Joan Vives

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

Latissimus dorsi costal tear in an elite handball player.

Few articles have reported a latissimus dorsi muscle injury, and all of the injuries reported were located in the humeral insertion of the muscle. We present a rare case of latissimus dorsi rupture at the level of the lateral chest area in an elite handball player. Imaging techniques such as sonography and magnetic resonance imaging allow accurate diagnosis and can prove useful in case management decisions. Fast and accurate diagnosis of muscular lesions in semiprofessional and professional athletes enables better treatment and better recovery of these injuries as well as a reduced reinjury risk.1 A 24-year-old man who plays professional handball in an elite national team felt sudden pain in the lateral region of his right rib midline during a jump with a forward eccentric arm movement while throwing the ball. During this movement, his arm and shoulder made an internal rotation below the level of the head with anteversion and adduction, with the aim of creating a marked effect on the ball. At the moment of release, the player felt the acute pain in the area corresponding to his rib cage. Physical examination revealed pain and tenderness in the lateral right rib region without any loss of motion. A deformity appeared quickly in the right anterolateral costal region, right in the area of pain, resembling a pseudotumor (Figure 1A). Sonography was performed 48 hours after the injury, and a 3-cm-wide fibrillar defect distant from the rib area of the latissimus dorsi insertion was observed. This rupture produced proximal retraction of 3 cm and a small well-demarcated fluid collection over the lateral aspect of the costal arches (Figure 1B). Magnetic resonance imaging (Figure 1C) was performed 5 days after sonography and showed extensive disruption of muscle fibers in the thickness of the latissimus dorsi muscle in its central and anterior aspects about 2 cm above the inferior angle of the scapula. The space between both ends of the rupture was filled with a subacute blood collection. Nondisrupted muscle fibers were evident peripheral to the rupture. Additional sonographic examinations showed spontaneous resorption of the hematoma and fibrillar rupture repair, leaving a stump-shaped deformity in the lateral right rib area of the latissimus dorsi muscle mass. One week after the injury, the patient started isometric contractions; after 15 days, he started isotonic contractions; and at 21 days, his joint muscular balance became normal. One month after the injury, he began gradually reintroducing sporting activities. Two months after the injury, he returned to perform full sports training with his team. As of this writing, he was asymptomatic and at full sporting performance. The latissimus dorsi is a broad and thin muscle that spans a large portion of the lower back. It originates in the last 6 thoracic vertebrae and lumbodorsal fascia, through