About using Ultrasound and Elastosonography imaging in the muscle injuries monitoring.

Deciding when the injured muscle can be remobilized is probably the most crucial decision in the recovery period after a trauma. The process of scar formation begins almost immediately following injury; immature scar tissue is susceptible to reinjury and the formation of granulation tissue at the site of injury needs to be monitored during the rehabilitation program.

2nd degree strain of biceps femoris: ultrasound monitoring in a professional athlete; the two images appear quite similar.

The rehabilitation program is usually regulated with reduced activity until the scar reaches sufficient strength to bear the muscle contraction.

How to differentiate the tissue structural changes in the site of injury?

In my daily practice the elastosonography examination allows to distinguish normal from inadequate healing, working as a “contrast agent” in the site of scar formation.

Looking at the referral colour scale I remind you that red colour means softness and blue colour means hardness.

Same patient studied with elastosonography examination.

15 days after the injury an immature granulation tissue is present (red color in the site of injury), while after 1 month  the scar seems to be progressing favorably (blue color is dominant).

In this case the difference between scar tissues elements is more evident with elastosonography than with standard B-mode ultrasound  examination. Power-doppler exam demonstrates the revascularization by ingrowing capillaries in the site of injury.

Also in this patient the thermographic evaluation shows an altered temperature diffusion in the left injured tigh; this is another useful information about the progression of the injurious event.