Indirect Muscle Injury Research Articles

Role of High Frequency Ultrasound in Assessment of Acute and Chronic Muscle Injuries in Comparison to MRI

Abstract Background The most common mechanism of injury of muscles is related to muscle strain (indirect muscle injury), mainly in the lower limbs. Muscles are at risk for disruption during eccentric contraction, as the force of active contraction is added to the passive stretching force applied to the myotendinous junction (MTJ). Although clinical examinations remain very important, it has been shown that radiological findings can aid clinicians in the initial assessment. Objective To evaluate the accuracy and specificity of high frequency ultrasound in identification and characterization of acute and chronic muscle injuries in comparison with MRI. Methods This ultrasonography & cross sectional study was done in private radiological centers with a period of 24 months on a random sample of 30 patients. Our study included 30 patients complaining of traumatic acute and chronic muscle injuries, 26 males (86.7%) and 4 females (13.3%), ranging in age from 18 to 55 years with a mean age of 37.5 years. Results The accuracy, sensitivity & specificity of ultrasound in detecting all muscle injuries in comparison to MRI: 86.7%, 87.5% & 83.3% respectively. The accuracy, sensitivity & specificity of ultrasound in detecting acute muscle injuries in comparison to MRI: 66.7%, 66.7 % & 66.7% respectively. The accuracy, sensitivity & specificity of ultrasound in detecting chronic muscle injuries in comparison to MRI: 95.2%, 94.4% & 100% respectively. Conclusion Ultrasound is highly operator dependent, useful for diagnosis of chronic muscle injury in comparison to the MRI, yet with pitfalls in acute muscle injuries, yet the ultrasound classification criteria for muscle injury can be used to predict the severity of injury and guide decision on the type of treatment and MRI is still considered the main diagnostic tool for muscle injuries and classification.

Acute Myocardial Infarction in COVID-19 Patients-A Review of Literature Data and Two-Case Report Series.

Background/Objectives: The newly emergent COVID-19 pandemic involved primarily the respiratory system and had also major cardiovascular system (CVS) implications, revealed by acute myocardial infarction (AMI), arrhythmias, myocardial injury, and thromboembolism. CVS involvement is done through main mechanisms-direct and indirect heart muscle injury, with high mortality rates, worse short-term outcomes, and severe complications. AMI is the echo of myocardial injury (revealed by increases in CK, CK-MB, and troponin serum markers-which are taken into consideration as possible COVID-19 risk stratification markers). When studying myocardial injury, physicians can make use of imaging studies, such as cardiac MRI, transthoracic (or transesophageal) echocardiography, coronary angiography, cardiac computed tomography, and nuclear imaging (which have been used in cases where angiography was not possible), or even endomyocardial biopsy (which is not always available or feasible). Two-case-series presentations: We present the cases of two COVID-19 positive male patients who were admitted into the Clinical Department of Cardiology in "Sfântul Apostol Andrei" Emergency Clinical Hospital of Galați (Romania), who presented with acute cardiac distress symptoms and have been diagnosed with ST elevation AMI. The patients were 82 and 57 years old, respectively, with moderate and severe forms of COVID-19, and were diagnosed with anteroseptal left ventricular AMI and extensive anterior transmural left ventricular AMI (with ventricular fibrillation at presentation), respectively. The first patient was a non-smoker and non-drinker with no associated comorbidities, and was later discharged, while the second one died due to AMI complications. Conclusions: From this two-case series, we extract the following: old age alone is not a significant risk factor for adverse outcomes in COVID-19-related CVS events, and that the cumulative effects of several patient-associated risk factors (be it either for severe forms of COVID-19 and/or acute cardiac injury) will most probably lead to poor patient prognosis (death). At the same time, serum cardiac enzymes, dynamic ECG changes, along with newly developed echocardiographic modifications are indicators for poor prognosis in acute cardiac injury in COVID-19 patients with acute myocardial injury, regardless of the presence of right ventricular dysfunction (due to pulmonary hypertension).

Magnetic resonance imaging predicts the days lost from training and competition: evaluation of 56 indirect muscle injuries in professional football players.

Lower limb muscle injuries have a strong impact in training and official competitions stoppage for professional football players. This study aimed to explore the relationship between oedema-like changes found on magnetic resonance imaging (MRI) in acute indirect thigh injuries muscles and the time required for the athlete to return to individual training - "return to training" (RTT) and for full availability for official competitions - "return to play" (RTP). Professional football players from 2017/2018 to 2021/2022 seasons top league team with clinical and ultrasound (US) diagnosis of acute hamstrings or quadriceps muscle injury, confirmed on 48/72h subsequent MRI, were included. MRI images were retrospectively re-evaluated. MRI parameters evaluated were cross-sectional area (CSA), cranio-caudal extension (CCE), distance to nearest insertion (DI) and volume (V). Univariate and multivariate analysis was performed to find factors related to RTT, RTP, and episodes of reinjuries. Thirty-four first traumatic muscle injuries met the inclusion criteria. The mean time to RTT and RTP was 22 (4-49) and 25 (4-55) days, respectively. CCE and V resulted as independent predictive MRI variables for the time to RTT (P=0.012) and RTP (P=0.02), respectively. Thresholds of CCE≥11.31 cm and V ≥19.5cc can predict a time to RTT≥22 days (Odds Ratio [OR] 9.5) and RTP≥25 days (OR 4.583), respectively. The decision on the time required for RTP is based on clinic and imaging evaluation; CCE and V of the MRI oedema-like changes help to define the prognosis of the injury.

Traumatic muscle injury.

Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.

The Role of Extracorporeal Shock Wave Therapy in the Treatment of Muscle Injuries: A Systematic Review.

Muscle injuries commonly occur in sports and can be classified as indirect and direct, according to the 2013 Munich Consensus Statement (MCS). Since recent evidence suggests that extracorporeal shock wave therapy (ESWT) improves muscular microcirculation and may increaseregenerationafter acute muscle injury, we performed a systematic review following the Preferred Reporting Items forSystematicReviews and Meta-Analyses (PRISMA) statement guidelines to access the efficacy and safety of ESWT in the treatment of patients with muscle injuries. PubMed and Cochrane were searched to screen for potentially relevant articles and the literature search was last updated in June 2023. The inclusion criteria were randomized controlled trials, observational studies, or case controls published in English, Portuguese, or Spanish that studied the effect of ESWT on indirect and direct muscle injuries in individuals aged ≥18, with at least one of the following reported outcomes: pain on the visual analogscale (VAS), functionality assessed either with disability scales or subjectively, time for return to play (RTP), re-injury rate, and ultrasonographic evaluation. The exclusion criteria were literature reviews, systematic reviews, studies in animals, studies in other languages, studies that failed to meet the targeted population or intervention and studies that didn't report any of the outcomes of interest. The quality of the studies was analyzed using the Cochrane Assessment Tool, the Newcastle-Ottawa Quality Assessment Scale, and the JBI Critical Appraisal Checklist. Eight studies were included in the systematic review (two randomized controlled trials, one prospective observational study, two retrospective observational studies, and three case reports), with a total of 143 adult participants. ESWT was associated with less pain on VAS, better function, reduction of size of lesion on ultrasound evaluation, faster RTP and/or lower re-injury rate in patients with indirect and direct muscle injuries and muscular hematomas, a frequent secondary complication of muscle injuries. The evidence regarding the use of ESWT for these types of injuries is therefore promising. Nevertheless, higher-quality studies are needed in the future to prove its efficacy, better comprehend its mechanisms of action and define treatment protocols (timing, type and parameters of ESWT).

Creatine kinase concentration on the second post-match day is not associated with risk of subsequent muscle injury in professional football players: a four-season cohort study

ABSTRACT Objective The objective of this study was to examine the relationship between creatine kinase (CK) concentration following official matches and the risk of subsequent muscle injury in professional male football (soccer) players. Methods Blood samples were collected on the second post-match day for CK analysis over four consecutive seasons in a professional football club. Players were then followed for five days to observe any occurrence of indirect muscle injury (structural or functional in nature). Players exposed to at least 45 minutes in two consecutive matches within seven days were considered valid cases for analysis. Results Eighty players participated in the study, generating 1,656 cases eligible for analysis, of which 229 resulted in muscle injuries. The hamstrings were the most frequently injured muscle group (54%), followed by the adductor (21%), triceps surae (19%), quadriceps (5%), and psoas (1%). While CK concentration was higher in muscle injury cases [783 ± 507 U/L (95%CI, 717 to 849; min–max, 105–2,800)] compared with uninjured cases [688 ± 446 U/L (95%CI, 665 to 711; min–max, 100–2,950)], it was not an accurate predictor of subsequent muscle injury risk in professional football players (sensitivity = 56%; specificity = 55%; odds ratio = 1.00; area under curve = 0.557). Conclusion CK concentration on the second post-match day cannot be used to effectively screen subsequent muscle injury risk in professional male football players.

Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The “Italian Injury Study” during the Serie a Championship

Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19. This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Can prognostic factors for indirect muscle injuries in elite football (soccer) players be identified using data from preseason screening? An exploratory analysis using routinely collected periodic health examination records

BackgroundIn elite football, periodic health examination (PHE) may be useful for injury risk prediction.ObjectiveTo explore whether PHE-derived variables are prognostic factors for indirect muscle injuries (IMIs) in elite players.DesignRetrospective cohort...

Three-dimensional turbo spin-echo (TSE) MRI assessment of indirect acute muscle injuries in athletes: comparison with two-dimensional TSE MRI.

To evaluate three-dimensional (3D) turbo spin-echo (TSE) magnetic resonance imaging (MRI) for the assessment of acute muscle injuries in elite athletes in comparison with two-dimensional (2D) MRI. Elite athletes with clinically suspected acute muscle injury of the thigh who underwent both 2D and 3D MRI protocols on the same day were retrospectively included. Two musculoskeletal radiologists independently assessed 2D and 3D MRIs, with both techniques evaluated separately 1-month apart. Muscle injuries were evaluated using the BAMIC and the INSEP classifications. A second assessment of injuries was performed by each reader 2 months after the initial readings. Agreement was determined using weighted kappa statistics. The level of diagnostic confidence in classifying injuries was also assessed for both MRI protocols. A total of 40 athletes were included. Intra-reader agreement when comparing injury grades from 2D vs. 3D for both INSEP and BAMIC classifications was almost perfect for both readers and ranged between 0.84 and 0.98. Inter-reader agreement was substantial to almost perfect and ranged from 0.78 to 0.93 for the 2D protocol, and from 0.78 to 0.95 for the 3D protocol. Intra-reader agreement for each MRI protocol separately was almost perfect to perfect for both readers and ranged between 0.84 and 1.00. Diagnostic confidence for grading injuries improved for both readers when using the 3D protocol. Compared to 2D MRI, 3D TSE MRI is a reliable technique for acute muscular injury assessment, providing faster acquisition times and improving the diagnostic confidence. • Compared to 2D MRI, 3D TSE MRI is a reliable technique for the assessment of acute muscular injuries. • 3D TSE MRI has the advantage of faster total acquisition times, thinner sections, and multiplanar reconstruction, improving the confidence for structural assessment including connective tissue involvement.

Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise.

Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.

The Value of Preseason Screening for Injury Prediction: The Development and Internal Validation of a Multivariable Prognostic Model to Predict Indirect Muscle Injury Risk in Elite Football (Soccer) Players

BackgroundIn elite football (soccer), periodic health examination (PHE) could provide prognostic factors to predict injury risk.ObjectiveTo develop and internally validate a prognostic model to predict individualised indirect (non-contact) muscle injury (IMI) risk during a season in elite footballers, only using PHE-derived candidate prognostic factors.MethodsRoutinely collected preseason PHE and injury data were used from 152 players over 5 seasons (1st July 2013 to 19th May 2018). Ten candidate prognostic factors (12 parameters) were included in model development. Multiple imputation was used to handle missing values. The outcome was any time-loss, index indirect muscle injury (I-IMI) affecting the lower extremity. A full logistic regression model was fitted, and a parsimonious model developed using backward-selection to remove factors that exceeded a threshold that was equivalent to Akaike’s Information Criterion (alpha 0.157). Predictive performance was assessed through calibration, discrimination and decision-curve analysis, averaged across all imputed datasets. The model was internally validated using bootstrapping and adjusted for overfitting.ResultsDuring 317 participant-seasons, 138 I-IMIs were recorded. The parsimonious model included only age and frequency of previous IMIs; apparent calibration was perfect, but discrimination was modest (C-index = 0.641, 95% confidence interval (CI) = 0.580 to 0.703), with clinical utility evident between risk thresholds of 37–71%. After validation and overfitting adjustment, performance deteriorated (C-index = 0.589 (95% CI = 0.528 to 0.651); calibration-in-the-large = − 0.009 (95% CI = − 0.239 to 0.239); calibration slope = 0.718 (95% CI = 0.275 to 1.161)).ConclusionThe selected PHE data were insufficient prognostic factors from which to develop a useful model for predicting IMI risk in elite footballers. Further research should prioritise identifying novel prognostic factors to improve future risk prediction models in this field.Trial registrationNCT03782389

An Unusual Cause of Rhabdomyolysis with Acute Kidney Injury

Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. It can result from a variety of etiologies which may include traumatic or non-traumatic causes. Rhabdomyolysis due to hanging is extremely uncommon and not described in literature. This case highlights rhabdomyolysis as a potential complication of hanging.

Exercise-induced rhabdomyolysis is not more severe or frequent after Crossfit than after Running or Strength training programs

Objective: Rhabdomyolysis is the death (lysis) of muscle fibers due to direct or indirect muscle injury, with release of the fiber content into the bloodstream. Several conditions are triggering the rhabdomyolysis, for example, changes in body temperature, intoxications and strenuous exercise. Although often the condition of the disease in question are associated with programs of extreme conditioning, specifically to Crossfit, there are few scientific data that prove such a relationship or lack thereof. The aim of this study is to assess the incidence and severity of cases of rhabdomyolysis in different modalities of training, Crossfit, strength training and Running.
 Method: A case study was carried out in 20 clinics in the city of Belém in the state of Pará. Data analysis was used to characterize the sample. The Shapiro-Wilk normality test was used and, based on the results, the data were submitted to non-parametric Mann-Whitney and Kruskal-Wallis tests.
 Results: The results showed that no differences were found between the proportions (χ² = 3.44; p = 0.17).
 Conclusions: The frequency of cases and their severity is similar between running, training and Crossfit.

The burden of muscle injuries in youth football

Background: Muscle injuries affect up to 72% of professional soccer players within one season and there are well reviewed, but muscle injuries in youth soccer players are not widely documented. The aim of this study was to investigate incidence, localization, pathomechanism and point of time of indirect muscle injuries in youth soccer players. Methods: Prospective cohort study. 5 teams (U15, U16, U17, U18 and U21) with 110 young male football players (age 16,8 (14,3–21) years, height 174,5 (146,1–190,0) cm, weight 65,7 (35,5–84,6) kg) were monitored for 12 months. Every muscle injury was documented and monitored on a standardized evaluation score. Results: In total, 53 muscle injuries were registered. On average, a player sustained 0,4 muscle injuries per season. There was only one re-injury (2%). The injury rate was 1,5 injuries per 1000h match- or /training hours, the match injury rate (6,9) being 7,7 times higher than the training injury rate (0,9). Sixty-nine percent were functional muscle injuries. Thirty-seven percent of all muscle injuries affected the hamstrings group and twenty-eight percent the adductors. The most common pathomechanism was overload (28%). Most of the injuries were recorded during the last 15 minutes of a game or a training (39,6%). Conclusion: Muscle injuries are a substantial problem for players and clubs, also in young male football players. This study confirmed previous results showing that the injury rate during games is higher than during trainings and that hamstrings injuries are the most common muscle injuries in soccer. However, a prolonged study period is recommended to gain better statistical values.

Influence of the MCT1 rs1049434 on Indirect Muscle Disorders/Injuries in Elite Football Players.

BackgroundThe aim of this study was to investigate the association between MCT1 rs1049434 polymorphism and indirect muscle injuries in elite football players. One hundred and seventy-three male elite Italian football players (age = 19.2 ± 5.3 years) were recruited from a first-league football club participating at the Official National Italian Football Championship (Serie A, Primavera, Allievi, Giovanissimi). The cohort was genotyped for the MCT1 rs1049434 polymorphism, and muscle injuries data were collected during the period of 2009–2014 (five football seasons).MethodsGenomic DNA was extracted using a buccal swab, and genotyping was performed using PCR method. Structural-mechanical injuries and functional muscle disorder were included in the acute indirect muscle injury group.ResultsParticipants with the MCT1 AA (AA = 1.57 ± 3.07, n = 69) genotype exhibit significantly higher injury incidents compared to participants with the TT genotype (TT = 0.09 ± 0.25, n = 22, P = 0.04).ConclusionsThe MCT1 rs1049434 polymorphism is associated with the incidence of muscle injuries in elite football players. We anticipate that the knowledge of athletes’ genetic predisposition to sports-related injuries might aid in individualizing training programs.

Epidemiological and clinical outcome comparison of indirect (‘strain’) versus direct (‘contusion’) anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001–2013)

BackgroundData regarding direct athletic muscle injuries (caused by a direct blunt or sharp external force) compared to indirect ones (without the influence of a direct external trauma) are missing in...

THE EFFECTS OF GROWTH FACTORS ON SKELETAL MUSCLE LESIONS

Skeletal muscle injuries are common causes of severe long-term pain and physical disability, accounting for up to 55% of all sports injuries. The phases of the healing process after direct or indirect muscle injury are complex but clearly defined processes comprising well-coordinated steps: degeneration, inflammation, regeneration, and fibrosis. Despite this frequent occurrence and the presence of a body of data on the pathophysiology of muscle injuries, none of the treatment strategies adopted to date have been shown to be really effective in strictly controlled trials. Most current muscle injury treatments are based on limited experimental and clinical data and/or were only empirically tested. Platelet-rich plasma (PRP) is a promising alternative approach based on the ability of autologous growth factors (GFs) to accelerate tissue healing, improve muscular regeneration, increase neovascularization and reduce fibrosis, allowing rapid recovery after muscle lesions. Thus, further experimental studies that include the quantification of specific GFs released by PRP, as well as additional data on angiogenesis, myogenesis and functional recovery are needed to ultimately validate the hypothesis of PRP efficacy in the treatment of muscle lesions and open the way for its wide clinical application.

Partial rupture of the adductor longus complicated by myositis ossificans

Muscle injuries may be direct or indirect. Indirectinjuries (‘strains’) are extremely common in ath-letes and most settle with conservative treatment.Myositis ossificans (MO–—extra skeletal ossification)is a rare complication of indirect muscle injury thattends to occur following a direct blow (i.e. musclecontusion-direct injury). It is rarely reported as aconsequence of a muscle strain.

Fractures of osteochondroma during physical exercise.

The mechanism responsible and the best form of treatment for fractures of osteochondromas remain unclear. We studied the incidence, cause, treatment, and outcome of fractures of osteochondroma over a 17-year period. Retrospective cohort study. We retrospectively reviewed all cases of osteochondroma at one institution over 17 years (1985 to 2002) to identify cases of fractures. These patients were then contacted for follow-up. Seven cases of fracture through the stalk of a pedunculated osteochondroma were identified. All fractures were sustained during physical exercise. One fracture was due to a direct blow, and the others to indirect muscle or tendon injury. Five patients were treated surgically with excision of the osteochondroma, and the other two received nonoperative treatment consisting of restriction of physical activity and observation. In all cases, patients were able to resume sporting activity within 4 to 8 weeks. The recovery period was shorter for patients who received surgical treatment. Surgical excision of the fractured osteochondroma may be preferable for patients engaging in sport.

Imaging of muscle injuries.

Although skeletal muscle is the single largest tissue in the body, there is little written about it in the radiologic literature. Indirect muscle injuries, also called strains or tears, are common in athletics, and knowing the morphology and physiology of the muscle-tendon unit is the key to the understanding of these injuries. Eccentric muscle activation produces more tension within the muscle than when it is activated concentrically, making it more susceptible to tearing. Injuries involving the muscle belly tend to occur near the myotendinous junction. In adolescents, the weakest link in the muscle-tendon-bone complex is the apophysis. Traditionally, plain radiography has been the main diagnostic modality for evaluation of these injuries; however, with the advent of MRI it has become much easier to diagnose injuries primarily affecting the soft tissues. This article reviews the anatomy and physiology of the muscle-tendon unit as they relate to indirect muscle injuries. Examples of common muscle injuries are illustrated.