Clinical and magnetic resonance imaging features of cricket bowler's side strain

Distal Abdominal Oblique Avulsion Injuries in Two Collegiate Hockey Players: A Case Report

ABSTRACT

While injuries to the abdominal oblique muscles near their origin at the lower ribs are commonly seen in sports that require explosive trunk rotational movements such as baseball and tennis, there are few reports in the literature of avulsion injuries to these muscles from their distal attachments at the iliac crest. We present the case of two collegiate male hockey players who suffered such injuries as a result of a direct impact mechanism while rotated at the waist. These injuries should be suspected when patients have significant pain in the lower abdominal region worsened by flexion and rotation of the trunk and can be accurately characterized by musculoskeletal ultrasound or MRI. With a conservative rehabilitation program focused on core, hip adductor, and hip flexor strengthening, our athletes were able to return to game participation within 6 wk of the initial injury.

Characteristics of internal oblique muscle strain in professional baseball players: a case series

Background

Internal oblique muscle strains can develop in professional baseball players, rendering the players unable to continue playing for a certain period. However, the characteristics of this injury are not well known. The purpose of the present study was to investigate the details of the injury and the post injury course of internal oblique muscle strain in professional baseball players.

Methods

The subjects were members of a single Japanese professional baseball team with a total of 188 players (81 fielders and 107 pitchers) who developed internal oblique muscle strains from January 2012 to December 2021. The diagnosis of muscle strain was made on the basis of local pain and magnetic resonance imaging findings. The incidence of internal oblique muscle strain, the details of the site of the injury, and the time to return to play were examined.

Results

There were 28 cases in 23 players (12.2%) of internal oblique muscle strain. The players were 16 fielders (24.7%) and 7 pitchers (7.5%), with a significantly greater incidence in fielders (p = 0.001). Although internal oblique muscle strain was more common on the side contralateral to the batting or pitching side, it occurred on either side. Most of the injury sites were at the region of the muscle insertion to the lower ribs. At a mean time of 36.5 months after the initial injury, 5 players (21.7%) developed another internal oblique muscle strain. The mean time to return to play was 27.7 ± 9.7 days (range, 4–53 days).

Conclusions

Baseball players who have symptoms at the side of the trunk should be regarded as having possible internal oblique muscle strain, and proactive examination should be considered.

Side Strain and Impact Injuries at the Iliac Crest Attachment of Lateral Abdominal Wall Musculature in Cricketers: An Uncommon Injury Pattern

Side strains refer to injuries of the internal/external oblique or the transversus abdominis, commonly at their attachment to the lower four ribs and rarely at their pelvic attachments. Injuries at the rib attachments are well-described while literature on iliac crest attachment injuries is sparse. We report four cricketers who had side strain and direct impact injuries with varying degrees of severity at the iliac crest attachment. The purpose of this article is to describe the anatomy, possible mechanism of injury, and imaging findings in the lateral abdominal wall muscle injuries at the iliac crest, which have not been described previously.

Athletic Injuries of the Thoracic Cage

A variety of sports require exposure to high-impact trauma or characteristic repetitive movements that predispose to injuries around the thorax. Appropriate prognostication and timely management are vital, as untreated or undertreated injuries can lead to pain, disability, loss of playing time, or early termination of sports participation. The authors review common athletic injuries of the thoracic cage, encompassing muscular, osseous, and vascular conditions, with an emphasis on mechanism, imaging features, and management. The authors also review pertinent soft-tissue and bony anatomy, along with relevant sports biomechanics. Generalized muscle trauma and more specific injuries involving the pectoralis major, latissimus dorsi, teres major, pectoralis minor, lateral abdominal wall and intercostals, serratus anterior, and rectus abdominis muscles are discussed. Osseous injuries such as stress fractures, sternoclavicular dislocation, costochondral fractures, and scapular fractures are included. Finally, thoracic conditions such as snapping scapula, thoracic outlet syndrome, and Paget-Schroetter syndrome are also described. Specific MRI protocols are highlighted to address imaging challenges such as the variable anatomic orientation of thoracic structures and artifact from breathing motion. Athletes are susceptible to a wide range of musculoskeletal thoracic trauma. An accurate imaging diagnosis of thoracic cage injury and assessment of injury severity allow development of an adequate treatment plan. This can be facilitated by an understanding of functional anatomy, sports biomechanics, and the unique injuries for which athletes are at risk. ^©RSNA, 2021.

Abdominal oblique muscle injury at its junction with the thoracolumbar fascia in a high school baseball player presenting with unilateral low back pain

Abdominal oblique muscle injury is characterized by acute pain and localized tenderness over the lateral trunk. This injury is particularly common among throwing athletes, and usually presents as anterolateral abdominal wall pain. Imaging evidence is scarce in regard to whether oblique muscle injury at its junction with the thoracolumbar fascia can instead present with low back pain. A high school baseball player with unilateral low back pain was referred to us with a different diagnosis.　Careful palpation and magnetic resonance imaging guided our care, and the patient returned to high-level competition after 7 weeks of conservative treatment, with no report of recurrence in the subsequent 12 months. Oblique muscle injury at its junction with the thoracolumbar fascia should be added to the differential diagnosis for throwing athletes with unilateral low back pain following a torque movement.

MRI findings are associated with time to return to play in first class cricket fast bowlers with side strain in Australia and England

OBJECTIVES

To investigate the reliability of reporting and relationship between MRI parameters at injury and time to return to play (RTP) in first class cricket fast bowlers with side strain in Australia and England.

DESIGN

Cohort study.

METHODS

Eighty MRI scans of side strain injuries to 57 fast bowlers were sourced. Ten scans were reported by three experienced radiologists to determine intra- and inter-rater reliability. The relationship between six MRI parameters (muscle injured, presence of a muscle tear, rib level of injury, presence of blood fluid products/haematoma, periosteal stripping, rib oedema) and time to RTP was investigated with 39 scans reported by a single radiologist with known intra-rater reliability. The association between parameters and time to RTP was analysed with an ordinal logistic regression model.

RESULTS

Recovery time was prolonged with a mean of 39days (standard deviation: 14days) and 44% of bowlers requiring more than 6weeks to RTP. Reliability levels between parameters varied widely. The presence or absence of a muscle tear was the only MRI parameter associated with time to RTP. Players with a muscle tear were 8 times more likely to take more than 6weeks to RTP. The multifactorial model was predictive of recovery time in only 53% of this cohort, leaving 47% of total variance in time to RTP unexplained.

CONCLUSIONS

The presence of a muscle tear was associated with time to RTP in cricket fast bowlers with side strain injury in first class cricket in Australia and England.

Trunk Side Strain Has a High Incidence in First-Class Cricket Fast Bowlers in Australia and England

OBJECTIVE

To investigate the past incidence of side strain injury and its associated factors in first-class cricket fast bowlers in Australia and England.

DESIGN

Retrospective case series.

SETTING

Professional cricket.

PARTICIPANTS

Cricket fast bowlers who were professionally contracted full time at first-class level in Australia and England in 2011. All bowlers were male and aged 18 or older. A bowler was defined as a fast bowler if the wicketkeeper would take their stance back from the stumps. There were 207 participants.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The association between bowling arm, player height, active trunk lateral flexion range of motion, side bridge endurance, volume of first-class cricket played, and the history of injury was determined.

RESULTS

Over half of the bowlers had sustained at least 1 side strain in their career. Seventy-seven percent of primary injuries occurred in bowlers aged 24 or under. A higher proportion of injured bowlers had reached first-class volume in their career. Recurrence occurred in 30% of bowlers, with over 30% of these bowlers sustaining at least 1 further recurrence. Nearly half of all recurrences occurred within 2 years with a further quarter in the next year. The injury was not associated with any measured factors.

CONCLUSIONS

Side strain is a common injury among first-class cricket fast bowlers, especially at younger ages. It was associated with the volume of first-class cricket played. Recurrence was common and occurred most frequently in the first 2 years after primary injury.

Injuries in Cricket

Context:

Cricket is a popular global sport that requires a combination of physical fitness, skill, and strategy. Although a noncontact sport, overuse and impact injuries are common since players engage in a wide range of physical activities, including running, throwing, batting, bowling, catching, and diving. Significant or match time-loss injuries are defined as those that either prevent a player from being fully available for selection in a major match, or during a major match, cause a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team’s captain. This review describes the various region-wise injuries sustained in cricket along with their epidemiology, biomechanics, treatment, and prevention.

Evidence Acquisition:

Data were collected from peer-reviewed articles (obtained via PubMed search) published through November 2016 that involved the medical, biomechanical, and epidemiological aspects of cricket injuries.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Cricket was one of the first sports to publish recommended methods for injury surveillance in 2005 from England, South Africa, Australia, the West Indies, and India. While the incidence of injuries is about the same, the prevalence of injuries has increased due to game format changes, increasing number of matches played, and decreased rest between matches. Bowling (41.3%), fielding, and wicket keeping (28.6%) account for most injuries. Acute injuries are most common (64%-76%), followed by acute-on-chronic (16%-22.8%) and chronic ones (8%-22%). The most common modern-day cricket injury is hamstring strain, and the most severe is lumbar stress fracture in young fast bowlers.

Conclusion:

With improved understanding of the scientific and medical aspects of cricket, along with advances in surgical and nonsurgical treatment techniques, the time to return to play has shortened considerably. While the prevalence of cricket injuries has increased, their severity has decreased over the past decades.

ACUTE TEARING OF THE OBLIQUE ABDOMINAL WALL INSERTION ONTO THE ILIAC CREST IN AN AUSTRALIAN FOOTBALL PLAYER: A CASE REPORT

BACKGROUND

Tears of the abdominal obliques have previously been reported in the vicinity of the lower ribs but they have not been reported in the vicinity of the iliac crest. The purpose of this case report is to describe the mechanism of injury and diagnosis of a distal abdominal oblique tear and subsequent rehabilitation programming.

CASE DESCRIPTION

A 21-year-old male Australian football player experienced acute right-sided abdominal pain during a game while performing a commonly executed rotation skill. He was assessed clinically before being further examined with ultrasound and magnetic resonance imaging which revealed a rupture of the abdominal oblique wall at its insertion onto the iliac crest. The player then underwent a structured and graduated rehabilitation program with clear key performance indicators to optimize return to play and prevent recurrence.

OUTCOMES

The player was able to return to play at 35 days post injury and had no recurrence or complications at 12 month follow up post injury.

DISCUSSION

This is the first time an abdominal oblique wall rupture at its insertion onto the iliac crest has been reported. In players with acute abdominal pain following twisting an insertional oblique tear should be considered as a differential diagnosis. A structured rehabilitation program may also help optimize an athlete's return to play after distal abdominal oblique rupture.

Side strain in sport: a narrative review of pathomechanics, diagnosis, imaging and management for the clinician

OBJECTIVES

To provide an overview of the published literature on epidemiology, pathomechanics and risk factors for side strain injury in sport, complemented by clinical perspectives of diagnosis and management strategies that are not covered in the literature.

DESIGN

Narrative review METHODS: A review of the literature was completed with all studies on side strain up until October 2015 included. As the studies were unable to be synthesised the findings were placed in a clinical context. As there were no papers on the management of side strain a clinical perspective from cricket was included.

RESULTS

Literature on side strain in sport is sparse with only nine papers dedicated to the injury. These comprise epidemiology, case studies, small case series and clinical reviews on imaging, injection and surgery. The epidemiology demonstrates that side strain is most commonly associated with cricket and baseball. Side strain typically occurs acutely mostly on the side contralateral to the dominant arm in athletes. Diagnosis is clinical with consistent imaging features that typically demonstrate a tear of the internal oblique from the lower ribs. Recovery periods can be prolonged and recurrence may occur. There has been no research on the management of side strain and the relationship between clinical assessment and imaging findings and time to return to play or risk of recurrence.

CONCLUSIONS

Side strain injury is prevalent in cricket and baseball. Recovery is extended and recurrence may occur. Incidence appears to be increasing. Knowledge on side strain is limited.

Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance

The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries.

Uncommon external abdominal oblique muscle strain in a professional soccer player: a case report

BACKGROUND

This is the first report of external abdominal oblique muscle injury occurring in a professional soccer player.

CASE PRESENTATION

A 28-year-old Caucasian professional soccer player presented after experiencing a popping sensation associated with strong parietal pain localized between the left 11th and 12th ribs. Ultrasound examination revealed a collection of fluid under the 11th rib, suggesting injury of the left external oblique muscle. Platelet-rich plasma treatment was administered and the soccer player returned to competition on the 21st day after treatment.

CONCLUSION

This rare injury results from a sudden intrinsic eccentric contraction of the internal oblique muscle while in a stretched position. Ultrasound can help to confirm the diagnosis and to monitor clinical follow-up. Platelet-rich plasma treatment could aid recovery in high-level athletes.

Cricket injuries: an orthopaedist's perspective

A decade ago, cricket has traditionally been regarded as relatively injury free, although it has been classified as having a "moderate" injury risk. At present, cricket has evolved into shorter and more competitive versions involving greater aggression and often played for long periods of time. This has expectedly ensued in an increase in the number of cricketing injuries similar to those seen in other sports which involve running, throwing, or being hit by a hard object. However, there are some injuries to look out for especially in cricket players. In this article, we have reviewed information about cricket injuries that will help orthopaedists make the correct diagnoses and initiate appropriate treatment. Orthopaedic surgeons and physiotherapists should work as a team to detect treatable cricket injuries at an early stage and ensure that every precaution is taken to minimize the risks of injury.

Abdominal muscle strains in professional baseball: 1991-2010

BACKGROUND

The abdominal core muscles (internal and external oblique, rectus and transversus abdominis) play an important role in the baseball activities of pitching and hitting. Proper abdominal muscle activation during throwing and swinging is crucial for generating optimal ball velocity and bat speed. Abdominal muscle strains can result in substantial loss of playing time, and their incidence has never been reported in baseball.

HYPOTHESIS

The incidence of abdominal muscle strains in Major League Baseball has been rising over the past 20 years. Injuries contralateral to the dominant arm or batting side are more common and require more time to recover.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Abdominal muscle strains in baseball players were determined by retrospective review of the Major League Baseball disabled list from 1991 to 2010. Player age, position, dominant hand, batting side, and recovery time were recorded.

RESULTS

There were 393 abdominal muscle strains in Major League Baseball from 1991 to 2010, constituting 5% of all baseball injuries. At least 92% of these injuries were internal/external oblique or intercostal muscle strains, and 44% of injuries were sustained by pitchers. The reinjury rate was 12.1%. An upward trend was seen from 1991 to 2010, especially in early-season injuries, and the overall injury rate was 22% higher in the 2000s than in the 1990s. Pitchers averaged 35.4 days on the disabled list compared with 26.7 days for position players (P < .01); 78.1% of pitcher injuries were contralateral to their dominant arm, and 70.3% of position player injuries were contralateral to their dominant batting side (excluding switch hitters). Position players missed more time for contralateral than for ipsilateral injuries (28.9 vs 21.2 days, P = .03), whereas pitchers missed more time for ipsilateral injuries (44.5 vs 32.8 days, P = .04).

CONCLUSION

The incidence of abdominal muscle strains in baseball has been increasing over the past 20 years, especially early in the season, and there is a relatively high reinjury rate. This upward trend is in spite of new and more advanced diagnostic procedures, preventive core strengthening exercise programs, and rehabilitation techniques. Injuries contralateral to the dominant arm or batting side are more common.

Imaging and ultrasound-guided steroid injection of internal oblique muscle strains in baseball pitchers

BACKGROUND

Internal oblique muscle injuries are common in professional baseball pitchers and may require a prolonged convalescence of up to 10 weeks. Most strains can be diagnosed clinically, but imaging can be helpful to assess the severity of injury, which may predict recovery and return to play.

HYPOTHESIS

Ultrasound-guided injection of steroid and local anesthetic into the muscle tear can speed recovery and subsequent return to play.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Three professional baseball pitchers with acute tears of the internal oblique muscle confirmed by magnetic resonance imaging underwent ultrasound-guided injection of steroid and local anesthetic.

RESULTS

All 3 patients experienced significant pain relief within a few days of the injection and were able to pitch at full speed within 3 weeks of injury (mean, 21 days) and return to able status by 5 weeks (mean, 30.7 days). The 3 athletes continue to pitch in Major League Baseball 36 months, 36 months, and 14 months, respectively, after injury, and none have sustained reinjury during this time.

CONCLUSION

Therapeutic injection of steroids and anesthetic under ultrasound guidance appears to speed recovery and rehabilitation in professional baseball pitchers with acute side strains.

Muscle inflammation induces a protein kinase Cepsilon-dependent chronic-latent muscle pain

Skeletal muscle injuries can induce chronic pain, but the underlying mechanism is unknown. One possible cause has been suggested to be an increased sensitivity to inflammatory mediators. We demonstrate that self-limited inflammatory hyperalgesia induced by intramuscular carrageenan (lasting approximately 5 days) results in a state of chronic-latent hyperalgesia, revealed by injection of prostaglandin E(2) (PGE(2)) 10 days after carrageenan at the same site. In carrageenan-pretreated muscle, PGE(2) produced hyperalgesia that was unattenuated even 14 days after injection, markedly longer than the 4-hour hyperalgesia induced by PGE(2) in naive rats. This chronic-latent hyperalgesia was reversed as well as prevented by spinal intrathecal injection of oligodeoxynucleotide antisense to protein kinase Cepsilon, a second messenger implicated in long-lasting plasticity in cutaneous nociceptors.

PERSPECTIVE

We describe a novel experimental model for chronic muscle pain, produced by mild acute muscle inflammation, that has clinical significance since it has the potential to reveal cellular processes by which acute inflammation or muscle trauma underlies chronic muscle pain.

Rib impingement in first class cricketers: case reports of two patients who underwent rib resection

Two first class cricket bowlers presented with costoiliac pain secondary to rib impingement. In both patients, conservative management of the injury had failed to improve symptoms. Surgical resection of the affected rib was undertaken. At follow up, both patients had made a good recovery and had returned to competitive cricket.

Uncommon abdominal muscle injury in a tennis player: internal oblique strain

The case of a strain injury of the internal oblique abdominal muscle in a professional tennis player is presented. This uncommon lesion resulted from eccentric, unbalanced trunk rotation. Magnetic resonance imaging helped to confirm the diagnosis. Tennis specific core strengthening is crucial for rehabilitation and recurrence prevention.