Longitudinal Study Comparing Sonographic and MRI Assessments of Acute and Healing Hamstring Injuries
David A. Connell1,
Michal E. Schneider-Kolsky1,
Jan Lucas Hoving2,
Frank Malara1,
Rachelle Buchbinder3,
George Koulouris1,
Frank Burke1 and
Cheryl Bass1
1 Department of Medical Imaging, Victoria House Hospital, 316 Malvern Rd.,
Prahran 3181, Australia.
2 Department of Epidemiology and Preventive Medicine, Monash University, Cabrini
Hospital, Melbourne, Victoria 3144, Australia.
3 Department of Clinical Epidemiology, Monash University, Cabrini Hospital,
Melbourne, Victoria 3144, Australia.
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Fig. 1A. —Rupture of intramuscular tendon in 28-year-old male
professional football player (Australian football). Coronal MR image shows
disruption of central tendon (long solid arrow) in middle third of
biceps tendon (open arrow) with hematoma tracking between disrupted
fibrils. Fluid signal intensity tracks around epimysial boundary (short
solid arrows).
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Fig. 1B. —Rupture of intramuscular tendon in 28-year-old male
professional football player (Australian football). Correlative longitudinal
sonographic image shows disruption of central tendon (straight arrow)
of torn biceps tendon and hematoma tracks (curved arrow) between torn
muscle fibers.
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Fig. 1C. —Rupture of intramuscular tendon in 28-year-old male
professional football player (Australian football). Axial MR image shows torn
retracted central tendon (straight arrow) with small pocket of
intramuscular hematoma (curved arrow) lying adjacent and fluid signal
tracks between muscle bundle.
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Fig. 2A. —Sudden onset of pain and inability to complete game in
31-year-old male professional football player (Australian football). Coronal
MR image shows disruption of muscle fibrils as they arise from central
intermuscular tendon of biceps (arrow). Longitudinal extent of tear
is visible.
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Fig. 2B. —Sudden onset of pain and inability to complete game in
31-year-old male professional football player (Australian football). Axial MR
image confirms small slit in central tendon of biceps (arrow) where
small pocket of fluidlike signal pools.
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Fig. 2C. —Sudden onset of pain and inability to complete game in
31-year-old male professional football player (Australian football).
Longitudinal sonogram shows central intramuscular tendon (arrows) and
focal area of low echotexture corresponding to area of muscle injury
(asterisks). However, visualization of longitudinal extent of tear is
made difficult by relatively poor contrast of sonography.
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Fig. 3A. —Moderate-grade strain injury in 23-year-old male professional
football player (Australian football) in upper third of thigh. Coronal MR
image shows tearing (arrows) of muscle fibers along central tendon of
biceps. Longitudinal extent of tear is easily measured on coronal image.
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Fig. 3B. —Moderate-grade strain injury in 23-year-old male professional
football player (Australian football) in upper third of thigh. Axial MR image
obtained at baseline can be used to estimate cross-sectional area of injury
with fluidlike signal (arrow) tracking into and around muscle
fibers.
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Fig. 3C. —Moderate-grade strain injury in 23-year-old male professional
football player (Australian football) in upper third of thigh. Axial MR image
obtained at 2-week follow-up shows incomplete resolution of fluid signal
(arrow) tracking into and around torn central tendon.
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Fig. 3D. —Moderate-grade strain injury in 23-year-old male professional
football player (Australian football) in upper third of thigh. Axial MR image
obtained at 6-week follow-up shows that high signal intensity has mostly been
replaced by focus of low signal (arrow) corresponding to
fibrosis.
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Fig. 4A. —Epimysial strain at boundary of long head of biceps with
short head of biceps in 24-year-old male professional football player
(Australian football). Axial MR image shows focal area of abnormal signal
(straight arrow) is predominantly affecting long head of biceps.
Small amount of high signal (curved arrow) tracks between
intermuscular covering in keeping with fluid or hematoma.
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Fig. 4B. —Epimysial strain at boundary of long head of biceps with
short head of biceps in 24-year-old male professional football player
(Australian football). Sonogram corresponding to A shows focal area of
low echotexture (cursors) on epimysial boundary corresponding to tear
(arrow).
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Fig. 4C. —Epimysial strain at boundary of long head of biceps with
short head of biceps in 24-year-old male professional football player
(Australian football). Axial MR image shows minimal residual high signal
(arrow) at epimysial boundary.
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Fig. 4D. —Epimysial strain at boundary of long head of biceps with
short head of biceps in 24-year-old male professional football player
(Australian football). Longitudinal sonogram shows linear band of increased
echogenicity (asterisks) corresponding to site of epimysial injury
(arrow) at 6-week follow-up. Note change in sonographic appearance
from baseline to 6-week image.
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Fig. 5. —Scatterplot and line of best fit depict correlation between
longitudinal length of injury as seen on MRI and number of days until return
to competition. Spearman's rank order correlation coefficient was 0.58.
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Copyright © 2004 by the American Roentgen Ray Society.
