AMSSM - American Medical Society for Sports Medicine

AMSSM LIBRARY OF SPORTS ULTRASOUND PATHOLOGY
Objective An educational resource of high-quality, de-identified images and videos displaying common and unique sports ultrasound pathology in case format. Anyone is welcome to submit cases. Please review the submission guidelines attached below. US Pathology Studies Submission Guidelines Current Library Master Spreadsheet QUESTIONS? Send an email to Kersten Schwanz, MD and Matthew Waldrop, MD.



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Traumatic Knee Lipohemarthrosis A 77-year-old female presented to the Emergency Department after sustaining a mechanical ground-level fall with subsequent right knee pain. She was unable to stand or extend her right knee due to pain. Physical exam showed a right knee effusion, inability to perform straight leg raise, limited knee extension due to pain, and tenderness of the patellar tendon and medial and lateral joint lines.

Carpal Tunnel Syndrome Secondary to Transthyretin Amyloidosis A 79-year-old male presented with progressive numbness and tingling in digits 1-3 of the right hand, along with wrist and hand pain. Physical exam demonstrated altered sensation in the median nerve distribution and thenar eminence atrophy. The atypical ultrasound findings during evaluation prompted further diagnostic workup, which ultimately led to a diagnosis of Transthyretin Amyloidosis (ATTR).

Tibialis Anterior Tenosynovitis A 69-year-old man presented with acute left ankle pain following a hiking trip in the mountains. He walked up and downhill in flat boat shoes for several hours. On awakening the next day, he noticed swelling in the anterior aspect of his ankle along with severe pain with predominantly dorsiflexion of his ankle. Physical examination in the Sports Medicine office revealed bilateral pes planus. There was limited left plantarflexion and dorsiflexion with both active and passive range of motion. Left sided limitation in active and passive dorsiflexion was noted. He had 5/5 strength with ankle plantarflexion and dorsiflexion, and severe pain with resisted ankle dorsiflexion.

Adventitial Bursitis of the 1st MTP Joint A 58-year-old woman presented with forefoot pain and swelling localized to the plantar aspect of the first metatarsophalangeal joint. She reported a longstanding history of daily high heel use as well as increased load on her feet from a half marathon training program. On physical exam, there was edema noted under the first metatarsal of the left foot as well as tenderness to palpation of the soft tissue over sesamoid and 1st MTP joint on the plantar aspect of the foot.

Rectus Abdominis Muscle Tear A 48-year-old male presented with acute abdominal pain after a snowboarding injury. While going downhill, his snowboard "caught an edge" in the snow and his body continued forward causing a sudden hyperextension of the torso. The patient had immediate onset of pain, which persisted and was exacerbated by maneuvers that increased intra-abdominal pressure, including sneezing, coughing, Valsalva maneuver. On physical exam, there was tenderness to palpation in the left lower quadrant and over the left lower abdominal muscles into the suprapubic region.

Partial Articular-sided Supraspinatus Tendon Tear/Avulsion (PASTA) A 39-year-old male presented with 3 years of left shoulder pain without a specific mechanism of injury or history of surgery. Pain was localized to the anterolateral aspect of the left shoulder and was exacerbated by overhead and reaching movements. His physical exam was significant for left shoulder abduction strength 5-/5 and a positive O'Brien test. Symptoms were refractory to formal therapy, guided home exercises, Tylenol, and NSAIDs. He had also received 2 prior subacromial bursa corticosteroid injections and one leukocyte-poor platelet rich plasma injection with only short-term symptom relief. He endorsed continued difficulty performing his work and activities of daily living.

Iatrogenic Brachial Plexopathy with Lateral Cord Transection A 61-year-old right-handed female developed immediate postoperative right upper extremity weakness, numbness, and severe pain following a right reverse shoulder arthroplasty which was complicated by axillary vein thrombosis and postoperative hematoma. Exam was notable for diffuse upper extremity weakness, though most prominent with elbow flexion, wrist flexion, and finger flexion. There were absent deep tendon reflexes of the biceps brachii and brachioradialis.

Posterior Interosseous Nerve (PIN) Injury A 22-year-old right-handed male presented with persistent left hand weakness and dorsal proximal forearm pain 8 months after an open reduction internal fixation (ORIF) surgery for a radius and ulna fracture from a motorcycle collision. Exam was notable for significant weakness with finger extension and thumb abduction without sensory loss.

Radial Tunnel Syndrome A 38-year-old right-handed male construction worker presented with chronic exertional dorsal right forearm pain. He had been experiencing these pain symptoms chronically for 5+ years and they were provoked with exertion, especially at his job with using jackhammers and saws. Symptoms were generally relieved with rest. Exam was notable for tenderness to palpation approximately 5cm distal of the lateral epicondyle on the dorsal side of the forearm, without any tenderness at the lateral epicondyle itself. Pain was reproduced with resisted wrist, finger, and thumb extension without focal weakness.

Flexor Carpi Ulnaris Calcific Tendinopathy A 33-year-old right-hand-dominant male squash player presented for atraumatic worsening left wrist pain and loss of range of motion over the previous 2 months. He denied previous injury or pain to the wrist. Physical exam of the left wrist demonstrated significant tenderness about the distal flexor carpi ulnaris tendon, wrist range of motion from 80 degrees of flexion through 0 degrees of extension. He had 4/5 strength in wrist flexion and ulnar deviation.

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