Sports-Related Muscle Injury in the Lower Extremity

Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Clinics in sports medicine (Impact Factor: 1.22). 11/2006; 25(4):803-42. DOI: 10.1016/j.csm.2006.06.011
Source: PubMed


Muscle injury and strains are very common among athletes. MR is the preferred method of evaluation because of superior contrast resolution, reproducibility, and excellent anatomic detail. Ultrasound is also useful and advocated by some as a front line diagnostic modality because of its lower costs and portability particularly in experienced hands. It is important to remember that injury usually occurs at the myotendinous junction, which may be intramuscular in the hamstring and quadriceps muscles. The size of injury and relationship to the myotendinous junction can provide prognostic information regarding convalescent period, which can be extremely important for the elite athlete. Literature on prognostication is limited and probably results from relative commonality and mild nature of most injuries but further studies are warranted as injuries could affect different sporting population more than others. Future developments regarding treatment will become more important and analysis and classification of imaging finding may provide better prognostication. For example, some have identified the importance of the COX pathway for muscle injury healing and possible deleterious effects of inhibitors (ie, nonsteroidal anti-inflammatory drugs) [137]. Others have experimentally shown the introduction of relaxin growth factor via gene therapy promotes muscle healing [138,139]. With new treatments on the horizon it is important to have supportive objective and accurate information regarding extent and types of injury to help stratify treatment groups and improve patient care. Precise reporting of the location of muscle and tendon injuries is needed, as prognosis may be different. Therefore continued evaluation and classification of muscle and tendon injury with imaging, such as MRI, particularly for the elite athlete should be performed.

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Article: Sports-Related Muscle Injury in the Lower Extremity

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    • "The gastrocnemius is considered at high risk for strains since it crosses two joints (the knee and ankle) and has a high density of type two fast twitch muscle fibers (Bryan Dixon, 2009). Injury to the gastrocnemius muscle is among the more common injuries occurring in the lower leg (12%) (Armfield et al., 2006). "
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    ABSTRACT: Background Scarce evidence exists about effectiveness and mechanisms of action of Kinesio tape (KT) application. Objectives To evaluate the effect of KT application over the gastrocnemius or hamstring on range of motion and peak force. Methods Thirty-six physical therapy students participated (18 per group). KT was applied with 30% tension for 48 h to: Group 1 – the gastrocnemius; Group 2 – the hamstrings. The straight leg raise (SLR), knee extension angle (KEA), weight bearing ankle dorsiflexion, gastrocnemius, quadriceps and hamstrings peak forces were evaluated prior to application, 15 min and 48 h after. Results and conclusions A significant increase of peak force in the gastrocnemius group appeared immediately and two days later; no immediate change of peak force in the hamstrings group, however, two days later, peak force significantly increased. SLR and ankle dorsiflexion increased immediately in the gastrocnemius group; KEA improved significantly only after two days. It is possible that certain muscles react differently when KT is applied, and the effect may be subsequently detected.
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    • "The two heads (medial and lateral) of the gastrocnemius unite into a broad aponeurosis, which eventually unites with the deep tendon of the soleus to form the Achilles tendon [25]. The gastrocnemius is considered at high risk for injury because it crosses the knee and ankle joints and has a high density of type II fibres [21, 26]. The soleus is considered low risk for injury because it only crosses the ankle joint and is largely comprised of type I fibres [27]. "
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    ABSTRACT: OBJECTIVES: Magnetic resonance (MR) imaging and ultrasound have become valuable tools for evaluation of traumatic muscle injuries in athletes. Common athletic injuries include strain, contusion and avulsion, which are characterised by muscle fibre disruption, intramuscular haemorrhagic dissection, haematoma at the musculotendinous junction, and perifascial blood or haematoma. METHODS: MR imaging may allow clinicians to predict the time required before athletes can return to competition and the risk of injury recurrence. RESULTS: Fluid-sensitive MR sequences, e.g., fat-suppressed T2-weighted or proton density-weighted turbo spin echo (TSE), and short-tau inversion recovery (STIR) sequences are suitable for detecting oedematous changes in the musculotendinous unit, and for delineating intramuscular or perifascial fluid collections or haematoma. T1-weighted spin echo sequences are used to visualise atrophy and fatty infiltration and to differentiate between haemorrhage/haematoma and oedema. While ultrasound may play a role as an adjunctive imaging method, it is less accurate than MR images for assessing the extent of the injury and it cannot differentiate between new and old injuries. CONCLUSIONS: In this pictorial review, imaging features of lower extremity muscle injuries including strain, contusion and avulsion are reviewed, focusing on MR and ultrasound imaging findings after initial injury and during follow-up, and their relevance in clinical practice is discussed. TEACHING POINTS: • MR imaging may allow clinicians to predict time required before athletes can return to competition • Fluid-sensitive MR sequences are suitable for detecting oedematous changes in the muscles • T1-weighted sequences are used to differentiate between haemorrhage/haematoma and oedema. • Ultrasound can also be used but is less accurate than MR imaging for assessing the extent of the injury.
    Insights into Imaging 09/2012; 3(6). DOI:10.1007/s13244-012-0190-z
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    • "However, as seen in our case, a fascial thinning is sometimes difficult to detect. It has been suggested the use of dynamic MR imaging in the evaluation of suspected muscle herniations to better delineate the fascial defect and the size of the muscle herniation, if dynamic sonography does not adequately define these features [26,27]. It was hypothesized that MRI can be useful in planning operative treatment [28]. "
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    ABSTRACT: Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described. We present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch. Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic) ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects.
    Patient Safety in Surgery 03/2012; 6(1):5. DOI:10.1186/1754-9493-6-5
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