Connective tissue injury in calf muscle tears and return to play: MRI correlation

2017 ◽  
Vol 52 (14) ◽  
pp. 929-933 ◽  
Author(s):  
Ashutosh Prakash ◽  
Tom Entwisle ◽  
Michal Schneider ◽  
Peter Brukner ◽  
David Connell
Keyword(s):  
Connective Tissue ◽  
Muscle Injury ◽  
Tissue Injury ◽  
Clinical Suspicion ◽  
Calf Muscle ◽  
Return To Play ◽  
Muscle Tear ◽  
Grade 3 ◽  
Mean Time ◽  
Connective Tissue Structure

ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.

scholarly journals Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668034 ◽  
Author(s):  
Brian C. Werner ◽  
Nicole S. Belkin ◽  
Steve Kennelly ◽  
Leigh Weiss ◽  
Ronnie P. Barnes ◽  
...  
Keyword(s):  
Relative Frequency ◽  
National Football League ◽  
Fluid Collection ◽  
Magnetic Resonance Images ◽  
Calf Muscle ◽  
Return To Play ◽  
Imaging Findings ◽  
Muscle Injuries ◽  
Lower Extremity Muscle ◽  
Imaging Characteristics

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results: A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries ( P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect ( P = .032) and the presence of a fluid collection ( P = .031) both correlated with return to play of longer than 2 weeks. Conclusion: Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

Outcome of rest with or without bandaging for treatment of carpal flexural contracture deformities in puppies: 47 puppies and 75 joints (2000–2018)

2021 ◽  
pp. 1-6
Author(s):  
Massimo Petazzoni ◽  
Carlo M. Mortellaro ◽  
Alessandro Esposito ◽  
Francesco Ferrari ◽  
Alessandro Piras ◽  
...  
Keyword(s):  
Treatment Option ◽  
Conservative Management ◽  
Medical Records ◽  
Clinical Relevance ◽  
Final Visit ◽  
Full Extension ◽  
Treatment Groups ◽  
Severity Grade ◽  
Grade 3 ◽  
Mean Time

Abstract OBJECTIVE To review outcome of dogs with carpal flexural contracture deformities treated with rest alone or with rest and bandaging. ANIMALS 47 dogs (75 joints). PROCEDURES Medical records of dogs with unilateral or bilateral carpal flexural contracture deformities were reviewed, and dogs were grouped according to deformity severity grade (graded on a scale from 1 to 3) at the time of diagnosis. Two treatment groups were compared: rest only and rest with a modified Robert-Jones bandage. All dogs were reevaluated weekly until recovery (ie, resolution of the deformity and lameness). RESULTS All dogs responded to conservative management, with all dogs regaining full extension of the antebrachiocarpal joint and ambulating normally at the time of the final visit. Mean ± SD time from initial diagnosis to recovery (ie, resolution of the deformity and lameness) was 2.9 ± 2.2 weeks (median, 2 weeks; range, 1 to 9 weeks). For dogs with grade 1 or 2 severity, mean time to recovery did not differ significantly between treatment groups. For dogs with grade 3 severity, however, mean time to recovery was significantly shorter for dogs treated with rest and bandaging than for dogs treated with rest alone. CLINICAL RELEVANCE Results suggested that conservative management (rest alone or rest and bandaging) was a successful treatment option for puppies with carpal flexural contracture deformity and that bandaging resulted in a shorter time to recovery for dogs that were severely affected.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players

2018 ◽  
Vol 39 (9) ◽  
pp. 1076-1081 ◽  
Author(s):  
Kenneth Smith ◽  
Norman Waldrop
Keyword(s):  
Range Of Motion ◽  
Operative Procedure ◽  
Case Series ◽  
Operative Management ◽  
Return To Play ◽  
First Metatarsophalangeal Joint ◽  
Operative Outcomes ◽  
Turf Toe ◽  
Grade 3

Background: Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. Methods: We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. Results: The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Conclusion: Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level of Evidence: Level IV, case series

The Italian Consensus Conference on Return to Play After Lower Limb Muscle Injury in Football

2021 ◽  
pp. 1-4
Author(s):  
Gian Nicola Bisciotti ◽  
Alessandro Corsini ◽  
Piero Volpi
Keyword(s):  
Lower Limb ◽  
Muscle Injury ◽  
Consensus Conference ◽  
Return To Play ◽  
Lower Limb Muscle ◽  
Limb Muscle

scholarly journals A Histoarchitectural Approach to Skeletal Muscle Injury: Searching for a Common Nomenclature

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090909 ◽  
Author(s):  
◽  
Ramon Balius ◽  
Marc Blasi ◽  
Carles Pedret ◽  
Xavier Alomar ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Connective Tissue ◽  
Muscle Injury ◽  
Muscle Injuries ◽  
Macroscopic Anatomy ◽  
Skeletal Muscle Injury ◽  
Tissue Structures ◽  
Definition Of

In recent years, different classifications for muscle injuries have been proposed based on the topographic location of the injury within the bone-tendon-muscle chain. We hereby propose that in addition to the topographic classification of muscle injuries, a histoarchitectonic (description of the damage to connective tissue structures) definition of the injury be included within the nomenclature. Thus, the nomenclature should focus not only on the macroscopic anatomy but also on the histoarchitectonic features of the injury.

scholarly journals Detection of Specific Antinuclear Reactivities in Patients with Negative Anti-nuclear Antibody Immunofluorescence Screening Tests

2002 ◽  
Vol 48 (12) ◽  
pp. 2171-2176 ◽  
Author(s):  
Ilse EA Hoffman ◽  
Isabelle Peene ◽  
Eric M Veys ◽  
Filip De Keyser
Keyword(s):  
Connective Tissue ◽  
Confidence Interval ◽  
Connective Tissue Disease ◽  
Indirect Immunofluorescence ◽  
Connective Tissue Diseases ◽  
Clinical Suspicion ◽  
Screening Tests ◽  
Strongly Correlated ◽  
Nuclear Antigens

Abstract Background: For detection of anti-nuclear antibodies (ANAs) and antibodies to extractable nuclear antigens (ENAs), samples frequently are screened with indirect immunofluorescence (IIF); further determination of anti-ENA antibodies is performed only when the result is positive. However, because anti-ENA reactivities are found in samples with low fluorescence intensities, we determined anti-ENA antibodies in samples with negative IIF and thus calculated the sensitivity of IIF for specific ANAs. Methods: We collected 494 samples consecutively referred by rheumatologists for routine ANA testing. IIF on HEp-2 and HEp-2000 (HEp-2 cells transfected with Ro60 cDNA) and line immunoassay (LIA) for the detection of specific ANAs were performed on all samples. Results: Fluorescence intensities and patterns on HEp-2 were strongly correlated with those on HEp-2000 [Spearman ρ = 0.852 (P &lt;0.001) and 0.838 (P &lt;0.001), respectively]. Sixty-eight of 494 samples were positive on LIA, of which only 72% (confidence interval, 68–76%) were detected with HEp-2 and 75% (confidence interval, 70–78%) with HEp-2000. Of 291 samples negative on both substrates, 12 were positive on LIA. Connective tissue diseases were diagnosed in four of these patients and suspected in at least three others. Conclusion: The HEp-2 and HEp-2000 substrates perform comparably for fluorescence intensities and patterns and for detecting specific ANAs, but some patients with negative IIF show reactivity on LIA. We recommend testing for fine reactivities, regardless of the IIF result, when the clinical suspicion for rheumatic connective tissue disease is high.

Which factors are predictive of return to play and re-injury following calf muscle strain injury?

2019 ◽  
Vol 22 ◽  
pp. S19
Author(s):  
B. Green ◽  
M. Lin ◽  
J. McClelland ◽  
A. Semciw ◽  
A. Schache ◽  
...  
Keyword(s):  
Calf Muscle ◽  
Return To Play ◽  
Muscle Strain ◽  
Muscle Strain Injury
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