Magnetic Resonance Imaging Abnormalities in the Shoulder and Wrist Joints of Asymptomatic Elite Athletes

Fredericson, Michael; Ho, Charles; Waite, Brandee; Jennings, Fabio; Peterson, Jeffrey; Williams, Christina; Mathesonn, Gordon O.

doi:10.1016/j.pmrj.2008.09.004

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Volume 1, Issue 2 , Pages 107-116, February 2009

Magnetic Resonance Imaging Abnormalities in the Shoulder and Wrist Joints of Asymptomatic Elite Athletes

Michael Fredericson, MD
- Department of Orthopedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-107A, Stanford, CA 94305-5336^⁎
- Address correspondence to: M.F.
Charles Ho, MD, PhD
- California Advanced Imaging, Atherton, CA^⁎
Brandee Waite, MD
- Department of Physical Medicine & Rehabilitation, UC Davis Medical Center, Sacramento, CA^⁎
Fabio Jennings, MD
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA^⁎
Jeffrey Peterson, MD
- Innovative Sports Medicine, Mountain View, CA^⁎
Christina Williams
- Department of Human Biology, Stanford University, Stanford, CA^⁎
Gordon O. Mathesonn, MD, PhD
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA^⁎

Received 1 June 2008; accepted 21 October 2008.

Objective

To characterize abnormalities on magnetic resonance images (MRI) in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of “normal” findings in this population.

Design

Cohort study.

Setting

Academic medical center.

Subjects

Division IA collegiate volleyball players (n=12), swimmers (n=6), and gymnasts (n=15) with no history of injury or pain and normal physical examination results.

Interventions

None.

Main Outcome Measures

Grade of severity of MRI changes of the shoulder and wrist joints. A 3- to 4-year follow-up questionnaire was administered to determine the clinical significance of the asymptomatic findings.

Results

All athletes demonstrated at least mild imaging abnormalities in the joints evaluated. Shoulder: Volleyball players had moderate and severe changes primarily in the labrum (50% moderate, 8% severe), rotator cuff (25% moderate, 17% severe), bony structures (33% moderate), and tendon/muscle (25% moderate, 8% severe). Swimmers had moderate changes primarily in the labrum (83% moderate) and ligament (67% moderate). Wrist: All gymnasts had changes in the wrist ligaments (40% mild, 60% moderate), tendons (53% mild, 47% moderate), and cartilage (60% mild, 33% moderate, 7% severe). Most gymnasts exhibited bony changes (20% normal, 47% mild, 26% moderate, 7% severe), the presence of cysts/fluid collections (80%), and carpal tunnel changes (53%). Swimmers had no wrist abnormalities. At follow-up interview, only 1 swimmer and 1 volleyball player reported shoulder problems during the study. Additionally, only 1 gymnast reported a wrist injury during their career.

Conclusion

Asymptomatic elite athletes demonstrate MRI changes of the shoulder (swimmers and volleyball players) and wrist (gymnasts) similar to those associated with abnormalities for which medical treatment and sometimes surgery are advised. Given the somewhat high frequency of these asymptomatic findings, care must be taken to correlate clinical history and physical examination with MRI findings in these patients with symptoms.