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 19TH 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:
• In vitro studies (Kobayashi et al JAP Jan

2013) reduced Fibrosis and increased muscle regeneration

• Mouse model; Losartan and Muscle

derived stem cell injection (Kobayashi et al AJSM 2016) similar result

• Losartan and PRP?
• Nutrient?
• Prosopis Glandulosa (plant derived SA)
• Reduced neutrophil derived secondary

injury without impairing macrophage. Regimen required (ongoing intake versus post injury) uncertain?

QUESTIONS?