Muscle injuries and additional disorders

6 min read

Strain

A strain is a tear, partial tear, overuse, or overstretching of a muscle or tendon. A strain can occur suddenly or over time. Hamstring and back muscle strains are common.

Acute strains occur when falling, jumping, or lifting heavy objects. Chronic strains occur with repetitive muscle movements, usually related to one’s job or during a sports activity. Poor condition, fatigue, failing to do warm-up exercises, environmental conditions (e.g., ice), and poor equipment are risk factors for strains. Signs and symptoms of strains include pain, swelling, and difficulty moving the affected muscle. With strains, muscle spasms may be felt.

During the examination, the provider will check the affected area and the range of motion. X-rays and MRI scans may be ordered to rule out other injuries. Treatment includes rest, ice (cold applications), compression (elastic wraps), and elevation (RICE) to help minimize the swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics may be taken. With severe strains, a brace or splint may be used to immobilize the area. Surgery may be done to repair a ruptured muscle. With treatment, the prognosis is good.

Tendinitis

Tendinitis is the inflammation of a tendon. It causes severe swelling of the tendon. Tendinitis occurs after repeated injury to a joint, such as the wrist or ankle. Some of the most common forms are named after the sports that increase their risk:

Tennis elbow (lateral epicondylitis): Causes pain in the forearm and wrist
Golfer’s elbow (medial epicondylitis): Causes pain in the inner forearm and numbness or tingling in the fingers

Tendinitis causes pain, tenderness, inflammation in the joint area, and a limited range of motion.

The provider will do an examination. In most cases, x-rays and other imaging procedures are not required unless the problem continues. Treatment consists of rest, splinting, heat and cold therapy, medications (NSAIDs, analgesics, and corticosteroid injections), and physical therapy.

Tetanus

Tetanus, also called “lockjaw,” is a serious condition that can lead to a medical emergency. Getting the tetanus vaccine can help prevent tetanus.

Tetanus is caused by Clostridium tetani bacteria. The spores from the Clostridium tetani bacteria are found in the soil, dust, manure, and saliva. Often, the spores enter the body through an injury, such as a deep cut, puncture wound, or eye injury. Once the spores enter the body, they develop into bacteria. Tetanus can cause painful muscle stiffness throughout the body, jaw cramping, headaches, seizures, fever, sweating, and vital sign changes (e.g., blood pressure and pulse). A person can have trouble opening her or his mouth and swallowing.

The provider performs an exam. No diagnostic tests exist to confirm tetanus. Treatment includes hospitalization, human tetanus immune globulin (TIG), medications to manage the muscle spasms, tetanus vaccine, and antibiotics. The more severe the case of tetanus, the poorer the prognosis. For those that survive tetanus, recovery may take up to 4 months.

Exam tip: Tetanus is diagnosed clinically - there’s no confirmatory lab test. Human tetanus immune globulin (TIG) gives immediate, short-term passive immunity, while the tetanus vaccine builds longer-term active immunity.

Torticollis

Torticollis occurs when the neck muscles spasm. This causes the head to tilt, lean forward or backward, or be rotated.

Torticollis can be genetic. In infants, it can be caused by birth trauma or a spinal abnormality. In adults, it can be caused by poor posture, insufficient head support while sleeping, or neck injury or infection. Torticollis causes neck spasms, tremors, headache, neck pain, and swelling and stiffness of the neck muscles. The range of motion for the head can be limited. One shoulder may be higher than the other shoulder.

After an examination, the provider may order an x-ray or CT scan. Treatment for torticollis present at birth involves passive stretching of the shortened neck muscle. Depending on the cause, treatment may involve heat and cold therapy, physical therapy, Botox injections, and surgery if other treatments fail.

Additional muscular system disorders

There are several other muscular system diseases:

Botulism: A rare but serious disease caused by Clostridium botulinum, which enters the body through contaminated food (e.g., honey, home-preserved/canned foods). The toxins cause muscle paralysis, leading to visual changes, slurred speech, and difficulty swallowing and breathing. Honey can carry Clostridium botulinum spores and should never be given to infants under one year old, since ingested spores cause infant botulism; foodborne botulism in older children and adults instead comes from preformed toxin in improperly home-canned or preserved foods.
Congenital myopathies: Rare congenital diseases that cause a lack of muscle tone and muscle weakness, cramps, and contractions, along with delayed motor skills, facial weakness, and drooping eyelids.
Dermatomyositis (DM): Affects people of all ages and is most common in women. Symptoms start with a rash on the face, chest, or extremities, followed by muscle weakness.
Endocrine myopathies: Caused by abnormal thyroid gland activity; they lead to weakness, atrophy, stiffness, cramps, and slowed reflexes.
Ganglion cyst: A benign round or oval lump that develops in the wrist, hand, ankle, or foot. The cyst is filled with a jelly-like fluid and develops along the tendons or joints. These cysts are painless unless they put pressure on a nearby nerve. Then, the person may experience tenderness, weakness, numbness, tingling, or pain in the affected area.
Muscle atrophy: The loss or wasting of muscle tissue. Physiologic atrophy occurs when muscles are not used enough, muscle tissue is lost. People who are bedridden or have conditions that cause limited movement (e.g., casts, strokes) are at risk for muscle atrophy. Pathologic atrophy is seen with starvation, long-term corticosteroid use, and aging. Neurogenic atrophy is caused by an injury (e.g., spinal cord injury) or disease of a nerve that connects with a muscle (e.g., amyotrophic lateral sclerosis and polio).
Muscular dystrophy: A group of inherited disorders that cause progressive muscle weakness and wasting. Duchenne muscular dystrophy is the most common form seen in childhood; it affects boys and typically presents with frequent falls, difficulty running, and progressive muscle weakness. Markedly elevated creatine kinase (CK) levels are a hallmark lab finding.
Myositis: Inflammation of the muscles caused by an injury, infection, or an autoimmune disease.
Shin splints: Cause pain in the front of the lower leg due to overuse of the leg muscles, tendons, or tibia. They are the result of inflammation of the bone tissue, tendons, and muscles around the tibia.

Exam tip: Don’t confuse the types of muscle atrophy. Physiologic atrophy comes from disuse (bed rest, casting), while neurogenic atrophy comes from nerve damage or disease (e.g., ALS, polio) - the muscle itself is fine, but it’s no longer getting a nerve signal. A patient with ALS who is losing muscle mass has neurogenic atrophy, not physiologic atrophy.

Next | 14.7 Introduction and skeletal system conditions

Muscle injuries and additional disorders

Strain

A strain is a tear, partial tear, overuse, or overstretching of a muscle or tendon. A strain can occur suddenly or over time. Hamstring and back muscle strains are common.

Tendinitis

Tennis elbow (lateral epicondylitis): Causes pain in the forearm and wrist
Golfer’s elbow (medial epicondylitis): Causes pain in the inner forearm and numbness or tingling in the fingers

Tendinitis causes pain, tenderness, inflammation in the joint area, and a limited range of motion.

Tetanus

Tetanus, also called “lockjaw,” is a serious condition that can lead to a medical emergency. Getting the tetanus vaccine can help prevent tetanus.

Torticollis

Torticollis occurs when the neck muscles spasm. This causes the head to tilt, lean forward or backward, or be rotated.

Additional muscular system disorders

There are several other muscular system diseases:

Botulism: A rare but serious disease caused by Clostridium botulinum, which enters the body through contaminated food (e.g., honey, home-preserved/canned foods). The toxins cause muscle paralysis, leading to visual changes, slurred speech, and difficulty swallowing and breathing. Honey can carry Clostridium botulinum spores and should never be given to infants under one year old, since ingested spores cause infant botulism; foodborne botulism in older children and adults instead comes from preformed toxin in improperly home-canned or preserved foods.
Congenital myopathies: Rare congenital diseases that cause a lack of muscle tone and muscle weakness, cramps, and contractions, along with delayed motor skills, facial weakness, and drooping eyelids.
Dermatomyositis (DM): Affects people of all ages and is most common in women. Symptoms start with a rash on the face, chest, or extremities, followed by muscle weakness.
Endocrine myopathies: Caused by abnormal thyroid gland activity; they lead to weakness, atrophy, stiffness, cramps, and slowed reflexes.
Ganglion cyst: A benign round or oval lump that develops in the wrist, hand, ankle, or foot. The cyst is filled with a jelly-like fluid and develops along the tendons or joints. These cysts are painless unless they put pressure on a nearby nerve. Then, the person may experience tenderness, weakness, numbness, tingling, or pain in the affected area.
Muscle atrophy: The loss or wasting of muscle tissue. Physiologic atrophy occurs when muscles are not used enough, muscle tissue is lost. People who are bedridden or have conditions that cause limited movement (e.g., casts, strokes) are at risk for muscle atrophy. Pathologic atrophy is seen with starvation, long-term corticosteroid use, and aging. Neurogenic atrophy is caused by an injury (e.g., spinal cord injury) or disease of a nerve that connects with a muscle (e.g., amyotrophic lateral sclerosis and polio).
Muscular dystrophy: A group of inherited disorders that cause progressive muscle weakness and wasting. Duchenne muscular dystrophy is the most common form seen in childhood; it affects boys and typically presents with frequent falls, difficulty running, and progressive muscle weakness. Markedly elevated creatine kinase (CK) levels are a hallmark lab finding.
Myositis: Inflammation of the muscles caused by an injury, infection, or an autoimmune disease.
Shin splints: Cause pain in the front of the lower leg due to overuse of the leg muscles, tendons, or tibia. They are the result of inflammation of the bone tissue, tendons, and muscles around the tibia.

Strain

A strain is a tear, partial tear, overuse, or overstretching of a muscle or tendon. A strain can occur suddenly or over time. Hamstring and back muscle strains are common.

Tendinitis

Tennis elbow (lateral epicondylitis): Causes pain in the forearm and wrist
Golfer’s elbow (medial epicondylitis): Causes pain in the inner forearm and numbness or tingling in the fingers

Tendinitis causes pain, tenderness, inflammation in the joint area, and a limited range of motion.

Tetanus

Tetanus, also called “lockjaw,” is a serious condition that can lead to a medical emergency. Getting the tetanus vaccine can help prevent tetanus.

Torticollis

Torticollis occurs when the neck muscles spasm. This causes the head to tilt, lean forward or backward, or be rotated.

Additional muscular system disorders

There are several other muscular system diseases:

Botulism: A rare but serious disease caused by Clostridium botulinum, which enters the body through contaminated food (e.g., honey, home-preserved/canned foods). The toxins cause muscle paralysis, leading to visual changes, slurred speech, and difficulty swallowing and breathing. Honey can carry Clostridium botulinum spores and should never be given to infants under one year old, since ingested spores cause infant botulism; foodborne botulism in older children and adults instead comes from preformed toxin in improperly home-canned or preserved foods.
Congenital myopathies: Rare congenital diseases that cause a lack of muscle tone and muscle weakness, cramps, and contractions, along with delayed motor skills, facial weakness, and drooping eyelids.
Dermatomyositis (DM): Affects people of all ages and is most common in women. Symptoms start with a rash on the face, chest, or extremities, followed by muscle weakness.
Endocrine myopathies: Caused by abnormal thyroid gland activity; they lead to weakness, atrophy, stiffness, cramps, and slowed reflexes.
Ganglion cyst: A benign round or oval lump that develops in the wrist, hand, ankle, or foot. The cyst is filled with a jelly-like fluid and develops along the tendons or joints. These cysts are painless unless they put pressure on a nearby nerve. Then, the person may experience tenderness, weakness, numbness, tingling, or pain in the affected area.
Muscle atrophy: The loss or wasting of muscle tissue. Physiologic atrophy occurs when muscles are not used enough, muscle tissue is lost. People who are bedridden or have conditions that cause limited movement (e.g., casts, strokes) are at risk for muscle atrophy. Pathologic atrophy is seen with starvation, long-term corticosteroid use, and aging. Neurogenic atrophy is caused by an injury (e.g., spinal cord injury) or disease of a nerve that connects with a muscle (e.g., amyotrophic lateral sclerosis and polio).
Muscular dystrophy: A group of inherited disorders that cause progressive muscle weakness and wasting. Duchenne muscular dystrophy is the most common form seen in childhood; it affects boys and typically presents with frequent falls, difficulty running, and progressive muscle weakness. Markedly elevated creatine kinase (CK) levels are a hallmark lab finding.
Myositis: Inflammation of the muscles caused by an injury, infection, or an autoimmune disease.
Shin splints: Cause pain in the front of the lower leg due to overuse of the leg muscles, tendons, or tibia. They are the result of inflammation of the bone tissue, tendons, and muscles around the tibia.