
Muscle strains, or pulled muscles, are a common injury, especially among athletes. They can occur when a muscle is overstretched or torn, damaging the muscle fibres and tendons attached to them. This can happen during regular activities like lifting something heavy, working out, or playing sports. To check for muscle damage, a doctor will typically ask about symptoms and perform a physical examination. They may also recommend imaging tests such as X-rays, CT scans, ultrasounds, or MRIs to assess the extent of the damage and rule out other issues like fractures or blood clots.
| Characteristics | Values |
|---|---|
| Muscle damage | A muscle strain or pulled muscle is an injury that occurs when you overstretch or tear a muscle or tendon |
| Cause | Force on a muscle is so great that the tissue is damaged |
| Symptoms | Pain, swelling, bruising, loss of strength and range of motion, fever, weight loss, numbness, nerve damage, difficulty controlling certain muscles |
| Diagnosis | Patient history, physical exam, X-ray, CT scan, MRI scan, Ultrasound, DEXA scan, arthrograms |
| Treatment | Rest, ice, compression, elevation, NSAIDs, stretching exercises, surgery |
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What You'll Learn

Ultrasound, CT, MRI, and X-ray scans
Ultrasound imaging has been a significant component of sports medicine and orthopaedics for decades. It is used to scan for tendon, ligament, and muscle injuries, as well as to analyse joints and identify soft tissue problems. Ultrasound is a dynamic examination that can be used at the point of care, such as at the bedside or on the sports field. It is flexible, easy to operate, and portable. It can be used to identify snapping hip syndrome, shoulder impingement, and trans-fascial muscle hernias, among other conditions.
Computed tomography (CT) scans are used to detect muscle damage and bone abnormalities. CT scans produce many different angles of the area in need of diagnosis, which are then turned into detailed cross-sectional images. Doctors can use these scans to see the position, size, and shape of muscles, bones, and organs, either in two-dimensional "slices" or as a whole three-dimensional image. A CT scan can be requested with or without an iodine-based contrast, which is a substance that causes muscle tissue to show up more clearly on the scan.
Magnetic resonance imaging (MRI) is an imaging technique that does not require exposure to radiation. It can be used to see very small tears and injuries to tendons, ligaments, and muscles, as well as some fractures that cannot be seen on X-rays or CT scans. MRI images of the soft-tissue structures of the body are often clearer and more detailed than with other imaging methods, making it a valuable tool for early diagnosis and evaluation of conditions such as tumours. MRI can also detect abnormalities that may be obscured by bone with other imaging methods.
X-rays are used to detect bone problems such as fractures. Different parts of the body allow varying amounts of X-ray beams to pass through, with soft tissues like blood, skin, fat, and muscle allowing most of the X-ray to pass through and appearing dark gray on the film, while denser areas like bones or tumours appear white. At a break in a bone, the X-ray beam passes through the broken area and appears as a dark line in the white bone.
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Symptoms: numbness, fever, weakness, bruising, etc
Muscle damage can result from a variety of causes, including injury, trauma, and high-intensity exercise. The symptoms of muscle damage can vary from mild to severe and may include:
Numbness: Numbness in the muscles can be a sign of muscle damage, particularly when accompanied by other symptoms such as weakness or swelling. This could be an indication of compartment syndrome, which is a serious condition that requires urgent medical attention.
Fever: While fever is not a common symptom of muscle damage, it can indicate an underlying infection or illness. Delayed-onset muscle soreness (DOMS), or muscle fever, can occur after unaccustomed exercise, particularly eccentric exercises that require the muscle to generate tension to control the rate it lengthens. This can cause mechanical disruption of sarcomeres (contractile units within muscle fibres), leading to swelling and inflammation.
Weakness: Weakness in the muscles can be a result of muscle damage, such as in the case of rhabdomyolysis, where muscle tissue breaks down. This can be caused by severe injury, burn, electrocution, or high-intensity exercise without proper rest. Weakness may also be a symptom of compartment syndrome, as mentioned earlier.
Bruising: Bruising, or muscle contusions, can occur due to a direct, blunt blow to the muscle. They can range from mild to severe and usually cause pain and swelling. In more severe cases, they can lead to muscle hematoma (blood buildup in muscle tissue) or even damage to internal organs if the impact is to the abdomen.
It is important to note that muscle damage can vary widely in severity and should be assessed by a healthcare professional, especially if symptoms persist or worsen. Proper rest, hydration, and gradual progression in exercise intensity are crucial to preventing and recovering from muscle damage.
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Grading system: Grade I, II, and III
Grading muscle injuries is important to determine the best course of treatment and recovery process. While there is a lack of uniformity in grading systems, most of them are three-grade systems that take into account factors such as pain, range of motion (ROM) limitation, swelling, and muscle gap or tendon involvement. Here is a description of each grade:
Grade I (Mild): A grade I injury is considered mild and may involve a small number of muscle fibre tears. It is characterized by mild pain, some swelling, and a minor loss of motion or function. The athlete may experience some discomfort and a slight decrease in performance but can usually continue with the sporting activity.
Grade II (Moderate): A grade II injury is considered moderate and involves a greater number of muscle fibre tears but without complete muscle rupture. It is characterized by moderate and poorly localized pain, disability, and a more significant loss of motion (10-25° ROM deficit). The athlete may limp or be unable to continue with the sporting activity.
Grade III (Severe): A grade III injury is severe and involves a complete muscle rupture. It is characterized by immediate and intense pain, more than 50% loss of motion (or <25° ROM deficit), a rapid decrease in muscle circumference compared to the healthy muscle, diffuse pain, and internal bleeding. The athlete will likely collapse in pain and require immediate medical attention.
It is important to note that these grading systems are based on clinical presentation and expert opinion. However, with the advancement of imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI), there have been attempts to develop more comprehensive and uniform grading systems that take into account the extent of muscle involvement and other objective measures.
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Treatment: RICE method, NSAIDs, and surgery
The RICE method, NSAIDs, and surgery are all possible treatments for muscle damage. The RICE method, which stands for Rest, Ice, Compression, and Elevation, is a widely recommended treatment for minor injuries. It involves limiting movement to prevent further injury, applying ice to reduce swelling, using compression, and elevating the injured area above the heart to reduce swelling. While this method is popular, it has been scrutinized for its use of rest and ice, as some believe that movement and alternative treatments may be more beneficial for the healing process.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to alleviate symptoms of exercise-induced muscle damage and restore normal physical function. NSAIDs can help reduce pain and improve mobility, but they may have detrimental effects on muscle regeneration and growth due to their impact on cyclo-oxygenase (COX) enzymes. It is important to note that occasional use of NSAIDs is generally not believed to negatively affect muscle growth, and they can be effective in managing pain. However, long-term use may be detrimental, and they should be avoided by individuals with certain medical conditions, such as kidney disease or a history of gastrointestinal bleeding.
In some cases of muscle damage, surgery may be required. Surgical intervention is typically considered for complete muscle tears or to address early and late complications associated with muscle injuries. One challenge with surgical muscle repair is achieving a strong end-to-end repair with appropriate tension to facilitate effective healing. To address this, the use of scaffolds as a biological augmentation has been proposed, showing promising results in animal studies. Biphosphonate therapy with oral medication is another surgical option with favourable outcomes, especially in the acute phase. It is important to note that surgery should not be attempted too early, as it may increase the risk of recurrence.
It is important to consult a medical professional for proper diagnosis and treatment of muscle damage. Self-treatment should be approached with caution, and if symptoms do not improve within a reasonable timeframe, seeking medical advice is recommended.
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Causes: Overstretching, over-exertion, and fatigue
Muscle damage can be caused by overstretching, over-exertion, and fatigue. Overstretching occurs when muscles, tendons, and ligaments are pushed beyond their normal range of motion, resulting in injuries such as strains, sprains, or tears. To avoid overstretching, it is crucial to stay within your flexibility limits and properly warm up before engaging in physical activities. Warm-up exercises should include light cardio and specific movements to prepare the muscles for the upcoming workout.
Over-exertion and fatigue often go hand in hand. Muscle fatigue is a symptom that decreases the force behind muscle movements, making you feel weaker. It is commonly associated with strenuous activities or exercise, but it can also be a sign of other health conditions. If fatigue is unrelated to physical exertion, it is essential to consult a doctor to rule out more serious issues. Treatment for muscle fatigue depends on the underlying cause and may include rest, hydration, a healthy diet, and stretching.
Engaging in physical activity without properly warming up or when the muscles are already tired can lead to a higher risk of muscle injury. Therefore, it is essential to listen to your body and adjust your activities accordingly. If you experience severe pain or unusual symptoms, it is important to seek medical attention.
To check for muscle damage, you can look for symptoms such as sharp or stabbing pains, bruising, swelling, muscle spasms, soreness, localized pain, shortness of breath, trembling, or a weak grip. In more serious cases, you may notice an inability to walk or lift your arm, significant swelling, a fever, or an open wound. If you suspect muscle damage, it is recommended to consult a doctor, especially if the injury is severe or persistent.
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Frequently asked questions
Muscle strains are common but painful injuries that occur when you overstretch or tear a muscle or tendon. Symptoms include sudden pain that worsens when contracting the muscle, swelling, bruising, loss of strength and range of motion. If you suspect you have a muscle strain, stop moving the affected area and rest until the pain improves.
If you suspect you have torn your muscle, visit your doctor. They will ask about your symptoms and may order imaging tests such as an X-ray, CT scan, ultrasound, or MRI scan to check for tears, blood clots, or internal bleeding.
For mild to moderate strains, your doctor may recommend the RICE method: Rest, Ice, Compression, and Elevation. They may also suggest nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and improve mobility. For severe tears, surgery may be required to repair the muscle.
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