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.

remodelling

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.

fibrosis

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.

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Soleus Myotendinous Junction Injury

About aponeurotic medial insertion injury of the soleus muscle.

Knowing the anatomy and biomechanics of the gastrocnemius-soleus complex – or triceps surae – is crucial for an understanding of the etiology and treatment of all its possible injuries. Today I want to show you a painful partial lesion at the aponeurotic medial insertion of the soleus muscle in a professional soccer player.

One month after a soleus injury, a patient suffered for pain and discomfort at the distal soleus myotendinous junction; first examination was made with an ultraportable device directly on the pitch during a daily training session. A partial injury of the aponeurotic medial insertion was evident, togheter with muscle perilesional edema.

soleus-injury

Sagittal Ultrasound comparative examination of the medial soleus myotendinous junction; normal findings on the right side.

soleus-medial-insertion

Sagittal GeStir (left) and Coronal T2w Mri scans of the same patient (0.3 Tesla).

fse_t2__2__and_fse_t2__4_

Axial (left) and Sagittal (right) T2w Mri scans (0.3 Tesla).

With the dynamic ultrasound examination is better appreciated also an inflammation along the course of the posterior tibial nerve.

Also in this case the elastosonography evaluation works like a “contrast agent” well depicting the lesional area.

You can find further information about the complex anatomy of the triceps surae in this interesting scientific paper: Anatomy of the Triceps Surae: A Pictorial Essay