We studied 25 amateur and professional athletes in different sports (soccer,
hockey,
rugby).
The diagnostic evaluation has been carried out on transferring athletes or in the evaluation of the patient,
before returning to his/her sport activity.
We preferred the WBMRI in transferring athletes and in those patients who seemed taking too long to recover from a trauma.
The dynamic ultrasound exam has been carried out on all patients to evaluate the muscle district of lower limbs,
independently from the traumas they reported.
In the 80% of cases,
the ultrasound exam gave us an out and out map and staged muscle traumatic memory from the oldest to the newest traumas,
even though patients did not report them.
Sometimes,
we found tissue anomalies,
after traumas.
We would like to point out that the proof of anomalies in muscle tissue repair we have ascertained did not seem to be part of a known repairing pathophysiology of the muscle.
The so-called post trauma ossificating miositis seems to define an anomalous repairing process of the stromal connective interfibrillar and interfascial district.
Ossificating miositis seems calling to those districts taking care of the distribution of calcification in muscles and it’s considered the evolution of a phlogistic process (Fig.
2).
The term heterotopic ossification represents a biological process of tissue reorganization.
Finally,
post trauma limited intramuscular ossification (PTLIO) seems to better apply to calcification.
In our clinical evidence,
following the athletes we examined,
should be differentiated by the spread or limited intramuscular ossification and could include an abnormal fibrotic repair process ( Fig3,
4 ) .
The echostructural modification of the muscle was homogeneous along the major axis of muscle fibers,
keeping their pattern unchanged,
and without any swelling or dislocation of adjacent tissues .
We used WBMRI on transferring athletes and on those who had to go back to their professional sport activities after a stop caused by a trauma,
at the end of rehab or after championship holidays.
All of them declared to feel a certain wrong weakness of the limb that had suffered a trauma.
The WBMRI showed a regular signal intensity of the anatomic site that was treated for traumas,
in all patients.
In a fencer that we examined before sending him back to his professional activity and that was treated for the reconstruction of the ACL (Anterior Cruciate Ligament) we found an altered signal in the proximal insertion of the gastrocnemious muscles that was interpreted as an anomalous functional overload caused by his athletic preparation (DOMS).
Such finding brought to a modification in his athletic preparation.
We believe that the problem in using WBMRI is the excessive load of information about the musculoskeletal district and the abdominal parenchymas,
thorax and heart,
taking to an important medical reporting responsibility of the radiologist,
with longer evaluation time for each district,
in order to avoid diagnostic delays and better identify which districts and organs need further investigation.
With our study,
we demonstrate that WBMRI allows the identification of incidental findings and traumas unknown or unwillingly unreported by the athlete’s Team or the athlete itself (Fig.5 ,
Fig.6 ).
We also believe that the use of such technique gives the possibility to better identify pathologies that even both Team or athlete might not know about (Fig.7,
Fig 8 ).
However,
the overview that this technique gives,
allows us to identify the critical areas and point directly the districts that have to be studied with other techniques,
limiting the number of exams and the use of ionizing radiations.
The WBMRI seemed having less sensitivity on older lesions,
while has proven to be much better in showing incidentalomas caused by bone pathologies.