Abstract Artificial intelligence (AI) is increasingly used in radiology. For pediatric patients, the only commercially available computer-aided detection/diagnosis tool currently available is for fracture detection. Here, our experience at a pediatric hospital with a 2-month trial of a commercial AI fracture-detection tool is described. Although the tool was sometimes helpful, particularly for subtle fractures and as confirmatory support in borderline cases, its overall value was limited by cost, false-positive and false-negative results, workflow inconsistency, and the burden of post-deployment monitoring. In our experience, aggregate performance alone did not capture the practical issues most relevant to clinical adoption, including delayed or missing AI results, provider confusion when AI and radiologist interpretations differed, and the infrastructure required for sustainable oversight. Our experience suggests that fracture-detection AI should be evaluated not only by diagnostic performance, but also by real-world clinical utility, workflow reliability, and implementation burden and provides real-word insight into these issues.
Abstract Musculoskeletal ultrasound offers a unique ability to perform dynamic, real-time assessment of musculoskeletal structures during motion, providing functional information that is not available with static imaging modalities. Dynamic ultrasound remains underutilized in pediatric sports-related musculoskeletal evaluation, where skeletal immaturity and pediatric-specific injuries present distinct diagnostic challenges. This review outlines the principles and clinical applications of dynamic ultrasound in the pediatric athlete. Common dynamic assessment techniques in the pediatric population are illustrated across frequently evaluated joints, including the shoulder, elbow, wrist and hand, hip and pelvis, knee, and foot and ankle. Applications include evaluation of joint instability, ligamentous injury, tendon subluxation or snapping, apophyseal avulsion injuries, and motion-dependent conditions. Dynamic ultrasound complements clinical and biomechanical assessment in pediatric athletes. Familiarity with pediatric-specific anatomy, conditions, and dynamic techniques can expand diagnostic confidence and enhance the role of ultrasound in sports-related musculoskeletal imaging.
Abstract Shoulder overuse injuries represent a broad and often overlapping spectrum shaped by repetitive loading, soft tissue adaptation, and changes in bone. Rather than distinct entities, they are better viewed along a continuum, where repeated microtrauma gradually leads to structural and functional alterations in tendons, capsulolabral structures, bursae, and bone. This narrative review covers the broad anatomical spectrum of shoulder overuse injuries, including rotator cuff disorders, impingement syndromes, labral and capsular abnormalities, biceps tendon pathology, bursal disease, and osseous and physeal injuries. Imaging alone is not always sufficient for diagnosis because many findings, especially in the rotator cuff, may also be present in asymptomatic individuals. Therefore, imaging should be interpreted in the context of the patient's clinical presentation and biomechanical factors. Magnetic resonance imaging remains central for structural assessment, whereas dynamic ultrasonography adds real-time functional information. Emerging techniques such as shear wave elastography may further improve evaluation by providing quantitative data. In practice, combining these approaches improves diagnostic confidence and helps guide management, with ongoing advances expected to further refine clinical decision-making.
Abstract Overuse injuries of the hand and wrist result from repetitive use or recurrent direct trauma, most often related to work or sports involving repetitive movements and weight-bearing. These stress-induced injuries affect a wide range of tissues, including tendons and tenosynovium, ligaments, neurovascular structures, cartilage, and bone. In athletes, although overuse injuries are less likely than acute traumatic injuries to cause long-term disability, untreated cases can significantly impair athletic performance. Magnetic resonance imaging plays a pivotal role in accurate diagnosis by demonstrating the bone, tendons, ligaments, nerves, and soft-tissue structures. Understanding the mechanisms of injury and their imaging appearance is essential for correct diagnosis and appropriate treatment planning. This review provides an overview of imaging findings in hand and wrist overuse injuries, with a specific focus on soft-tissue lesions. Bone lesions are reviewed extensively in a prior article in this journal.
