Kategoriarkiv: Adults injuries

Rupture of the biceps tendon

RUPTURE OF THE BICEPS TENDON

Diagnosis: RUPTURE OF THE BICEPS TENDON
(Ruptura biceps brachii)


Anatomy:
The biceps muscle (M biceps brachii) has two tendons, fastened on the shoulder blade. One tendon (caput longum) passes through the shoulder joint. The two tendons join the biceps muscle on the upper arm and are anchored just below the elbow on the forearm. The function of the biceps muscle is to bend the elbow and supination (rotation) of the forearm. The long head of the biceps tendon has a tendon sheath that communicates with the shoulder joint.

 

  1. Sulcus bicipitalis medialis
  2. M. biceps brachii
  3. Epicondylus medialis
  4. Aponeurosis
    m. bicipitis brachii
  5. Sulcus bicipitalis lateralis
  6. Caput longum
    (m. bicipitis brachii)
  7. Caput breve
    (m. bicipitis brachii)
  8. M. coracobrachialis
  9. Processus coracoideus

SHOULDER AND UPPER ARM MUSCLES FROM THE FRONT

Cause: A rupture of the biceps muscle (caput longum) often occurs due to changes in the tendon due to wear and tear following many years’ repetitive load or attributable to a single violent load (for example weight lifting). Ruptures occur most often when the muscle is contracting while being stretched (eccentric contraction). Long-term inflammation of the tendon sheath (tenosynovitis) increases the chance of a rupture of the tendon. It is rare for healthy tendons to rupture.

Symptoms: Sudden insetting localised tenderness exterior and to the front of the shoulder after load. Sometimes radiating down the upper arm. Pain is aggravated when external pressure is applied to the biceps tendon, the front of the shoulder, when the muscle is activated (attempting to bend the arm against resistance) and when the muscle is taut (stretching and at the same time rotating inwards in the elbow (pronating)). A swelling can often be observed (the contracted biceps muscular belly) above the bend of the arm (cubital fossa).

Acute treatment: Click here.

Examination: In case of sudden insetting pain and swelling above the elbow a medical examination should be carried out to ensure the correctness of the diagnosis and to commence the correct treatment. Normal medical examination is often sufficient to form the diagnosis, but if any doubts exist the examination should be supplemented by an ultrasound scan, which is the most suited examination for shoulder injuries (article) (Ultrasonic image).

Treatment: The treatment consists of relief and slow rehabilitation of the biceps muscle and the other muscles around the shoulder. Only in cases of total rupture of the biceps muscle should surgery be considered, as the vast majority of ruptures are treated with rehabilitation.

Complications: If smooth progress is not achieved the correctness of the diagnosis should be considered, or whether complications have arisen. Amongst others the following should be considered:

and pain inside the shoulder (the fluid in the biceps tendon may emanate from the shoulder joint).

Rupture of the large chest nuscle

BRISTNING AF DEN STORE BRYSTMUSKEL

Diagnosis: RUPTURE OF THE LARGE CHEST MUSCLE
(Ruptura M pectoralis major)


Anatomy:
The large chest muscle (M pectoralis major) is fan shaped covers the front surface of the chest wall and fastens on humerus (crista tuberculi majoris). The function of the chest muscle is, amongst others, to bring the arm along the body and to bend and rotate inwards in the shoulder (like when throwing). The large chest muscle forms the forward fold in the armpit.

  1. M. pectoralis majo
    (pars clavicularis)
  2. Sternum (Breastbone)
  3. M. pectoralis major
    (pars sternocostalis)
  4. M. pectoralis major
    (pars abdominalis)
  5. M. serratus anterior
  6. M. deltoideus
  7. Acromion
  8. Clavicula (Collar bone)

SHOULDER MUSCLES FROM THE FRONT

Cause: When a muscle is subjected to a load beyond the strength of the muscle (fitness training, weight lifting, wrestling), a rupture occurs. The vast majority of ruptures in athletes are total. The rupture is usually located at the anchor on the humerus.

Symptoms: In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”). In severe cases a sudden jolting pain is felt in the muscle (partial “muscle rupture” or “pulled muscle”) and in the worst case a violent snap, rendering the muscle unusable (“total muscle rupture”). In muscle injuries the following three symptoms are characteristic: pain upon pressure, stretching and activation against resistance. In total ruptures a defect can often be seen and felt at the forward fold in the armpit.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no inconveniences with normal usage of the arm, medical examination is not necessarily required. Though the severity of the tenderness is not always a measure of the severity of the injury. In case of more pronounced tenderness or pain medical examination is required to ensure the diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis. Pain will be present when pressure is applied to the damaged and deteriorated muscle, when the arm is squeezed to the body against resistance (adduction) and when the muscle is stretched. If there is uncertainty regarding the diagnosis, the medical examination should be supplemented with an ultrasound or MRI scan, which is the most suitable examinations to ensure the diagnosis (article).

Treatment: In athletes with total ruptures located at the point of attachment on the humerus, most advise surgery (article). If the rupture is not total or if the rupture is in the muscle belly, relief and careful rehabilitation is recommended. In total ruptures a rehabilitation period stretching over several months must be expected before maximal loading can be resumed.

Rehabilitation naturally depends on the degree of rupture and the treatment (conservative / operative). It is advised to avoid fitness training the first couple of months, and hereafter resume it with a very low load so as not to rupture the muscle again.

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

Rupture of the lower shoulder blade muscle

RUPTURE OF THE LOWER SHOULDER BLADE MUSCLE

Diagnosis: RUPTURE OF THE LOWER SHOULDER BLADE MUSCLE
(Tendinitis M infraspinatus)


Anatomy:
Four muscles are part of the rotator cuff surrounding the shoulder joint, and controls, coordinates and assists movement of the shoulder: M infraspinatus (the lower shoulder blade muscle), M supraspinatus, M subscapularis and M teres minor. The infraspinatus muscle rotates the arm outwards.

 

  1. Acromion
  2. Tuberculum majus humeri
  3. M. infraspinatus
  4. Spina scapulare
  5. M. supraspinatus

SHOULDER BLADE MUSCLES FROM THE REAR

Cause: When a muscle is suddenly subjected to a load in excess of the strength of the muscle, a rupture will occur in the muscle. Rupture of the infraspinatus (the lower shoulder blade muscle) is a common throwing injury (handball). Inflammation of the tendon (tendinitis) often precede larger ruptures and tendinitis is not rare combined with inflammation of the bursa (bursitis subacromialis).

Symptoms: In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”, “inflammation of the tendon”), which can precede larger ruptures if the exercise intensity is not altered. In severe cases a sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a violent snap is felt, rendering the muscle unusable (“total muscle rupture”). In case of muscle damage the following three symptoms are characteristic: pain upon pressure (externally, on the back of the shoulder), stretching and activation against resistance (rotation outwards against resistance).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain and in lack of progress a medical examination should be carried out to ensure the correctness of the diagnosis and to commence the correct treatment (article-1) (article-2). A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis the medical examination should be supplemented with an ultrasound scan, which is the most suitable examination for shoulder damage (Ultrasonic image) (article).

Treatment: The treatment primarily involves relief from the pain inducing activity, stretching and rehabilitation of the muscles around the shoulder. In light cases with slowly insetting tenderness after load, without the sensation of a snap and good function of the muscle (“muscle strain”, “imminent pulled muscle”, “inflammation of the tendon”), medical treatment in the form of rheumatic medicine (NSAID) or injection of corticosteroid (usually in the subacromiale bursa over the infraspinatus muscle). Since the injection of corticosteroider is part of a long-term rehabilitation of a long-term injury, it is often necessary for rehabilitation to stretch over several weeks to months to reduce the risk of recurrences and ruptures. The tendon can of course not sustain maximum load after a prolonged injury-period and only a short-term rehabilitation period. Ultrasound guided injection gives the maximal effect with minimal risk, since “blind” injections hit the wrong structures in more than half the cases (article). In case of lack of progress in rehabilitation and medical treatment, an operative treatment can be attempted.

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

Shoulder

Inflammation of the tendon sheath of the upper shoulder blade muscle

INFLAMMATION OF THE TENDON SHEATH OF THE UPPER SHOULDER BLADE MUSCLE

Diagnosis:

INFLAMMATION OF THE TENDON SHEATH OF THE UPPER SHOULDER BLADE MUSCLE
(Tendinitis M supraspinatus)

Anatomy: Four muscles are part of the rotator cuff surrounding the shoulder joint, and controls, coordinates and assists movement of the shoulder: M supraspinatus (the upper shoulder blade muscle), M infraspinatus, M subscapularis and M teres minor. When the arm is moved away from the body and above the head (abducated) the supraspinatus muscle slips under the upper bone projection of the shoulder blade (acromion).

  1. Acromion
  2. Tuberc. majus
    (humeri)
  3. M. infraspinatus
  4. Spina scapulae
  5. M. supraspinatus

SHOULDER BLADE MUSCLES FROM THE REAR
Shoulder

Cause: In case of repeated loads with the arm above the head (tennis, swimming) the upper shoulder blade muscle tendon (M supraspinatus) become inflamed swells and may become squeezed between the head of the upper arm (caput humeri) and the upper bone projection of the shoulder blade (acromion). Additionally this causes fraying and weakening of the tendon with risk of ruptures. It is not uncommon for tendinitis to be seen in conjunction with inflammation of the bursa (bursitis subacromialis).

Symptoms: Slowly insetting local tenderness after load, exterior and to the front of the shoulder. Sometimes radiating down the upper arm. The pain deteriorates when external pressure is applied to the supraspinatus muscle, on the front of the shoulder, when the muscle is activated (the arm is lifted to the side) and when the muscle is stretched (hand is brought to the loin). Due to the inflammation and wear and tear changes, calcification can occur in the shoulder muscle.

Acute treatment: Click here.

Examination:
In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain or trouble lifting the arm away from the body and in case of lack of progress, a medical examination should be performed to ensure the correctness of the diagnosis and treatment. Ordinary clinical examination is often sufficient to make the diagnosis (article-1) (article-2). If there is uncertainty surrounding the diagnosis, it should be supplemented with an ultrasound scan, which is the most suitable examination for shoulder injuries (article).

Treatment: The treatment primarily involves relief from the pain inducing activities, stretching and rehabilitation of the muscles around the shoulder. If lack of progress in rehabilitation a medical treatment in the form of rheumatic medicine (NSAID) or injection of corticosteroid (usually in the bursa above the supraspinatus muscle) may be considered. Since the injection of corticosteroid is part of a long-term rehabilitation of a long-term injury, it is often necessary that the rehabilitation period stretches over several weeks to months, to reduce the risk of recurrences and ruptures. Naturally the tendon can not sustain maximum load after only a short rehabilitation period. If calcification is present in the shoulder muscle, an attempt may be made to extract this at the same time corticosteroid is injected around the calcification (article). The optimal effect at minimal risk can be accomplished by performing the injections guided by ultrasound. The wrong structures are hit in more than half the cases where the injection is done blindly (article). In lack of progress with rehabilitation and medical treatment a surgical treatment can be attempted.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

Rupture of the upper shoulder blade muscle

BRISTNING AF ØVRE SKULDERBLADSMUSKEL

Diagnosis: RUPTURE OF THE UPPER SHOULDER BLADE MUSCLE
(Ruptura M supraspinatus)


Anatomy:
Four muscles are part of the rotator cuff surrounding the shoulder joint, and controls, coordinates and assists movement of the shoulder: M supraspinatus (the upper shoulder blade muscle), M infraspinatus, M subscapularis and M teres minor. When the arm is moved away from the body and above the head (abducated) the supraspinatus slips under the upper bone projection of the shoulder blade (acromion).

 

  1. Acromion
  2. Tuberculum majus humeri
  3. M. infraspinatus
  4. Spina scapulare
  5. M. supraspinatus

SHOULDER BLADE MUSCLES FROM THE REAR

Cause: With age and repeated loads with the arm above the head (tennis, swimming) the upper shoulder blade muscle tendon (M supraspinatus) becomes stiffer and less flexible, and is more easily squeezed between the head of the upper arm (caput humeri) and the acromion, causing the tendon to become frayed and weakened with risk of ruptures. When a muscle is suddenly subjected to a load in excess of the strength of the muscle, a rupture occurs (fall on an outstretched arm, lifting or throwing of heavy objects). The vast majority of ruptures are partial muscle ruptures. The vast majority of total ruptures are seen in older people with wear and tear changes in the muscle tendon (in very old people total ruptures are very frequent). It is very rare for healthy tendons to rupture.

Symptoms: In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”). In severe cases a sudden shooting pain in the muscle is felt (partial “muscle rupture” or “pulled muscle”) and in the worst case a sudden snap is felt, rendering the muscle unusable (“total muscle rupture”). With muscle damage the following three symptoms are characteristic: pain upon pressure, stretching (hand to the loin) and activation against resistance (lifting the arm to the side or above the head). The pain is localized on top and external to the shoulder. After a longer period, loss of muscle can be observed on the back of the shoulder blade. With many older people the rupture has not produced symptoms.

Acute treatment: Click here.

Examination: Light cases with only minimal tenderness do not necessarily require medical examination. In case of more pronounced pain or trouble lifting the arm away from the body and in case of lack of progress, a medical examination should be carried out to ensure the correct diagnosis and treatment. Ordinary medical examination is often sufficient to make the diagnosis (article-1) (article-2). Returning to the bedside: using the history and physical examination to identify rotator cuff tears, 2) The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator cuff tears. If there is uncertainty about the diagnosis it should be supplemented with ultrasound, which is the most suitable examination for shoulder injuries (article) (Ultrasonic image). If there is doubt as to whether it is a total or partial rupture, the doctor can inject a local anaesthetic around the rupture. If, after this, the arm is able to move freely, it is not a total rupture (diagnostic blockade).

Treatment: Only in cases of near total rupture of the supraspinatus muscle can surgery be considered. Renewed ruptures occur relatively frequently after surgery (article). In partial ruptures and total ruptures in the elderly the treatment is short-term relief and careful rehabilitation of the part of the supraspinatus muscle, which has not ruptured.

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

Shoulder

Inflammation of the bursa

INFLAMMATION OF THE BURSA

Diagnosis: INFLAMMATION OF THE BURSA
(Bursitis)

Anatomy: Around the shoulder joint are numerous bursas, reducing the pressure on muscles, tendons and ligaments, where these lie close to bone projections. Between the upper bone-projection (acromion) and the upper shoulder blade muscle (M Supraspinatus) lies the largest bursa in the shoulder (bursae subacromiale), which often communicates with the shoulder joint (Photo).

 

  1. Acromion
  2. Tuberc. majus
    (humeri)
  3. M. infraspinatus
  4. Spina scapulae
  5. M. supraspinatus

SHOULDER BLADE MUSCLES FROM THE REAR
Shoulder

Cause: Upon repeated loads or blows, the bursa can become inflamed, increasing the production of fluids, swelling and becoming painful. Inflammation of the subacromiale bursae is often caused by working with the arm above the level of the head. When the arm is moved away from the body and above the level of the head (abducted) the supraspinatus muscle slips under the upper bone projection of the shoulder blade (acromion). With age, the supraspinatus tendon becomes stiff and unremitting, and is more easily squeezed between the head of the upper arm (caput humeri) and the acromion, causing the bursa to be squeezed and swell.

Symptoms: Pain upon pressure on the bursa, which occasionally (but far from always) may feel swollen. Pain in the subacromiale bursae is worsened when the arm is at a right angle to the body. Inflammation of the bursa often causes nightly pain, and pain when lying on the side of the inflamed bursa.

Acute treatment: Click here.

Examination:
In light cases with only minimal tenderness medical examination is not necessarily required. In case of pain that is more pronounced or lack of progress, a medical examination should be carried out to ensure the correct diagnosis and treatment. The doctor may carry out various clinical examinations, which not always allows a certain diagnosis (article). The diagnosis is most rapidly made with ultrasound (allowing simultaneous treatment) (article), (Ultrasonic image).

Treatment: The treatment primarily involves relief. Possible removal of the provoking factor, if known. The treatment may be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa, possibly preceded by draining of the bursa. This procedure can advantageously be guided by ultrasound, (article). In the absence of any effect, an operative solution with removal of the bursa may be attempted (and in cases of bursitis subacromiale removal of a part of the shoulder’s upper bone projection (acromion). Thereby avoiding that the supraspinatus muscle and the bursa is squeezed between the head of the upper arm and the acromion, when the arm is raised).

Rehabilitation, specific: The treatment is dependent on which bursa is inflamed, but sports activity can be carefully resumed once pain has diminished, especially if the triggering cause has been determined, and subsequently removed. Generally careful training of the shoulder muscles is recommended, primarily with the arm below the level of the head.

Complications: If smooth progress is not achieved the correctness of the diagnosis, or whether complications have arisen should be considered. Amongst others the following should be considered:

Stress fracture

STRESS FRACTURE

Diagnosis: STRESS FRACTURE
(Stress fracture)


Anatomy:
The femur is the only bone in the thigh. Innumerable muscles are attached to the bone.

 

  1. Caput femoris
  2. Collum femoris
  3. Trochanter minor
  4. Trochanter major

THIGH BONE FROM THE FRONT

Cause: Repeated loads, particularly when walking or running, can cause such great stress that cracks (stress fractures) appear in the shaft of the femur (article).

Symptoms: Pain and tired sensation in the thigh. The pain is aggravated upon applying pressure (direct and indirect tenderness) and applying load (walking, running).

Examination: X-ray. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks, if stress fractures are still suspected. Scintigraphy, CT, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image). The frequency of stress fractures in the femur is probably more often than presumed (article). It is crucial for the result of the treatment that the diagnosis is made as early as possible (article).

Treatment: The treatment primarily comprises relief. Only in special cases is surgery necessary (article).

Rehabilitation: The rehabilitation is completely dependant on the type of fracture and the treatment (relief or surgical). A rehabilitation period of 2-4 months must be expected before maximum participation in sports activity can be resumed (article).

Complications: If progress is not smooth, you should be medically re-evaluated to ensure that the fracture is healing according to plan. In some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.

Chronic compartment syndrome

CHRONIC COMPARTMENT SYNDROME

Diagnosis: CHRONIC COMPARTMENT SYNDROME
(Chronic compertment syndrome)


Anatomy:
The thigh muscles are divided into three groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias); a front, an inner and a rear muscle compartment (Drawing).

Cause: The muscles can increase so quickly following intensive training that the muscle membranes surrounding the muscles cannot keep up, causing the pressure in the muscle compartment to increase. The pressure can in some cases increase so greatly that impingement of blood vessels and nerves can occur. In other cases, chronic muscle compartment syndrome can arise as a complication to earlier muscle ruptures.

Symptoms: With chronic compartment syndrome there is slowly insetting pain in the anterior muscles after a few minutes activity. There is a sensation that the muscle is “tightened” and becomes hard, which is accompanied by discomfort. If the activity is stopped the discomfort diminishes, but returns after a short period of resuming the sports activity once again.

Examination: The diagnosis is made on the basis of the characteristic history and possibly with a pressure measurement in the muscle compartment (article).

Treatment: With chronic muscle compartment syndrome the treatment primarily comprises relief and slowly increasing training intensity, rheumatic medicine (NSAID), and massage (article). If there is scar tissue in the muscle, ultrasound guided injection of corticosteroid around the scar tissue formation can be attempted. In cases where there is a lack of progress a surgical splitting of the muscle membranes can be performed, which is usually a minor procedure with good results (article-1) (article-2).

Once the pain has diminished, the sports activity can generally be slowly resumed according to the principles mentioned under rehabilitation, general.

Complications: In cases of lack of progress with relief and slow rehabilitation, an ultrasound scan should be performed before possible surgery to rule out scar tissue formation in the muscles from previous muscle ruptures. Ultrasound guided injection of corticosteroid can be attempted in the area surrounding the scar tissue if scar tissue is in evidence in the muscles.

Acute compartment syndrome

ACUTE COMPARTMENT SYNDROME

Diagnosis: ACUTE COMPARTMENT SYNDROME
(Acute compartment syndrome)


Anatomy:
The thigh muscles are divided into three groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias); a front, an inner and a rear muscle compartment (Drawing).

Cause: The pressure in a muscle compartment can rise so fast (due to bleeding or fluid extraction) that the muscle membranes cannot keep up. The pressure in the muscle compartment can therefore increase so greatly that impingement of blood vessels and nerves can occur.

Symptoms: With the acute muscle compartment syndrome there is increasing pain, which is often more powerful than expected from the primary evaluation of the extent of the injury. At the same time sensory disturbances can occur in the lower leg and feet.

Acute treatment: Click here.

Examination: The diagnosis is made on the basis of the characteristic history, increased circumference of the thigh, tight and hard anterior thigh muscle and by a pressure measurement in the muscle compartment (article).

Treatment: With acute muscle compartment syndrome the treatment in severe cases comprises acute splitting of the muscle membrane. It is imperative for the continuing function of the muscle that this operation be acute, which is, of course, only possible if the athlete seeks acute medical attention (article-1) (article-2). In mild cases, surgery can be omitted under close hospital observation (article).

Rehabilitation: The rehabilitation is completely dependant on which muscle groups are affected, the provoking cause (blow to the muscle, muscle rupture or over-training) and which treatment that has been performed (relief, surgical splitting). Once pain has decreased, the sports activity can generally be slowly resumed according to the principles as mentioned under rehabilitation, general.

Complications: Muscles and nerves can suffer permanent damage if the treatment is not started as soon as possible.

Special: Since there is a chance of permanent disability, the injury should be reported to your insurance company.

Muscular bleeding in the anterior thigh

MUSKELBLØDNING I FORLÅR

Diagnosis: MUSCULAR BLEEDING IN THE ANTERIOR THIGH
(Haematoma musculi)


Anatomy:
The thigh muscles are dealt up in three muscle groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias): a front, an inner and a rear muscle compartment. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).

 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: If a muscle is subjected to kicks or the like the muscle belly, which contains blood vessels, is pressed against the bones inflicting a contusion and rupture of the muscle fibres and blood vessels. The rupture usually occurs deep in the muscle. In other cases the bleeding can occur after a large or smaller muscle rupture in the anterior thigh. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle), in other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the sub cutis). The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort when walking, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as this is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury.

Treatment: The treatment primarily consists of relief and rehabilitation as with muscle rupture in the anterior thigh. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. If the bleeding is located medial (M vastus mediale) or lateral on the thigh (M vastus lateralis), the rehabilitation will usually go more quickly. If the bleeding is located in the centre of the front thigh muscle (M vastus intermedius or M rectus femoris), a longer period of rehabilitation must be expected as sudden jumping or kicking will comprise a risk of a muscle rupture in the damaged anterior thigh muscle. Some recommend treatment with rheumatic medicine (NSAID) and advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle). Treatment with ultrasound has generally no convincing effect.

Bandage: Certain bandages on the thigh have shown to be effective in reducing the risk of muscular bleeding in contact sports (article).

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.