Diagnosis

Description
Concerning muscle and tendon injuries, the diagnosis is based on clinical examination, that is, on symptomatology and physical examination by a doctor or physiotherapist. It is very important to take into consideration the risk factors and know the lesion mechanism very well. Image studies, whether through ultrasonography of tender parts (US) and/or magnetic resonance (MR), are complementary tests of great interest very useful to specify the diagnosis and issue a more accurate prognosis. On the other hand, there is not a biochemical marker specific enough helping on the severity of the injury and the definitive prognosis of each of the different muscle injuries, although this is an active research field.
Localized bioimpedance measurements in muscular lesions in the four major groups of lower extremity. (Dra. Eng. Lexa Nescolarde-Selva) - Edicion 2011
Edition 2011

Researcher: Dra. Eng. Lexa Nescolarde-Selva

The bioimpedance analysis (BIA) is a safe method, convenient and noninvasive for measuring electrical responses to the introduction of a low level alternating current in a living organism.

The real part of the impedance vector (Z), the resistance (R) represents opposition to the flow of alternating current through intracellular and extracellular ionic solutions and the imaginary or reactance (Xc) the delay on the passage of the current through cell membranes and the interstices of the fabric. When the disturbance is produced in a specific area, the BIA localized (segmental) is sufficiently sensitive to detect changes in the localized region.

The project main has, as a main objective, to determine the relative changes in BIA and vector data in relation to the severity of injuries (grade I, II and III) including DOMS. Moreover, identifying the magnitude of the relative differences in bioimpedance components between the reference values and damage, and monitor changes in the trajectory of the vector Z (and their values) as bio-markers around the sport game.

The measurements were performed at 50 kHz, with a “tetrapolar” analyzer with phase measurement (BIA-101; Akern-Srl, Florence, Italy) injecting an alternating current of 450 μARMS to measure R, Xc and phase angle (PA). Errors of measurement, determined with a precision resistor of 0.1% tolerance and a capacitor of 1% were <1 Ω for R and <2% by Xc.

For localized bioimpedance measurements were used pre-gelled electrodes (Tyco Healthcare, Kendall Ref 31050522, USA) of very low impedance (<6 Ω) to minimize the measurement error produced by bioimpedance electrode-skin interface.

MRIs were performed at Clinica Creu Blanca Barcelona by Dr. Xavier Alomar with 3.0T MRI system (Magnetom poison, Siemens Medical Solutions).

In conclusion we have found that: (1) all the players show a symmetry vector of Z values in the left and right in the four major groups of the lower extremities. (2) We found no significant difference (1-5% in R and Xc, and <1% in PA) between measurements made before and after the same type of workout in a group of 30 soccer players. (3) The percentage change in impedance vector parameters of grade III injury was 23.1% R, 45.1% and 27.6% Xc PA, for grade II 20.6% R, 31.6% and 13.3% Xc PA, and grade I 11.9% R, 23.5% and 12.1% Xc PA. Identifying parameters deficits BIA 6% for R and Xc within degree I and II, and 3% R and Xc 15% grade III injury when returned to game players.

These preliminary results indicate that BIA-located could be an alternative method to identify and characterize muscle injury severity. Also, keep track of recovery to return to the game, from the point of view of avoiding injury care possible re-injury.







Currently we are working on the identification of the optimal location of the electrodes for the bioimpedance measurement of each injury and assessing the percentage of change of each. The measurements were carried out in the Medical Service of the FCB by the doctor Xavier Yanguas Laws (FCB) and Dr. Lexa Nescolarde Selva (UPC). Nescolarde L, Yanguas J, H Lukaski, Alomar X, Javier Rosell-Ferrer J and Rhodes G (2013): Localized bioimpedance to Assess muscle injury. Physiol Meas, 34 (2) :237-245.
Soleus muscle: anatomical MRI on the corpse and the correlation distribution of injuries by effort (Carles Pedret) - 2010 Edition
Edition 2010

Researcher: Carles Pedret and Dr. Ramon Balius

The latest research reveals that understanding injury mechanisms and pinpointing the location of injuries are some of the most useful tools for prognosis, follow-up and treatment of muscle injuries.

By properly using imaging techniques, correctly interpreting them and understanding the anatomy of the different muscles we can increasingly tailor treatment to each injury so the athlete can return from injury more quickly and more safely.





Muscle injuries can be classified in two ways.

- By cause of injury (direct or indirect).

- By type of muscle injury (myotendinous injuries, central tendon injuries or septal lesions and myofascial injuries).

There is currently no consensus on the exact definition and location of the main muscles affected specifically by sports injuries. This hinders communication when several doctors are treating the same athlete and makes it difficult for treatment to be planned correctly and thus for the athlete to return from injury.

Objectives:

1) Describe the anatomy (diagnosis, prognosis and the best treatment) of the main types of injuries in the hamstring muscle group based on the location of the injury.

Over the last three years, 85 hamstring injuries were recorded, of which 71 were deemed suitable for study. All were diagnosed using 3T magnetic resonance imaging (MRI), and 25 of the injuries were viewed using MRI when the athlete returned from injury.

Discussion and statistical analysis of the large amount of data collected will enable us to identify and create a list of injury locations, prognoses and the time needed for athletes to return from each type of injury.
Fast and slow myosins as markers of muscle injury. ( Dra. Roser Cussó) - Edition 2010
Edition 2010

Researcher: Dra. Roser Cussó

The valuation of fast myosins in blood is the only specific marker of injuries that occur in fast-twitch fibers. Injuries slow twitch fibers can be assessed by quantifying blood slow myosins.

The project has studied how these markers relate to the degree of injury and has been seen in Grade I lesions that only faster myosins are increased and indicate the caution that must be taken to advance an injury that may get worse to a Grade II or III, then showing a dramatic increase of both myosins.

These markers have been very meticulously followed in the periodical revisions of the FCB first team basketball and football players. The valuation of myosins has shown the quality of training and matches of the last two years compared to 8 years ago when the number of injured was higher. Also noted that players with high values of myosin, which have continued playing in the course of time, have been injured. Tracking markers, fast and slow myosin, is a good indicator of muscular state of the individual.

A study of these markers has been made in type-2 diabetic patients who have submitted a physical therapy training to improve their condition. This monitor has indicated how training increases the fiber characteristics capable of capture more glucose from the blood. It was a way to evaluate the training followed with a direct relation between the exercises done, blood glucose concentrations and molecules (GLUT4) involved in glucose uptake by muscle. Once accomplished to see the use and meaning of myosins determinations, we designed a protocol for ELISA determination. This technique allows the measuring of many samples at once in a term of 4 hours. Western Blotts are being prepared for Titina marker analysis, as a marker of elasticity of the fibers and fast and slow troponin markers of both fibers lesions but small molecular weight.

Currently it is been studied what kind of exercise is causing the most of the injuries and how differential fibers, type I and/or II, are injured according to concentric exercises, eccentric, or combination of both. Under this topic it is also wanted to study what part of the fiber (membrane, contractile apparatus, mitochondria etc ...) is injured depending the kind of exercise. This marker provides each of the cellular compartments.

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