Terminology and classification of muscle injuries in sport: The Munich consensus statement

Abstract

ObjectiveTo provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies.MethodsThirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system.ResultsThe response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type.ConclusionsA consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature.What are the new thingsConsensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries.Level of evidenceExpert opinion, Level V.

MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance

“…Some authors prefer the term tear rather than strain for such injuries, noting that strain is often applied indiscriminately to a range of muscle injuries that vary in etiology and pathophysiology (2). Strain is the most common injury resulting in lost playing time in professional athletes, sidelining over one-third of soccer and football players during a typical season (2,19).…”

“…Acute muscle injuries are classified by the mechanism of injury into strain caused by indirect stretching, contusion after a direct blow, laceration resulting from penetrating trauma, and compartment syndrome arising from elevated pressure (1)(2)(3)(4). While clinical classification systems primarily emphasize only acute forms of muscle trauma, radiologists also need to be familiar with a range of subacute and obtain quantitative information in muscle injury.…”

Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries

“…The severity of an HSI affects the delivery of care, but much discussion surrounds the grading of HSIs. Many classification systems have been presented in the literature based on clinical examination findings, 20,21 available ROM, 10,22 type of injury (functional or structural), 23 and imaging findings 24 ; yet a validated grading system does not exist, 21 and no system correlates with prognosis. 25 Furthermore, researchers 26 have shown no difference in time to RTP for patients with a grade 1 versus grade 2 HSI based on a traditional 3-point clinical grading scale.…”

Return to sport after muscle injury

“…Physical examination may reveal swelling and ecchymosis. Palpation serves to detect a discrete defect, edema, and increased muscle tone due to injury [25]. Strength testing is best done with bilateral comparison to identify decreased strength of the injured muscle or post-injury changes [24].…”