Acute muscle strain injuries: a proposed new classification system

Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play

BACKGROUND

to describe role of alternative management as an approach to management and rehabilitation of multiple hip muscles tears by the use of 1 RM (Repetition Maximum) testing and hip muscle strengthening program along with the use of sports specific drills for rehabilitation and recovery. There is very limited literature describing multiple hip muscle tears and the conservative management of the same. 1RM testing and strengthening of hip muscles is an approach that is able to help in the return to sports of an athlete without surgical intervention.

METHODS

the patient, is a 21-year-old male hockey player who presented with pain right buttock, right lower leg and a limp on the right side while walking. Physical examination revealed a positive Trendelenburg sign both in stance and gait phase. Hip rotational movements showed a normal range of motion, there was a severe pain in the right buttock on movements which he described at 8/10 on VAS (Visual Analogue Scale). Strength assessment revealed weakness of the right hip flexors and extensors and also of the abductor and external hip rotator muscles. Treatment protocol followed was based on 1 RM testing of muscles and hip strengthening exercises and sports specific drills.

RESULTS

following the intervention, the patient reported pain at 0/10 VAS while doing all activities and also showed good muscle control with no limp.

CONCLUSIONS

this highlights an alternative protocol for treating multiple hip muscle tears and illustrates the importance of 1 RM testing as a part of examination and sports medicine intervention.

Evaluation and management of hamstring injuries

Muscle injuries are the most common injuries in sports, with hamstring injuries accounting for 29% of all injuries in athletes. These injuries lead to prolonged impairment and have a reinjury risk of 12% to 31%. They range from mild muscle damage without loss of structural integrity to complete muscle tearing with fiber disruption. Novel MRI scores are increasingly being used and allow a more precise prediction of return to sport. In this article, the authors review the history, mechanisms of injury, and classification systems for hamstring injuries as well as present the latest evidence related to the management of hamstring injuries, including intramuscular and both proximal and distal insertional injuries. Indications for surgical treatment of certain proximal and distal avulsions, biological augmentation to the nonoperative treatment of midsubstance injuries, and advances in risk reduction and injury prevention are discussed.

Single nucleotide polymorphisms associated with non-contact soft tissue injuries in elite professional soccer players: influence on degree of injury and recovery time

BACKGROUND

The biological mechanisms involved in non-contact musculoskeletal soft tissue injuries (NCMSTI) are poorly understood. Genetic risk factors may be associated with susceptibility to injuries, and may exert marked influence on recovery times.

METHODS

Data on type and degree of injury and recovery time were collected in 73 male professional soccer players (43 White, 11 Black Africans and 19 Hispanics) who suffered total of 242 injuries (203 muscle, 24 ligament, and 15 tendon injuries). One single nucleotide polymorphism (SNPs) in the following genes were analyzed: Elastin (ELN); Titin (TTN); SRY-related HMG-box (SOX15); Insulin-like growth factor 2 (IGF2); Chemokine, CC motif, ligand 2 (CCL2); Collagen type 1 alpha 1(COL1A1); Collagen type 5 alpha 1 (COL5A1), and Tenascin C (TNC).

RESULTS

There was evidence of a statistically significant association between the degree of injury and the IGF2 genotype (P = 0.034). In addition, there was evidence of a statistically significant association between the degree of muscle injury and CCL2 (P = 0.026) Finally, there was evidence of a statistically significant association between ELN and degree of injury (p = 0.009) and recovery time (P = 0.043). There was no evidence of a statistically significant association between any of the genes studied and degree of injury or recovery time for tendon injuries.

CONCLUSION

SNPs in the IGF2, CCL2, and ELN genes may be associated to the degree and recovery time of NCMSTI.

Muscle injuries: ultrasound evaluation in the acute phase

Muscle injuries can be classified as extrinsic or intrinsic injuries as well as contusions and lacerations, and clinical assessment is composed of the history and physical examination. Diagnostic imaging, particularly ultrasound (US) examination, is essential to a correct assessment of the severity of the injury and to exclude important complications as these two elements influence treatment decisions, prognosis and time to return to unrestricted physical activity. This paper presents the main clinical and US features of acute muscle injuries.

Ultrasound evaluation of superficial lumps and bumps of the extremities in children: a 5-year retrospective review

Ultrasonography is commonly requested for evaluation of palpable soft-tissue masses of the extremities in children. Although malignancy is quite rare in these children, it remains a primary diagnostic concern. As a result, knowledge of the common and uncommon soft-tissue lesions as well as sonographic techniques for optimized evaluation are crucial for accurate assessment. This review describe the sonographic imaging appearance of the most commonly encountered superficial soft-tissue lesions at a tertiary academic pediatric hospital. Features of malignancy and findings warranting further evaluation such as lesion size, heterogeneity, vascularity and depth of involvement are also discussed.

Non contact Hamstring injuries in sports

Hamstring muscle injuries are frequent in different sports and are a clinical challenge for Sports Medicine Teams. Injury Mechanics are import to know while assessing the injured athlete. There are at least two distinctly different types of acute hamstring injuries, which are best distinguished by the different injury situations. Classifying the severity of the injury is equally important. Active Range of motion measurements, proper imaging selection and the anatomical location of the injury must be considered. Once the diagnosis is established rehabilitation issues must be considered. Recurrence rate of the injury and prevention are issues that must always be included in our Hamstring Injuries approach as Clinicians.