Treatment of Acute Thigh Muscle Injury with or without Hematoma Puncture in Athletes / Tratamento das lesões musculares agudas da coxa com ou sem punção do hematoma em atletas

Abstract Objectives To correlate the mean time of return of athletes to sport after acute injury of the thigh muscle with hematoma that was punctured or not. Methods Study based on clinical intervention, controlled and non-randomized with 20 amateur and professional athletes, divided into moderate and total or subtotal thighs lesions, according with the Munich Consensus Statement. Nine athletes were included in the intervention group and 11 athletes in the control group. In the intervention group, the athletes were submitted to a puncture of the hematoma, associated to physical therapy; the control group did only physical therapy. The variable mean time of return to sport was analyzed using the Mann-Whitney test and a significance level of 5% (p < 0.05; 95% confidence interval [CI]) was established. Results The mean group was composed mostly of men, eight of them were amateur athletes. There were three women, two of whom were amateur athletes. The average age of participants was 34.70 ± 12.79 years. There were 13 patients with posterior thigh lesions, 5 with anterior lesions and two with adductor lesions. Considering all injuries, the mean time of return to sport was of 48.50 ± 27.50 days in the intervention group. In the control group, this period was of 102.09 ± 52.02 days, showing a statistically significant difference between them (p = 0.022). Conclusion In the present study, hematoma drainage in athletes with moderate and total or subtotal muscle injuries associated with hematomas decreased their return time to sport.

Resumo Objetivos Comparar o tempo médio de retorno dos atletas ao esporte após lesão muscular aguda da coxa com hematoma que foi ou não puncionado. Métodos Estudolongitudinal de intervenção clínica, controlado e não randomizado, com participação de 20 atletas amadores e profissionais com lesão muscular aguda do tipo parcial moderada ou (sub)total na região da coxa, segundo a classificação do Consenso de Munique. Nove atletas foram incluídos no grupo intervenção e 11 no grupo controle. Os atletas do grupo intervenção foramsubmetidos a punção do hematoma e fisioterapia e os do grupo controle, apenas a fisioterapia. A variável tempo de retorno ao esporte foi analisada como teste deMann-Whitney e o nível de significância usado foi 95% (p < 0,05). Resultados A população estudada foi composta principalmente por homens, dos quais oito eram praticantes de esportes no nível amador. Três mulheres, das quais duas eram amadoras, foram incluídas no estudo. A média de idade dos participantes foi de 34,70 ± 12,79 anos. Houve 13 indivíduos com lesões na região posterior da coxa, cinco comlesões na região anterior e dois com lesões na região adutora. Considerando todas as lesões, o tempo médio de retorno ao esporte foi de 48,50 ± 27,50 dias no grupo intervenção. Já no grupo controle, esse intervalo foi de 102,09 ± 52,02 dias (p = 0,022). Conclusão No presente estudo, a punção do hematoma muscular mostrou-se efetiva em abreviar o tempo de retorno ao esporte dos atletas com lesões musculares parciais moderadas e (sub)totais associadas a hematomas. Abstract Objectives To correlate the mean time of return of athletes to sport after acute injury of the thigh muscle with hematoma that was punctured or not.

Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions / 医学前沿

Current research on common musculoskeletal problems, including osteoarticular conditions, tendinopathies, and muscle injuries, focuses on regenerative translational medicine. Platelet-rich plasma therapies have emerged as a potential approach to enhance tissue repair and regeneration. Platelet-rich plasma application aims to provide supraphysiological concentrations of platelets and optionally leukocytes at injured/pathological tissues mimicking the initial stages of healing. However, the efficacy of platelet-rich plasma is controversial in chronic diseases because patients' outcomes show partial improvements. Platelet-rich plasma can be customized to specific conditions by selecting the most appropriate formulation and timing for application or by combining platelet-rich plasma with synergistic or complementary treatments. To achieve this goal, researchers should identify and enhance the main mechanisms of healing. In this review, the interactions between platelet-rich plasma and healing mechanisms were addressed and research opportunities for customized treatment modalities were outlined. The development of combinational platelet-rich plasma treatments that can be used safely and effectively to manipulate healing mechanisms would be valuable and would provide insights into the processes involved in physiological healing and pathological failure.

Surgical treatment of rectus femoris injury in soccer playing athletes: report of two cases / Tratamento cirúrgico da lesão do reto femoral em jogadores de futebol: um relato de dois casos

ABSTRACT Muscle injury is the most common injury during sport practice. It represents 31% of all lesions in soccer, 16% in track and field, 10.4% in rugby, 17.7% in basketball, and between 22% and 46% in American football. The cicatrization with the formation of fibrotic tissue can compromise the muscle function, resulting in a challenging problem for orthopedics. Although conservative treatment presents adequate functional results in the majority of the athletes who have muscle injury, the consequences of treatment failure can be dramatic, possibly compromising the return to sport practice. The biarticular muscles with prevalence of type II muscle fibers, which are submitted to excentric contraction, present higher lesion risk. The quadriceps femoris is one example. The femoris rectus is the quadriceps femoris muscle most frequently involved in stretching injuries. The rupture occurs in the acceleration phase of running, jump, ball kicking, or in contraction against resistance. Although the conservative treatment shows good results, it is common that the patient has lower muscle strength, difficulty in return to sports, and a permanent and visible gap. Surgical treatment can be an option for a more efficient return to sports.

RESUMO As lesões musculares são uma das mais comuns ocorridas por traumas nos esportes. Elas constituem 31% de todas as lesões no futebol, 16% no atletismo, 10,4% no rúgbi, 17,7% no basquete e de 22% a 46% no futebol americano. Representam um problema desafiador na traumatologia, já que os músculos lesados se curam vagarosamente e com eventual recuperação incompleta da função. Embora o tratamento conservador resulte em bons resultados funcionais na maioria dos atletas com lesão muscular, as consequências da falha do tratamento podem ser dramáticas, possivelmente atrasam o retorno ao esporte. Os músculos mais frequentemente envolvidos são os biarticulares ou aqueles com maior complexidade estrutural (por exemplo, adutor longo), que são submetidos a contração excêntrica e contêm principalmente fibras de contração rápida (tipo 2). Um representante desse grupo é o quadríceps femoral, que se constitui pelos músculos reto femoral, vasto medial, vasto intermédio e vasto lateral. O reto femoral é o músculo do quadríceps mais envolvido nas lesões por estiramento. É mais lesado nas fases de aceleração do "tiro", salto de explosão, chute da bola ou quando há uma contração contra resistência. Mesmo que o tratamento conservador apresente bons resultados, é comum que o paciente tenha diminuição da força muscular, dificuldade de retorno ao esporte e gap permanente e visível. O tratamento cirúrgico pode ser uma opção para um retorno mais eficiente ao esporte.

Estirar o precalentar ¿qué recomendar en la consulta diaria? / Stretching or preheat: What do you recommend in daily medical practice?

Es ampliamente creído y conocido que precalentar y estirar antes de la realización de ejercicio físico mejora el rendimiento y disminuye las lesiones, tratamos de buscar la mejor evidencia sobre el tema.

Is widely believed and known that preheating and stretch before physicalexercise improves performance and decreases injury, here we’ll try to find the best evidence on the subject.

Evaluation of dynamic changes of rabbit mulsle's restoration after damaging using acoustic radiation force impulse / 中华超声影像学杂志

ObjectiveTo observe the dynamic change of muscle tissue restoration after damaging at different observation time through acoustic radiation force impulse(ARFI).MethodsAccording to different observation time,16 healthy rabbits were randomly divided into four groups,including before injury,1 day after injury,7 day after injury,14 day after injury.A homemade gravity hammer was used to establish damage model of rabbit gastrocnemius,then applied ARFI to observe changes of virtual touch tissue quantification (VTQ) of gastrocnemius.All the rabbits were executed after measurement,then the pathological changes of muscle tissue were observed under microscope.Results The VTQ of damaged muscle group were significantly higher than that of nomal muscle group( P ＜0.01),and VTQ of 1 day,7day,14 day group after injuried had significant difference between two groups (P ＜ 0.01).Through pathological examination,normal musule fibers were continual and there were not swelling and bleeding.One days after injury,muscle fibers were fractured,swollen,bleeding and congestive.7 days after injury,large areas of muscle cells were necrotic,and amounts of calcium salt depositsed.14 days after injury,lots of fiber cells proliferated,and the deposits of calcium obviously reduced.The results of ultrasound elastography were consistent with these of pathological.ConclusionsARFI can direct,noninvasively evaluate the changes of muscle tissue restoration after different time of injury,and provide objective basis for diagnosis and treatment.

Lesiones musculoesqueléticas en mujeres adultas sedentarias que ingresan a un programa de ejercicio físico / Musculoskeletal injuries in sedentary adult women entering a physical exercise program

Introducción: Las lesiones músculoesqueléticas son un problema sumamente frecuente en México, sin embargo no existen estadísticas sobre su epidemiología; existen datos de acuerdo con el Sistema Nacional de Salud de la prevalencia de fracturas que fueron causantes de alrededor 85 964 hospitalizaciones en hombres y en mujeres de 52 042, mientras que en luxaciones y esguinces, su prevalencia en hombres fue de 7 486 y en mujeres de 3 878 que representaron cerca del 2% del total; estas lesiones son: contusiones, fracturas, esguinces, luxaciones y lesión muscular (domat), su incidencia supone entre el 10% y 55% de todas estas lesiones3. Objetivo: Identificar la incidencia y describir los factores predisponentes de lesiones músculoesqueléticas en mujeres adultas sedentarias con factores de riesgo de osteoporosis y que inician un programa de ejercicio físico para mejorar la densidad mineral ósea. Metodología: Estudio prospectivo, longitudinal y descriptivo, conformado por N = 99 mujeres sedentarias entre 45 a 60 años de edad con factores de riesgo para padecer osteoporosis, que ingresaron al proyecto "Eficacia de un programa de entrenamiento físico para mejorar la densidad mineral ósea". Para el tratamiento estadístico se obtuvieron medidas de tendencia central, dispersión y de correlación. Resultados: 26% de las mujeres presentaron lesiones inducidas por el ejercicio físico, como bursitis rotuliana, esguince grado 1 y 2, fisura de tibia, periostitis y dolor muscular de aparición tardía o Domat. A pesar de que las características físicas predominantes en estas mujeres no fueron favorables comparándolas con los parámetros esperados para su edad, sexo y actividad física, no podemos afirmar que estas hayan sido los factores predisponentes para sufrir lesiones, ya que su correlación no resultó estadísticamente significativa. Discusión: No encontramos reportada la frecuencia de lesiones en este tipo de población que inicie un programa de ejercicio físico, por lo tanto no tenemos referentes para comparar la incidencia. Conclusiones: A pesar de que el ejercicio físico fue organizado y controlado y se otorgó cuidado integral con énfasis en la prevención, se presentaron lesiones músculo esqueléticas.

Introduction: musculoskeletal injuries are extremely common problem in Mexico, but there are no statistics on the epidemiology data are in agreement with the National Health System of the prevalence of fractures that were the cause of about 85 964 hospitalizations men and women of 52 042, while dislocations and sprains, its prevalence in males was 7 486 and 3 878 women representing about 2% of the total. These injuries are bruises, fractures, sprains, dislocations and muscle injury (domat), its incidence is between 10% and 55% of all these lesiones3. To identify the incidence and describe the predisposing factors of musculoskeletal injuries in sedentary adult women with risk factors for osteoporosis and initiate an exercise program to improve bone mineral density. Methods: Prospective, longitudinal, descriptive, consisting of N = 99 sedentary women 45 to 60 years old with risk factors for osteoporosis, which joined the project "Effectiveness of a physical training program to improve bone mineral density". For statistical treatment were measured central tendency, dispersion and correlation. Results: 26% of women had lesions induced by exercise, such as patellar bursitis, sprain, grade 1 and 2, crack of tibia, periostitis and delayed onset muscle soreness or Domat. Although the physical characteristics prevalent in these women were not favorable compared with the expected parameters for age, sex and physical activity can not say that these have been the predisposing factors for injury, because their correlation was not statistically significant . Discussion: We found the frequency of injuries reported in this population to engage in an exercise program, therefore we have no benchmark to compare the incidence. Conclusions: Although exercise was organized and controlled and was given comprehensive care with emphasis on prevention, musculoskeletal lesions.

Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius ("Tennis Leg")

OBJECTIVE: The purpose of this study was to demonstrate the ultrasonographic (US) findings of rupture and the healing process of the medial head of the gastrocnemius ("Tennis Leg"). MATERIALS AND METHODS: Twenty-two patients (age range: 30 to 45 years) with clinically suspected ruptures of the medial head of the gastrocnemius were referred to us for US examination. All the patients underwent US of the affected limb and the contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients were performed at two-week intervals during the month after injury and at one-month intervals during the following six months. RESULTS: Of the 22 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in seven patients (31.8%); the remaining 15 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 20 patients (90.9%). The thickness of the fluid collection, including the hematoma in the patients with complete rupture (mean: 9.7 mm), was significantly greater than that seen in the patients with partial tear (mean: 6.8 mm) (p < 0.01). The primary union of the medial head of the gastrocnemius with the soleus muscle in all the patients with muscle rupture and fluid collection was recognized via the hypoechoic tissue after four weeks. CONCLUSION: Ultrasonography is a useful imaging modality for the diagnosis and follow-up examination for the patients suffering with rupture of the medial head of the gastrocnemius.