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MRI EVALUATION OF TENNIS INJURIES TENNIS ELBOW AND BEYOND

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MRI EVALUATION OF TENNIS INJURIES TENNIS ELBOW AND BEYOND Peter P. Chow, M.D., M.P.H. Pacific Medical Imaging & Oncology Center, Alhambra, CA Valley Imaging Partnership, – PowerPoint PPT presentation

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Title: MRI EVALUATION OF TENNIS INJURIES TENNIS ELBOW AND BEYOND


1
MRI EVALUATION OF TENNIS INJURIESTENNIS ELBOW
AND BEYOND
  • Peter P. Chow, M.D., M.P.H.
  • Pacific Medical Imaging Oncology Center,
    Alhambra, CA
  • Valley Imaging Partnership,
  • West Covina, CA

2
Tennis Injuries Overview
  • Extremely high demands on structural integrity of
    the bodys joints.
  • Repetitive, asymmetrical and technically
    challenging movements at high speed in dynamic
    settings.
  • Testing the limits of players physical and
    mental endurance

3
Top 5 Tennis Injuries
4
Tennis Injuries Facts-in ATP professional Players
  • 35-50 to lower extremities
  • 20 to upper limb
  • 20 to lower back
  • Chronic overuse conditions more likely to occur
    in upper body
  • Acute injuries more likely to occur in the lower
    limbs.

5
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6
Sprain vs. Partial tear
7
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8
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9
93 y/o F, lat. Ankle pain
10
Muscle Injuries in Tennis
Hamstring muscles
Calf muscles
11
Middle-aged male pushing a stalled car and felt a
pop in the calf
12
Rupture of Plantaris Tendon(Tennis Leg)
  • Middle-aged patients
  • Forced dorsiflection of the ankle with the knee
    in extention
  • Audible pop in the calf, with subsequent pain
    and swelling, and frequently with a palpable mass
    caused by hematoma
  • Often associated with ACL tear and posterolateral
    corner injuries

13
Calf Injury
Tommy Haas
14
Injuries to Med. Gastronemius muscle (Tennis Leg)
15
23 y/o F semi-pro athlete, training tennis gt6h/day
16
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17
Medial Tibial Stress Syndrome
  • Also known as shin splints
  • Characterized by hyperintense signal along the
    anterior tibial border
  • Related to periosteal avulsion and periostitis at
    the medial soleus insertional site
  • Grade I (periosteal edema)thru grade IV (stress
    fracture)

18
Shin Splints -- periostitis
19
Medial Tibial Stress Syndrome
20
BONE BRUISE-26 y/o M MR Tech
4 wk 7wk
9 wk after injury
21
Jumpers knee
Patellar tendinosis
22
Patellar Chondromalacia
No. 1 USC player turned professional
30 y/o male, anterior knee pain
23
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24
Hamstring Injury
M. Sharapova at Pan Pacific Open, Feb. 2007
25
Partial Tear of Biceps Femoris
26
Hamstring Injuries
  • MR depicts the location and extent of injuries
  • MR useful in grading of muscular injuries
  • Grade I limited muscle fiber disruption
  • Grade II partial tears at musculotendinous
    junction without retraction of muscle
  • Grade III complete disruption of the
    musculotendinous junction, often with retraction
  • Treatment options depend on the location and
    severity of the injury

27
Melbourne, Australia 01/06
Kim Clijsters
28
The combined rotation and extension of the back
during serving places high demands on the back
29
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30
Pars Stress Fracture 30 of adolescents involved
in sports will have an episode of low back
pain. Lumbar spondylolysis is one of the causes
of LBP in this age group of athletes. Athletes
involved in sports requiring repetitive bending
and straightening of the spine are most commonly
affected Most patients have excellent clinical
outcomes with conservative measures, and surgery
is rarely necessary
31
Spondylolysis
32
R. Nadal at Queens Club, June 2006
33
Shoulder Pain in Athletes
  • AC joint sprain
  • Calcific rotator cuff tendinopathy
  • Clavicle fracture
  • Dislocated shoulder
  • Adhesive capsulitis
  • Rotator cuff tear
  • Subacromial bursitis

34
Subacromial Impingement
35
Shoulder Impingement Syndrome
Adequate subacromial space
Narrowed subacromial space
36
Articular sided partial tear
High school varsity baseball pitcher-shoulder
pain before end of the season games
37
Ulnar Sided Wrist Pain
38
Extensor Carpi Ulnaris(ECU) Tendinitis
  • Related to racquet sports with repetitive wrist
    motion
  • Squash
  • Badminton
  • Raquetball
  • Tennis
  • Rowing
  • Tennis player with two-handed backhand
  • using excessive ulnar deviation in
  • nondominant wrist

39
Players who hit with a lot of topspin are at
increased risk for extensor carpi ulnaris tendon
injury
40
ECU Tendinitis Tennis Wrist
41
Ganglion cyst Carpal tunnel syndrome
42
Tennis Elbow
  • Middle-aged female with a single-handed backhand
    who leads with elbow
  • Straightens elbow and extends wrist on contact
  • Placing the wrist extensors under excessive
    tension
  • Correct form swinging from the shoulder with a
    straight arm and using the entire body to execute
    the stroke

43
TENNIS ELBOW
  • A painful condition caused by inflammation or
    small tears of the wrist extensors and tendons,
    esp. extensor carpi radialis brevis rubbing over
    the lateral epicondyle and the radial head
  • Most experts believe that tennis elbow is caused
    by overloading of the forearm muscles due to
    faulty backhand technique

44
LATERAL EPICONDILITIS
45
Lateral Epicondylitis
46
Lateral Epicondylitis - Mild
47
The backhand is generally found to be the prime
cause of tennis elbow in non-professionals due to
the complexity of this stroke. A bent elbow or
"swinging" just at the elbow and not the entire
arm, causes excess torques and forces in the
elbow region.
Other causes of tennis elbow are Late backhand
stroke with hyper-extended wrist. Too tight of
grip. Excessive wrist "pop" on overhand serve.
Forehand stroke with excessive wrist movement.
Using too many topspin shots.
48
Single vs. double-handed backhand
49
Electromyographic and cinematographic analysis
of elbow function in tennis players using
single- and double-handed backhand strokes
  • It is generally believed that tennis players
    using a double-handed backhand rarely develop
    lateral epicondylitis since the helping arm
    appears to absorb more energy and changes the
    mechanics of the swing.
  • Giangarra CE, et al, American Journal of Sports
    Medicine, Vol 21, Issue 3 394-399.

50
Vania King (???)
51
Racquet Selection to Avoid Tennis Elbow
  • Use a more flexible racquet made of graphite,
    fiberglass, etc.
  • Use an oversized racquet with bigger sweet spot
  • Use a heavier but comfortable racquet
  • Lower string tension by 10
  • Correct grip size. Add a cushioned over grip.
  • Do not use extra-long racquet

52
If you followed all those tips that I gave you
  • There is no guarantee that you will become a
    better tennis player.
  • There is a good chance that you will have a
    pain-free elbow.
  • You will enjoy tennis better and live your life
    happily after.

53
CONCLUSION
  • Because of its superior soft tissue
    discrimination, multiplanar capability,
    non-invasive, and non-radioactive nature, MR is
    well-suited for imaging in sport medicine.
  • Understanding of mechanism of injuries would
    enable better diagnosis and facilitate management
    of sport injuries.
  • Patient education can be better achieved by
    providing visual evidence of disease processes.
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