AMSSM - American Medical Society for Sports Medicine

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.



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Distal Quadriceps Tendinosis A 30-year-old female presented with a 3-month history of insidious onset of right superior knee pain. Pain was worse with jumping, running, and going up and down stairs. She endorsed the occasional sensation of her quadriceps "giving out", particularly when going downstairs.

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).

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