Abstract
MRI is the “gold standard” for the assessment of muscle injuries. This chapter includes a discussion of the structure of muscle and the muscle–tendon junction, the use of MRI and ultrasound for the assessment of muscle injury and the current grading systems for both modalities. Muscle injuries include: muscle strain/tear, muscle contusion, delayed onset muscle soreness, compartment syndrome and muscle hernias. Complications of muscle injuries include: myositis ossificans and calcific myonecrosis. Sports specific injuries to rectus abdominis, the flexor-pronator muscle group, hamstrings (acute and recurrent injuries) and rectus femoris and side strain have also been addressed.
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References
Aagaard H, Jorgensen U (1996) Injuries in elite volleyball. Scand J Med Sci Sports 6:228–232
Arciero RA, Shishido NS, Parr TJ (1984) Acute anterolateral compartment syndrome secondary to rupture of the peroneus longus muscle. Am J Sports Med 12(5):366–367
Armfield DR, Kim DH, Towers JD et al (2006) Sports-related muscle injury in the lower extremity. Clin Sports Med 25:803–842
Armstrong RB (1984) Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 16(6):529–538
Askling C, Tengvar M, Saartok T et al (2007) Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 35:197–206
Balius R, Pedret C, Pacheco L et al (2011) Rectus abdominis muscle injuries in elite handball players: management and rehabilitation. Open Access J Sports Med 2:69–73
Balius R, Pedret C, Galilea P et al (2012) Ultrasound assessment of asymmetric hypertrophy of the rectus abdominis muscle and prevalence of associated injury in professional tennis players. Skeletal Radiol 41:1575–1581
Beiner JM, Jokl P (2001) Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg 9:227–237
Benjamin M, Kaiser E, Milz S (2008) Structure-function relationships in tendons: a review. J Anat 212(3):211–228. doi:10.1111/j.1469-7580.2008.00864.x
Best TM, Hunter KD (2000) Muscle injury and repair. Phys Med Rehabil Clin North Am 11:251–266
Bianchi S, C Martinoli, Waser NP et al. (2002) Central aponeurosis tears of the rectus femoris: sonographic findings. Skeletal Radiol 31:581–586. doi 10.1007/s00256-002-0559-z
Blankenbaker DG, Tuite MJ (2010) Temporal changes of muscle injury. Semin Musculoskelet Radiol 14(2):176–193
Brophy RH, Wright RW, Powell JW et al (2010) Injuries to kickers in American football: the National Football League experience. Am J Sports Med 38(6):1166–1173
Brukner P, Khan K (2002) Clinical sports medicine. Revised 2nd edn. McGraw-Hill, Australia
Bryan Dixon J (2009) Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med 2:74–77
Clanton TO, Coupe KJ (1998) Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 6(4):237–248
Cleak MJ, Eston RG (1992) Delayed onset muscle soreness: mechanisms and management. J Sports Sci 10(4):325–341
Colosimo AJ, Wyatt HM, Frank KA et al (2005) Hamstring avulsion injuries. Oper Tech Sports Med 13:80–88
Comin J, Malliaras P, Baquie P et al (2013) Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med 41:111–115
Connell DA, Jhamb A, James T (2003) Side strain: a tear of internal oblique musculature. Am J Roentgen 181:1511–1517
Connell DA, Schneider-Kolsky ME, Hoving JL (2004) Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. Am J Roentgenol 183(4):975–984
Connell D, Ali K, Javid M et al (2006) Sonography and MRI of rectus abdominis muscle strain in elite tennis players. Am J Roentgen 187:1457–1461
Counsel P, Breidahl W (2010) Muscle injuries of the lower leg. Semin Musculoskelet Radiol 14:162–175
Cross TM, Gibbs N, Houang MT (2004) Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med 32(3):710–719
Davies JAK (1979) Peroneal compartment syndrome secondary to rupture of the peroneus longus. A case report. J Bone Joint Surg Am 61(5):783–784
Dierking JK, Bemben MG, Bemben DA et al (2000) Validity of diagnostic ultrasound as a measure of delayed onset muscle soreness. J Orthop Sports Phys Ther 30:116–122
Early JS, Ricketts DS, Hansen ST (1994) Treatment of compartmental liquefaction as a late sequela of a lower limb compartment syndrome. J Orthop Trauma 8:445–448. doi:10.1097/00005131-199410000-00015
Ekstrand J, Hägglund M, Waldén M (2011a) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39(6):1226–1232
Ekstrand J, Hägglund M, Waldén M (2011b) Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 45:553–558
Ekstrand J, Healy JC, Waldén M (2012) Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med 46:112–117
El-Khoury GY, Brandser EA, Kathol MH (1996) Imaging of muscle injuries. Skeletal Radiol 25(1):3–11
Elliott KG, Johnstone AJ (2003) Diagnosing acute compartment syndrome. J Bone Joint Surg (Br) 85(5):625–632
Elsayes KM, Lammle M, Shariff A et al (2006) Value of magnetic resonance imaging in muscle trauma. Curr Probl Diagn Radiol 35(5):206–212
Entrekin RR, Porter BA, Sillesen HH et al (2001) Real-time spatial compound imaging: Application to breast, vascular, and musculoskeletal ultra-sound. Semin Ultrasound CT MR 22:50–64
Exeter D, Connell DA (2010) Skeletal muscle: functional anatomy and pathophysiology. Semin Musculoskelet Radiol 14(2):97–105. doi:10.1055/s-0030-1253154
Eygendaal D, Rahussen FTG, Diercks RL (2007) Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med 41:820–823. doi:10.1136/bjsm.2007.038307
Farber JM, Buckwalter KA (2002) MR imaging in nonneoplastic muscle disorders of the lower extremity. Radiol Clin North Am 40(5):1013–1031
Finni T, Hodgson JA, Lai AM et al (2003) Nonuniform strain of human soleus aponeurosis-tendon complex during submaximal voluntary contractions in vivo. J Appl Physiol 95:829–837
Fleckenstein JL, Canby RC, Parkey RW et al (1988) Acute effects of exercise on MR imaging of skeletal muscle in normal volunteers. Am J Roentgenol 151(2):231–237
Fleckenstein JL, Weatherall PT, Parkey RW et al (1989) Sports-related muscle injuries: evaluation with MR imaging. Radiology 172(3):793–798
Folsom GJ, Larson CM (2008) Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med 36(1):104–109
Garrett WE (1996) Muscle strain injuries. Am J Sports Med 24:S2–S8
Gibbs NJ, Cross TM, Cameron M et al (2004) The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. Am J Sports Med 7:248–258
Guillodo Y, Bouttier R, Saraux A (2011) Value of sonography combined with clinical assessment to evaluate muscle injury severity in athletes. J Athl Train 46(5):500–504
Gyftopoulos S, Rosenberg ZS, Schweitzer ME (2008) Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. Am J Roetgenol 190:W182–W186. doi:10.2214/AJR.07.2947
Hasselman CT, Best TM, Hughes C (1995) An explanation for various rectus femoris strain injuries using previously undescribed muscle architecture. Am J Sports Med 23(4):493–499
Hawkins RD, Hulse MA, Wilkinson C et al (2001) The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 35:43–47
Hayashi D, Hamilton B, Guermazi A (2012) Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imaging 3(6):591–601
Holobinko JN, Damron TA, Scerpella PR (2003) Calcific myonecrosis: keys to early recognition. Skeletal Radiol 32:35–40
Huard J, Li Y, Fu FH (2002) Muscle injuries and repair: current trends in research. J Bone Joint Surg (Am) 84:822–832
Hughes C 4th, Hasselman CT, Best TM et al (1995) Incomplete, intrasubstance strain injuries of the rectus femoris muscle. Am J Sports Med 23:500–506
Humphries D, Jamison M (2004) Clinical and magnetic resonance imaging features of cricket bowler’s side strain. Br J Sports Med 38:e21. doi:10.1136/bjsm.2003.005272
Hurme T, Kalimo H, Lehto M (1991) Healing of skeletal muscle injury. An ultrastructural and immunohistochemical study. Med Sci Sports Exerc 23:801–810
Jackson DW, Feagin JA (1973) Quadriceps contusions in young athletes. Relation of severity of injury with treatment and prognosis. J Bone Joint Surg (Am) 55:95–105
Järvinen TA, Kääriäinen M, Järvinen M et al (2000) Muscle strain injuries. Curr Opin Rheumatol 12(2):155–161
Järvinen TA, Järvinen TL, Kääriäinen M et al (2005) Muscle injuries: biology and treatment. Am J Sports Med 33(5):745–764
Jozsa LG, Kannus P (1997) Human tendons: anatomy, physiology, and pathology, 1st edn. Human Kinetics Publishers, Champaign, p. 105
Kääriäinen M, Kääriäinen J, Järvinen TL (1998) Correlation between biomechanical and structural changes during the regeneration of skeletal muscle after laceration injury. J Orthop Res 16(2):197–206
Kalimo H, Rantanen J, Jarvinen M (1997) Muscle injuries in sports. Baillieres Clin Orthop 2:1–24
Kibler WB (1994) Clinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis. Med Sci Sports Exerc 26:1203–1206
Kijowski R (2011) Magnetic resonance imaging of muscle injury. In: Conference Proceedings
Kneeland JB (1997) MR imaging of muscle and tendon injury. Eur J Radiol 25:199–208
Koulouris G, Connell D (2005) Hamstring muscle complex: an imaging review. Radiographics 25(3):571–586
Koulouris G, Connell DA, Brukner Pl et al (2007a) Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35(9):1500–1506
Koulouris G, Ting AYI, Jhamb A et al (2007b) Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol 36:921–927
Kramer FL, Kurtz AB, Rubin C et al (1979) Ultrasound appearance of myositis ossificans. Skeletal Radiol 4:19–20
Lansdown DA, Ding Z, Wadington M (2007) Quantitative diffusion tensor MRI-based fiber tracking of human skeletal muscle. J Appl Physiol 103:673–681
Larson RC, Sierra RJ, Sundaram M et al (2004) Calcific myonecrosis: a unique presentation in the upper extremity. Skeletal Radiol 33:306–309. doi:10.1007/s00256-003-0740-z
Lee JC, Healy J (2004) Sonography of lower limb muscle injury. AJR Am J Roentgenol 182:341–351
Linklater JM, Hamilton B, Carmichael J et al (2010) Hamstring injuries: anatomy, imaging, and intervention. Semin Musculoskelet Radiol. 14(2):131–161
Litwiller DV, Amrami KK, Dahm DL et al (2007) Chronic exertional compartment syndrome of the lower extremities: improved screening using a novel dual birdcage coil and in-scanner exercise protocol. Skeletal Radiol 36:1067–1075. doi:10.1007/s00256-007-0360-0
Mair SD, Seaber AV, Glisson RR et al (1996) The role of fatigue in susceptibility to acute muscle strain injury. Am J Sports Med 24:137–143
Malliaropoulos N, Papacostas E, Kiritsi O et al (2010) Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 38:1813–1819
Maquirriain J, Ghisi JP, Kokalj AM (2007) Rectus abdominis muscle strains in tennis players. Br J Sports Med 41:842–848
McCarthy EF, Sundaram M (2005) Heterotopic ossification: a review. Skeletal Radiol 34(10):609–619
Megliola A, Eutropi F, Scorzelli A et al (2006) Ultrasound and magnetic resonance imaging in sports-related muscle injuries. Radiol Med 111(6):836–845
Milisano LP, Hunter GA (1992) Liquefaction and calcification of a chronic compartment syndrome of the lower limb. J Orthop Trauma 6:245–247
Mueller-Wohlfahrt H, Haensel L, Mithoefer K et al (2012) Terminology and classification of muscle injuries in sport: a consensus statement. Br J Sports Med 0:1–9. doi:10.1136/bjsports-2012-091448
Muramatsu K, Ihara K, Seki T (2009) Calcific myonecrosis of the lower leg: diagnosis and options of treatment. Arch Orthop Trauma Surg 129:935–939. doi:10.1007/s00402-009-0890-0
Nirschl RP, Pettrone FA (1979) Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg (Am) 61:832–839
Noonan TJ, Garrett WE Jr (1992) Injuries at the myotendinous junction. Clin Sports Med 11(4):783–806
Nurenberg P, Giddings CJ, Stray-Gundersen J et al (1992) MR imaging-guided muscle biopsy for correlation of increased signal intensity with ultrastructural change and delayed-onset muscle soreness after exercise. Radiology 184(3):865–869
O’Brien M (2005) The anatomy of the Achilles tendon. Foot Ankle Clin 10:225–238
O’Donoghue DO (1962) Treatment of injuries to athletes. WB Saunders, Philadelphia
Olsen KM, Chew FS (2006) Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics 26:871–885. doi:10.1148/rg.263055099
Opar DA, Williams MD, Shield AJ (2012) Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med 42:209–226
Orchard J (2001) Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 29:300–303
Orchard J, Seward H (2003) AFL injury report 2003. J Sci Med Sport 7:264–265
Palmer WE, Kuong SJ, Elmadbouh HM (1999) MR imaging of myotendinous strain. Am J Roentgenol 173:703–709
Pearl AJ (1981) Anterior compartment syndrome: a case report. Am J Sports Med 9(2):119–120
Peck RJ, Metreweli C (1988) Early myositis ossificans: a new echographic sign. Clin Radiol 39:586–588
Peetrons P (2002) Ultrasound of muscles. Eur Radiol 2002(12):35–43
Quintero AJ, Wright VJ, Fu FH et al (2009) Stem cells for the treatment of skeletal muscle injury. Clin Sports Med 28(1):1–11
Renwick SE, Naraghi FF, Worrell RV et al (1994) Cystic degeneration and calcification of muscle: late sequelae of compartment syndrome. J Orthop Trauma 8:440–444. doi:10.1097/00005131-199410000-00014
Ringler MD, Litwiller DV, Felmlee JP et al (2013) MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol 42:385–392. doi:10.1007/s00256-012-1487-1
Rybak LD, Torriani M (2003) Magnetic resonance imaging of sports-related muscle injuries. Top Magn Reson Imaging 14(2):209–219
Ryu KN, Bae DK, Park YK et al (1996) Calcific tenosynovitis associated with calcific myonecrosis of the leg: imaging features. Skeletal Radiol 25:273–275. doi:10.1007/s002560050078
Schneider-Kolsky ME, Hoving JL, Warren P et al (2006) A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med 34(6):1008–1015
Shellock FG, Fukunaga T, Mink JH (1991) Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging. Radiology 179(3):659–664
Shelly MJ, Hodnett PA, MacMahon PJ (2009) MR imaging of muscle injury. Magn Reson Imaging Clin N Am 17(4):757–773
Silder A, Heiderscheit BC, Thelen DG et al (2008) MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol 37(12):1101–1109
Slavotinek JP (2010) Muscle injury: the role of imaging in prognostic assignment and monitoring of muscle repair. Semin Musculoskelet Radiol 14(2):194–200
Slavotinek JP, Verrall GM, Fon GT (2002) Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. Am J Roentgenol 179(6):1621–1628
Standring S (2005) Gray’s anatomy: the anatomical basis of clinical practice, 39th edn. Elsevier, Edinburgh
Stauber WT (1989) Repair models and specific tissue responses in muscle injury. In: Leadbetter WB, Buckwalter JA, Gordon SL (eds) Sports induced inflammation: clinical and basic science concepts. American Association of Orthopaedic Surgeons, Rosemont, pp 205–213
Stedman TL (2000) Stedman’s medical dictionary, 27th edn, Lippincott, Williams & Wilkins, Philadelphia
Stevens KJ, Crain JM, Akizuki KH et al (2010) Imaging and ultrasound-guided steroid injection of internal oblique muscle strains in baseball pitchers. Am J Sports Med 38:581–585. doi:10.1177/0363546509350105
Temple HT, Kuklo TR, Sweet DE et al (1998) Rectus femoris muscle tear appearing as a pseudotumor. Am J Sports Med 26:544–548
Vangsess CT Jr, Jobe FW (1991) Surgical treatment of medial epicondylitis. Results in 30 elbows. J Bone Joint Surg 73:409–411
Verleisdonk EJ (2002) The exertional compartment syndrome: a review of the literature. Orthop Traumatol Rehabil 4(5):626–631
Verrall GM, Slavotinek JP, Barnes PG et al (2001) Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br J Sports Med 35(6):435–439; discussion 440
Verrall GM, Slavotinek JP, Barnes PG et al (2003) Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med 31(6):969–973
Viau MR, Pedersen HE, Salciccoioli GG et al (1993) Ectopic calcifcation as a late sequela of compartment syndrome. Report of two cases. Clin Orthop Relat Res 176:178–180
Wang JW, Chen WJ (2001) Calcific myonecrosis of the leg: a case report and review of the literature. Clin Orthop Relat Res 389:185–190. doi:10.1097/00003086-200108000-00026
Weishaupt D, Schweitzer ME, Morrison WB (2001) Injuries to the distal gastrocnemius muscle: MR findings. J Comput Assist Tomogr 25(5):677–682
Woodhouse JB, McNally EG (2011) Ultrasound of skeletal muscle injury: an update. Semin Ultrasound CT MR 32(2):91–100. doi:10.1053/j.sult.2010.12.002
Woods C, Hawkins RD, Maltby S et al (2004) Football Association Medical Research Programme. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med 38(1): 36–41
Zaraiskaya T, Kumbhare D, Noseworthy MD (2006) Diffusion tensor imaging in evaluation of human skeletal muscle injury. J Magn Reson Imaging 24:402–408
Zeiss J, Ebraheim NA, Woldenberg LS (1989) Magnetic resonance imaging in the diagnosis of anterior tibialis muscle herniation. Clin Orthop Relat Res 244:249–253
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Dimmick, S., Rehnitz, C., Weber, MA., Linklater, J.M. (2013). MRI of Muscle Injuries. In: Weber, MA. (eds) Magnetic Resonance Imaging of the Skeletal Musculature. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_878
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