Diagnostic Imaging in Athletes with Chronic Lower Leg Pain
Michele Gaeta1,
Fabio Minutoli1,
Silvio Mazziotti1,
Carmela Visalli1,
Sergio Vinci1,
Felice Gaeta2 and
Alfredo Blandino1
1 Department of Radiological Sciences, University of Messina, Policlinico
"G. Martino," Via Consolare Pompea 1871, 98165, Messina,
Italy.
2 Sport Medicine, Faculty of Motor Science, University of Messina, Policlinico
"G. Martino," Messina, Italy.
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Fig. 1A —Tibial periostitis in 32-year-old man who was professional
basketball player. Axial (A) and coronal (B) fast STIR images
show periosteal edema. Detached and thickened periosteum can be seen as
signal-void line (arrow).
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Fig. 1B —Tibial periostitis in 32-year-old man who was professional
basketball player. Axial (A) and coronal (B) fast STIR images
show periosteal edema. Detached and thickened periosteum can be seen as
signal-void line (arrow).
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Fig. 2A — Longitudinal tibial stress fracture in 34-year-old man who
was runner and had chronic medial tibial stress syndrome lasting 6 months.
Orthogonal radiograph obtained 10 days before MR and CT examinations does not
show fracture.
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Fig. 2B — Longitudinal tibial stress fracture in 34-year-old man who
was runner and had chronic medial tibial stress syndrome lasting 6 months.
Axial T2-weighted MR image shows longitudinal tibial stress fracture as
cortical hyperintense line. Hypointense calcified periosteal callus
(arrow) as well as bone marrow edema can also be seen.
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Fig. 2C — Longitudinal tibial stress fracture in 34-year-old man who
was runner and had chronic medial tibial stress syndrome lasting 6 months.
High-resolution CT image shows, with better advantage, longitudinal tibial
stress fracture with calcified periosteal callus (arrow).
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Fig. 3B —Medial tibial stress syndrome in 21-year-old man who was
runner. Three-dimensional CT reconstruction image of same patient confirms
evident osteopenia (arrows) of anterior and posterior tibial
cortices. Note normal density of fibula and lateral tibial cortices.
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Fig. 4A —Tibial stress injury in 27-year-old woman who was handball
player and had chronic leg pain. Fast STIR image shows both periosteal
(arrowheads) and bone marrow edema (asterisk) but not
fracture.
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Fig. 4B —Tibial stress injury in 27-year-old woman who was handball
player and had chronic leg pain. Axial turbo spin-echo T1-weighted image
confirms absence of cortical fracture. Bone marrow edema (asterisk)
and periostitis (arrowhead) are less conspicuously appreciable in
comparison with fast STIR image in A.
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Fig. 5A —Medial tibial stress syndrome in 20-year-old man who was
runner. High-resolution CT image reveals multiple areas of osteopenia and
cavities (arrows) of anterolateral tibial cortex representing stress
related lesions.
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Fig. 6 —Chronic compartment syndrome in 30-year-old man who was
runner. Fat-saturated T2-weighted axial MR image, obtained immediately after
exercise, shows evident edema of tibial anterior and deep posterior
compartment muscles (arrows). Slight, questionable hyperintensity can
be seen in other muscles of anterior compartment (arrowheads).
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Fig. 7 —33-year-old female long-distance runner with right lower leg
chronic exertional compartment syndrome lasting 3 months. Patient refused
catheter pressure measurement. Fat-suppressed T2-weighted axial MR image
obtained immediately after pain-inducing exercise shows swelling and
hyperintensity of anterior compartment muscles.
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Fig. 8A —Chronic hypertrophic demyelinating neuropathy in 24-year-old
male basketball player. Axial T1-weighted turbo spin-echo image shows enlarged
common peroneal nerve (arrow) with loss of normal fascicular pattern.
Note slight fatty replacement because of early muscular atrophy of denervated
muscles.
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Fig. 8B —Chronic hypertrophic demyelinating neuropathy in 24-year-old
male basketball player. Fast STIR image shows enlarged and hyperintense common
peroneal nerve (arrow). Muscles of anterolateral and peroneal
compartments are diffusely hyperintense because of denervation.
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Fig. 9A —19-year-old man who complained of right leg pain that
appeared with hard exercise and abated with rest. (Reprinted with permission
from [15], Utsunomiya D,
Sawamura T. Popliteal artery entrapment syndrome: noninvasive diagnosis by
MDCT and MRI. Australas Radiol 2007; 51[spec no]:B101–B103)
Occlusion of right popliteal artery is seen on 64-MDCT angiography image.
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Fig. 9B —19-year-old man who complained of right leg pain that
appeared with hard exercise and abated with rest. (Reprinted with permission
from [15], Utsunomiya D,
Sawamura T. Popliteal artery entrapment syndrome: noninvasive diagnosis by
MDCT and MRI. Australas Radiol 2007; 51[spec no]:B101–B103)
Delayed phase axial CT image of right popliteal fossa shows abnormal anatomy
in which medial head of gastrocnemius muscle (MHG) courses between thrombosed
popliteal artery (PA) and popliteal vein (PV).
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Fig. 9C —19-year-old man who complained of right leg pain that
appeared with hard exercise and abated with rest. (Reprinted with permission
from [15], Utsunomiya D,
Sawamura T. Popliteal artery entrapment syndrome: noninvasive diagnosis by
MDCT and MRI. Australas Radiol 2007; 51[spec no]:B101–B103) MR
angiography is comparable to CT angiography (A) in showing occlusion of
right popliteal artery.
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Fig. 9D —19-year-old man who complained of right leg pain that
appeared with hard exercise and abated with rest. (Reprinted with permission
from [15], Utsunomiya D,
Sawamura T. Popliteal artery entrapment syndrome: noninvasive diagnosis by
MDCT and MRI. Australas Radiol 2007; 51[spec no]:B101–B103)
Axial T2-weighted image also shows abnormal anatomy responsible for
entrapment. Black arrow indicates popliteal artery, white arrow indicates
popliteal vein, and arrowhead indicates medial head of gastrocnemius
muscle.
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Fig. 10A —Tendinopathy in 38-year-old male long-distance runner.
Sagittal fast STIR image shows tendinopathy and partial tear (black
arrow) of Achilles tendon (white arrows). Edema of peritenoneum
(arrowheads) also can be seen.
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Fig. 10B —Tendinopathy in 38-year-old male long-distance runner.
T1-weighted axial turbo spin-echo image confirms enlargement of Achilles
tendon with marked medial hyperintensity (arrow) and posterior
peritenonitis (arrowheads).
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Fig. 11A —Calcification of interosseous membrane at insertion of tendon
of posterior tibial muscle in 29-year-old male professional soccer player
complaining of chronic pain of 1 year with recurrent episodes of acute pain.
Proton density–weighted fat-saturated axial image shows calcification
(arrow) of interosseous membrane at insertion of posterior (P) tibial
muscle. A = anterior tibial muscle.
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Fig. 11B —Calcification of interosseous membrane at insertion of tendon
of posterior tibial muscle in 29-year-old male professional soccer player
complaining of chronic pain of 1 year with recurrent episodes of acute pain.
Coronal T2-weighted fat-saturated turbo spin-echo image shows tendon
calcification (asterisk) and edema (arrow) of posterior
tibial muscle (P) at tendon–muscle junction. Muscle injury was probably
due to reduced elasticity of tendon–muscle junction in patient with
chronic overuse of muscle. Inflammation or recurrent strain can explain
muscular abnormalities.
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Fig. 12A —Chronic bursitis in 32-year-old male soccer player with
slight chronic pain and swelling on medial side of upper part of lower leg.
Axial T1-weighted turbo spin-echo image (A) and coronal fat-suppressed
T2-weighted turbo spin-echo image (B) show enlarged bursa
(arrowheads) containing multiple ossified loose bodies
(arrows). Bursitis is not anserine bursitis because it was located
superficial to pes anserinus tendons. This is adventitious bursa caused by
chronic friction from upper edge of stiff shin-guard.
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Fig. 12B —Chronic bursitis in 32-year-old male soccer player with
slight chronic pain and swelling on medial side of upper part of lower leg.
Axial T1-weighted turbo spin-echo image (A) and coronal fat-suppressed
T2-weighted turbo spin-echo image (B) show enlarged bursa
(arrowheads) containing multiple ossified loose bodies
(arrows). Bursitis is not anserine bursitis because it was located
superficial to pes anserinus tendons. This is adventitious bursa caused by
chronic friction from upper edge of stiff shin-guard.
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Copyright © 2008 by the American Roentgen Ray Society.
