Use of the portabe ultrasound besides the rugby picht: Findings and

Use of the portabe ultrasound besides the rugby picht:
Findings and guided procedures.
Poster No.:
C-0943
Congress:
ECR 2016
Type:
Educational Exhibit
Authors:
M. J. FACHETTI, F. Dellavedova; ROSARIO/AR
Keywords:
Interventional non-vascular, Musculoskeletal system, Extremities,
Ultrasound, Diagnostic procedure, Drainage, Puncture, Athletic
injuries
DOI:
10.1594/ecr2016/C-0943
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Learning objectives
The aim of this presentation is:
1-To demonstrate the advantage of the use of portable ultrasound in a semiprofessional
rugby team during Argentinian Rugby Tournament.
2- To describe diagnostic and therapeutic studies made and to show the most commonly
affected muscle groups when playing rugby.
3- To define the role of the musculoskeletal radiologist within the team medical staff and
to describe the work methodology chosen in relation with the other members of the team
medical staff, coaches and players.
Background
The musculoskeletal radiologist plays a vital role providing diagnoses in sports medicine.
But the studies are generally carried out at hospital or an imaging centre.
The team medical staff of Unión de Rugby de Rosario (Rosario Rugby Team) is
composed of two sports medicine doctors, a musculoskeletal radiologist and two sports
physiotherapists.
In order to play a more active role in the team medical staff, a musculoskeletal radiologist
carrying a portable ultrasound machine attended all the matches and trainings during the
Argentinian National Rugby Championship. (Fig. 1)
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Fig. 1: ULTRASOUND SCAN
Page 3 of 28
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
The role of the radiologist in the team medical staff was crucial, suggesting the most
accurate study, performing the imaging studies, aiding diagnosis, guiding therapy, as
well as agreeing with the doctors, physiotherapists and coaching staff the return to play.
(Fig. 2)
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Fig. 2: PRP GUIDED INJECTION
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References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
The relationship between the radiologist, the other members of the team medical staff,
the coaching staff and the players was extremely important since monitoring the evolution
of injuries by images gave the rugby players greater confidence when returning to
competition.
Fig. 3: BESIDES RUGBY PICHT
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Images for this section:
Page 6 of 28
Fig. 2: PRP GUIDED INJECTION
Page 7 of 28
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 1: ULTRASOUND SCAN
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© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
Fig. 3: BESIDES RUGBY PICHT
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
Page 10 of 28
Findings and procedure details
During the tournament and pre-season competition, 43 ultrasound studies (diagnostic
and therapeutic) were performed. 39 out of them were diagnostic studies and 4 were
therapeutic ones. (Fig. 4)
Fig. 4
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
For statistical analysis, injuries were defined as indirect or direct according to their injury
mechanism and in chronic or acute according to evolution.
Within the group of chronic injuries evaluated, we found plantar fasciitis, adductor
tendonitis and retro calcaneal bursitis. (Fig. 5)
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Fig. 5: ADDUCTOR TENDONITIS
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Regarding the direct injuries, the ones found were muscle injuries (bruises and
contusions), suspected fractures and joint sprains. (Fig. 6, 7, 8)
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Fig. 6: VASTUS INTERMEDIUS HAEMATOMA
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Page 13 of 28
Fig. 7: FOLLOW UP OF VASTUS INTERMEDIUS HAEMATOMA
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Indirect injuries were found in the hamstring muscle group and leg muscles. (Fig. 9, 10)
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Fig. 9: HAMSTRING TEAR
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Page 15 of 28
Fig. 10: MEDIAL GASTROCNEMIUS TEAR
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
The therapeutic procedures consisted of injecting Platelet Rich Plasma (one in indirect
injury and another one in direct muscular injury) and guided intra-articular injection of
steroids. (Fig. 11, 12)
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Fig. 11: ULTRASOUND GUIDED PRP INJECTION GASTROCNEMIUS TEAR
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
Page 17 of 28
Fig. 12: ULTRASOUND GUIDED PRP INJECTION GASTROCNEMIUS TEAR
References: DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON ROSARIO/AR
As regards the number of muscle injuries in relation to the number of total injuries was
as follows: In total, 17 injuries occurred. There were 7 direct injuries and 3 indirect.
Out of the total number of examined injuries, 41.1% were muscle direct injuries and 17.6%
were indirect injuries.
The methodology of work was structured in the following way:
The team medical staff met some hours before the match to evaluate the possibility of
any interventional procedure if necessary.
During the match, the musculoskeletal radiologist remained beside the pitch with the
medical doctors and the physiotherapists in case the players need medical attention.
After the match, ultrasound scans were performed in the changing room to evaluate the
players who had a specific medical need. In that way, the radiologist worked together with
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the other members of the team medical staff deciding on the best therapeutic procedures
when needed. During the following training, they evaluated the evolution of the injuries.
On one occasion an ultrasound scan was performed in the rugby field while the match
was interrupted.
The medical staff and the coaching staff met several times a week to evaluate the
evolution of the players and their return to the competition.
Images for this section:
Fig. 5: ADDUCTOR TENDONITIS
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
Page 19 of 28
Fig. 6: VASTUS INTERMEDIUS HAEMATOMA
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
Page 20 of 28
Fig. 7: FOLLOW UP OF VASTUS INTERMEDIUS HAEMATOMA
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 8: ILIAC CREST CONTUSION
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 9: HAMSTRING TEAR
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 10: MEDIAL GASTROCNEMIUS TEAR
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 11: ULTRASOUND GUIDED PRP INJECTION GASTROCNEMIUS TEAR
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Fig. 12: ULTRASOUND GUIDED PRP INJECTION GASTROCNEMIUS TEAR
© DIAGNOSTICO POR IMAGENES, HOSPITAL ESCUELA EVA PERON - ROSARIO/
AR
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Conclusion
The advantage of having a radiologist doing ultrasound scans during the match or training
and having an active role in the medical staff can be summarized in the following aspects:
- Accurate, effective diagnosis and management of the injury within the first 24 hours.
- It gives the possibility of performing early ultrasound guided procedures in order to
accelerate rehabilitation and shorten the time to return to sports participation.
- Teamwork and collaboration between the medical doctors and therapists boosted the
medical staff and the team's confidence.
- Enables statistical studies that help to take preventive measures to reduce the injury
incidence.
Personal information
[email protected]
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