Evaluation of Muscle Injuries

Abstract

Muscle injuries are very frequent in athletes, and despite their high incidence, advances in clinical diagnostic criteria, imaging, management, and rehabilitation strategies are still debated in literature. The diagnosis of muscle injury is mainly based on history and clinical examination. The examiner should start with a precise history of the circumstances surrounding the injury, before reviewing the player’s symptoms and identifying any previous related injury problems. When making a diagnosis, the first step is to differentiate between injury categories, indirect or direct muscle injuries. In a contusive injury, pain onset is usually immediate, the insult is direct, and symptoms increase in association with size and entity of the hematoma. The active range of motion is reduced, and the athlete cannot continue to train and compete. When functional disability appears early, a new assessment is recommended after 24 h to better define the injury. In nonstructural injuries, athletes complain of soreness, heaviness, and stiffness of the muscle, usually increasing with exercise, at times present at rest. On palpation, it is possible to appreciate stiffness of some bundles. It is important to distinguish these injury types because they have different prognoses, causing different absences. This chapter discusses the main principles of the physical evaluation of muscle injuries, including relevant imaging modalities in context.