0:00

So when we have injuries that are largely at the surface,

0:04

they are mostly at the fascia.

0:06

We don't have any big holes in the muscle, it's just emus.

0:10

But the architecture's reasonably good.

0:12

Small areas in here, these ones tend

0:15

to do better than when the tendon is involved.

0:18

And these injuries that are predominantly

0:21

around the epimysium, nice example here involving the soleus

0:26

and a runner, uh, make up about somewhere between four

0:29

and 20% of muscle strains.

0:32

And the patients are often able to return

0:34

to their activities relatively quickly once you start

0:39

to get into tendon damage.

0:41

And here you can see that the tendon

0:43

of the gastrocnemius is disrupted

0:47

and we have voids in the muscle, not just edema,

0:51

then you're looking at a significantly longer

0:54

return, uh, to play.

0:55

And again, uh, the validations that I've mentioned here,

0:59

they have recently done some validation work in the

1:02

quadriceps as well.

1:04

Um, just this is, uh, this tendon damage seems

1:07

to correlate really best, uh, with the longer,

1:11

uh, return to play.

1:12

And then the worst prognosis is damage to the free tendon.

1:16

And here we see a free tendon disruption

1:18

of the conjoining tendon

1:20

and high grade of the semimembranosus more anteriorly

1:24

with a large fluid collection.

1:25

And obviously this is going to take a long time to recover

1:29

and many of these may require a surgical, uh, reattachment

1:33

of the tendon when the tendon is torn, uh,

1:36

near the footprint, uh, as it has, uh, in this, uh, example.

1:41

So what do I like to report? Uh, I don't give a number.

1:45

I basically say which muscles involved where it is,

1:48

whether it's proximal, mid distal, a rough idea of size.

1:53

I just do it as a cross-sectional area.

1:56

I don't bother with diameter. That makes no sense to me.

1:58

'cause muscles are different sizes.

2:00

The length of the area really focus in on whether there's

2:04

architectural distortion.

2:06

The tendon itself is abnormal.

2:09

The length of the tendon abnormality in which tendon

2:12

region, uh, is affected.

2:15

I do like the feature of, uh, FC Barcelona

2:17

that they consider previous injury

2:19

because we know that an athlete

2:22

that's had an injury in one location is at higher risk

2:26

of getting an injury in the same location.

2:28

This was an athlete who continued to play.

2:31

Uh, there's a lot of financial downside

2:34

to these athletes not playing.

2:35

So they, they, they, they don't sometimes do rational things

2:39

and he's reinjured himself 12 days later

2:42

and now has a much more extensive injury

2:44

with the frank tear, uh, in the muscle.

2:46

We also know that re injuries take longer to heal.

2:49

And really that's the only thing from FC Barcelona

2:53

to add into the baac.

2:54

And I always look for signs of prior injury because

2:59

Healed does not mean normal.

3:01

Uh, tendons that have been damaged when they heal

3:05

are often stiff.

3:06

And we have loss of tissue compliance.

3:09

So here we can see that there's a lot of tendon thickening.

3:12

There's not any fluid around it. Perhaps a tiny bit here.

3:16

The patient at this point did clinically have a low grade

3:20

strain, uh, injury, just a halo of fluid, uh,

3:23

next to the tendon.

3:25

But you can think about this kind of as a rubber band,

3:28

it's really hard to tell by looking at a rubber band if it's

3:30

gonna stretch or if it's gonna break

3:32

or if it's gonna be stiff.

3:33

And, um, so we don't really know by looking at this tendon

3:38

how it's going to behave.

3:39

So just because there's no fluid does not mean that

3:42

that tendon is gonna be normal.

3:44

Here's another example of a previous injury.

3:47

No edema in this case.

3:49

Lot of thickening in the interface

3:51

between the gastroc anemia and the soleus.

3:54

I don't see the plantar in this case.

3:56

I don't really bother about the plantar actually.

3:59

Um, but uh, we know

4:01

that there's been a so-called chronic tennis leg injury.

4:04

And then we also have muscle atrophy.

4:06

The medial head of the gastroc anemia add,

4:08

its a neurotic insertion, uh,

4:10

to the tibia is Foley, uh, atrophic.

4:13

So those are the findings that you really wanna look for.

4:16

Tendon thickening and irregularity, focal regions

4:20

of muscle fibrosis or atrophy.

4:22

Just another example here in a rectus injury, we have, uh,

4:27

the higher levels abnormalities involving the direct head

4:31

of the rectus, which is fat replaced

4:34

and further distally abnormalities involving the central

4:38

indirect head, which has fatty replacement,

4:41

perhaps a little bit of tendon thickening, uh,

4:43

and, uh, irregularity, uh, as well, more distally.

4:47

So those are what you're gonna look for.

4:49

And remember that this doesn't really have any mass effect.

4:53

You're gonna be looking for areas of atrophy

4:56

that don't cause a mass like a lipoma would.

4:59

Uh, that's simply fat replacing the damaged, uh, muscle, uh,

5:03

tissues.