Muscle Injuries: Difference between revisions
mNo edit summary |
mNo edit summary |
||
| Line 8: | Line 8: | ||
Literature study does not reveal great consensus when it comes to classifying muscle injuries, despite their clinical importance. However, the most differentiating factor is the trauma mechanism. Muscle injuries can therefore be broadly classified as either traumatic (acute) or overuse (chronic) injuries. | Literature study does not reveal great consensus when it comes to classifying muscle injuries, despite their clinical importance. However, the most differentiating factor is the trauma mechanism. Muscle injuries can therefore be broadly classified as either traumatic (acute) or overuse (chronic) injuries. | ||
<div style="mso-element:comment-list"><div style="mso-element:comment"><div id="_com_1" class="msocomtxt"></div> </div> </div> <!--EndFragment--> | <div style="mso-element:comment-list"><div style="mso-element:comment"><div id="_com_1" class="msocomtxt"></div> </div> </div> <!--EndFragment--> | ||
'''Acute''' injuries are usually the result of a single traumatic event and cause a macro-trauma to the muscle. There is an obvious link between the cause and noticeable symptoms. They mostly occur in contact sports such as rugby, soccer and basketball because of their dynamic and high collision nature.<ref name=" | '''Acute''' injuries are usually the result of a single traumatic event and cause a macro-trauma to the muscle. There is an obvious link between the cause and noticeable symptoms. They mostly occur in contact sports such as rugby, soccer and basketball because of their dynamic and high collision nature.<ref name="One">Tero AH Järvinen, Teppo LN Järvinen, Minna Kääriäinen, Hannu Kalimo, Markku Järvinen. Basic Science Update: Muscle Injuries: Biology and Treatment. Am J Sports Med May 2005; 33: 745-764</ref><ref name="Eight">Best TM. Soft-tissue injuries and muscle tears. Clin Sports Med. Jul 1997; 16(3):419-34</ref> | ||
'''Overuse''', chronic or exercise-induced injuries are subtler and usually occur over a longer period of time. They result from repetitive micro-trauma to the muscle. Diagnosing is more challenging since there is a less obvious link between the cause of the injury and the symptoms. | '''Overuse''', chronic or exercise-induced injuries are subtler and usually occur over a longer period of time. They result from repetitive micro-trauma to the muscle. Diagnosing is more challenging since there is a less obvious link between the cause of the injury and the symptoms. | ||
<div id="_com_1" class="msocomtxt"></div> <!--EndFragment--> | <div id="_com_1" class="msocomtxt"></div> <!--EndFragment--> | ||
== Muscle strains == | == Muscle strains == | ||
<!--StartFragment-->A strain to the muscle or muscle tendon is the equivalent of a sprain to ligaments. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress. This mostly occurs as result of a powerful eccentric contraction or overstretching of the muscle. Therefore, it is typical for non contact sports with dynamic character such as sprinting, jumping… . | <!--StartFragment-->A strain to the muscle or muscle tendon is the equivalent of a sprain to ligaments. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress. This mostly occurs as result of a powerful eccentric contraction or overstretching of the muscle. Therefore, it is typical for non contact sports with dynamic character such as sprinting, jumping… . | ||
Strains are categorized into 3 grades of severity | Strains are categorized into 3 grades of severity: | ||
<!--StartFragment-->'''Grade I '''(mild) strains affect only a limited number of fibers in the muscle. There is no decrease in strength and there is full active and passive range of motion. Pain and tenderness are often delayed to the next day.<br> '''Grade II''' (moderate) strains have nearly half of muscle fibers torn. Acute and significant pain is accompanied by swelling and a minor decrease in muscle strength.<br> '''Grade III''' (severe) strains represent complete rupture of the muscle. This means either the tendon is separated from the muscle belly or the muscle belly is actually torn in 2 parts. Severe swelling and pain and a complete loss of function are characteristic for this type of strain. | <!--StartFragment-->'''Grade I '''(mild) strains affect only a limited number of fibers in the muscle. There is no decrease in strength and there is full active and passive range of motion. Pain and tenderness are often delayed to the next day.<br> '''Grade II''' (moderate) strains have nearly half of muscle fibers torn. Acute and significant pain is accompanied by swelling and a minor decrease in muscle strength.<br> '''Grade III''' (severe) strains represent complete rupture of the muscle. This means either the tendon is separated from the muscle belly or the muscle belly is actually torn in 2 parts. Severe swelling and pain and a complete loss of function are characteristic for this type of strain. | ||
| Line 38: | Line 38: | ||
Related articles: | Related articles: | ||
[http://www.physio-pedia.com/index.php5?title=Shin-splints Shin splints] | [http://www.physio-pedia.com/index.php5?title=Shin-splints Shin splints] | ||
= Repair process = | = Repair process = | ||
Revision as of 19:34, 31 December 2010
Skeletal muscle injuries
represent great part of all traumas in sports medicine. They should be treated
with necessary precaution since a failed treatment can postpone an athlete’s
return to the field with weeks or even months and cause recidivism.
Types of skeletal muscle injuries[edit | edit source]
Literature study does not reveal great consensus when it comes to classifying muscle injuries, despite their clinical importance. However, the most differentiating factor is the trauma mechanism. Muscle injuries can therefore be broadly classified as either traumatic (acute) or overuse (chronic) injuries.
Acute injuries are usually the result of a single traumatic event and cause a macro-trauma to the muscle. There is an obvious link between the cause and noticeable symptoms. They mostly occur in contact sports such as rugby, soccer and basketball because of their dynamic and high collision nature.[1][2]
Overuse, chronic or exercise-induced injuries are subtler and usually occur over a longer period of time. They result from repetitive micro-trauma to the muscle. Diagnosing is more challenging since there is a less obvious link between the cause of the injury and the symptoms.
Muscle strains[edit | edit source]
A strain to the muscle or muscle tendon is the equivalent of a sprain to ligaments. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress. This mostly occurs as result of a powerful eccentric contraction or overstretching of the muscle. Therefore, it is typical for non contact sports with dynamic character such as sprinting, jumping… .
Strains are categorized into 3 grades of severity:
Grade I (mild) strains affect only a limited number of fibers in the muscle. There is no decrease in strength and there is full active and passive range of motion. Pain and tenderness are often delayed to the next day.
Grade II (moderate) strains have nearly half of muscle fibers torn. Acute and significant pain is accompanied by swelling and a minor decrease in muscle strength.
Grade III (severe) strains represent complete rupture of the muscle. This means either the tendon is separated from the muscle belly or the muscle belly is actually torn in 2 parts. Severe swelling and pain and a complete loss of function are characteristic for this type of strain.
Related articles:
Hamstring Strain
Quadriceps Muscle Strain
Calf Strain
Groin strain
Muscle contusion (bruise)[edit | edit source]
Related articles:
Muscle cramp[edit | edit source]
Muscle soreness[edit | edit source]
Exercise-induced muscle injuries
[edit | edit source]
Related articles:
Repair process[edit | edit source]
Regardless the underlying cause, the processes occurring in injured muscles tend to follow the same pattern. Functional recovery however varies from one type of injury to another. Two phases can be distinguished in the repair process.
- The destruction phase starts with the actual trauma that causes muscle fibers to tear. Immediate necrosis of myofibers takes place due to detoriation of the sarcoplasm, a process that is halted within hours after the trauma by lysosomal vesicles forming a temporary membrane.
An inflammatory process takes place as a reaction on the torn blood vessels. Specialized cells start removing necrotized parts of the fibers. - In the repair and remodeling phase, the actual repair of the injured muscle takes place. Myofibers start regenerating out of satellite cells (= undifferentiated reserve cells) and a connective tissue scar is being formed in the gap between the torn muscle fibers. In the first 10 days after the trauma, this scar tissue is the weakest point of the affected muscle. After 10 days however, eventual re-rupture will rather affect adjacent muscle tissue than the scar tissue itself, although full recovery (up to the point of preinjury strength) can take a relatively long time.
Vascularisation of the injured area is a prerequisite for recovering from a muscle injury. New capillaries originate from the remainings of injured blood vessels and find their way to the center of the injured area. Early mobilization plays a very important role since it stimulates the vascularisation process. Similar wise, intramuscular nerves will regenerate to re-establish the nerve-muscle contact.
Diagnostic procedure
[edit | edit source]
Treatment[edit | edit source]
Treatment of acute skeletal muscle injuries[edit | edit source]
The RICE-principle (rest, ice, compression and elevation) is generally considered as being the best method to minimize swelling and relief pain within the first 24 to 48 hours. Although the different components of the RICE-principle have each shown their effectiveness in experimental studies, the use of the all-round concept is yet to proved in randomized clinical trials.
After first aid, therapy must be tailor made according to the severity and extent of the injury. A short period of immobilization after the trauma prevents excessive formation of scar tissue (which will have a deleterious effect on mobility and strength of the healed muscle) and prevents rerupture by allowing the scar tissue to gain sufficient strength to bear contraction forces. Immobilization should not be continued after the acute phase (first few days) to avoid the negative effects such as muscle atrophy, retarded strength recovery and excessive formation of connective tissue within the muscle.
Early mobilization already starts after a few days, if the acute phase has passed without further complications and recovery seems to be progressing. In comparison to immobilization, mobilization induces significant histological changes such as increased vascularisation of the injured area, better regeneration of muscle fibers and more parallel orientation. It has the additional advantage that the muscle will sooner gain its original strength.
The active treatment needs to be built up gradually from isometric exercises to isotonic exercises. Only if those exercises can be performed without pain, isokinetic training should be started.
As muscle injuries generally recover well with conservative treating, surgical intervention is only to be considered in cases with very specific indications:
- Large intramuscular hematoma
- Complete muscle tear (strain of third degree)
- Partial strain (2nd degree) if more than half of the muscle belly is affected
- Scar adhesions that cause persistent pain and limited extension (>4-6 months)
