Magnetic Resonance Imaging Abnormalities in the Shoulder and Wrist Joints of Asymptomatic Elite Athletes

Objective: To characterize abnormalities on magnetic resonance images (MRI) in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of "normal" findings in this population. Design: Cohort study. Setting: Academic medical center. Subjects: Division IA collegiate volleyball players (n=12), swimmers (n=6), and gymnasts (n=15) with no history of injury or pain and normal physical examination results. Interventions: None. Main Outcome Measures: Grade of severity of MRI changes of the shoulder and wrist joints. A 3- to 4-year follow-up questionnaire was administered to determine the clinical significance of the asymptomatic findings. Results: All athletes demonstrated at least mild imaging abnormalities in the joints evaluated. Shoulder: Volleyball players had moderate and severe changes primarily in the labrum (50% moderate, 8% severe), rotator cuff (25% moderate, 17% severe), bony structures (33% moderate), and tendon/muscle (25% moderate, 8% severe). Swimmers had moderate changes primarily in the labrum (83% moderate) and ligament (67% moderate). Wrist: All gymnasts had changes in the wrist ligaments (40% mild, 60% moderate), tendons (53% mild, 47% moderate), and cartilage (60% mild, 33% moderate, 7% severe). Most gymnasts exhibited bony changes (20% normal, 47% mild, 26% moderate, 7% severe), the presence of cysts/fluid collections (80%), and carpal tunnel changes (53%). Swimmers had no wrist abnormalities. At follow-up interview, only 1 swimmer and 1 volleyball player reported shoulder problems during the study. Additionally, only 1 gymnast reported a wrist injury during their career. Conclusion: Asymptomatic elite athletes demonstrate MRI changes of the shoulder (swimmers and volleyball players) and wrist (gymnasts) similar to those associated with abnormalities for which medical treatment and sometimes surgery are advised. Given the somewhat high frequency of these asymptomatic findings, care must be taken to correlate clinical history and physical examination with MRI findings in these patients with symptoms.