Carles Pedret

Central aponeurosis tears of the rectus femoris: practical sonographic prognosis

Objective: This study is a statistical analysis to establish whether a correlation exists between the level and degree of rectus femoris (RF) central tendon injury and the amount of time that an athlete is unable to participate subsequently, referred to as “sports participation absence” (SPA). Design: Causal–comparative study. Patients: 35 players from two high-level Spanish soccer teams with an injury to the central tendon of the RF based on clinical and ultrasound criteria. Main Outcome Measure: Ultrasound examination was performed with an 8–2 MHz linear multifrequency transducer. All studies included both longitudinal and transverse RF sections. Results: At the proximal level the SPA time is 45.1 days when the injury length is 4.0 cm. This value increases by 5.3 days with each 1 cm increase in the length of injury. In the case of distal level injury, SPA time is 32.9 days when the injury length is 3.9 cm. This value increases by 3.4 days with each 1 cm increase. In the total representative sample, SPA time when the injury length is 4.2 cm corresponds to 39.1 days. This value increases by 4.2 days per length unit. Conclusions: RF central tendon injury at the proximal level is associated with a greater SPA time than at the distal level. Patients with a grade II injury have an SPA time longer than those with a grade I injury whether the injury is located proximal or distal.

Stress Fractures of the Metacarpal Bones in Adolescent Tennis Players: A Case Series

Background: There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal. Purpose: The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players—the carpal boss. Study Design: Case series; Level of evidence, 4. Methods: Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player. Results: Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip. Conclusion: Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.

The acute effects of different stretching exercises on jump performance.

Pacheco, L, Balius, R, Aliste, L, Pujol, M, and Pedret, C. The acute effects of different stretching exercises on jump performance. J Strength Cond Res 25(11): 2991–2998, 2011—The purpose of this study was to demonstrate the short-term effects of different stretching exercises during the warm-up period on the lower limbs. A controlled, crossover clinical study involving 49 volunteers (14 women and 35 men; mean age: 20.4 years) enrolled in a “physical and sporting activities monitor” program. The explosive force was assessed using the Bosco test. The protocol was as follows: The test involved a (pre) jump test, general warm-up, intervention and (post) jump test. Each volunteer was subjected to each of the 5 interventions (no stretching [NS] and stretching: static passive stretching [P]; proprioceptive neuromuscular facilitation [PNF] techniques; static active stretching in passive tension [PT]; static active stretching in active tension [AT]) in a random order. The jump test was used to assess the squat jump, countermovement jump (CMJ), elasticity index (EI), and drop jump. An intragroup statistical analysis was performed before and after each intervention to compare the differences between the different stretching exercises. An intergroup analysis was also performed. Significant differences (p < 0.05) were found between all variables for the interventions “P,” “PNF,” and “TA” in the intragroup analysis, with each value being higher in the postjump test. Only the “P” intervention showed a significant difference (p = 0.046) for “EI,” with the postvalue being lower. Likewise, significant differences (p < 0.05) were observed for the “CMJ” measurements during the intergroup analysis, especially between “NS” and the interventions “P,” “PNF,” “AT,” and “PT,” with each value, particularly that for “AT,” being higher after stretching. The results of this study suggest that static active stretching in AT can be recommended during the warm-up for explosive force disciplines.

Intratendinous gouty tophus mimics patellar tendonitis in an athlete

We describe the imaging and pathologic features of a case of intratendinous patellar gouty tophus incidentally discovered in a patient with knee pain. The possibility of intratendinous gouty tophus must be kept in mind by sports physicians, especially in the management of patellar tendinopathy in athletes. It may be associated with other injuries, such as enthesopathies or partial tendon tears.

Ultrasound assessment of asymmetric hypertrophy of the rectus abdominis muscle and prevalence of associated injury in professional tennis players

ObjectiveTo assess rectus abdominis (RA) thickness and injury prevalence using ultrasound in a group of professional tennis players. Observations with regard to muscle fiber repair is described. We likewise studied the potential link between RA volume asymmetry and the risk of muscle strain.Materials and methodsThe degree of asymmetry between the different RA slices was assessed using ultrasound in 61 professional tennis players. The history of RA injury in these tennis players was likewise studied, taking into account the following factors: dominant vs non-dominant arm, history of RA strains, duration thereof and number of recurrences. Ultrasound examination was performed with an 8- to 12-MHz linear multi-frequency transducer.ResultsUltrasound revealed the presence of fibrous scar tissue in the RA muscle in 18 cases (29.5%). In all instances, the lesion was located in the RA on the side of the nondominant arm. In 16 of the cases, the lesion was infra-umbilical and L2 was affected in two cases. The mean maximum width of the fibrous repair tissue was 9 mm (range 5–16). The mean distance between the umbilicus and the scar was 5.8 cm (range 2.9–11.4). Statistical study of the ultrasound measurements obtained for the different slices revealed statistically significant differences between the different depths and according to arm dominance.ConclusionsIn the series studied, the prevalence of RA muscle lesion in professional tennis players was 29.5%. Asymmetric hypertrophy of the RA muscle appears to constitute a risk factor for suffering an injury in this location.

Return to Play After Soleus Muscle Injuries.

Background Soleus muscle injuries are common in different sports disciplines. The time required for recovery is often difficult to predict, and reinjury is common. The length of recovery time might be influenced by different variables, such as the involved part of the muscle. Hypothesis Injuries in the central aponeurosis have a worse prognosis than injuries of the lateral or medial aponeurosis as well as myofascial injuries. Study Design Case series; Level of evidence, 4. Methods A total of 61 high-level or professional athletes from several sports disciplines (soccer, tennis, track and field, basketball, triathlon, and field hockey) were reviewed prospectively to determine the recovery time for soleus muscle injuries. Clinical and magnetic resonance imaging evaluation was performed on 44 soleus muscle injuries. The association between the different characteristics of the 5 typical muscle sites, including the anterior and posterior myofascial and the lateral, central, and medial aponeurosis disruption, as well as the injury recovery time, were determined. Recovery time was correlated with age, sport, extent of edema, volume, cross-sectional area, and retraction extension or gap. Results Of the 44 patients with muscle injuries who were analyzed, there were 32 (72.7%) strains affecting the myotendinous junction (MT) and 12 (23.7%) strains of the myofascial junction. There were 13 injuries involving the myotendinous medial (MTM), 7 affecting the MT central (MTC), 12 the MT lateral (MTL), 8 the myofascial anterior (MFA), and 4 the myofascial posterior (MFP). The median recovery time (±SD) for all injuries was 29.1 ± 18.8 days. There were no statistically significant differences between the myotendinous and myofascial injuries regarding recovery time. The site with the worst prognosis was the MTC aponeurosis, with a mean recovery time of 44.3 ± 23.0 days. The site with the best prognosis was the MTL, with a mean recovery time of 19.2 ± 13.5 days (P < .05). There was a statistically significant correlation between recovery time and age (P < .001) and between recovery time and the extent of retraction (P < .05). Conclusion Wide variation exists among the different types of soleus injuries and the corresponding recovery time for return to the same level of competitive sports. Injuries in the central aponeurosis have a significantly longer recovery time than do injuries in the lateral and medial aponeurosis and myofascial sites.

Isolated Tears of the Gracilis Muscle

Background: Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. Purpose: To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective review of 7 elite athletes with posterior thigh pain (3 dancers, 2 soccer players, 1 tae kwon do player, 1 tennis player). In all athletes, the injury occurred during thigh adduction with the hip internally rotated, as clearly evident at ultrasound scans performed 1 to 20 days after the injury. Management included an initial rest period, followed by physiotherapy and gradual return to sports activities. Results: According to the ultrasound scans, the lesions were in the proximal-middle third junction of the thigh, at the muscle-tendon junction. The lesions were classified as grade 2 (partial discontinuity). The muscle injury area was, on average, 17.1 × 23.7 mm (range, 10-31 × 9-46 mm). The average length of the lesions was 40.14 mm (range, 20-52 mm). All athletes recovered and returned to full performance within 6 weeks of the injury (average, 35.6 days). Conclusion: Medial thigh pain after eccentric contraction during hip adduction should raise suspicion of a gracilis muscle tear. Ultrasound is useful, and full recovery occurs within 6 weeks from the injury.

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

Ultrasound-Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg

Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high‐resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3‐year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to “return to play.” All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.

Sonography and MRI of latissimus dorsi strain injury in four elite athletes.

ObjectiveThe objective of this study was to describe the MR and sonographic findings in latissimus dorsi (LD) muscle strain in athletes, and to review the most common injuries described in the literature, most of which are humeral avulsions.Material and methodsFour injuries and two reinjuries of the myotendinous junction of the LD were followed from the day of injury until the return to play. Sonography (US) and MR imaging were performed in each case to confirm the diagnosis and to monitor the healing process.ResultsAll cases had acute and isolated pain in the back of the shoulder while performing an eccentric maneuver of the arm and the shoulder. US and MR images demonstrated that injuries were located in the middle and cranial portion of the latissimus dorsi surrounding the myotendinous junction. After rehabilitation, all players played at high level again.ConclusionsIsolated lesions of LD are very rare. They can be demonstrated by US and MR images.