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E1641. Painful Plié: Review of Lower Extremity MSK Injuries in Professional Ballerinas
Authors
  1. Ramon Saucedo; Houston Methodist Hospital
  2. Rupert Stansbrough; Mayo Jacksonville
  3. Aydin Soheili; Houston Methodist Hospital
  4. Devon Divito; Houston Methodist Hospital
  5. Michael Trakhtenbroit; Houston Methodist Hospital
  6. John Labis; Houston Methodist Hospital
  7. Stephen Herrmann; Houston Methodist Hospital
Background
Ballerinas are high performance athletes with endemic lower extremity injuries such as stress fractures, apophysitis, posterior ankle impingement, and ischiofemoral impingement that occur secondary to high intensity training and classic ballet poses. Various case series/ case reports exist regarding MRI findings of specific regions of the body as they pertain to ballet-related injury (e.g., the foot & ankle), however, this review will comprise lower extremity ballet injuries from the hips to to the toes. We review multiple cases of ballet-related injuries to educate attending and resident radiologists about these patterns of injury in this specific subset of patients.

Educational Goals / Teaching Points
Ballerinas are high performance competitive athletes with endemic lower extremity injuries secondary to classic poses, such as en pointe and demipointe, and rigorous training regimens. These injuries include stress fractures, apophysitis, posterior ankle impingement, ischiofemoral impingement and various ligamentous tears. There have been multiple studies evaluating MRI findings of ballerina injuries in a specific region of the body (e.g., foot & ankle). This presentation will help resident and attending radiologists assess these patterns of injury in multiple lower extremity regions in this subset of patients. Some of these patterns of injury, such as early stress fracture or reactive bone marrow edema, are asymptomatic incidental findings that can guide training or recovery regimens at the time of diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multiplanar lower extremity MRI (e.g., hip, ankle, foot) demonstrating characteristic patterns of injury commonly seen in ballerinas. For example: stress fracture- increased bone marrow fluid signal without definite fracture; apophysitis- bilateral iliac crest and anterior inferior iliac spine increased fluid signal; posterior ankle impingement- tibiotalar and subtalar joint effusions, reactive talar bone marrow edema, reactive changes in the anterior and posterior talofibular ligaments; extra-articular snapping hip syndrome- increased fluid signal at the myotendinous junctions of the bilateral iliopsoas muscles

Conclusion
All of the aforementioned injury patterns are secondary to intense training regimens and classical positions of ballet dancers. Intense running and jumping movements, along with classic ballet poses such as en pointe and demipointe, contribute to this lower extremity injury pattern in an otherwise healthy cohort of competitive athletes. Resident and attending radiologists would benefit from learning about the pattern of injuries in this subset of patients, especially since some of these findings may present as asymptomatic incidental findings that can guide training and recovery.