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Biology and Etiology of Muscle-Tendon Injuries

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Muscle Injury in the Athlete

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Abstract

The detrimental event on a muscular level founds one of the most recurring traumatic insults in sporting environment. The entity of the lesion can go from simple sprain, often associated with the breakage of small vessels, with appearance of pain and swelling, to complete muscular tear. The consequences for the athlete, which appear linked with the entity of the lesion, are always unpleasant and involve suspension, more or less long, of sporting activity, not to mention suitable therapy. In this chapter, we will try to clear up the different physiological aspects, which normally characterize the traumatic event, and to describe, even if only summarize, the mechanism of muscular repair.

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Notes

  1. 1.

    Dystrophin: the dystrophin is a protein and an important part of a protein complex that connects the cytoskeleton of a muscle fiber to the surrounding extracellular matrix through the cell membrane. Its deficiency is one of the causes of muscular dystrophy. It was identified in 1987 by Louis M. Kunkel, after the discovery, in 1986, of the mutated gene that causes Duchenne muscular dystrophy (DMD). Normal tissue contains small amounts of dystrophin (about 0.002% of the total amount of muscle proteins), but its absence leads to both DMD and fibrosis, a condition of muscle stiffness. A different mutation of the same gene results in a defective dystrophin, leading to Becker’s muscular dystrophy (BMD). The dystrophin is, at today, the longest known gene.

  2. 2.

    In Duchenne muscular dystrophy, due to spontaneous mutations of the Xp21 gene, the research of dystrophin with immuno-histochemical methods demonstrates the absence of protein in all muscle fibers, or its presence in up to 3% of the fibers.

  3. 3.

    Plasmalemma: membrane that externally delimits the protoplast, that is the protoplasmic body of a cell (cell membrane).

  4. 4.

    These experimental studies have been conducted thanks to the use of a specific dye called “ruthenium red.” Ruthenium red inhibits Ca++ ATPase in sarcolemma, sarcoplasmic reticulum, and mitochondria, causing rapid and dramatic damage to muscle ultrastructure.

  5. 5.

    Acetylcholinesterase is an enzyme belonging to the class of hydrolases that catalyzes the following reaction: acetylcholine + H2O → choline + acetate. The enzyme is normally present in the mammalian organism localized in the post-synaptic membrane of cholinergic junctions. Its function is to hydrolyze acetylcholine by cleaving it into choline and acetic acid. The activity of this enzyme can be modified both by drugs and natural toxins. For example, in the diagnosis of myasthenia gravis, the patient is inoculated a drug, the pyridostigmine, which with its inhibition of the enzyme brings a slight strengthening of the motor faculties confirming the hypothesis of the supposed diagnosis.

  6. 6.

    Leukotrienes: leukotrienes are lipid molecules belonging to the immune system that contribute to inflammatory processes in asthma and bronchitis, their antagonists are used in the treatment of these diseases. They are eicosanoids, derivatives of arachidonic acid due to the action of the enzyme 5-lipoxygenase. Their production is usually accompanied by that of histamine, which is also greatly involved in cases of inflammation and asthma.

  7. 7.

    Tromboxane or tromboxane: thromboxane is a molecule of a lipid nature, derived from arachidonic acid in the cyclooxygenase pathway. In its active form, it is characterized by an endometoxide in the penta-atomic ring typical of prostaglandins, modified. The tromboxane (TXA2) has a marked aggregating platelet activity and a constricting vessel activity. Receptor antagonists and inhibitors of thromboxane synthesis are therefore indicated in the treatment of cardiovascular diseases.

  8. 8.

    Arachidonic acid is a poly-unsaturated fatty acid, meaning that it has more carbon-carbon bonds in its molecule. The arachidonic acid present in the human body is introduced with the diet or derives from linoleic acid (essential fatty acid). Inside the cells is bound to membrane phospholipids (phosphatidylinositol, phosphatidylcholine, phosphatidylethanolamine).

  9. 9.

    Lisophospholipids: molecules produced by the hydrolysis of phospholipids by phospholipases which therefore have only one fatty acid.

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Authors and Affiliations

  1. Head of Medical Department, F.C. Internazionale, Milano, Italy

    Piero Volpi

  2. Istituto Clinico Humanitas, Milano, Italy

    Piero Volpi

  3. FIFA Center of Excellence, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Gian Nicola Bisciotti

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Volpi, P., Bisciotti, G.N. (2019). Biology and Etiology of Muscle-Tendon Injuries. In: Muscle Injury in the Athlete. Springer, Cham. https://doi.org/10.1007/978-3-030-16158-3_1

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