Tibial Stress Fracture

Today a show you the case of a young football player  that came to my observation for a persistent pain on his postero-medial compartment of the leg; as you can see from the dynamic ultrasound examination, a gross irregularity of the cortical tibial surface was evident with intense periostal hypervascularity.

The tibia is the most common site of a stress fracture in the lower body, especially in young athletes. Don’t forget that sensibility of the ultrasound scan with bone-like structures is 100% but 0% specificity. The integration with other imaging modalities is always needed; Mri exam is essential.


Sagittal Stir-3D Shark-T1w Mri scans 0.3 Tesla (from left to right)


Axial Stir (left) and T2w (right) Mri scans (0.3 Tesla); intense periostal reaction is evident.

With plain radiograph positive findings may take months to appear; don’t be surprised if during the first few weeks after the onset of symptoms, x-rays of the damaged area may look normal; not in this case….


Plain radiographs of the same patient: acute phase (left) and two months after (right).

Patellar Tendon Degeneration part II

about patellar tendon degeneration

In a previous post I showed you my daily routine in studying patellar tendon degeneration and how crucial is to combine all the imaging modalities for a better treatment strategies.

It’s not easy to study post-surgical outcomes of a tendon with the Mri evaluation; lots of artifacts and calcfications doesn’t allow a clear visualization of tendon’s fibres.


Sagittal T1w (left) and GeStir (right) of patellar tendon degeneration 10 years after surgery reconstruction; red arrows indicate the site of pain.

This is the case of a patient that ten years after surgical reconstruction of the patellar tendon, starts to feel pain. Is it possible to “see” the pain? Gross tendon degeneration is evident but, only with ultrasound examination I can better depict the hypervascularity of the tendon in the site of referred pain and the relationship between patellar tendon and Hoffa’s fat pad, its well known “biomechanical attenuator”.

But I also asked to myself: what’s behind this tendon degeneration? Dynamic Mri study gave me the answer: a scarce patellar mobility during active flexion-extension movements was evident.

Less patellar mobility means more stress for the tendon. Isn’t it?

0.3 and 1.5 Tesla Mri

Sometimes, if my daily agenda allows to spread my curiosity (time is never enough!), I make a comparison between 0.3 and 1.5 Tesla Mri imaging studying the same patient.

These are the pictures of a sprained medial collateral ligament of a professional football player, quite similar to what is shown in my recent post medial collateral ligament tear.


Coronal T2w (left) and Sagittal T2w (right) Mri scan (0.3 tesla)

I always complete my study with a dynamic ultrasound exam; in this patient the presence of a calcification is noted, not visible on Mri scans.


Comparison between Axial and Coronal Mri scans of the same patient.


Sagittal Pd Tse Fs (1.5 tesla) and Fast Stir (0.3 Tesla).