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Classification and grading of muscle injuries: a narrative review.

ABSTRACT: A limitation to the accurate study of muscle injuries and their management has been the lack of a uniform approach to the categorisation and grading of muscle injuries. The goal of this narrative review was to provide a framework from which to understand the historical progression of the classification and grading of muscle injuries. We reviewed the classification and grading of muscle injuries in the literature to critically illustrate the strengths, weaknesses, contradictions or controversies. A retrospective, citation-based methodology was applied to search for English language literature which evaluated or utilised a novel muscle classification or grading system. While there is an abundance of literature classifying and grading muscle injuries, it is predominantly expert opinion, and there remains little evidence relating any of the clinical or radiological features to an established pathology or clinical outcome. While the categorical grading of injury severity may have been a reasonable solution to a clinical challenge identified in the middle of the 20th century, it is time to recognise the complexity of the injury, cease trying to oversimplify it and to develop appropriately powered research projects to answer important questions.

SUBMITTER: Hamilton B

PROVIDER: S-EPMC4387470 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Classification and grading of muscle injuries: a narrative review.

Hamilton Bruce B Valle Xavier X Rodas Gil G Til Luis L Grive Ricard Pruna RP Rincon Josep Antoni Gutierrez JA Tol Johannes L JL

British journal of sports medicine 20141113 5

A limitation to the accurate study of muscle injuries and their management has been the lack of a uniform approach to the categorisation and grading of muscle injuries. The goal of this narrative review was to provide a framework from which to understand the historical progression of the classification and grading of muscle injuries. We reviewed the classification and grading of muscle injuries in the literature to critically illustrate the strengths, weaknesses, contradictions or controversies. ...[more]

PMID: 25394420

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Project description:OBJECTIVE: To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies. METHODS: Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system. RESULTS: The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type. CONCLUSIONS: A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature. WHAT ARE THE NEW THINGS: Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries. LEVEL OF EVIDENCE: Expert opinion, Level V.

Project description:[original title] Combined gene expression and genomic profiling define two intrinsic molecular subtypes of urothelial carcinoma and gene signatures for molecular grading and outcome. In the present investigation we sought to refine the classification of urothelial carcinoma by combining information on gene expression, genomic, and gene mutation levels. For these purposes we performed gene expression analysis of 144 carcinomas, and whole genome array-CGH analysis and mutation analyses of FGFR3, PIK3CA, KRAS, HRAS, NRAS, TP53, CDKN2A, and TSC1, in 103 of these cases. Hierarchical cluster analysis identified two intrinsic molecular subtypes, MS1 and MS2, which were validated and defined by the same set of genes in three independent bladder cancer data sets. The two subtypes differed with respect to gene expression and mutation profiles, as well as with the level of genomic instability. The data shows that genomic instability was the most distinguishing genomic feature of MS2 tumors, and that this trait was not dependent on TP53/MDM2 alterations. By combining molecular and pathological data it was possible to distinguish two molecular subtypes of Ta and T1 tumors, respectively. In addition, we define gene signatures validated in two independent data sets that classify urothelial carcinoma into low (G1/G2) and high grade (G3) tumors as well as non-muscle and muscle-invasive tumors with high precisions and sensitivities, suggesting molecular grading as a relevant complement to standard pathological grading. We also present a gene expression signature with independent prognostic impact on metastasis and disease specific survival. We conclude that the combination of molecular and histopathological classification systems may provide a strong improvement for bladder cancer classification and produce new insights into the development of this tumor type. 144 bladder cancer tumor samples and 12 normal samples were analyzed on 2-color cDNA or oligo microarrays using the Stratagene Universal Human Reference RNA as the common reference sample. 24 samples are hybridized to both the cDNA and oligo platform and these were used for merging of data from the two different gene expression platforms into a single expression matrix and for subsequent evaluation steps. The merged gene expression matrix used for analyses is supplied as a supplementary file (at the foot of this record). 103 of the samples were also analyzed on a BAC array containing ~32 000 BAC clones. Arrays were produced at the Swegene Centre for Integrative Biology at Lund University (SCIBLU).

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Classification and grading of muscle injuries: a narrative review.

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Classification and grading of muscle injuries: a narrative review.

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