What Tests Should You Have After a Sports Injury?

The first step is to see a doctor.

“Imaging does not replace a clinical examination; it complements it. Describing clearly what happened, where the pain is and how it developed helps the doctor choose the most appropriate examination and avoid unnecessary tests or investigations performed at the wrong time,” explains Professor Sconfienza.

A general practitioner can help direct the patient to the most appropriate specialist. Depending on the type of injury, this may be:

• an orthopaedic surgeon or trauma specialist, for fractures and injuries involving ligaments, menisci and tendons;
• a sports medicine physician, who assesses the injury in relation to the sport being practised;
• a physiatrist, particularly for overuse-related pain and rehabilitation.

Not every sports injury requires imaging. A minor injury may sometimes be assessed through clinical examination alone. When imaging is needed, the choice depends on the structure suspected to be injured: bone, muscle, tendon, ligament or cartilage.

An X-ray is generally the first-line examination when a bone injury is suspected, such as a fracture or dislocation.

It is quick and uses low doses of ionising radiation, but provides limited and indirect information about injuries to muscles, tendons and ligaments. In addition, during the first few days it may fail to show very small or non-displaced fractures.

Ultrasound is often the first-line examination for superficial soft tissues.

“It allows structures to be assessed in real time, including while the patient moves the joint,” the doctor explains. “This is often very useful because, during the examination, the operator can also clinically assess the patient and focus directly on the area of greatest concern.”

Ultrasound does not use ionising radiation, which means it can be repeated several times, including during recovery.

Magnetic resonance imaging (MRI) is the most comprehensive examination in musculoskeletal imaging because it can evaluate multiple structures within a single study, including the cruciate ligaments, menisci, cartilage and bone marrow oedema.

MRI does not use ionising radiation, but the examination takes longer. Before undergoing MRI, patients should report the presence of pacemakers, prostheses or other metallic implants or devices.

There is no single examination that is appropriate for every injury: the choice depends on the mechanism of injury and the symptoms. Professor Sconfienza provides several examples of common sports-related injuries, while emphasising that the choice of examination should always be made by a doctor.

• Ankle sprain: an X-ray is usually performed if the patient is unable to bear weight or if the pain is localised over the bone. Ultrasound can assess the ligaments and tendons, while MRI is generally reserved for cases in which pain persists beyond 3–4 weeks.
• Knee injury: an X-ray can help rule out a fracture. If the joint remains swollen, unstable or locked, MRI can clarify whether the ligaments, meniscus or cartilage are involved.
• Muscle tear: ultrasound is often used as a first-line examination, particularly because it is readily accessible. However, in minor injuries, ultrasound may not always detect the lesion adequately. MRI is useful for a more detailed assessment or when it is necessary to estimate recovery time.
• Fall onto the shoulder: an X-ray can rule out a fracture or dislocation, ultrasound can assess the rotator cuff tendons, and MRI can evaluate instability.
• Overuse pain affecting the shin, foot or hip in runners: assessment usually begins with an X-ray, with MRI used for further investigation. Ultrasound is useful only for targeted evaluation of certain superficial structures.

When should imaging be performed?

Timing also matters.

“In the past, it was often suggested that it was better to wait for some time after the injury before performing radiological investigations. Today, there is an increasing tendency to perform imaging as soon as possible. This is because an early diagnosis helps plan appropriate treatment more quickly.”

After an injury, it is advisable to stop the activity. Continuing to train “to see if it gets better” can make the problem worse. During the first few hours, the following may be useful:

• rest;
• ice, never applied directly to the skin;
• elevation of the injured limb;
• if necessary, a light compression bandage.

These are general recommendations and should always be adapted according to the doctor’s instructions. When attending a medical consultation, it is useful to bring any previous investigations, even older ones, as well as a list of current medications.

When to go to the Emergency Department

It is advisable to seek prompt assessment in the Emergency Department in the presence of:

• sudden and severe pain;
• obvious deformity;
• inability to bear weight or move the joint;
• very rapid swelling;
• tingling or loss of sensation;
• an open wound.

“A sports injury that is assessed correctly from the beginning makes it possible to choose the most appropriate treatment pathway,” Professor Sconfienza concludes. “The right test is needed at the right time.”

The pathway begins with a specialist consultation, during which the mechanism of injury is reconstructed and the appropriate investigations are selected.

The images are assessed by radiologists specialising in musculoskeletal imaging, leading to a diagnosis and a decision between conservative treatment and, when necessary, surgery.

In some cases, ultrasound is also used therapeutically: interventional radiology includes targeted image-guided procedures.

Once the acute phase has passed, physiatrists and physiotherapists develop a personalised rehabilitation programmebased on the patient’s sport, age and goals, working on mobility, strength, coordination and proprioception.

Before returning to sport, functional tests assess tissue recovery and help reduce the risk of reinjury.