Classification of Muscle Lesions

  • Nicola MaffulliEmail author
  • Rocco Aicale
  • Domiziano Tarantino


Muscle injuries are frequent in athletes and their optimal management and rehabilitation strategies are still debated in literature. Most muscle injuries are managed conservatively with good results, while surgery is reserved only for larger tears. The diagnosis is usually clinical and imaging tools are used to identify the extent and site of lesion for relevant prognostic predictive factors. The new classification of muscle injures is proposed based on anatomy, biomechanics, and imaging features. They can be classified as direct (contusion and laceration) and indirect (divided into 4 different types). A early diagnosis associated with an optimal management of the lesions is the best choice to return to the pre-injuries activity level: this is the purpose of the new classification of muscle lesions reported.


Soccer Player Muscle Injury Eccentric Contraction Muscle Belly Musculotendinous Junction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agre JC (1985) Hamstring injuries. Proposed aetiological factors, prevention, and treatment. Sports Med 2:21–33CrossRefPubMedGoogle Scholar
  2. Armfield DR, Kim DH, Towers JD et al (2006) Sports-related muscle injury in the lower extremity. Clin Sports Med 25:803–842CrossRefPubMedGoogle Scholar
  3. Bianchi S, Martinoli C, Waser NP et al (2002) Central aponeurosis tears of the rectus femoris: sonographic findings. Skelet Radiol 31:581–586CrossRefGoogle Scholar
  4. Borowski L, Yard E, Fields S et al (2008) The epidemiology of US high school basketball injuries, 2005–2007. Am J Sports Med 36:2328–2335CrossRefPubMedGoogle Scholar
  5. Boutin RD, Fritz RC, Steinbach LS (2002) Imaging of sports related muscle injuries. Radiol Clin N Am 40:333–362CrossRefPubMedGoogle Scholar
  6. Brancaccio P, Somma F, Provenzano F et al (2013) Changes in muscular pennation angle after crenotherapy. Muscles Ligaments Tendons J 9(3):112–115Google Scholar
  7. Brandser EA, El-Khoury GY, Kathol MH et al (1995) Hamstring injuries: radiographic, conventional tomographic, CT, and MR imaging characteristics. Radiology 197:257–262CrossRefPubMedGoogle Scholar
  8. Chan O, Del Buono A, Maffulli N et al (2012) Acute muscle strain injuries: a proposed new classification system. Knee Surg Sports Traumatol Arthrosc 20:2356–2362CrossRefPubMedGoogle Scholar
  9. Charvet B, Ruggiero F, Le Guellec D (2012) The development of the myotendinous junction. A review. Muscles Ligaments Tendons J 2:53–63PubMedPubMedCentralGoogle Scholar
  10. Connell DA, Potter HG, Sherman MF et al (1999) Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology 210:785–791CrossRefPubMedGoogle Scholar
  11. Connell DA, Schneider-Kolsky ME, Hoving JL et al (2004) Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 183:975–984CrossRefPubMedGoogle Scholar
  12. Corazza A, Orlandi D, Baldari A et al (2014) Thigh muscles injuries in professional soccer players: a one year longitudinal study. Muscles Ligaments Tendons J 24(3):331–336Google Scholar
  13. Cross TM, Gibbs N, Houang MT et al (2004) Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med 32:710–719CrossRefPubMedGoogle Scholar
  14. De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 174:393–399CrossRefPubMedGoogle Scholar
  15. Ehman RL, Berquist TH (1986) Magnetic resonance imaging of musculoskeletal trauma. Radiol Clin N Am 24:291–319PubMedGoogle Scholar
  16. Ekstrand J, Hägglund M, Waldén M (2011) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39:1226–1232CrossRefPubMedGoogle Scholar
  17. El-Khoury GY, Brandser EA, Kathol MH et al (1996) Imaging of muscle injuries. Skelet Radiol 25:3–11CrossRefGoogle Scholar
  18. Falcieri E (2014) Basic science & clinic around skeletal muscles. Muscles Ligaments Tendons J 24(3):253Google Scholar
  19. Garrett WE Jr (1990) Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc 22:436–443CrossRefPubMedGoogle Scholar
  20. Garrett WE (1996) Muscle strain injuries. Am J Sports Med 24:S2–S8CrossRefPubMedGoogle Scholar
  21. Garrett WE, Safran MR, Seaber AV et al (1987) Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 15:448–454CrossRefPubMedGoogle Scholar
  22. Greco A, McNamara MT, Escher RM et al (1991) Spin-echo and STIR MR imaging of sports-related muscle injuries at 1.5T. J Comput Assist Tomogr 15:994–999CrossRefPubMedGoogle Scholar
  23. Isner-Horobeti M, Dufour S, Vautravers P et al (2013) Eccentric exercise training: modalities, applications and perspectives. Sports Med 43:483–512CrossRefPubMedGoogle Scholar
  24. Jarvinen TA, Jarvinen TL, Kaariainen M et al (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764CrossRefPubMedGoogle Scholar
  25. Jonhagen S, Nemeth G, Eriksson E (1994) Hamstring injuries in sprinters. The role of concentric and eccentric hamstring muscle strength and flexibility. Am J Sports Med 22:262–266CrossRefPubMedGoogle Scholar
  26. Keller K, Engelhardt M (2014) Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J 24(3):346–350Google Scholar
  27. Kneeland JP (1997) MR imaging of muscle and tendon injury. Eur J Radiol 25:198–208CrossRefPubMedGoogle Scholar
  28. Koh ES, McNally EG (2007) Ultrasound of skeletal muscle injury. Semin Musculoskelet Radiol 11:162–173CrossRefPubMedGoogle Scholar
  29. Lee JC, Healy J (2004) Sonography of lower limb muscle injury. AJR Am J Roentgenol 182:341–351CrossRefPubMedGoogle Scholar
  30. Lopez V, Galano G, Black C et al (2012) Profile of an American amateur rugby union sevens series. Am J Sports Med 40:179–184CrossRefPubMedGoogle Scholar
  31. Malliaropoulos N, Papacostas E, Maffulli N et al (2010) Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 38:1813–1819CrossRefPubMedGoogle Scholar
  32. Melegati G, Tornese D, Gevi M et al (2014) Reducing muscle injuries and reinjuries in one Italian professional male soccer team. Muscles Ligaments Tendons J 24(3):324–330Google Scholar
  33. Mueller-Wohlfahrt HW, Haensel L, Mithoefer K et al (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47:342–530CrossRefPubMedGoogle Scholar
  34. Nikolaou PK, Macdonald BL, Glisson RR et al (1987) Biomechanical and histological evaluation of muscle after controlled strain injury. Am J Sports Med 15:9–14CrossRefPubMedGoogle Scholar
  35. Palmer WE, Kuong SJ, Elmadbouh HM (1999) MR imaging of myotendinous strain. AJR Am J Roentgenol 173:703–709CrossRefPubMedGoogle Scholar
  36. Pomeranz SJ, Heidt RS (1993) MR imaging in the prognostication of hamstring injury. Work in progress. Radiology 189:897–900CrossRefPubMedGoogle Scholar
  37. Shellock FG, Fukunaga T, Mink JH et al (1991) Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging. Radiology 179:659–664CrossRefPubMedGoogle Scholar
  38. 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. AJR Am J Roentgenol 179:1621–1628CrossRefPubMedGoogle Scholar
  39. Taylor DC, Dalton JD Jr, Seaber AV et al (1993) Experimetal muscle strain injury. Early functional and structural deficits and the increased risk for reinjury. Am J Sports Med 21:190–194Google Scholar
  40. Walton M, Rothwell A (1986) Reactions of thigh tissues of sheep to blunt trauma. Clin Orthop Relat Res 176:273–281Google Scholar

Copyright information

© ISAKOS 2017

Authors and Affiliations

  • Nicola Maffulli
    • 1
    • 2
    Email author
  • Rocco Aicale
    • 1
  • Domiziano Tarantino
    • 1
  1. 1.Department of Musculoskeletal DisordersSchool of Medicine and Surgery, University of SalernoSalernoItaly
  2. 2.Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End HospitalLondonUK

Personalised recommendations