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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Acromioclavicular joint osteoarthritis with joint effusion A 76-year-old male presented to clinic with progressively worsening right shoulder pain without trauma or injury to the shoulder. Pain was superolateral and exacerbated by lifting objects in front of his body. Exam was notable for positive Hawkins test for impingement and tenderness over the acromioclavicular joint.

Morel-Lavallee Lesion of the Medial Knee A 31-year-old female rugby player presented with 17 days of right knee pain following a direct blow to the medial knee while being tackled. She endorsed medial knee pain with associated swelling, as well as numbness and tingling localized to the injury location. She denied prior history of right knee injury. She had a history of left knee complete ACL rupture ten years ago status-post surgical reconstruction. She also had a Morel-Lavallee lesion near her left knee five years ago from a rugby injury that resolved with conservative management. Exam was notable for significant ecchymosis over the medial knee with a large area of fluctuance consistent with a possible fluid pocket, with no warmth or erythema present. She was tender to palpation over the right medial femoral condyle and medial patellar facet. She had no strength or range of motion deficits, no ligamentous laxity, and normal special tests. 170 mL of serous fluid was aspirated with ultrasound-guidance, followed by a corticosteroid injection. The lesion recurred three months after ther initial aspiration (about four months post-injury) and was re-aspirated yielding only 10 mL of serous fluid, followed by another corticosteroid injection. She attempted return-to-sport four months after the second aspiration (about eight months after injury), but the lesion recurred a subsequent time. This time following aspiration of 37 mL of serous fluid, a doxycycline sclerodesis was performed. Unfortunately, the lesion recurred two months later after the sclerodesis, and she ultimately underwent an open surgical resection of the lesion with short-term drain placement about one full year after the initial injury. Her post-operative course was uncomplicated, and she returned to rugby four months after surgery without recurrence of the Morel-Lavallee lesion. Given her history of bilateral Morel-Lavallee lesions, she undwerwent a workup for connective tissue disorders.

Medial Gastrocnemius Aponeurosis Tear and Hematoma A 37-year-old male presented with a 6-month history of left calf pain that developed while running. He reported a popping sensation in his left lower leg at the start of his pain without any bruising observed. Exam was only notable for focal tenderness over the distal medial gastrocnemius muscle with intact range of motion and strength of the left ankle. Thompson test was negative

Quadriceps Hematoma and Myositis Ossificans 22-year-old male Division I basketball player presents to clinic for re-aspiration of large quadricep hematoma that was sustained during a basketball game about four weeks prior. Initial aspiration was completed two weeks prior. Athletic trainer stated right thigh swelling had recurred, and the patient was having limited knee flexion.

Acute Distal Triceps Tendon Rupture A 78-year-old male presented to clinic after a fall at home with posterior elbow pain, bruising, and palpable defect just proximal to the olecranon.

Radial Tunnel Syndrome A 52-year-old female presented with insidious onset of left lateral elbow pain that radiated over the dorsal aspect of the forearm, which had been bothering her for a few months. Motor and sensory exams of the left upper extremity were normal. There was no pain with passive wrist flexion and resisted wrist extension. She had tenderness to palpation over the radial tunnel, but no tenderness over the lateral epicondyle. Tinel sign was positive at the radial tunnel.

Prepatellar Bursitis A 71-year-old male presented with right anterior knee pain and swelling after a fall onto the right knee 2 months prior. Right knee pain was aggravated by kneeling. Exam showed a circular subcutaneous fluctuant fluid collection over the patella measuring 6 cm in diameter without redness, warmth to touch or drainage. There was mild tenderness to palpation of the fluid collection but no tenderness to palpation of the medial or lateral joint lines. Range of motion and strength of the right knee were normal.

Midportion Achilles Tendinopathy and Partial Tear A 55-year-old male presented with a one-year history of insidious onset right posterior ankle pain. He was an avid runner, hiker, and rock climber but had been unable to engage in these activities in previous months due to worsening symptoms. On physical examination, the midportion of the right Achilles tendon was markedly thickened and tender to palpation. The patient was unable to perform a single-leg calf raise because of pain.

Insertional Achilles Tendinopathy and Haglund Syndrome A 54-year-old female runner presented with a two-year history of insidious onset posterior ankle pain that began while running. Over the prior two months, the pain had intensified significantly, ultimately preventing her from continuing to run. On physical examination, there was tenderness over the superior aspect of the posterior calcaneus at the Achilles tendon insertion. She was able to perform single-leg calf raises and single-leg hops, both of which reproduced her symptoms.

Anterior Cruciate Ligament Cyst A 26-year-old female weightlifter with history of previous right tibial plateau fracture sustained two years ago from dropping a barbell during a snatch attempt presented with right knee pain and limited knee flexion. Pain was deep and worsened with squatting and lunging, limiting her return to sport.

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