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Complications of Muscle Injury

Scar tissue formation
Muscle fibers that have been overloaded with resultant bleeding and rupture become less contractile. The space between ruptured muscle fiber ends fills with blood which clots and is gradually replaced by connective tissue. The formation of scar tissue may leave the muscle with areas of varying elasticity; further injury (rupture or hematoma) may then occur if the muscle is exercised too hard, too soon. If scar tissue causes persistent problems it may be necessary to remove it surgically; this, however, is not common.
Traumatic myositis ossificans (‘charley horse’, heterotopic bone formation)

If immediate treatment is inadequate, a deeply located  intramuscularhematoma may gradually become calcified and ossified. Ossification continues as long as healing is disrupted by repeated impact or
contraction. This will result in areas of varying strength and elasticity in the affected muscle, and an increased risk of further injury. Ossification is a lengthy inflammatory process for which doctors hesitate to recommend active treatment for a long period. If muscle function and flexibility are significantly impaired for more than 6–10 weeks and X-rays reveal ossification, then surgical removal of the ossification should be considered. Return to sport is possible after 8–10 weeks.

Misdiagnosis of tumor
Complete muscle ruptures can sometimes be misinterpreted and diagnosed as tumors during their later stages. A mass may be found which increases gradually in size. A thorough clinical examination is essential if the correct diagnosis is to be made. The following sequence of events is typical. The adductor longus muscle is located on the inner (medial) side of the thigh and its function is to draw the leg inwards (adduction); it originates in the pubic bone and is inserted into the femur. Partial rupture usually affects its origin, and complete rupture its insertion. The latter may occur without pain and without causing any major problems. Gradually, however, an enlarging
lump in the thigh becomes more noticeable. It may be mistaken for a tumor, but in fact is caused by an increase in muscle bulk. The original muscle, having shortened following rupture, is forced to work over a shorter distance, and therefore harder than previously, when a new insertion is formed by scar tissue. The diagnosis of ‘old total rupture of adductor longus’ is not difficult to make, provided examination takes place with the muscle in both the relaxed and the contracted states.

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