Exercise-related muscle edema in the padel player’s shoulder

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3 Tesla MRI in the assessment of functional muscle edema

In explosive sports like padel, intense training can lead to exercise-induced muscle edema (EIME), often described as imaging-related DOMS: a physiological MRI finding, frequently clinically silent and not associated with structural injury.

The case: a 19-year-old padel player with extremely high training loads

This case involves a 19-year-old competitive athlete training nine times per week, with no reported shoulder pain. MRI shows a typical pattern of overload-related muscle edema, a transient and physiological condition in highly trained athletes.

Shoulder MRI muscle edema 1

STIR MRI: diffuse hyperintensity involving the deltoid and rotator cuff, preserved architecture, no hemorrhagic streaks.

Shoulder MRI muscle edema 2

Subtle post-exercise muscle edema: typical imaging-related DOMS pattern with no signs of injury.

What does MRI show?

3 Tesla MRI highlights:

  • Diffuse, ill-defined T2/STIR hyperintensity within the muscle bellies
  • Mild increase in muscle volume
  • Intact fibers and fascia
  • No hematoma or disruption
  • Completely silent clinical presentation

This represents a benign and reversible picture consistent with a physiological response to intense exertion.

Why does it happen?

Repeated overhead actions in padel—smash, bandeja, víbora, explosive trunk rotation— place high demand on the deltoid and rotator cuff, especially during eccentric phases and deceleration. The result is a transient inflammatory response with fluid shift, without structural damage.

DOMS or injury? The key differences

  • DOMS: diffuse signal, intact fibers, often no pain
  • Muscle injury: focal/linear “streaky” signal, possible hematoma, pain

Athlete management

In an asymptomatic context like this:

  • No need to stop training
  • Consider optimizing weekly load distribution
  • Active recovery and light mobility work after sessions
  • Follow-up only if pain or performance drop occurs

Conclusions

Overload-related muscle edema is a common finding in young, highly trained padel players. Correct recognition helps avoid misdiagnosis as a muscle tear and prevents unnecessary downtime. 3 Tesla MRI is the most sensitive tool to distinguish physiology from pathology in the athlete’s muscle.