Value of Sonography Combined With Clinical Assessment to Evaluate Muscle Injury Severity in Athletes

Abstract

Context:Predicting when an athlete can return to sport after muscle injury is a major concern.Objective: To determine whether combining objective clinical and ultrasound findings at presentation accurately predicted time to sport resumption in athletes with muscle injuries.Design: Cohort study. Setting: Sports medicine clinic. Patients or Other Participants: A total of 93 consecutive patients, 87 male and 6 female, were seen over a 1-year period for sudden-onset muscle pain while engaging in a sporting activity within the last 5 days and inability to continue the training session or game. Intervention(s): Standardized physical examination and sonogram.Main Outcome Measure(s): Statistical associations between clinical and sonographic features at presentation and time to sport resumption (<40 days or ≥40 days) were evaluated using multivariate models. Correlations between time to sport resumption predicted by a sports medicine specialist and actual time to sport resumption were evaluated using the Spearman rank correlation coefficient.Results: The 93 patients had 95 injuries, caused by muscle contraction in 86 cases and impact in 9 cases. Only 7 injuries had normal sonogram findings. Late sport resumption was associated with 4 clinical criteria (bruising, tenderness to palpation, range-of-motion limitation compared with the other limb, and increased pain with isometric contraction during passive limb straightening) and 4 sonographic criteria (disorganized fibrous tissue, intramuscular hematoma, intermuscular hematoma, and power Doppler signal). The Spearman rank correlation coefficient between predicted and actual times was 0.669 (P < .0001) for mild exercise resumption and 0.804 (P < .0001) for full sport resumption.Conclusion: A combination of physical and sonographic data collected during the acute phase of sport-related muscle injury was effective in predicting time to sport resumption.Key Words: diagnostic imaging, contusions, strains, sports, return to sport Key Points• Sonography was useful for diagnosing acute sport-related muscle injuries, monitoring the course of the injuries, and guiding the drainage of fluid if needed.• In combination with the objective physical findings, sonographic findings were beneficial in predicting injury severity and time to resumption of sport.

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