Magnetic resonance imaging patterns of shoulder injuries in strength trainers
How to cite this article: Ariyanayagam T, Kollimarla VS, Rachakonda A, Choudur HN. Magnetic resonance imaging patterns of shoulder injuries in strength trainers. Indian J Musculoskelet Radiol, doi: 10.25259/IJMSR_31_2023
Weightlifting, a recent addition to strength training regimes of elite athletes, offers various benefits such as increased muscle/tendon/bone strength, bone density, metabolism, and cardiac function. Although beneficial, weightlifting can contribute to various shoulder pathologies that include rotator cuff impingement and injuries to tendons/muscles/bones of the shoulder and shoulder girdle, with specific patterns of injury identified on magnetic resonance imaging (MRI). Our pictorial essay, therefore, aims to familiarize radiologists and sports medicine physicians with the mechanisms, various types, and MRI patterns of shoulder/shoulder-girdle injuries, thereby enabling appropriate alterations to training regimens to prevent further injury.
Magnetic resonance imaging
Strength training through weightlifting exercises (particularly the “clean-and-jerk,” a two-move lift) has increasingly become a prevalent part of athletes’ training regimens.[1-4] The first movement, the “clean,” is the lifting of the barbell from the ground to a resting position on the lifter’s shoulders [Figure 1a]. The second movement is the “jerk” wherein both arms are extended to lift the barbell above the head [Figure 1b]. With the clean-and-jerk maneuver, the goal is to develop strength by lifting the maximum weight possible in one repetition. Although weightlifting has many benefits including increased muscle/tendon/bone strength, bone density, metabolism, and cardiac function, it can also lead to injuries, as the body is exposed to great forces.[5-9]
Weightlifting most commonly injures the shoulder joint, followed by the lower back and elbow.[10,11] The spectrum of shoulder injuries can be ascribed to the transmission of force through the shoulder girdle during the phases of the clean-and-jerk. At the end of the “clean” phase, the weight is transmitted vertically through the lateral clavicles and acromioclavicular (AC) joints. During the “jerk,” as the weight is lifted to full overhead extension, force is transmitted through the glenohumeral joint and the inferior joint capsule.
In this pictorial assay, we present the commonly seen magnetic resonance imaging (MRI) patterns of shoulder injuries caused by weightlifting regimens of elite athletes referred to the radiology department of our tertiary sports-medicine center. These patients had a history of shoulder pain and/or limited range of movement. The patients did not have any history of direct shoulder injury relating to a contact sport (i.e., football/wrestling/ basketball) or other forms of strength training. Specific injury patterns relating to the biomechanics of weightlifting are discussed in this article.
By the end of the “clean” phase, the force of the weight is transmitted vertically through the lateral clavicles and AC joints [Figure 2a]. During the “jerk,” the weight is lifted to full overhead extension and the force is transmitted through the glenohumeral joint in a craniocaudal direction along the line of the vector force [Figure 2b].[12,13] The MR images demonstrate that the injuries sustained during these two maneuvers occur exclusively along the line of force.
The AC joint injuries include AC joint sprain [Figure 3], capsule-ligamentous complex tears [Figure 4], joint separation, and post-traumatic arthropathy [Figure 5]. Tendon injuries include deltoid tendon tears [Figure 6], rotator cuff tendinosis [Figure 7], and rotator cuff tears [Figures 8 and 9]. Rotator cuff pathologies include rotator cuff hypertrophy leading to pseudo-impingement from overfilling of the subacromial space [Figure 10]. Injuries of the glenohumeral joint include labrum [Figure 11], capsule, and glenohumeral ligamentous injuries [Figures 12 and 13]. Bony injuries include distal clavicle [Figure 14] and coracoid [Figure 15] stress reactions, marrow edema, traction edema, and cystic changes at the greater tuberosity of the humerus at the attachment of the rotator cuff tendons [Figure 16].
Knowledge of the biomechanics, injury patterns, and MRI appearances of weightlifting injuries, in conjunction with the clinical history of weightlifting regimens, can help with an accurate diagnosis of the underlying cause of shoulder pain and limitation of movement.
These shoulder injuries can have serious implications on an athlete’s function, performance, and return to sport. With weightlifting becoming a popular feature of strength-training programs, even in amateur athletes, the risk of shoulder injuries would undoubtedly rise.
This pictorial assay, therefore, aims to familiarize radiologists and sports physicians with MR patterns of shoulder/shoulder-girdle injuries to ensure the detection and timely treatment of weightlifting injuries.
All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Declaration of patient consent
Patient’s consent not required as patient’s identity is not disclosed or compromised.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The author(s) confirms that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using the AI.
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