about a combined diagnostic approach of muscle injuries using thermography, ultrasound, and MRI exams.
Pain and discomfort in the adductor region of the left thigh immediately after a football match in a professional player. Using thermography, asymmetric distribution of the skin temperature is evident in that site.
I always suggest to execute both MRI and ultrasound examinations; in this case, you can see how it is useful to have a portable device, it allows you to make a preliminary diagnosis before the MRI study and indeed, to observe the follow up of muscle injury directly at the sports center where the team train every day.
The dynamic ultrasound examination shows diffuse muscular edema with a partial tear of the left adductor brevis.The perfect combination of all of these imaging procedures is crucial to better plan the recovery period.
8 days after recovery and physiotherapy period that is the situation on MRI exam. The thermography exam shows a better situation but still remains an asymmetric distribution of the skin temperature.
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.
As I showed in my previous post “Are Muscle Strains Hot?” a difference of temperature occurs between the site of injury and the peripheral tissues.
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.