Musculoskeletal sprains and strains - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Muscle injuries occur from either direct or indirect trauma.
Predisposing factors include type of muscle architecture (i.e., pennate muscle, type II fast twitch muscle fibers, muscle-tendon units that span 2 joints), previous injury, and inadequate warm-up before exercise.
Eccentric contraction (i.e., muscle contraction associated with forcible lengthening of the contracting muscle, such as when lowering a weight or pitching a ball) causes more frequent injury.
History and physical exam are key in diagnosis and grading of the injury as grade 1 (mild), 2 (moderate), or 3 (severe with complete rupture).
Conservative treatment is all that is required for most patients with grade 1 or 2 injuries.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Bahr R. Can we prevent ankle sprains? In: MacAuley D, Best TM, eds. Evidence-based sports medicine, 14th ed. London: BMJ, 2002:470.
Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73-94.[Abstract]
Noonan TJ, Garrett WE Jr. Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg. 1999;7:262-269.[Abstract]
Speer KP, Lohnes J, Garett WE Jr. Radiographic imaging of muscle strain injury. Am J Sports Med. 1993;21:89-95.[Abstract]
Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin North Am. 2002;40:333-362.[Abstract]
Wexler RK. The injured ankle. Am Fam Physician. 1998;57:474-480.[Abstract][Full Text]
Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.[Abstract][Full Text]
Hertel J. The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. J Athl Train. 1997;32:350-358.[Abstract][Full Text]

Referenced Articles

1. Wise DD. Physiotherapeutic treatment of athletic injuries to the muscle-tendon complex of the leg. Can Med Assoc J. 1977;117:635-639.[Abstract][Full Text]
2. Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22:675-692.[Abstract]
3. Beynnon BD, Renstrom PA, Alosa DM, et al. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001;19:213-220.[Abstract]
4. Woods C, Hawkins R, Hulse M, et al. The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains. Br J Sports Med. 2003;37:233-238.[Abstract][Full Text]
5. Bahr R. Can we prevent ankle sprains? In: MacAuley D, Best TM, eds. Evidence-based sports medicine, 14th ed. London: BMJ, 2002:470.
6. van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331.e6.[Abstract][Full Text]
7. Doherty C, Delahunt E, Caulfield B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40.[Abstract][Full Text]
8. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010 Oct 6;92(13):2279-84.[Abstract][Full Text]
9. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73-94.[Abstract]
10. Garrett WE Jr. Muscle strain injuries. Am J Sports Med. 1996;24(suppl 6):2-8.[Abstract]
11. Jarvinen MJ, Lehto MU. The effects of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Med. 1993;15:78-89.[Abstract]
12. Crisco JJ, Jokl P, Heinen GT, et al. A muscle contusion injury model: biomechanics, physiology, and histology. Am J Sports Med. 1994;22:702-710.[Abstract]
13. Kalimo H, Rantanen J, Jarvinen M. Muscle injuries in sports. Bailliere's Clin Orthop. 1997;2:1-24.
14. Kujala UM, Orava S, Jarvinen M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. 1997;23:397-404.[Abstract]
15. Noonan TJ, Garrett WE Jr. Injuries at the myotendinous junction. Clin Sports Med. 1992;11:783-806.[Abstract]
16. Hurme T, Kalimo H, Lehto M, et al. Healing of skeletal muscle injury: an ultrastructural and immunohistochemical study. Med Sci Sports Exerc. 1991;23:801-810.[Abstract]
17. Hubbard TJ, Wikstrom EA. Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access J Sports Med. 2010 Jul 16;1:115-22.[Abstract][Full Text]
18. Garrick JG, Requa RK. The epidemiology of foot and ankle injuries in sports. Clin Sports Med. 1988;7:29-36.[Abstract]
19. Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: a literature review. J Athl Train. 2002;37:376-380.[Abstract][Full Text]
20. Tabrizi P, McIntyre WM, Quesnel MB, et al. Limited dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg Br. 2000;82-B:1103-1106.[Abstract][Full Text]
21. Noonan TJ, Garrett WE Jr. Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg. 1999;7:262-269.[Abstract]
22. Arrington ED, Miller MD. Skeletal muscle injuries. Orthop Clin North Am. 1995;26:411-422.[Abstract]
23. Best TM. Soft tissue injuries and muscle tears. Clin Sports Med. 1997;16:419-434.[Abstract]
24. Speer KP, Lohnes J, Garett WE Jr. Radiographic imaging of muscle strain injury. Am J Sports Med. 1993;21:89-95.[Abstract]
25. McKay GD, Goldie PA, Payne WR, et al. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103-108.[Abstract][Full Text]
26. Chiodo CP, Glazebrook M, Bluman EM, et al. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:503-510.[Abstract]
27. O'Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35:1865-1869.[Abstract]
28. Milne L. Ottawa ankle decision rules. West J Med. 1996;164:67.[Abstract][Full Text]
29. Stiell IG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2:966-973.[Abstract]
30. Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin North Am. 2002;40:333-362.[Abstract]
31. Expert Panel on Musculoskeletal Imaging., Smith SE, Chang EY, et al. ACR Appropriateness Criteria® Acute Trauma to the Ankle. J Am Coll Radiol. 2020 Nov;17(11s):S355-S366.[Abstract][Full Text]
32. Martella I, Azzali E, Milanese G, et al. MRI in acute ligamentous injuries of the ankle. Acta Biomed. 2016;87(Suppl 3):13-19.[Abstract]
33. Westacott DJ, Minns JI, Foguet P. The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears-a systematic review. Hip Int. 2011;21:637-645.[Abstract]
34. Miyamoto RG, Elser F, Millett PJ. Distal biceps tendon injuries. J Bone Joint Surg Am. 2010;92:2128-2138.[Abstract][Full Text]
35. American Medical Association. Committee on the Medical Aspects of Sports. Standard nomenclature of athletic injuries. Chicago, IL: American Medical Association; 1966.
36. Wexler RK. The injured ankle. Am Fam Physician. 1998;57:474-480.[Abstract][Full Text]
37. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.[Abstract][Full Text]
38. Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl). 2011;124:4050-4055.[Abstract]
39. Kerkhoffs BM, Rowe BH, Assendelft WJ, et al. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg. 2001;121:462-471.[Abstract]
40. Beynnon BD, Renstrom PA, Haugh L, et al. A prospective, randomized clinical investigation of the treatment of first-time ankle sprains. Am J Sports Med. 2006;34:1401-1412.[Abstract]
41. Ardèvol J, Bolíbar I, Belda V, et al. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc. 2002;10:371-377.[Abstract]
42. Jones P, Lamdin R, Dalziel SR. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev. 2020 Aug 12;8:CD007789.[Abstract][Full Text]
43. Busse JW, Sadeghirad B, Oparin Y, et al. Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries : A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med. 2020 Nov 3;173(9):730-738.[Abstract][Full Text]
44. Qaseem A, McLean RM, O'Gurek D, et al. Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. 2020 Nov 3;173(9):739-748.[Abstract][Full Text]
45. Kaikkonen A, Kannus P, Järvinen M. Surgery versus functional treatment in ankle ligament tears. A prospective study. Clin Orthop Relat Res. 1996 May;(326):194-202.[Abstract][Full Text]
46. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75.[Abstract][Full Text]
47. Costa ML, Achten J, Marian IR, et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448.[Abstract][Full Text]
48. Hertel J. The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. J Athl Train. 1997;32:350-358.[Abstract][Full Text]
49. Lynch SA, Renström PA. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med. 1999;27:61-71.[Abstract]