Imaging for sports injuries (sprains and strains)

Imaging is appropriate when:

• There was a significant mechanism (twisting, impact, audible 'pop')
• The joint is swollen, locking, giving way, or cannot bear weight
• Pain has not improved over two to four weeks of conservative care
• A specific structural injury is suspected (ACL, meniscus, rotator cuff, Achilles)
• A pediatric or skeletally immature athlete has persistent symptoms (growth plate concern)

Validated rules like the Ottawa Ankle, Ottawa Knee, and Pittsburgh Knee Rules help clinicians decide who needs an X-ray after acute injury.

X-ray is first-line for most acute sports injuries to evaluate for fracture, dislocation, and bony avulsions.

MRI is the test of choice for ligament and tendon injuries (ACL, meniscus, rotator cuff, Achilles, hamstring), cartilage damage, and bone bruises that X-ray misses entirely.

Ultrasound can evaluate superficial tendons (Achilles, patellar tendon) and is useful when a dynamic study is helpful.

Arthrogram (MR or CT) is used for select questions — labral tears in the shoulder or hip, post-operative cartilage evaluation, and complex meniscal injuries.

Note: musculoskeletal ultrasound capability varies by location; check with the scheduler when booking.

MRI evaluates muscles, tendons, ligaments, cartilage, bone marrow, and joint fluid. It is the most complete single test for soft-tissue sports injuries. The radiologist grades injuries (grade I, II, III) to communicate severity and inform management.

Sprain — ligament injury, graded I (microscopic), II (partial), III (complete tear).

Strain — muscle or tendon injury, similarly graded.

ACL or other ligament tear — common in pivoting sports; surgical decision depends on patient activity level.

Meniscal tear — discussed in detail on our knee-pain page.

Rotator cuff tear — discussed on our shoulder-pain page.

Stress fracture — repetitive overload; MRI detects early before X-ray changes appear.

Cartilage lesion — focal cartilage damage; may need arthrography for full evaluation.

Many sports injuries are managed nonoperatively with rehabilitation. Surgical referral is appropriate for unstable ligament tears in active patients, displaced fractures, and select cartilage and meniscal injuries.

Bring your physician's order. MRI takes about 30 minutes; arthrography adds 30 minutes. See our MRI service, our X-ray service, our ultrasound service, and our arthrogram service for locations.