MANAGEMENT IN SPORT DR L JOE CONWAY FSEM 19 TH MAY 2018 DEFINITION; - PowerPoint PPT Presentation

MUSCLE CONTUSION MANAGEMENT IN SPORT DR L JOE CONWAY FSEM 19 TH MAY 2018

DEFINITION; MUSCLE CONTUSION • Direct Blow Muscle Fibres Causes injury with disruption fibres and bleeding • Behaves differently to a muscle strain. Can be difficult to differentiate from strain acutely. • In general less functional impairment • May Present post competition

MUSCLE INJURY • Basic components of muscle ; • Contractile tissue (myofibre) and myo- tendinous junction. • Connective tissue frame work on which contracting tissue exerts force. • Injury Mechanisms ; • Strain; tensile injury usually at muscular tendinous junction. • Contusion; direct blow. • Laceration; wound.

HEALING PROCESS • Phases healing; • Destruction • Repair • Remodeling

HEALING PROCESS Destruction; Rupture • Necrosis • Formation Haematoma • Inflammatory reaction (with secondary injury and chemotaxis/GF accumulation).

HEALING PROCESS • Repair • Phagocytosis of dead tissue • Regeneration of myofibres/connective tissue/vascular and neural structures (Satellite cells/GFs) .

HEALING PROCESS Remodeling; Maturation of the myofibre. • Re organization of the scar (prevent excess scar). • Recovery of functional capacity.

COMMON SITES • Quadriceps most common • Calf • Gluteal • Upper Limbs

GRADING INJURY CLINICALLY • Loss ROM: Quadriceps; Mild > 90 degrees Knee Flexion Moderate 45-90 degrees Knee Flexion Severe < 45 Degrees Knee flexion • Loss Strength • Knee Effusion • Gait

CLINICAL PRESENTATION • During game • Tends to be more severe • Risk aggravation continue play • Post game • Post game screen • Next day • Repeat review next day

INVESTIGATIONS • X-ray? • MRI: intra muscular or intermuscular • Ultrasound (MO)

TREATMENT • Prevent secondary injury • Rest • Ice • Compression • Elevation • Protect; Brace Knee in position of maximum flexion

POTENTIAL TREATMENTS • Query soft tissue therapy at sites away form Contusion • Anti inflammatory medication? • Query drainage defined local swelling?

PREVENTION • Education; use RICE if suspect injury • Screening team after games and before recovery sessions • Avoid Alcohol, Heat, Massage, Electrotherapy

COMPLICATIONS • Myositis Ossificans; • Seen severe Quadriceps (?lateral) Contusion • Calcification of contusion • Increased pain with worsening ROM 2 weeks post injury • Radiographic changes delayed • Indomethacin for prevention? • Delay surgical excision if considered

COMPLICATIONS • Severe Pain and loss ROM developing rapidly over 12-24 hours? • Some studies have noted increased Compartment Pressure • Diaz et al AJSM 2003 advocate conservative herapy

RETURN TO PLAY • Full pain free ROM and normal strength? • Full Functional rehabilitation • Strengthen individual muscle groups • Re establish motor patterns • Meet baseline functional capacity parameters • Pad to protect? Especially contact sports

FUTURE PREVENTION AND TREATMENT • Losartan: • Nutrient? • In vitro studies (Kobayashi et al JAP Jan • Prosopis Glandulosa (plant derived SA) 2013) reduced Fibrosis and increased • Reduced neutrophil derived secondary muscle regeneration injury without impairing macrophage. Regimen required (ongoing intake • Mouse model; Losartan and Muscle versus post injury) uncertain? derived stem cell injection (Kobayashi et al AJSM 2016) similar result • Losartan and PRP?

QUESTIONS?