MRI EVALUATION OF TENNIS INJURIES TENNIS ELBOW AND BEYOND

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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

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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

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Top 5 Tennis Injuries
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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.

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Sprain vs. Partial tear
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93 y/o F, lat. Ankle pain
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Muscle Injuries in Tennis
Hamstring muscles
Calf muscles
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Middle-aged male pushing a stalled car and felt a
pop in the calf
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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

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Calf Injury
Tommy Haas
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Injuries to Med. Gastronemius muscle (Tennis Leg)
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23 y/o F semi-pro athlete, training tennis gt6h/day
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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)

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Shin Splints -- periostitis
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Medial Tibial Stress Syndrome
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BONE BRUISE-26 y/o M MR Tech
4 wk 7wk
9 wk after injury
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Jumpers knee
Patellar tendinosis
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Patellar Chondromalacia
No. 1 USC player turned professional
30 y/o male, anterior knee pain
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Hamstring Injury
M. Sharapova at Pan Pacific Open, Feb. 2007
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Partial Tear of Biceps Femoris
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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

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Melbourne, Australia 01/06
Kim Clijsters
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The combined rotation and extension of the back
during serving places high demands on the back
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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
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Spondylolysis
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R. Nadal at Queens Club, June 2006
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Shoulder Pain in Athletes

• AC joint sprain
• Calcific rotator cuff tendinopathy
• Clavicle fracture
• Dislocated shoulder
• Adhesive capsulitis
• Rotator cuff tear
• Subacromial bursitis

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Subacromial Impingement
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Shoulder Impingement Syndrome
Adequate subacromial space
Narrowed subacromial space
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Articular sided partial tear
High school varsity baseball pitcher-shoulder
pain before end of the season games
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Ulnar Sided Wrist Pain
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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

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Players who hit with a lot of topspin are at
increased risk for extensor carpi ulnaris tendon
injury
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ECU Tendinitis Tennis Wrist
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Ganglion cyst Carpal tunnel syndrome
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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

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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

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LATERAL EPICONDILITIS
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Lateral Epicondylitis
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Lateral Epicondylitis - Mild
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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.
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Single vs. double-handed backhand
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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.

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Vania King (???)
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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

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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.

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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.