Apophyseal injuries in soccer players.

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Imaging findings of lower limb involvement following COVID-19.

Coronavirus disease 2019 (COVID-19) is known mainly by the severe acute respiratory syndrome, with myalgia as a common clinical symptom. Recent reports described musculoskeletal complications related to COVID-19 such as myositis, neuropathy and arthropathy. Radiologists and ordering physicians should be aware of lower limb complications following severe COVID-19 for optimal patient care.

Bilateral upper extremity myositis after COVID-19 vaccination.

Vaccination adverse reactions are common and usually are represented by transitory pain and edema. We present a case of bilateral muscle edema involving shoulders and arms due to myositis following COVID-19 vaccination, and focus on the imaging findings to differentiate with other diagnosis such as infection and tumors.

Automatic MRI segmentation of pectoralis major muscle using deep learning.

To develop and validate a deep convolutional neural network (CNN) method capable of selecting the greatest Pectoralis Major Cross-Sectional Area (PMM-CSA) and automatically segmenting PMM on an axial Magnetic Resonance Imaging (MRI). We hypothesized a CNN technique can accurately perform both tasks compared with manual reference standards. Our method is based on two steps: (A) segmentation model, (B) PMM-CSA selection. In step A, we manually segmented the PMM on 134 axial T1-weighted PM MRIs. The segmentation model was trained from scratch (MONAI/Pytorch SegResNet, 4 mini-batch, 1000 epochs, dropout 0.20, Adam, learning rate 0.0005, cosine annealing, softmax). Mean-dice score determined the segmentation score on 8 internal axial T1-weighted PM MRIs. In step B, we used the OpenCV2 (version 4.5.1, https://opencv.org ) framework to calculate the PMM-CSA of the model predictions and ground truth. Then, we selected the top-3 slices with the largest cross-sectional area and compared them with the ground truth. If one of the selected was in the top-3 from the ground truth, then we considered it to be a success. A top-3 accuracy evaluated this method on 8 axial T1-weighted PM MRIs internal test cases. The segmentation model (Step A) produced an accurate pectoralis muscle segmentation with a Mean Dice score of 0.94 ± 0.01. The results of Step B showed top-3 accuracy > 98% to select an appropriate axial image with the greatest PMM-CSA. Our results show an overall accurate selection of PMM-CSA and automated PM muscle segmentation using a combination of deep CNN algorithms.

Bilateral pectoralis major MRI in weightlifters: findings of the non-injured side versus age-matched asymptomatic athletes.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. METHODS: We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. RESULTS: We identified 36 male subjects with unilateral PM injury with mean age 35.7 ± 8 years and 10 age- and gender-matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P < 0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. CONCLUSION: Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.

Subacromial-subdeltoid bursitis following COVID-19 vaccination: a case of shoulder injury related to vaccine administration (SIRVA).

Vaccination injection site adverse reactions are usually mild and transient, and post-vaccination musculoskeletal symptoms, such as myalgia and arthralgia, are very common. Shoulder injury related to vaccine administration (SIRVA), defined as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm, is a well-established condition in the medical literature, yet underreported. In such cases, subacromial-subdeltoid bursitis may occur, leading to shoulder dysfunction and ongoing pain. Millions of doses of vaccines for the prevention of COVID-19 have been administered to adults worldwide during the pandemic. We report a case of subacromial-subdeltoid bursitis after COVID-19 vaccination, related to the unintentional injection of vaccine solution into the bursa resulting in a robust immune-mediated inflammatory reaction.

Relationship between anterior cruciate ligament rupture and the posterior tibial and meniscal slopes in professional soccer athletes.

OBJECTIVE: Several anatomical parameters have been associated with increased risk of anterior cruciate ligament rupture; however, published studies provide conflicting results. The objectives of this study are to assess whether there is a relationship between anterior cruciate ligament rupture and the lateral and medial posterior tibial slopes, as well as the lateral and medial posterior meniscal slopes and posterior tibial and meniscal delta-slopes. MATERIALS AND METHODS: A retrospective case-control study was conducted in professional soccer athletes, using images from knee magnetic resonance imaging scans in athletes with clinical and radiological diagnosis of anterior cruciate ligament rupture, and control group, with no signs of ligament rupture. RESULTS: The lateral and medial posterior tibial slopes, the lateral and medial posterior meniscal slopes, and the posterior tibial and meniscal delta-slopes showed significant differences between the groups (p < 0.05). Multivariate analysis logistic regression revealed that the lateral and medial posterior meniscal slopes proved to be predictors for increased risk of anterior cruciate ligament rupture in professional soccer players. CONCLUSION: Posterior tibial and meniscal slopes and tibial and meniscal delta-slopes are related to a greater risk of rupture of the anterior cruciate ligament in professional male soccer athletes. The lateral and medial posterior meniscal slopes are predictors for ligament rupture.

Pericruciate fat pad of the knee: anatomy and pericruciate fat pad inflammation: cadaveric and clinical study emphasizing MR imaging.

OBJECTIVE: The pericruciate fat pad is located in the intercondylar fossa, intimate with the cruciate ligaments. With MR imaging, signal abnormality of the pericruciate fat pad has been observed in patients with posterior knee pain. The purpose of this study was to describe the anatomy of the pericruciate fat pad in cadaveric specimens and to document the clinical spectrum of pericruciate fat pad inflammation. MATERIALS AND METHODS: Twelve cadaveric knees underwent MR imaging with T1 and T2 multiplanar images. Cadaveric sections were then prepared for macroscopic evaluation, with additional histologic analysis performed in four cases. MR images in seventeen patients (ten males, seven females; average age, 31.5 years; age range, 19-57 years) involved in intensive sporting activity and with posterior knee pain were reviewed. RESULTS: MR images in cadaveric specimens showed a fat pad that was located above and between the cruciate ligaments, near their attachment sites in the inner portion of the femoral condyles, within the intercondylar fossa. Fatty tissue covered by a thin layer of synovial membrane was confirmed at histology. Seventeen patients with posterior knee pain and without gross cartilage, meniscal, or ligamentous abnormalities all revealed an increased signal in this fat pad in fluid-sensitive fat-suppressed images, mainly in the sagittal and axial planes. In eight cases, enhancement of this fat pad was demonstrated following intravenous gadolinium administration. CONCLUSIONS: The pericruciate fat pad is a structure located in the intercondylar fossa, intimate with both the anterior and posterior cruciate ligaments. Inflammatory changes in this fat pad may be found in patients, especially athletes with posterior knee pain.

Epifisiólise proximal do úmero em atleta de ginástica olímpica / Proximal humeral epiphysiolysis in a gymnast

CONTEXTO: Existem diversas causas de dor no ombro do atleta. Estruturas como tendões e ligamentos são freqüentemente acometidas por lesões. No atleta jovem com esqueleto imaturo, as afecções ósseas devem ser lembradas como possíveis causas de dor. RELATO DE CASO: Os autores relatam a ocorrência da epifisiólise proximal do úmero em um atleta de ginástica olímpica e discutem a literatura a respeito do assunto. CONCLUSÃO: A lesão da placa fisária proximal do úmero em atletas é pouco freqüente. O diagnóstico precoce e correto tratamento evitam que ocorra deformidades severas e déficits funcionais.

CONTEXT: There are different causes for shoulder pain in athletes. Structures such as tendons and ligaments are frequently affected by injuries. In young athletes with immature skull, bone injuries must be ruled as a cause of pain. CASE REPORT: The authors present a case of proximal humeral epiphysiolysis in a gymnast and review literature addressing this topic. CONCLUSION: Injuries on proximal humeral physeal plates of athletes are uncommon. The early diagnosis and correct treatment can avoid deformity and functional deficits.

Enfisema cérvico-facial, pneumomediastino e mediastinite após procedimento dentário / Cervico-facial emphysema, pneumomediastinum and mediastinitis as complications of a dental procedure

O enfisema cérvico-facial é raramente descrito na lieratura como complicaçäo de procedimento dentário. Este artigo refere-se a um relato com ampla revisäo, de um paciente que após tratamento dentário desenvolveu quadro de enfisema cérvico-facial, progredindo para pneumomediastino e mediastinte, sendo esta última uma complicaçäo rara e extremamente grave. O diagnóstico foi feito por exames de radiografias simples e tomografia computadorizada. A paciente desenvolveu quadro de empiema pleural e septcemia, evoluindo para o óbito no 12º. dia após o tratamento dentário