E1789. Imaging Sports Injuries of the Shoulder and Elbow: What the Treating Physicians Need to Know
  1. Shruti Kumar; University of Arkansas Medical School
  2. Gitanjali Bajaj; University of Arkansas Medical School
Sports related upper extremity injuries are becoming exceedingly common, especially those related to overhead throwing. Acute injuries are often encountered in contact sports like wrestling and football while chronic injuries are seen in chronic repetitive stress injuries like gymnastics and swimming. The purpose of this exhibit is to describe the imaging features of commonly encountered shoulder and elbow athletic injuries, identify the key points to include in the report, and discuss factors that the treating physicians need to know for timely diagnosis and management of these injuries.

Educational Goals / Teaching Points
Shoulder, followed by elbow, are the most common joints involved in sports related trauma. Injuries can range from acute to chronic repetitive stress injuries. Common disorders in overhead throwing athletes are the intrinsic impingement of the shoulder and valgus overload syndrome of the elbow. Common shoulder athletic injuries include glenohumeral joint dislocation, glenohumeral internal rotation deficit (GIRD), internal impingement, superior labrum anterior posterior(SLAP) tears, rotator cuff tears, acromioclavicular joint injuries, little league’s shoulder, biceps, triceps injuries. Common elbow injuries include ulnar collateral ligament tear, valgus extension overload syndrome, ulnar neuritis, flexor pronator mass injuries, little league’s elbow, medial and lateral epicondylitis. Other injuries include pectoralis major tears.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pectoralis major tear is seen in weight training and high performance athletes. Sternal head constitutes 80% of the volume and is more commonly torn. Injury leads to either complete tendinous avulsion or myotendinous junction tear. GIRD results from chronic attritional tearing of the posterior capsule from repetitive throwing and causes posterior capsular thickening and shortening. In anterior shoulder instability, determining if the Hill-Sachs defects are on-track or off-track can help guide management. Off-track Hills-Sachs defect is treated by Latarjet procedure, and on track defect is treated by labral repair. Majority UCL tears are complete, however partial tears can occur near the humeral attachment in baseball pitchers. Partial tears that involve the proximal fibers are more likely to heal with conservative therapy than distal tears. Valgus extension overload syndrome results from simultaneous valgus and extension forces and leads to posteromedial elbow impingement.

A basic understanding of the biomechanics of sports injuries helps in better prediction of the pattern of injuries. Imaging not only plays an important role in diagnosis, management and follow up of these patients but also in prognostication of the time needed for their recovery.