Basketball injuries.

Basketball injuries are most prevalent in the lower extremity, especially at the ankle and knee. Most basketball injuries are orthopedic in nature and commonly include ligament sprains, musculotendinous strains, and overuse injuries including stress fractures. By virtue of its excellent contrast resolution and depiction of the soft tissues and trabecular bone, magnetic resonance imaging has become the principal modality for evaluating many basketball injuries. In this article, commonly encountered basketball injuries and their imaging appearances are described. The epidemiology of basketball injuries across various age groups and levels of competition and between genders are reviewed.

MR imaging features of osteochondritis dissecans of the femoral sulcus.

OBJECTIVE: The objective of this study was to describe the MR imaging features of osteochondritis dissecans of the femoral sulcus, which have not been described previously. CONCLUSION: Osteochondritis dissecans of the femoral sulcus has been recognized as a unique clinical and radiographic entity, warranting early diagnosis and appropriate treatment. Although this type of osteochondritis dissecans may be inconspicuous on radiography, fast spin-echo proton density-weighted and T2-weighted MR imaging sequences allow evaluation for articular cartilage integrity and lesion stability. Because of the orientation of the femoral sulcus, osteochondritis dissecans involving the femoral sulcus is best evaluated on axial and sagittal images.

Imaging the painful hip.

With the advent of magnetic resonance imaging and, subsequently, magnetic resonance arthrography, the imaging algorithm for hip pain has evolved considerably. Magnetic resonance imaging has supplanted bone scintigraphy as the first line imaging test after conventional radiographs in the setting of suspected occult fracture, transient marrow edema, and osteonecrosis. Computed tomography scanning and magnetic resonance imaging are invaluable for the evaluation of monarticular arthropathies such as pigmented villonodular synovitis and synovial osteochondromatosis. By combining conventional magnetic resonance imaging with capsular distention afforded by arthrography, magnetic resonance arthrography has become the imaging examination of choice for disorders of the acetabular labrum and for the evaluation of articular cartilage at the hip.

Imaging of stress fractures in the athlete.

Osseous stress fractures and stress reactions represent the effect of abnormal repetitive stress on normal bone. An accurate and thorough clinical history and sequential radiographs often suffice 40 make the diagnosis especially when the fracture occurs in one of the common locations, such as the tibia, metatarsals, or calcaneus. In cases that are atypical in location or clinical presentation the authors rely more on MR imaging, radionuclide bone scanning, and occasionally CT. MR imaging detects early changes of osseous stress injury and allows precise definition of anatomy and extent of injury, and is the preferred modality for evaluating the continuum of osseous manifestations of stress injury. MR imaging is useful in evaluating shin splints, early osseous stress injuries, and overt stress fracture. In the elite athlete prompt diagnosis and early rehabilitation are the goals.

Complications of Arthrography.

Serious reactions to intra-articular contrast media are exceedingly rare, and arthrography is considered to be a very safe procedure. To assess the safety of arthrography, a questionnaire was sent to 180 radiologists experienced in arthrography. The 134 respondents had performed approximately 262,000 arthrograms throughout their career. Their experience included 45 cases of infection, eight cases of anaphylaxis, and five cases of vascular complications; no deaths were reported. Most of the reactions reported were minor and included pain, vasovagal reactions, and urticaria. In addition, the respondents reported approximately 13,300 magnetic resonance (MR) arthrograms, which had been performed with intra-articular gadolinium. Of these, there were only six cases of reported reactions, all of which were minor, including vasovagal reactions, pain, and headaches.

Anesthetic and Corticosteroid Joint Injections: A Primer.

Complex joint anatomy may render the clinical diagnosis of a patient with joint pain difficult. Pain may be referred to a joint from an adjacent area (e.g., from the back to the hip) making the diagnosis difficult. The radiologist with the use of fluoroscopy is the ideal person to perform diagnostic and therapeutic joint injections. Long-acting anesthetic alone or combined with a corticosteroid may help the clinician localize the cause of the joint pain and subsequently institute the proper therapy. This article includes a discussion of the commonly used injectable corticosteroids that are available. The choice of corticosteroid is based on personal preference. Depomedrol (Upjohn, Kalamazoo, MI) is the least expensive corticosteroid available; however, a relatively insoluble drug such as Aristospan (Lederle, Deerfield, IL) or a combination drug such as Celestone Soluspan (Schering, Kenilworth, NJ) may be a better choice in rheumatoid arthritis. The technique used to inject the hip and the shoulder is discussed.

Subtalar Joint Arthrography.

The purpose of this study was to determine the accuracy and the specificity of an optimum technique of posterior talocalcaneal/posterior subtalar (PST) joint arthrography and anesthetic injection in patients with hindfoot pain. Fifty-five PST joints were studied in 55 patients. The posteromedial approach was used in the first 24 patients, followed by an anterolateral approach in 31 patients. The ease of performance, success of confirming PST needle position, and adverse effects were noted. After contrast injection, a combination of 1% lidocaine and 0.5% bupivacaine was injected. Results consisted of 47 arthrographically confirmed PST injections. The posteromedial approach was deemed more difficult; three patients had tendon sheath opacification and four had unwanted anesthesia of the toes. The anterolateral approach was technically easier and no extra-articular structures were visualized or anesthetized. Therefore, PST arthrography with anesthetic injection is optimized with an anterolateral approach.