Muscle rupture after minimal trauma of the spastic muscle: three case reports of patients with spinal cord injury

Abstract

Study design: Retrospective study of three cases. Objectives: To report three cases of muscle rupture caused by minimal trauma in spinal cord injury (SCI) patients with severe spasticity and a literature review of the underlying mechanisms. Setting: Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Belgium Methods: Retrospective study of three cases of muscle ruptures in SCI patients with severe spasticity. All muscle lesions were diagnosed by ultrasound. Literature review (Pubmed) was performed to identify extrinsic and intrinsic risk factors. Results: According to the literature and our clinical findings, several structural and mechanical alterations of the spastic muscle in combination with specific stretching during therapy or a transfer can cause a muscle rupture after minimal trauma. Conclusion: To the authors' knowledge, this is the first report of muscle rupture due to spasticity in SCI patients. Altered mechanical properties of the spastic muscle in combination with extreme stretching may cause partial or complete ruptur. Although this is a rare complication of spasticity, medical staff and therapists should be aware of the risk factors in order to prevent and quickly identify muscle lesions.

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

“…In the available literature, we found four reports of SMH in patients after SCI. Carpentier [ 23 ] described three cases of spontaneous muscle damage in patients with SCI—all patients had SMH of the lower limb, two musculus semimembranosus and one adductor muscle. These patients, similarly to ours, had swelling of the limb, with only one person feeling pain (ASIA C).…”

“…No significant injury was found and a diagnosis was made, as in most of our patients, on the basis of ultrasound. All patients described by Carpentier [ 23 ] had intense spasticity, which the authors associated with the cause of muscle damage during rehabilitation—muscle stretching and transfers. None of the described patients received anticoagulant treatment or prophylaxis, which differed from the patients described by us.de Almeida [ 24 ] also described two cases after SCI at the thoracic level, in the chronic phase nine months after the injury and four months after that.…”

Case report – Gluteal hematoma in two spinal cord patients on enoxaparin for venous thromboembolism prophylaxis: evidence needed for a wiser choice

“…Immobility plays a major role in these algorithms, but it is possible that chronic spinal cord injury and muscle atrophy may lead to a collapse of venules, reducing the risk of thrombus formation. In higher lesions, spasticity may further reduce the risk of VTE and increase the risk of muscle rupture and bleeding [25].…”