World Medical & Health Games

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Hilda Joseph
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1 The place of surgical treatment in chronic muscular lesions Dr Benjamin Dessart ICOS Sport Doctor In tribute to the Dr Jean-Pierre Franceschi

2 Epidemiology Acute muscle injury = 1st cause of injury among professional football players Chronic muscle injury = rare Lower limbs +++ (90%): IJ > Add > Quad 5 times more frequent in competition 2

3 Chronic muscular lesions When facing a muscle injury: Most of the time : good evolution Chronicity = complications 2 situations: Lack of initial support Reccurent injuries with +/- past trauma Surgical management : After failure of medical treatment and proven functionnal discomfort after 3

4 Surgery à Rare Evolution of Surgery indications (Traumato Sport department of Pr Jaegger) More effec6ve medical support

5 Surgical principle No suture indication of muscle fibers = RISK OF NECROSIS Stitched muscle = Doomed muscle 5

6 Examination History of the trauma Severe muscular injury background Detail of treatments follow-up Pain every time resuming sport(same location, same gesture) Return to sport too early? 5

7 Morphology Palpation Physical examination Induration/swelling/dehiscence/indurated cord Stretching Limitation of amplitudes /pain Isometric contraction: à OFTEN NORMAL Pain/lack of strength/change of aspect

8 Imagery reviews Radiography Intra-muscular calcification Ossification of periosteal origin Ultrasound (gold standard; same = acute injury) MRI (before surgery, 3D assessment) Scintigraphy (differential diagnosis) Secondary ossification of the anterior right muscle

9 Classification Sequela lesions: EARLY: Organized hematoma Beginning Intra-muscular ossification LATE: Fibrous nodule Fibrous degeneration Cystic lesion Calcification ossification Sequela of (proximal) rupture Muscle Atrophy Fat degeneration

10 SURGICAL INDICATIONS Fiber scars ++++ Encysted hematoma +/- Ossifiying myositis++ Special case: Chronic exertional compartment syndrome (CECS)

11 Fiber scar Fibrous nodule Scar = stronger than the initial musculo tendinous junction Secondary dyskinesias with lesions around this scar Iterative pains, brief. Incomplete recovery of the sport. Examination: Pain during tightness Sometimes palpable Less marked than an acute accident

12 Fiber scar Fibrous nodule Treatment: Functional: Deep transverse massage / Shockwave therapy / Eccentric Sometimes surgery: Medical treatment failure Delay> 6 weeks Operating technique: 1. Adhesiolysis Musculo aponeurotic intermuscular 2. Excision of pathological tissues

13 Cystic lesions Encysted hematomas Intra-muscular fluid pocket with sclerotic shell Palpation: renal tumefaction Treatment: Puncture/compression under echo ++ Surgery: wide surgery with padding

14 Calcification Calcification Same clinical picture as the fibrous nodule

radiographic US ok if post traumatic MRI, Scintigraphy,

15 Ossification Ossification Extrinsic mechanisms ++ Contact sport/fighting sport Discovery possibly radiographic US ok if post traumatic MRI, Scintigraphy, CT-scan (differential diagnosis) 10% muscle contusion complications

16 Ossification Support: Therapeutic abstinence +++ (well tolerated) Sometimes resection surgery in case of residual pain

Chronic exertional compartment syndrome (CECS)

Epidemiology: Men, running ++ Specific sports

17 Chronic exertional compartment syndrome (CECS) Definition: muscle(s) cramped in its inextensible aponeurotic lodge by default of fluid drainage (venous or lymphatic) Epidemiology: Men, running ++ Specific sports (repeated movements, «arm pump») : motorcycle, scuba-diving, motorsport

1/3 case : with muscle hernia Charlopain test Dynamic

18 Chronic exertional compartment syndrome (CECS) Physical examination: Pain during effort, at the same place, need to : î or stop the effort 1/3 case : with muscle hernia Charlopain test Dynamic intracompartmental muscle measurements: Rest: > 15 mm Hg Post-exercise: > 30 mm Hg after 1 min

19 Chronic exertional compartment syndrome (CECS) Support: Botulinum toxin (efficiency = 10 month) Surgery: fasciotomies

20 Post-operative rehabilitation Essential secondary rehabilitation support Surgery = bleeding = necrotic risk Identical to a recent and SERIOUS muscle injury (> stage 2 Rodineau and Durey) Return to sport after at least 6 weeks

21 Conclusion Chronic muscular injury: Inadequate initial support Insufficient support Ultrasound: gold standard for diagnosis and follow-up Rarely surgery or even exceptionally PREVENTION +++ (isocikinetic assessment at the beginning of the season) Immobilization =

22 Conclusion et ouverture au débat. A personnaliser

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. Introduction Compartment Syndromes of the Leg Related to Athletic Activity Mark M. Casillas, M.D. Consequences of a misdiagnosis persistence of a performance limitation loss of function/compartment loss