Biceps Femoris Fibrosis

about ultrasound monitoring of muscle injury remodelling phase

In my recent post Ultrasound Muscle Injuries Monitoring I showed the importance of the dynamic ultrasound and elastosonography exam in the study of the granulation tissue at the site of injury during the rehabilitation program.

Today I want to remind you to take care about muscle also after the final phases of remodeling (3–6 months after trauma), in which maturation of the regenerating fibers into a functional contractile unit takes place.


Axial (left) and Coronal (right) Mri scans of a late left biceps femoris injury evaluation (1.5 Tesla).

In these cases the Mri exam is less sensistive than ultrasound imaging; don’t forget to always perform both imaging modalities.


The patient suspected a reinjury in the same site of a previous trauma; first evaluation was made with an ultraportable device.

The power-doppler exam togheter with the elastosonography evaluation, show an incomplete scar maturation.

It Depends

If someone asks me what’s best between Mri and Ultrasound imaging in the study of muscles? I usually give the same answer: always use both modalities! It depends on what kind of informations you need to know from them. Take a look at the following images.

This is the case of an high degree strain of the biceps femoris, in a 17 years old professional football player. One month after injury a fibrotic scar is evident along the course of the proximal tendon-aponeurosis. Great panoramicity of Mri scan but with ultrasound exam you can best appreciate the real extent and morphology of the calcifications.

compara zecca

Coronal and axial Mri scans: comparison between T1w and Pdw Spair acquisitions

 Sagittal dynamic ultrasound exam of the same patient


The elastosonography evaluation well depicts the calcification hardness but stable scarring evolution; irregular thermoregulation is evident in the injured left thigh after one month.

I always use the thermographic camera during the recovery period, morover when the athletes come back to specific sport activity.