9.15 Muscle Strains and Tears
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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 distant 
    sites, where it does not imply additional 
    injury. Arrange for followup.

Discussion
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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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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