The MRI Report – What Tomorrow’s MRI May Tell Us

What is a MRI scan??

“MRI” stands for Magnetic Resonance Imaging. It is an amazing way to view the deep anatomic structures of the body. It is a scan that can create a 3-D image in many different angles, and is often used to evaluate if there is an injury to one of our favorite athlete’s joint. The injured athlete is placed in a large magnet that when turned on, positions or realigns all the water molecules in the body a certain way that creates the fine detailed anatomic image we are able to see. This is an incredible radiology procedure, and as this gigantic magnet realigns the athlete’s molecules, the athlete is completely unaware of the process. This is a totally painless procedure. The hardest part is the fact that the athlete has to remain perfectly still for 30 to 45 minutes on average, and often times they are listening to music or fall asleep. As a former professional athlete myself that has had two MRI scans, the hardest thing for me was staying still while my nose was itching…
MRI Scan Pic

The MRI Report:

Once the MRI scan is performed, a trained radiologist that specializes in reading and interpreting the images makes the diagnosis. Often times, this diagnosis, along with the evaluation of the MRI scan and physical examination of the orthopedic sports medicine surgeon, determines the fate of the injured athlete. The diagnosis is usually made or suspected on the field, and the MRI scan gives the definitive diagnosis and ultimately helps determine when the athlete will be able to return to play.

Continue to read and learn how these different injuries, and The MRI Report, seals the fate of our favorite athletes around the league.

Often times an injury occurs on the field that causes immediate pain and swelling. The joint “blows up” and the athlete may feel like they cannot continue to play. This may be simply because of pain, or a feeling like the joint is too unstable. This means the joint will “buckle” or “go out” if any stress like running or pivoting is placed on the joint. If the team doctor has concerns about a true injury, and the athlete cannot return to the game, a MRI scan will often be ordered.

 

What Tomorrow’s Shoulder MRI Might Tell Us!!!

 

The Shoulder:

Out for the season: If an athlete has any one of these injuries per The MRI Report, they will be out for the season. They will require surgery to reconstruct the injured structures.

 

  • Fully torn rotator cuff tear – for most high level athletes, this may be a career ending MRI diagnosis
  • Large displaced glenoid fracture – caused from complete shoulder dislocation
  • Large flipped labral tear  – the labrum is the cartilage ring that surrounds the cup (glenoid). AKA – “bucket handle tear”
  • Grade 4 – 5 AC joint separation – Extremely rare injury where the AC joint separates into the muscle belly and gets stuck out-of-place

Glenoid Fracture

                                                                                                                                                                Glenoid Fracture

AC Separation

                                                                                                                                                                 AC Separation

Need surgery, but may return before end of season: These athletes may need arthroscopic tendon or cartilage repair surgery, but may opt to play through injury and undergo surgery after season. If injury too painful or risky, may decide on immediate surgery in which they will usually be out for the remaining season.

 

  • Acute shoulder dislocation (if large labral tear or glenoid socket bone loss or fracture noted)
  • SLAP tear – tear of the proximal biceps tendon off the top of the glenoid socket
  • Complete rupture of long head biceps tendon – Some special athletes may elect to not repair this tendon, e.g. John Elway
  • Partial rotator cuff tear – will require repair if pain and weakness prevent full return of function. Most devastating in throwing athletes.
  • Large loose body in shoulder joint

Acute Shoulder Dislocation

Acute Shoulder Dislocation

No surgery, but may miss several weeks during season: These athletes typically will not require surgery, but may miss several weeks for recovery, and depending on time of the season, may or may not make it back to play.

 

  • Acromio-clavicular separation (AC joint sprain) – Grade 3 separations may be too painful to play through for a few weeks, but not unheard of…
  • Large shoulder bone contusion (bruise) – Caused from shoulder subluxation or dislocation
  • High grade rotator cuff tendonitis or tendonosis – rotator cuff shows signs of inflammation
  • Complete rupture of long head biceps tendon – Some special athletes may elect to not repair this tendon, e.g. John Elway

 

No surgery, and may miss a few days and/or one to two games: These athletes usually will not miss any substantial time away from play, but need the MRI scan to “rule out” one of these more serious injuries.

 

  • AC joint sprain or separation – Grade 1-3. Most grade 1 sprains football players will play through… Grade 2 sprains may be very painful but can still play through. Most grade 3 sprains will require more time for healing and reduction of pain while maintaining shoulder strength
  • Bone contusion from direct blow to shoulder – may be related to impaction injury crushing the rotator cuff, or subluxation injury stretching the capsule

 

 

The Knee:
The Knee

Out for the season: If an athlete has any one of these injuries per The MRI Report, they will be out for the season. They will require surgery to reconstruct the injured structures.
Normal ACLTorn ACL

• Torn ACL Ligament
• Torn ACL and MCL Ligament
• Torn PCL with associated ACL, MCL or LCL ligament tear
• Rupture of distal quadriceps tendon
• Rupture of patellar ligament
• Dislocation of patella
• Large meniscus tear that requires repair

Bones Bruises

Ref: Dr. Kiran K V Acharya. “Pattern of bone bruise in ligament injury (single or multiple) of bone”

Need surgery, but may return before end of the season: These athletes may need arthroscopic surgery, but with speedy recovery, may return to play in the same season.

 MRI Meniscal Tear

• Large meniscus tear - requires removal and ”smoothing out”
• Loose body - requires removal
• Large unstable cartilage injury - requires removal or fixation

No surgery, but may miss several weeks during season: These athletes typically will not require surgery, but may miss several weeks for recovery, and depending on time of the season, may or may not make it back to play. These injuries usually require bracing and to protect the injured structure.
* MCL rupture/sprain no other injuries
* LCL rupture/sprain no other injuries
* PCL rupture/sprain no other injuries
* Large bone contusion or bone bruise - no ligament tear

No surgery, and may miss a few days and/or one to two games: These athletes usually will not miss any substantial time away from play, but need the MRI scan to “rule out” one of these more serious injuries.
* Small bone bruise or contusion
* Mild MCL sprain
* Mild LCL sprain
* Mild PCL sprain
* Mild effusion

*** Most knee injures that cause swelling and do not involve a major ligament or meniscus tear, the time to return to play is determined by getting most of the fluid out of the knee and returning the strength to at least 85 – 90%. The faster the medical team can do this, the sooner the athlete can return to play without increased risk of re-injury or further injury. ***

 

Foot/Ankle

Ankle sprain - The ankle is stabilized by three ligaments on the outside and one large ligament on the inside of the ankle joint. The ligaments on the outside of the ankle are most commonly injured. These are called the Anterior Tibial Fibular Ligament and the Calcaneal Fibular Ligament, and they are named based on the bone structures that they connect. They can be stretched or torn with a roll, twist, or misstep of the foot. The symptoms include swelling, pain, and decreased range of motion. After a sprained ankle, the athlete is at increased risk for future sprains. The treatment is rest, ice, compression, and physical therapy to strengthen the muscles of the foot and ankle, focusing on balance. The recovery time is variable depending on the severity of the sprain. Mild sprains recover within a few days, moderate sprains normally recover in 1-3 weeks (but may require protective bracing for 5-8 weeks). Severe sprains may take 6-12 months to fully recover, although return to sports is generally much sooner. Only the most severe and unstable ankle sprains require surgery. Ligament instability reconstructions for the ankle require three to four months to fully heal, with full strength and sport activity occurring closer to five to six months. This comes with extensive physical therapy and training for balance, agility, and conditioning.

High ankle sprain (Syndesmosis injury)– This injury involves a strong ligament that holds the two bones at the bottom of the leg together – the tibia and fibula – and is called the Syndesmosis. If the syndesmosis ligament is torn, this ankle sprain can last longer than a typical “bad” ankle sprain. The recovery can involve a period of non-weight bearing and take twice as long to heal. These injuries can easily sideline an athlete for the entire season.