Role of Clinical Evaluation for the Diagnosis of Acute and Chronic Muscle Injuries

Abstract

Sports-related muscle injuries occur predominantly in the thigh and calf muscles including hip adductors, quadriceps, and hamstring muscles. Rapid and accurate diagnosis is the key to a successful outcome after a muscle injury. Clinically, it is important to differentiate extrinsic lesions from intrinsic lesions as well as to determine their severity. Extrinsic lesions result from a blunt impact – kick, strike –that injures the muscle directly causing a variable degree of damage ranging from simple contusion to laceration of muscle fibers. Intrinsic lesions occur when muscle fibers are stretched more or less violently. The anatomic severity of the injury is not easy to determine but many lesions can be well differentiated with careful physical examination. Until quite recently, clinicians used a wide variety of relatively vague terms such as pulled muscle, strain, overstretching, tear, or rupture to describe these injuries. The current classification attempts to provide a more objective evaluation system (grades 0–4) and offers the advantage of providing a good description of each type of lesion which facilitates the diagnostic procedure. Clinical tests (passive stretching, active contraction against resistance) and palpation are helpful to guide complementary explorations to a specific muscle group or muscle.