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Therapeutic Ultrasound in Navicular Stress Injuries in Elite Track and Field Athletes

Malliaropoulos, Nikolaos MD, MSc, PhD*,¶; Alaseirlis, Dimosthenis MD, PhD; Konstantinidis, George MD*; Papalada, Agapi PT*; Tsifountoudis, Ioannis MD; Petras, Kosmas MD*; Maffulli, Nicola MD, PhD, FRCP, FRCS(Orth)§,¶

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 278–282
doi: 10.1097/JSM.0000000000000356
Original Research
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Objective: To ascertain whether therapeutic ultrasound (TUS) can be used to assess the progression of conservative management in navicular stress injuries.

Design: This is a prospective, clinical case series. Level of evidence IV.

Setting: All participants were examined and followed up in a private Sports Injury Clinic.

Participants: Ten elite track and field athletes with severe dorsal midfoot pain over the navicular bone participated in this study.

Interventions: All patients underwent both TUS and magnetic resonance imaging (MRI) evaluation. The painful threshold of TUS on initial evaluation was a mean of 0.707 ± 149 W/cm2, and MRI detected a navicular stress injury in all patients. The athletes received conservative treatment and underwent sequential TUS evaluations at 4, 8, 12 and 16 weeks.

Main Outcome Measures: Therapeutic ultrasound pain threshold values were recorded, and the patients were additionally asked to grade local tenderness on a Visual Analogue Scale. Time to return to play was also recorded.

Results: The level of pain produced by the application of TUS on a navicular stress fracture seemed to correlate well with Visual Analogue Scale scores and the grade of fracture demonstrated on MRI. The initial low TUS painful mean value increased to a normal mean value of 1.97 ± 0.067 W/cm2 by 16 weeks. When clinical and TUS findings had returned to normal, the patients were allowed to return to sports activities, with no recurrences experienced during the study period.

Conclusions: The production of pain associated with the application of TUS on a navicular stress fracture is a safe and reproducible method of monitoring the resolution of these fractures. We have used it successfully in making return-to-play decisions for elite level track and field athletes.

*National Track & Field Centre, Sports Injury Clinic, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece;

General Clinic—EUROMEDICA, Thessaloniki, Greece;

Asclepios Diagnostic Center, Thessaloniki, Greece;

§Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; and

Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, United Kingdom.

Corresponding Author: Nicola Maffulli, MD, MS, PhD, FRCP, FRCS(Orth), Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy (n.maffulli@qmul.ac.uk).

This investigation received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The authors report no conflicts of interest.

Received April 27, 2014

Accepted April 01, 2016

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