Sports Medicine: Just the Facts

CHAPTER 19 • ELECTRODIAGNOSTIC TESTING 111

KNEE

• Anteroposterior and lateral views are standard for the
  series. Except in the setting of acute trauma where frac-
  ture is of clinical concern, these should be obtained in the
  upright position. In acute trauma, the lateral view should
  be positioned in a cross-table manner to allow demon-
  stration of a lipohemarthrosis, a sign of fracture. A patel-
  lar view (sunrise of Merchant) shows the patellofemoral
  joint to best advantage. The flexed PA view gives insight
  into the intercondylar notch, and is more sensitive than
  the straight upright position for detecting early joint
  space narrowing. Oblique views may show additional
  contour abnormalities of the osseous structures or
  demonstrate a nondisplaced fracture.

ANKLE/FOOT

• Anteroposterior, lateral and oblique views are usually
  obtained. As with the knee, the films should be taken
  upright except when an acute fracture is suspected.
  Alignment abnormalities require weight-bearing for
  proper evaluation. If a subtle Lisfranc injury is sus-
  pected, weight-bearing AP films of both feet may be
  needed to evaluate for mild widening through compar-
  ison with the uninjured side. The Harris view provides
  a perpendicular projection of the calcaneous. Coalitions
  are often only seen on an oblique view of the foot.

CONCLUSION

• When dealing with the athlete, plain radiography is
  usually the first imaging study that should be per-
  formed. This holds true whether dealing with an acute
  injury or overuse.


• MRI is preferred for the diagnosis of radiographically
  occult bone injury and soft tissue trauma, be it acute
  or chronic. This is not an urgent examination unless
  one is dealing with an elite athlete where return to
  play is an issue, or if there is concern for a radi-
  ographically occult fracture in a weight-bearing bone.


• CT is preferred for complex bone trauma.


• The clinical history will effect both image acquisition
  and interpretation. Open communication between clini-
  cian and radiologist is essential for optimal patient care.

BIBLIOGRAPHY

Anderson MW, Greenspan A: State of the art: Stress fractures.
Radiology199:1–12, 1996.
Ballinger PW:Merrills Atlas of Radiographic Positions and
Radiographic Procedures, 3rd, vol 1.St Louis, MO, Mosby, 1986.

Farooki S, Seeger LL: Magnetic resonance imaging in the evalu-

ation of ligament injuries. Skeletal Radiol28:61–74, 1999.

Helms CA: The impact of MR imaging in sports medicine.

Radiology224:631–635, 2002.

Imhof H, Fuchsja ̈ger M: Traumatic injuries: Imaging of spinal

injuries. Eur Radiol12:1262–1272, 2002.

Lin J, Fessell DP, Jacobson JA, et al: An illustrated tutorial of

musculoskeletal sonography: Part I, Introduction and general

principles. Am J Roentgenol175:637–645, 2000a.

Lin J, Fessell DP, Jacobson JA, et al: An illustrated tutorial of

musculoskeletal sonography: Part II, Upper Extremity. Am J

Roentgenol175:1071–1079, 2000b.

Lin J, Fessell DP, Jacobson JA, et al: An illustrated tutorial of

musculoskeletal sonography: Part III, Lower Extremity. Am J

Roentgenol175:1313–1321, 2000c.

Lund PJ, Nisbet JK, Valencia FG, et al: Current sonographic

applications in orthopaedics. Am J Roentgenol166:889–895,

1996.

Rubin DA: MR imaging of the knee menisci. Radiol Clin North

Am35:21–44, 1997.

19 ELECTRODIAGNOSTIC TESTING

Venu Akuthota, MD

John Tobey, MD

INTRODUCTION

• Electrodiagnostic(EDX) testing can be an important
  tool in the evaluation of athletes with neurologic prob-
  lems.


• The thorough EDX consultation integrates the history,
  physical examination, and selected nerve conduction
  or needle electromyographic studies into a meaning-
  ful diagnostic conclusion (Robinson and Stop-Smith,
  1999).


• EDX studies are an extension of the clinical examina-
  tion.


• Whereas imaging studies identify structural abnor-
  malities, EDX studies evaluate the physiology and
  function of the peripheral nervous system.
  •A negative EDX examination does not rule out the pos-
  sibility of pathology because electrophysiologic studies
  are time and severity dependent (Rogers, 1996).


• Clinical judgment is used in EDX, therefore EDX
  studies are highly dependent on the quality of the
  electromyographer (Robinson and Stop-Smith,
  1999).


• This chapter will describe the pathophysiology of nerve
  injury and associated chronology of electrophysiologic