Ultrasound for diagnosis of apophyseal injuries

Abstract

Avulsion injuries of the apophysis is a problem in young athletes. A correct diagnosis is necessary for establishing the appropriate treatment and the rehabilitation program. However, it is often difficult to distinguish between a simple muscle strain and an avulsion fracture. The X-ray examination is helpful only when an ossification center of the apophysis exists. Ultrasonography is considered the suitable diagnostic tool for these cases. From June 1988 to June 1993, 243 young athletes were seen with an anamnestic and clinically suspected apophyseal injury of the lower extremity. In all cases X-ray examination and ultrasound examination were performed. In 80 cases the diagnosis was confirmed by X-ray examination and in 97 by ultrasonography. Four criteria were defined for the sonographic examination: (a) a hypoechogenic zone, (b) increased distance to the apophysis, (c) dislocation of the apophysis, and (d) mobility of the apophysis on dynamic examination. These criteria are correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable avulsion of the apophysis. Ultrasonography is a proven technique for the detection of apophyseal injuries. In comparison to X-ray examination, it has the advantages of no radiation exposure, early detection even without ossification center, and dynamic examination.

Physical Examination and Magnetic Resonance Imaging of Stress-Related Bone Injuries in Tuber Ischiadicum

“…There is an opinion that during adolescence, the skeleton is more vulnerable than the tendons and muscles [7,8]. Frequency and/or excessive load to the growing skeleton can result in an SRBI and pain as symptoms [5].…”

“…Frequency and/or excessive load to the growing skeleton can result in an SRBI and pain as symptoms [5]. Stress reactions or stress fractures in the enthesis in the pelvic girdle skeleton can therefore indicate the site of the pelvic pain [5,7,8,9,10]. This stress reaction or stress fracture has a better tendency to heal if recognized early [7].…”

“…This study shows that it can be possible to diagnose the stress reaction or stress fracture in the enthesis with a PE. Ultrasound scanning can also be a tool for early diagnosis in this condition [1,8].…”

Musculoskeletal Ultrasound in Pediatric Trauma

“…Color-coded duplex ultrasound or power Doppler ultrasound may be helpful in distinguishing symptomatic from noninflamed lesions. General Considerations Ultrasound evaluation of musculosceletal injuries represents an ideal supplementary investigation to radiography in children [37][38][39]. Many musculoskeletal injuries and disorders can be visualized using high-resolution sonography (Table 1).…”

Despeckling of ultrasound images of bone fracture using multiple filtering algorithms

“…Lazovic et al [2] reported that out of 234 suspected apophyseal fractures in adolescents, 80 were detected by radiography and 97 by ultrasound. Rathfelder and Paar [3] described good results in the first substantial study on the possible application of ultrasound in the diagnosis of fractures in children.…”