Cortical Irregularity Research Articles

Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws

Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is characterized by exposed nonvital maxillary or mandibular bone. Cone-beam computerized tomography (CBCT) is an attractive modality for 3-dimensional imaging of the jaws. The purpose of this study was to compare the clinical and radiographic features of a series of 7 subjects with BONJ who were evaluated by both CBCT and digital panoramic radiography. Seven subjects with BONJ were evaluated by clinical examination, CBCT, and digital panoramic radiography. Radiographic findings included sclerosis, cortical irregularity, lucency, mottling, fragmentation/sequestra formation, sinus communication, and persistent sockets. There was high correlation between the anatomic location of clinical and radiographic findings. In nearly all cases, CBCT demonstrated a greater extent and quality of changes compared with panoramic radiography. Cone-beam CT is superior to panoramic radiography in its ability to characterize the nature and extent of radiographic changes in BONJ. Use of CBCT should be strongly considered when radiographic evaluations are included in prospective research investigations of BONJ. However, in the majority of cases of BONJ the clinical significance of improved imaging remains unclear, and therefore specific guidelines for routine clinical care cannot be recommended at this time.

Diagnostic Imaging Following Cervical Spine Injury

The patient was a 23-year-old woman referred to physical therapy for the primary treatment of knee pain which began 4 months prior following a twisting injury. During the patient interview, the patient also complained of neck pain and numbness and tingling in her bilateral hands and feet which began 6 weeks earlier after jumping into a 2 meter pool head first and striking her head on the floor of the pool. Due to concern over a serious cervical spine injury, the physical therapist focused his initial physical examination on the patient's cervical spine. Physical examination findings were remarkable for midline cervical spine tenderness and decreased sensation throughout both hands and feet. Cervical spine radiographs were ordered, which revealed a cortical irregularity along the anterior aspect of the superior endplate of the C7 vertebral body, which was concerning for an anterior-superior compression fracture. Computed tomography scanning was completed for further evaluate the area of injury and revealed minimally displaced anterior compression fractures within the C7, T1, T2, and T3 vertebral bodies. Due to the paresthesias in the upper and lower extremities, magnetic resonance imaging was completed, which demonstrated no evidence for significant central canal or foraminal stenoses. The patient was referred to a neurosurgeon who recommended conservative management. J Orthop Sports Phys Ther 2010;40(3):189. doi:10.2519/jospt.2010.0405

Imaging findings at the donor site after iliac crest bone harvesting

Postoperative imaging after iliac crest bone harvesting is commonly performed, but has not been extensively reported in the literature. The objective of this analysis was to investigate the donor site after iliac crest graft harvesting. Between January and December 2008, 3,450 patients underwent CT, which included the pelvis. Eighty-four patients were found whose iliac crests were harvested. The patient population consisted of 47 male and 37 female subjects ranging from 10 to 80 years old (mean 52.6 years) at the time of iliac bone harvesting. With the inclusion of prior examinations, 188 CT examinations, 17 MR imaging studies, and 19 bone scintigrams were analyzed at various time points after surgery. Computed tomography images demonstrated fluid collections, hematoma, and air at the donor site up to 1 month after bone harvesting. The air then disappeared. Fluid collection decreased in size by 4 months. Scar-like changes at the harvest site and irregular thick cortical bone were observed after 4 months. Later, CT and MR imaging demonstrated small scar-like lesions and cortical irregularities. The appearance of harvest site abnormalities depends on the time elapsed after surgery.

Enthesiopathy of the flexor carpi ulnaris at the pisiform: Findings of high-frequency sonography

Objectives Acute or chronic pain at the pisiform may be due to tendinopathy of the flexor carpi ulnaris tendon (FCU) insertion, mechanical overuse, bony fractures, and osteoarthritis of the pisiform-triquetral joint. Enthesiopathy of the FCU at the pisiform might exhibit abnormalities assessable for sonographic characterization. This study aimed to determine the most relevant sonographic features of tendinopathy of the FCU insertion at the pisiform. Materials and methods We retrospectively analyzed radiological findings of 9 patients admitted for high-frequency sonographic evaluation of a painful pisiform FCU insertion. The FCU insertion was assessed for active enthesiopathy in terms of tendon thickening and hyperemia, peritendinous effusion, peritendinous hyperemia, peritendinous soft tissue thickening, cystic fluid collections, erosive cortical irregularities, and osteoproliferative alterations at the pisiform. Results Of all patients, 5 had inflammatory rheumatic disorders and the remainder had a painful pisiform FCU insertion related to overuse. While peritendinous effusion, pisiform erosive cortical irregularities, and peritendinous soft tissue thickening at the FCU insertion were exclusively found in rheumatic patients, active enthesiopathy of the FCU tendon, pisiform osteoproliferative alterations, and hyperemia of the peritendinous soft tissue were inconsistent and found in both groups. Cystic fluid collections from the pisiform-triquetral joint were only seen in patients with overuse. Conclusions In this small case series of patients with pain at the pisiform FCU insertion, we could reveal several typical sonographic features for insertion tendinopathy. Further studies should prove if these sonographic features could impact on the management of patients with pain at the pisiform.

Assessment of Achilles enthesitis in the spondyloarthropathies by colour Doppler energy ultrasound in the context of the ‘enthesis organ’

Objectives: To identify the characteristic features of Achilles enthesitis of the spondyloarthropathies (SpA) detectable by colour Doppler energy ultrasound (CDEU) in the context of the ‘enthesis organ’.Methods: Seventy patients with SpA and 15 healthy subjects were clinically evaluated and underwent CDEU examination of the Achilles entheses. The CDEU images were evaluated according to five distinctive CDEU features of enthesitis in the context of the enthesis organ.Results: Fifty-six of the 70 SpA patients (80%) showed at least one abnormal finding of the enthesitis on CDEU examination, affecting 91 of 140 Achilles entheses examined (65%). Only 22 of 140 Achilles entheses (15.7%) showed abnormal vascularization in the peri-sesamoidal and periosteal areas or in the area of enthesis fibrocartilage. In addition, 67 (47.9%) and 18 (12.9%) of 140 Achilles entheses examined showed cortical bone irregularities and erosions, respectively, at areas of the periosteal and the enthesis fibrocartilage. Sixteen (88.9%) of 18 clinically detected Achilles enthesitis and six (75%) of eight Achilles entheses with swelling on clinical examination presented corresponding abnormalities on CDEU examination. The Doppler twinkling artefact (TA) was observed consistently in all normal entheses and completely disappeared upon stabilization of the probe application. The C-reactive protein (CRP) level was higher in the patients with cortical bone erosion than in those without erosion.Conclusions: This study demonstrates the characteristic features of enthesitis detectable by CDEU in the context of the enthesis organ and shows a good correlation with clinical as well as with laboratory findings.

Evaluation of the Patellar Tendon in Transtibial Amputees

This study aimed to provide sonographic imaging of the patellar tendon (PT) - one of the main weight bearing structures for prosthetic use - in transtibial amputees. Thirteen males, who had been under follow-up for unilateral traumatic transtibial amputations, were enrolled. After physical examination of the limb, pain was evaluated by visual analogue scale and Leeds Assessment of Neuropathic Symptoms and Signs. Sonographic evaluations were performed by using a linear array probe (Aloka UST-5524-7.5 MHz) on both sides. Measurements pertaining to the contralateral limbs were taken as controls. In three subjects (23.1%), two with a silicone liner and one with a pelite liner, cortical irregularities were detected at the tibial insertion of the PT on the amputated sides. PTs were found to be thicker on the amputated sides when compared with those of the contralateral sides (p = 0.03), and this increase in thickness correlated with disease duration (r = 0.67, p = 0.01). Overall, our preliminary results imply that after transtibial amputation, PTs of the amputated sides tend to become thicker by time. These findings need to be complemented with future studies. In this regard, sonography seems to be promising for imaging the soft tissue problems of the stump.

0072: Ultrasound of Epicondylitis

Lateral epicondylitis is one of the most common disorder around the elbow. There is evidence that the degenerative process in lateral epicondylitis more selectively involves the origin of the extensor carpi radialis brevis as a result of overuse injury. The main US signs of lateral epicondylitis include a focal hypoechoic area on either a normal background or one characterized by a diffuse decrease in echotexture with loss of the fibrillar pattern. Focal hypoechoic areas, anechoic foci reflecting interstitial tears, calcifications, cortical irregularities and a hypervascular pattern at Doppler imaging correlate with clinical symptoms. The lateral ulnar collateral ligament may be injured in association with tears of the common extensor tendon as a result of the same forces or overuse mechanisms and an unsuspected tear of this ligament may be cause of conservative therapy failure. In case of coexisting tear of the lateral ulnar collateral ligament, a full-thickness defect of tendon fibers which reaches the radiocapitallar joint is found. In refractory cases that have failed to respond to physiotherapy and anti-inflammatory drugs, US can guide a dry needling procedure to treat painful tendinopathy. This technique consists of multiple passages with the needle in the tendon substance with or without intratendinous autologous blood or platelet-rich plasma supplement. On the medial aspect of the elbow, medial epicondylitis has the same histopathological picture as the more common lateral epicondylitis. This disorder derives from repetitive stress or overuse of the flexor-pronator musculature, most often affecting the pronator teres and the flexor carpi radialis. The US appearance of medial epicondylitis is similar to that of lateral epicondylitis. The main role of US is to distinguish the involvement of the tendon from a lesion of the underlying medial collateral ligament. Similar to the lateral epicondyle, enthesopathy may be observed at this site instead of tendinopathy. Lateral epicondylitis is one of the most common disorder around the elbow. There is evidence that the degenerative process in lateral epicondylitis more selectively involves the origin of the extensor carpi radialis brevis as a result of overuse injury. The main US signs of lateral epicondylitis include a focal hypoechoic area on either a normal background or one characterized by a diffuse decrease in echotexture with loss of the fibrillar pattern. Focal hypoechoic areas, anechoic foci reflecting interstitial tears, calcifications, cortical irregularities and a hypervascular pattern at Doppler imaging correlate with clinical symptoms. The lateral ulnar collateral ligament may be injured in association with tears of the common extensor tendon as a result of the same forces or overuse mechanisms and an unsuspected tear of this ligament may be cause of conservative therapy failure. In case of coexisting tear of the lateral ulnar collateral ligament, a full-thickness defect of tendon fibers which reaches the radiocapitallar joint is found. In refractory cases that have failed to respond to physiotherapy and anti-inflammatory drugs, US can guide a dry needling procedure to treat painful tendinopathy. This technique consists of multiple passages with the needle in the tendon substance with or without intratendinous autologous blood or platelet-rich plasma supplement. On the medial aspect of the elbow, medial epicondylitis has the same histopathological picture as the more common lateral epicondylitis. This disorder derives from repetitive stress or overuse of the flexor-pronator musculature, most often affecting the pronator teres and the flexor carpi radialis. The US appearance of medial epicondylitis is similar to that of lateral epicondylitis. The main role of US is to distinguish the involvement of the tendon from a lesion of the underlying medial collateral ligament. Similar to the lateral epicondyle, enthesopathy may be observed at this site instead of tendinopathy.

Structural Changes, Not Neovascularization, Accounts For The Variation In Pain With Infrapatellar Tendinopathy

The source of pain in patients experiencing chronic overuse tendinopathy is not completely understood. It has been proposed that vascular in-growth within the area of tendon degeneration is closely associated with an exaggerated nociceptive response. Changes to the sonographic appearance of the tendon are often reported with tendon disease; however, a detailed examination of the sonographic structure of tendon pathology as it relates to the onset of pain has not been performed. PURPOSE: To construct a statistical model that would account for the variation in pain scores reported by tendinopathy patients based on eight sonographic features. METHODS: Clinical and sonographic data were collected from 244 consultations of 51 patients receiving injections of hyperosmolar dextrose/lidocaine for their infrapatellar tendinopathy. Pain scores were documented using visual analog scales (VAS) for pain at rest, pain with activities of daily living, and pain during or immediately after sports. The following sonographic features were documented for all visits: hypoechogenicity, obvious intratendinous tears, occult intratendinous tears, injectant spread, neovascularity, intratendinous calcification, periostitis, and cortical irregularities. Each VAS item was entered into its own backward stepwise regression model (p ≥ 0.1 for exclusion) as the dependent variable with all eight sonographic features included as independent variables. RESULTS: The appearance of periostitis and both obvious and occult intratendinous tears explained a significant variation in the pain scores at rest (R2 =.14, F(3, 240) = 12.71, p <.001); periostitis, both obvious and occult intratendinous tears, and spread of injectant explained a significant variation of pain with activities of daily living (R2 =.08, F(4, 239) = 4.86, p <.01); and periostitis, and both obvious and occult intratendinous tears, spread of injectant and intratendinous calcification explained a significant amount of the variation of pain associated with sport (R2 =.09, F(5, 238) = 4.51, p <.01). CONCLUSIONS: The sonographic appearance of tearing within the tendon, in addition to periosteal and cortical changes at the enthesis, explains a significant portion of the pain experienced by patients with infrapatellar tendinopathy.

Differential Diagnosis of Fibular Pain in a Patient With a History of Breast Cancer

A 46-year-old avid female runner was referred to physical therapy for left ankle pain following an inversion injury sustained 1 month earlier while running. The patient had a history of breast cancer, but her health screening was otherwise unremarkable. The patient presented with a normal ankle examination, except for localized tenderness to palpation proximal to the distal tip of the left fibula. The physical therapist was concerned about the possibility of a fibular fracture and ordered ankle radiographs, which were read as normal by the radiologist. The physical therapist, however, observed a slight cortical irregularity of the distal fibula on the anterior-posterior radiograph that corresponded with the site of palpation tenderness, and consequently ordered a bone scan to differentiate active versus old pathology. The bone scan revealed an area of increased metabolic activity at the site of the cortical irregularity, so the physical therapist ordered magnetic resonance imaging, which revealed an incom...

Acromial stress fracture in a young wheelchair user with Charcot-Marie-Tooth disease: a case report

Acromial stress fractures are rare and have not been highlighted as a potential complication of wheelchair use. We report the case of a 22-year old female wheelchair bound patient with Charcot-Marie-Tooth disease who presented with a four-year history of shoulder pain which impaired mobility and quality of life. Plain radiographs showed a cortical irregularity of the acromion but no double-density sign. After CT scans a non-united acromial stress fracture was diagnosed. She had no other shoulder pathology. The new technique of using a superiorly closing wedge osteotomy with cancellous lag screw fixation was successful in correcting the mobile non-united acromial fragment and resolving her pain.

Frontal Parosteal Lipoma

Parosteal lipoma of the head and neck is very rare, and there is no reported case of parosteal lipoma in the frontal region. We present the case of frontal parosteal lipoma in a 20-year-old man who was referred for a forehead mass causing a cosmetic problem. Computed tomography revealed an osseous projection with cortical irregularity and soft tissue enlargement. Excision of the lesion revealed a 7 x 4.5-cm lobulated, encapsulated, yellow tan mass. Histopathologic examination revealed mature adipose tissue, and pathologic diagnosis of lipoma was made. Here, we present the first case of parosteal lipoma in the frontal region.

Abnormalities of the Lesser Tuberosity on Radiography and MRI: Association with Subscapularis Tendon Lesions

The objective of our study was to retrospectively evaluate the association between abnormalities of the lesser tuberosity and subscapularis tendon lesions. Cortical irregularities and cysts of the lesser tuberosity were evaluated on radiographs and MR images in 70 patients: 31 with normal subscapularis tendons and 39 with subscapularis tendon tears. These imaging findings were correlated with subscapularis tendon tears diagnosed during arthroscopy and with fatty atrophy of the subscapularis muscle seen on MR images. Correlations between imaging findings, patient age, history of trauma, and the reference standards were assessed using gamma coefficients. Interreader agreement was calculated using kappa values. For the diagnosis of subscapularis tendon tears, the sensitivity of cortical irregularities and cysts on radiographs was 44%/51% (reader 1/reader 2) and 21%/21%, respectively; specificity was 65%/68% and 87%/87%. The sensitivity of cortical irregularities and cysts on MRI was 64%/72% and 36%/39%. Specificity was 48%/45% and 81%/77%. For fatty atrophy of the subscapularis muscle, the sensitivity of cortical irregularities and cysts on radiographs was 67%/73% and 17%/27%, respectively; the specificity was 63%/63% and 83%/85%. Significant (p < 0.05) positive correlations were found between cortical irregularities and surgical grade of subscapularis tendon tear for reader 2 (radiography, gamma = 0.39; MRI, gamma = 0.45) and between lesser tuberosity abnormalities and patient age (gamma = 0.11 and 0.43) for both readers. Interobserver agreement of imaging findings varied from moderate to substantial (kappa = 0.50-0.76). Abnormalities of the lesser tuberosity are moderately associated with subscapularis tendon tears and patient age. Cysts seen in the lesser tuberosity on shoulder radiographs or MR images are relatively specific for subscapularis tendon tears and muscle atrophy.

Aspect échographique des fractures des extrémités

US, a non-irradiating imaging modality, is complementary to radiographs in the evaluation of limb fractures. US may in some cases demonstrate or suggest the presence of a fracture without corresponding abnormality on radiographs, or confirm or exclude a possible fracture detected on radiographs. Knowledge of the US features of fractures is necessary. In this article, the different direct and indirect US findings of fractures will be reviewed, with radiographic correlation. Direct findings include cortical discontinuity or irregularity. Indirect findings include subperiosteal or juxtaphyseal hematoma suggesting cortical or physeal fractures respectively.

Duplicate publication with consequence of potential misinformation and further controversy

We find ourselves in the awkward position of submitting a commentary on our review appearing in Pediatric Radiology entitled “Neuroimaging of nonaccidental trauma: pitfalls and controversies” after it has been e-published, but before it has come out in print [1]. Since it is too late to revise the article, we hope to publish this commentary alongside it. The decision to write this letter at this time is due to our desire to avoid any possibility of potential propagation of misinformation. Ironically, our review deals with controversies and pitfalls, and the reason for this letter is due to controversy as well. This controversy, which has been brewing for some time, is regarding the potential pitfall of confusing the neuroimaging findings of hemophagocytic lymphohistiocytosis (HLH) with nonaccidental trauma. We recently became fully aware of the details of this controversy and felt obligated to write this letter. In a recent letter to the editor of Pediatric Radiology, Dr. Leonidas asks the question “What now?” regarding an independently confirmed case of duplicate publication [2]. Dr. Leonidas’s letter is in reference to another letter published in Pediatric Radiology written earlier in 2007 by Hansen and Frikke entitled “Dual and discrepant case publication in regard to hemophagocytic lymphohistiocytosis and child abuse” [3]. In their letter, Hansen and Frikke accuse Fitzgerald and McClain of publishing the same case of HLH twice in two different journals and leaving out critical clinical information in one journal, resulting in two different interpretations of the findings [4, 5]. Dr. Leonidas’s letter confirms the dual submission accusation made by Hansen and Frikke, providing dates and proving that the two articles were submitted to two different journals within days of one another. Further, Dr. Leonidas confirms the accusation of Hansen and Frikke that the two articles did include at least one case of HLH with differing interpretations of the clinical findings [2]. In the article published in Pediatric Radiology by Fitzgerald and McClain, the authors describe the imaging findings of 25 children with HLH, including bone and brain involvement [4]. The bony findings, described as periosteal reaction, cortical irregularity, osteopenia and rib fractures, were not stated to be due to HLH, but their cause was not made clear. Regarding the brain findings, one of the cases included in the Fitzgerald-McClain article was also included in an article by Rooms, Fitzgerald and McClain in Pediatrics entitled “Hemophagocytic lymphohistiocytosis masquerading as child abuse: presentation of three cases and review of central nervous system findings in hemophagocytic lymphohistiocytosis” [5]. In their article (from which we reprinted with permission an axial CT image showing intracranial hemorrhage and cerebral edema), Rooms et al. warn of the pitfall of confusing HLH with nonaccidental Pediatr Radiol (2008) 38:839–840 DOI 10.1007/s00247-008-0821-1

Diagnostic Value of Ultrasonography for Clinical Medial Epicondylitis

Park G-Y, Lee S-M, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Objectives To assess the ultrasonographic findings and to evaluate the value of ultrasonography as a diagnostic method for detecting clinical medial epicondylitis. Design A prospective, single-blind study. Setting An outpatient rehabilitation clinic in a tertiary university hospital. Participants Twenty-one elbows from 18 patients with clinical medial epicondylitis and 25 elbows without medial epicondylitis were evaluated. Interventions Not applicable. Main Outcome Measures The clinical diagnosis of medial epicondylitis was based on the patient’s symptoms and clinical signs in a physical examination performed by a physiatrist. An experienced radiologist made the real-time ultrasonographic diagnosis based on the detection of at least one of the following abnormal findings: a focal hypoechoic or anechoic area, tendon nonvisualization, intratendinous calcifications, and cortical irregularity. Results Ultrasonography revealed positive findings in 20 of 21 elbows with medial epicondylitis and was negative in 23 of 25 without medial epicondylitis. Ultrasonography showed sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for clinical medial epicondylitis of 95.2%, 92%, 93.5%, 90.9%, and 95.8%, respectively. Tendinosis was observed in 15 elbows, and a partial-thickness tear, including 1 intrasubstance tear, was detected in 5 elbows. The most common ultrasonographic abnormality was a focal echogenic abnormality (15 hypoechoic, 5 anechoic) of the tendons. Conclusions Our results indicate that ultrasonography is informative and accurate for the detection of clinical medial epicondylitis. Therefore, ultrasonography should be considered as an initial imaging method for evaluating medial epicondylitis.

Bilateral mesial temporal polymicrogyria: a case report

Polymicrogyria is a malformation of cortical organisation morphologically marked by an irregular brain surface with multiple excessively folded small gyri. Cortical thickness is reduced but appears increased in some areas...

Avulsive Cortical Irregularity and F-18 FDG PET

Abstract:F-18 FDG PET showed marked uptake in the posteromedial left distal femoral metaphysis of a 9-year-old boy whose history of trilateral retinoblastoma indicated a high risk of additional malignancies, including osteosarcoma. Evaluation with radiographs and MRI revealed that an avulsive cortic

US of the Shoulder: Rotator Cuff and Non–Rotator Cuff Disorders

Ultrasonography (US) has been shown to be an effective imaging modality in the evaluation of both rotator cuff and non-rotator cuff disorders, usually serving in a complementary role to magnetic resonance imaging of the shoulder. US technique for shoulder examination depends on patient positioning, scanning protocol for every tendon and anatomic part, and dynamic imaging. The primary US signs for rotator cuff supraspinatus tendon tears are tendon nonvisualization for complete tears, focal tendon defect for full-thickness tears, a hypoechoic defect of the articular side of the tendon for an articular-side partial-thickness tear, and flattening of the bursal surface of the tendon for a bursal-side partial-thickness tear. Secondary US signs such as cortical irregularity of the greater tuberosity and joint and subacromial-subdeltoid bursal fluid are helpful when correlated with the primary signs. Tendon degeneration, tendinosis, and intrasubstance tear are demonstrated as internal heterogeneity. Long-head biceps tendon abnormalities include instability, acute or chronic tear, and tendinosis. The acromioclavicular joint is assessed for dislocation, fluid collection, cysts, and bone erosions. Other non-rotator cuff disorders include synovial disorders such as adhesive capsulitis and synovial osteochondromatosis; degenerative disorders such as osteoarthritis, amyloid arthropathy, hemarthrosis, and chondrocalcinosis; infectious disorders such as septic arthritis and bursitis; and space-occupying lesions.

Unilateral Limb Enlargement in a Dog with a Malignant Peripheral Nerve Sheath Tumor

A 3- to 4-month-old female Golden Retriever dog presented with right hind limb enlargement. Physical examination of the limb and radiographic findings initially included soft tissue swelling with elongation, bowing, and cortical irregularity of the femur and tibia. During a period of approximately 7 months, pathology in the limb progressed to include tarsal laxity, muscle atrophy, avulsion of the gastrocnemius muscle, and luxation of the patella. During surgical intervention to shorten the limb and repair the patellar luxation, a large soft tissue cyst was identified along the caudal aspect of the femur and stifle. The limb was later amputated, and a final diagnosis of malignant peripheral nerve sheath (PNS) tumor of the sciatic nerve and surrounding soft tissues was made. The unilateral limb enlargement in this dog appears to have been because of the development and progression of a malignant PNS tumor. The presentation and associated pathologic changes in the limb are unusual for canine PNS tumor but have similarities with neurofibromatosis in the limbs of humans.

Sonographic evaluations in elite college baseball athletes

This study compared the thickness of the biceps and supraspinatus tendons, the widths of the subacromial space in the frontal and scapular planes, and abnormal sonographic findings in the shoulders of injured, and uninjured elite college baseball athletes and healthy controls. This study recruited two groups of 42 and 12 athletes, with and without histories of shoulder injuries, respectively, as well as one control group of 16 college students who were matched for physical characteristics but not involved in sports. The results showed that the thickness of the biceps and supraspinatus tendons and the subacromial space widths at 0 degrees and 90 degrees shoulder abduction in the frontal plane were significantly greater in the athletes than in the controls (P-values <0.004). The occurrences of the acromioclavicular joint bulging, bicep tendon degeneration, infraspinatus tendon degeneration and infraspinatus cortical irregularity differ significantly between the injured athlete and the group of uninjured athletes and controls (P-values <0.05). However, only infraspinatus tendon degeneration corresponded to the injury histories. There was a high similarity of sonographic spectrum of abnormal findings among the groups. Longitudinal follow-ups are required to determine the clinical importance of the sonographic spectrums and the occurrences of abnormal finding in asymptomatic athletes' shoulders.