Cord Transection A 61-year-old right-handed female developed immediate postoperative right upper extremity weakness, numbness, and severe pain following a right reverse shoulder arthroplasty which was complicated by axillary vein thrombosis and postoperative hematoma. Exam was notable for diffuse upper extremity weakness, though most prominent with elbow flexion, wrist flexion, and finger flexion. There were absent deep tendon reflexes of the biceps brachii and brachioradialis.

Posterior Interosseous Nerve (PIN) Injury A 22-year-old right-handed male presented with persistent left hand weakness and dorsal proximal forearm pain 8 months after an open reduction internal fixation (ORIF) surgery for a radius and ulna fracture from a motorcycle collision. Exam was notable for significant weakness with finger extension and thumb abduction without sensory loss.

Radial Tunnel Syndrome A 38-year-old right-handed male construction worker presented with chronic exertional dorsal right forearm pain. He had been experiencing these pain symptoms chronically for 5+ years and they were provoked with exertion, especially at his job with using jackhammers and saws. Symptoms were generally relieved with rest. Exam was notable for tenderness to palpation approximately 5cm distal of the lateral epicondyle on the dorsal side of the forearm, without any tenderness at the lateral epicondyle itself. Pain was reproduced with resisted wrist, finger, and thumb extension without focal weakness.

Flexor Carpi Ulnaris Calcific Tendinopathy A 33-year-old right-hand-dominant male squash player presented for atraumatic worsening left wrist pain and loss of range of motion over the previous 2 months. He denied previous injury or pain to the wrist. Physical exam of the left wrist demonstrated significant tenderness about the distal flexor carpi ulnaris tendon, wrist range of motion from 80 degrees of flexion through 0 degrees of extension. He had 4/5 strength in wrist flexion and ulnar deviation.

Acromioclavicular joint osteoarthritis with joint effusion A 76-year-old male presented to clinic with progressively worsening right shoulder pain without trauma or injury to the shoulder. Pain was superolateral and exacerbated by lifting objects in front of his body. Exam was notable for positive Hawkins test for impingement and tenderness over the acromioclavicular joint.

Morel-Lavallee Lesion of the Medial Knee A 31-year-old female rugby player presented with 17 days of right knee pain following a direct blow to the medial knee while being tackled. She endorsed medial knee pain with associated swelling, as well as numbness and tingling localized to the injury location. She denied prior history of right knee injury. She had a history of left knee complete ACL rupture ten years ago status-post surgical reconstruction. She also had a Morel-Lavallee lesion near her left knee five years ago from a rugby injury that resolved with conservative management. Exam was notable for significant ecchymosis over the medial knee with a large area of fluctuance consistent with a possible fluid pocket, with no warmth or erythema present. She was tender to palpation over the right medial femoral condyle and medial patellar facet. She had no strength or range of motion deficits, no ligamentous laxity, and normal special tests. 170 mL of serous fluid was aspirated with ultrasound-guidance, followed by a corticosteroid injection. The lesion recurred three months after ther initial aspiration (about four months post-injury) and was re-aspirated yielding only 10 mL of serous fluid, followed by another corticosteroid injection. She attempted return-to-sport four months after the second aspiration (about eight months after injury), but the lesion recurred a subsequent time. This time following aspiration of 37 mL of serous fluid, a doxycycline sclerodesis was performed. Unfortunately, the lesion recurred two months later after the sclerodesis, and she ultimately underwent an open surgical resection of the lesion with short-term drain placement about one full year after the initial injury. Her post-operative course was uncomplicated, and she returned to rugby four months after surgery without recurrence of the Morel-Lavallee lesion. Given her history of bilateral Morel-Lavallee lesions, she undwerwent a workup for connective tissue disorders.

Medial Gastrocnemius Aponeurosis Tear and Hematoma A 37-year-old male presented with a 6-month history of left calf pain that developed while running. He reported a popping sensation in his left lower leg at the start of his pain without any bruising observed. Exam was only notable for focal tenderness over the distal medial gastrocnemius muscle with intact range of motion and strength of the left ankle. Thompson test was negative

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