0:00

I mentioned doms.

0:02

Now DOMS is something that we don't normally do imaging for.

0:05

So DOMS is a syndrome of muscle pain that is delayed.

0:10

So the pain typically starts one to two days

0:12

after the activity.

0:14

It's often something strenuous that the patient did

0:16

for hours and hours.

0:18

They don't have an acute injury, but then they develop pain.

0:22

And this was a weightlifter

0:23

who developed DOMS involving his brachialis.

0:26

And the important thing to be aware of with this entity is

0:30

that the muscle changes can persist for weeks.

0:33

I think it can be sometimes challenging

0:35

to distinguish this from denervation, which also tends

0:39

to involve the muscle diffusely.

0:42

But with Doms, at least in the early phases, there tends

0:46

to be a little bit of peri muscular

0:47

and peri fascial edema, which is not a feature

0:50

that you see in denervation and denervation.

0:53

Uh, the muscle is uniformly involved

0:55

and there is no, uh, fluid seen in the adjacent,

0:59

uh, soft tissues.

1:00

Here's another example.

1:02

A different patient also a weightlifter showing delayed

1:05

onset muscle soreness involving the brachialis.

1:08

And this is a muscle that we rarely see acute strains in,

1:12

but it's a common muscle to be involved in doms.

1:16

And the reason that we see change,

1:17

so diffusely is when you look at this at a histologic level,

1:21

this is not disease at the surface of the muscle

1:24

or along the tendon.

1:25

It's a level of injury taking place at the

1:28

Sarco mirror itself.

1:29

So it involves the entire length of the muscle.

1:34

So it's not localized like the strains

1:36

that we're gonna look at later.

1:37

You can see this in a variety of different muscles.

1:40

I've seen, uh, doms in the forearm, uh, related to swimming.

1:45

I've seen it in the shoulders related to tennis.

1:48

Uh, this was a child, a case given to me by Dr.

1:51

Bosch from Santiago, Chile, uh, of a child

1:54

who was given a twist board, uh, for Christmas.

1:57

And he just twisted for several hours

2:00

and then developed this acute syndrome

2:03

of doms involving the biceps of femoral.

2:06

So it can be seen in any location

2:08

and often it's just one muscle that is involved.

2:11

We, again, rarely need to do imaging for that

2:14

because it's diagnosed, uh, clinically,

2:16

but you may see edema on a delayed basis,

2:19

not know why it's going on.

2:20

And then you can seek the history whether the patient had

2:23

had some strenuous activity in the weeks prior.

2:26

I.