Master athletes (≥40 years) represent a rapidly growing population with muscle injuries that differ substantially from those of younger athletes. Age-related changes, including type II fiber loss, fatty infiltration, fibrosis, tendon degeneration, and prior scarring, can significantly alter biomechanics, injury patterns, imaging appearance, and recovery timelines. This review summarizes epidemiology, key muscle groups, biomechanics, ultrasound and MR imaging features, and structured reporting considerations. Practical recommendations highlight prognostic factors, complications, and imaging strategies tailored to this unique population.
Shoulder arthroplasty has expanded in recent years with ongoing improvements in implant design and surgical techniques. Preoperative planning relies on radiographs, whereas computed tomography is preferred for bone assessment and MR imaging for soft tissues. Postoperative imaging assesses implant position and detects complications. Familiarity with expected imaging appearances and complications is essential.
Wrist osteoarthritis most often develops as a secondary condition resulting from ligamentous injury or fracture-related complications, rather than as primary idiopathic degeneration. Failure of specific intrinsic and extrinsic stabilizers, as well as scaphoid nonunion or malunion after distal radius fractures, leads to predictable biomechanical alterations that drive progressive carpal collapse and compartmental joint degeneration. Distinct instability-related patterns-including scapholunate advanced collapse, hamate arthrosis lunotriquetral ligament tear, and scaphotrapeziotrapezoid osteoarthritis advanced collapse-and fracture-related patterns, such as scaphoid nonunion advanced collapse and post-distal radius malunion osteoarthritis, progress through characteristic sequences of articular involvement with important diagnostic and therapeutic implications.
Cartilage injury is a prevalent source of pain and disability, often progressing to osteoarthritis if untreated. MR imaging represents the reference standard for comprehensive cartilage evaluation, combining high-resolution morphologic sequences with advanced quantitative techniques that reveal early biochemical changes. This review summarizes the anatomic organization of the osteochondral unit, current MR imaging methods for detection and grading of cartilage lesions, and key classification systems correlating imaging and arthroscopic findings. It discusses the role of image-guided intra-articular therapies and postoperative MR imaging evaluation, emphasizing the expanding potential of functional and artificial intelligence-enhanced MR imaging in diagnosis, treatment planning, and outcome monitoring.
Spine degeneration represents a continuum of biomechanically related alterations that evolve over time. Disc degeneration is partly attributable to physiologic aging or senescence and partly due to pathologic conditions and this distinction is sometimes not very clear. Standard MR imaging is the mainstay for evaluating spine degeneration and newer noninvasive quantitative MR imaging techniques are rapidly emerging to detect early biochemical changes before the onset of structural changes. Degenerative disc disease although being a common and remarkable health problem, is still not completely understood and contributes significantly to years of life disability.
Adult acquired flatfoot deformity (AAFD) is a progressive condition characterized by collapse of the medial longitudinal arch, pain, and functional impairment. It predominantly affects middle-aged women and is associated with obesity, diabetes, hypertension, and anatomic variants. MR imaging is the gold standard for evaluating osseous, tendinous, and ligamentous structures, enabling accurate diagnosis and staging. This review summarizes the role of MR imaging in AAFD, detailing normal anatomy, pathophysiological mechanisms, classification systems, and advanced imaging protocols. Key MR imaging findings include posterior tibial tendon dysfunction, spring and deltoid ligament involvement, and secondary osseous changes.
Osteoporotic vertebral compression fractures (OVCFs) are common fragility fractures associated with aging, pain, spinal deformity, and increased risk of subsequent fractures. Computed tomography and MR imaging are central to diagnosis and differential evaluation from malignant fractures. Acute OVCFs demonstrate marrow edema with partial preservation of fatty marrow. Advanced MR imaging techniques improve diagnostic confidence. Diffusion-weighted imaging shows relatively higher apparent diffusion coefficient values in benign fractures. Most patients respond favorably to conservative management emphasizing analgesia, early mobilization, rehabilitation, and osteoporosis-directed therapy. Vertebral augmentation remains controversial and should be reserved for carefully selected patients with acute fractures and severe refractory pain.
This article provides an overview of ultrasound guided injection and needle therapies for degenerative conditions of musculoskeletal structures of senior athletes, particularly in the treatment of osteoarthritis and tendinopathies. Therapies include cortisone injections, viscosupplementations, aspiration, lavage, barbotage and fenestration procedures, and regenerative treatments.
Degenerative musculoskeletal disorders, particularly knee osteoarthritis and lumbar spine degeneration, are increasingly prevalent and contribute substantially to global disability and health care costs. Rising imaging volumes have prompted interest in artificial intelligence (AI) to improve efficiency and consistency in imaging assessment. For knee osteoarthritis, AI models applied to radiographs and MR imaging demonstrate performance comparable to expert radiologists, though early disease classification remains challenging. In lumbar spine MR imaging, AI shows promise for automating grading and segmentation but is limited by heterogeneous methods. Future progress depends on standardized frameworks, diverse datasets, external validation, and integration of imaging with meaningful outcomes.
Disorders of the hip abductor mechanism are a frequent cause of lateral hip pain and functional impairment. This article focuses on MRI evaluation of the gluteus medius and minimus tendons, emphasizing the relationship between tendon pathology, muscle quality, and biomechanics. Key imaging features of tendinopathy, partial and full-thickness tears, tendon elongation, and fatty infiltration are discussed, together with their clinical and surgical implications. The value of MRI in both preoperative assessment and postoperative follow-up is highlighted, particularly in distinguishing adaptive changes from structural failure and progressive muscle degeneration.
Sarcopenia is an age-related skeletal muscle disorder characterized by progressive loss of muscle strength, mass, and structural integrity. MRI plays a central role in evaluating muscle volume, fatty infiltration, inflammation, fibrosis, and architectural changes using advanced techniques including Dixon imaging, PDFF quantification, T2 mapping, diffusion imaging, IVIM, and ultrashort-echo-time sequences. Radiomic analysis further improves characterization of muscle degeneration and osteosarcopenia by extracting quantitative imaging biomarkers. These MRI-derived metrics support the diagnosis, phenotyping, risk stratification, and longitudinal monitoring of sarcopenia.
Osteoarthritis (OA) is a low-grade inflammation contributes to pain, synovial changes, tissue remodeling, and structural progression in at least a subset of patients. This review examines the molecular, cellular, imaging, and clinical evidence supporting the inflammatory component of OA and discusses how this evolving view may influence disease definition, phenotyping, prognosis, and treatment development.
