9.15 Muscle Strains and Tears

agk’s Library of Common Simple Emergencies

Presentation

Strains occur during or after a vigorous overstretching of a muscle bundle that leads to an insidious development of pain and tightness which is worse with use and better with rest. Tears of the muscle belly tend to be partial, with sudden onset of pain and partial loss of function. Often a tear occurs with considerable bleeding which can lead to remarkable hematomas, causing swelling at the site and dissecting along tissue planes to create ecchymoses at distant, uninvolved sites. Complete tears are more likely in the tendinous part of the muscle, and produce immediate loss of function, and retraction of the torn end, creating a deformity and bulge.

What to do:

• Obtain a history of the mechanism of injury, and test individual muscle functions. A complete tear of a muscle merits orthopedic consultation.
• Even for a partial tear of a muscle belly, try to refine the diagnosis to a specific muscle or muscle group, to help exclude other possibilities.
• For muscle strains, provide soft splinting, analgesics and instruct the patient to apply warm moist compresses for comfort.
• For muscle tears, construct a loose splint to immobilize the injured part, and instruct the patient in rest, elevation, and ice.
• Warn the patient that partial tears can become complete, and that blood will change color and percolate to the skin at distan sites, where it does not imply additional injury. Arrange for followup.

Discussion

Some restrict the term “strain” for muscle injuries, and “sprain” for ligament injuries. A complete tear of the plantaris tendon in the leg is difficult to differentiate from a partial tear of the gastrocmius muscle, but the treatment for both is the same.

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