Sports injuries can't hide from imaging techniques

Sports injuries often require the use of x-rays and more sophisticated diagnostic imaging studies to determine the nature and severity of the injury. These studies and techniques have evolved significantly over recent years.

Among the most commonly used imaging studies are x-ray, computerized tomography (CT) and magnetic resonance imaging (MRI). X-rays were first used in the late 19th century, primarily to determine fractures and other boney injuries. CT scans came into use in the early 1970s and are designed to measure differences in density, especially in bones. MRIs create images based on changes in tissues such as tearing and swelling.

Dr. Nathaniel Dueker is a board certified musculoskeletal radiologist at The William W. Backus Hospital. He took time to review some of the most common sports injuries that require imaging:

• Head injuries. Concussions are among the most common injuries seen in sports. While there is no image that can diagnose a concussion, a CT scan should reveal any evidence of acute hemorrhage or skull fracture. Persistent symptoms may warrant the eventual use of an MRI to look for chronic damage.

• Shoulder injuries. These injuries typically involve tendons and ligaments. After a plain x-ray to rule out a fracture, an MRI is the best diagnostic tool. This study can demonstrate structural changes in the complex system that makes up the shoulder joint. An MRI of the shoulder can be performed with dye injected into the joint. This exam, called an MRI arthrogram, can be performed in different positions and may reveal subtle tears.

• Knee injuries. Traumatic sports injuries to the knee typically result in ligament and cartilage tears. While x-rays will rule out bone injuries, MRI is an outstanding technique for viewing damage to these structures.

Appropriate diagnostic imaging studies can limit the need for surgery and get athletes back in the game sooner.

The heart is a muscle that needs training too

When athletes are described as “having a lot of heart” it often refers to their desire to compete even in the face of overwhelming adversity. In sports medicine, an “athlete’s heart” has an entirely different meaning.

The human heart is composed of four chambers: the right atrium, right ventricle, left atrium and left ventricle. The heart functions as a pump moving blood from the right side of the heart to the lungs where it becomes infused with oxygen. The left-sided chambers then jettison oxygenated blood throughout the circulatory system to other organs.

The left ventricle has the greatest demand and tends to become enlarged, creating a condition known as “left ventricular hypertrophy.”

If blood vessels become narrowed due to atherosclerosis, it requires more work for the heart to pump against resistance. The pumping mechanism must work harder and faster. That strain can lead to heart failure and death.

Like all muscles, the heart can be trained to increase in size and work more efficiently. A fitness regimen that will improve cardiac efficiency should consist of several forms of exercise:

• Aerobic activities such as running, rowing or cycling will maintain a high heart rate over an extended period of time.

• Resistance activities include weight lifting and other strength-oriented sports.

• Cross-training programs include a combination of aerobic and resistance activities. Boxers and other athletes who participate in sports where high levels of strength must be maintained over long periods of time rely heavily on these programs.

“The enlarged, more efficient athlete’s heart is a normal response to exercise training,” said Dr. Craig Denegar, a professor of kinesiology at the University of Connecticut. Screening athletes before athletic participation can be challenging since an enlarged left ventricle can also indicate significant cardiac disease.

A regular exercise program can produce a heart that pumps more blood with less effort.