Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries

Nikolaos Malliaropoulos; Georgios Bikos; Ioannis Tsifountoudis; Dimosthenis Alaseirlis; Dimitrios Christodoulou; Nat Padhiar; Nicola Maffulli

doi:10.1016/j.surge.2022.06.002

Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries

Surgeon. 2023 Aug;21(4):225-229. doi: 10.1016/j.surge.2022.06.002. Epub 2022 Aug 2.

Authors

Nikolaos Malliaropoulos¹, Georgios Bikos², Ioannis Tsifountoudis³, Dimosthenis Alaseirlis⁴, Dimitrios Christodoulou⁵, Nat Padhiar⁶, Nicola Maffulli⁷

Affiliations

¹ Sports and Exercise Medicine Clinic, Asklipiou, Thessaloniki, Greece; Sports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK; Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK. Electronic address: contact@sportsmed.gr.
² Euromedica-Arogi Rehabilitation Clinic, Pylaia, Thessaloniki, Greece. Electronic address: bikosg77@yahoo.gr.
³ Asclepios Diagnostic Center, Thessaloniki, Greece. Electronic address: tsifjo@gmail.com.
⁴ General Clinic-Euromedica, Thessaloniki, Greece; First Department of Orthopaedic Surgery, Aristotle University of Thessaloniki, Greece. Electronic address: iraridim@hotmail.com.
⁵ Sports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK. Electronic address: evechristodoulou@yahoo.gr.
⁶ Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; London Sports Care, BMI London Independent Hospital, London, UK. Electronic address: nat.padhiar@londonsportswise.co.uk.
⁷ Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; First Department of Orthopaedic Surgery, Aristotle University of Thessaloniki, Greece; Department of Orthopaedics, School of Medicine, Surgery and Dentistry, Salerno, Italy; Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, United Kingdom. Electronic address: n.maffulli@qmul.ac.uk.

PMID: 35927163
DOI: 10.1016/j.surge.2022.06.002

Abstract

Objective: Tibial stress injuries are challenging in terms of early diagnosis, management strategy, and safe return-to-play. In the present study, pain production associated with the application of therapeutic ultrasound (TUS) was used as a primary diagnostic tool to assess tibial bone stress injuries, and the sensitivity of this procedure was compared with Magnetic Resonance Imaging (MRI).

Subject and methods: The study was designed as a retrospective analysis of prospectively collected data on tibial bone stress injuries in elite Track and field athletes attending the National Track and Field Athletics Centre in Thessaloniki, Greece, in the period 1995-2007. All patients underwent evaluation by TUS, and the sensitivity of the procedure was compared with MRI.

Results: Four of 29 athletes showed a positive TUS examination for stress injury while MRI showed normal findings. Additionally, 5 athletes evidenced MRI findings typical of a tibial bone stress injury, while TUS evaluation was negative. Using MRI as the standard, TUS displayed a sensitivity of 79.2%.

Conclusion: Therapeutic ultrasound is a reproducible modality with satisfactory reliability and sensitivity related to MRI, and could represent a useful tool for clinicians to primarily assess suspected tibial bone stress injuries in high qualification Track and Field athletes.

Keywords: Athletes; Bone stress injuries; Reliability; Therapeutic ultrasound; Tibia.

MeSH terms

Athletes
Humans
Magnetic Resonance Imaging
Pain Threshold
Reproducibility of Results
Retrospective Studies
Track and Field*
Ultrasonic Therapy*