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Keywords:
Musculoskeletal soft tissue, Musculoskeletal system, Ultrasound, MR, Diagnostic procedure, Athletic injuries, Trauma
Authors:
D. Capannelli, M. Miceli, M. Piolanti, F. Monetti, S. Galletti, L. Barozzi; Bologna/IT
DOI:
10.1594/ecr2014/C-0822
Methods and materials
During a period of three years 114 athletes,
mainly soccer and basketball players with a history of traumatic muscle injuries mainly to lower limbs,
were examined with US.
The US examination was performed from 6 to 72 hours after the trauma and compared with MRI,
performed from 2 to 7 days after the trauma.
US was performed using linear high frequencies probes (7.5-13 MHz) for superficial lesions and hematomas,
whereas convex-array traducers (3.5-7 MHz) were used in case of deep lesions to have a superior spatial resolution.
MRI was performed using axial spin echo T1-weighted,
axial spin echo T2-w and coronal short time inversion recovery (STIR) sequences.
Additional scans were performed in all planes depending on the anatomical site of the lesion.
US and MRI assessed the presence of hematomas,
the characteristics and extension of muscle injury and if there was a structural lesion with its approximate size.
Doppler evaluation was performed to assess the blood flow signal.
Traumas were distinguished into minor and major traumas according to the intensity of the injured force and the degree of muscle damage.
Minor traumas included Delayed-onset muscle soreness (DOMS),
lengthening and mild contusions.
Major traumas were defined as strains and moderate-severe contusions.
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Minor traumas
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Major traumas
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Indirect traumas
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DOMS
Lengthenings
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Strains
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Direct traumas
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Mild contusions
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Severe contusions
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Direct injuries as contusions were graded according to the Jackson-Feagin classification [1] that defined a three-stage clinical grading system:
- mild contusion: range of motion (ROM) less than one-third normal;
- moderate contusion: ROM one-third to two-thirds of normal;
- severe contusion: greater than two-thirds loss of ROM.
Indirect injuries were classified according to the following grades:
- first-degree lesion (only few myofibers involved);
- second-degree lesion (less than ¾ of muscle axial area is damaged);
- third-degree lesion incomplete (more than ¾ of muscle axial area is damaged);
- third-degree lesion complete (total interruption).