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In recent years, different classifications for muscle injuries have been proposed based on the topographic location of the injury within the bone-tendon-muscle chain. We hereby propose that in addition to the topographic classification of muscle injuries, a histoarchitectonic (description of the damage to connective tissue structures) definition of the injury be included within the nomenclature. Thus, the nomenclature should focus not only on the macroscopic anatomy but also on the histoarchitectonic features of the injury.

Background: Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. Purpose: To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective review of 7 elite athletes with posterior thigh pain (3 dancers, 2 soccer players, 1 tae kwon do player, 1 tennis player). In all athletes, the injury occurred during thigh adduction with the hip internally rotated, as clearly evident at ultrasound scans performed 1 to 20 days after the injury. Management included an initial rest period, followed by physiotherapy and gradual return to sports activities. Results: According to the ultrasound scans, the lesions were in the proximal-middle third junction of the thigh, at the muscle-tendon junction. The lesions were classified as grade 2 (partial discontinuity). The muscle injury area was, on average, 17.1 × 23.7 mm (range, 10-31 × 9-46 mm). The average length of the lesions was 40.14 mm (range, 20-52 mm). All athletes recovered and returned to full performance within 6 weeks of the injury (average, 35.6 days). Conclusion: Medial thigh pain after eccentric contraction during hip adduction should raise suspicion of a gracilis muscle tear. Ultrasound is useful, and full recovery occurs within 6 weeks from the injury.

In recent years, different classifications of muscle injury have been proposed based on topographic location within the bone-tendon-muscle chain.1,3,4,7 Furthermore, because the degree and level of extracellular matrix (ECM) involvement might vary greatly, we propose to include histoarchitectural considerations in the gross anatomic description of muscle injuries.

Background: There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal. Purpose: The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players—the carpal boss. Study Design: Case series; Level of evidence, 4. Methods: Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player. Results: Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip. Conclusion: Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.