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Excessive Exercise by Gym Enthusiast Leading to Rhabdomyolysis: A Case Report |
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Utsavi Tejas Modi, Pramod Vaijnath Nagure, Vasudha Ravindra Nikam, Tejaskumar Bankimbabu Modi, Tejas Sudhakar Shetty 1. IIIrd Year Resident, Department of Radiodiagnosis, D. Y. Patil Medical College, Kolhapur, Maharashtra, India. 2. Senior Resident, Department of Radiodiagnosis, D. Y. Patil Medical College, Kolhapur, Maharashtra, India. 3. Associate Dean-Academic, Department of Anatomy, D. Y. Patil Medical College, Kolhapur, Maharashtra, India. 4. Senior Resident, Department of Radiodiagnosis, D. Y. Patil Medical College, Kolhapur, Maharashtra, India. 5. Ist Year Resident, Department of Radiodiagnosis, D. Y. Patil Medical College, Kolhapur, Maharashtra, India. |
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Correspondence Address : Dr. Utsavi Tejas Modi, IIIrd Year Resident, Department of Radiodiagnosis, D. Y. Patil Medical College, Kolhapur-416003, Maharashtra, India. E-mail: utsavimodi.05@gmail.com |
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| ABSTRACT |  | ||||||||||||||||
: Rhabdomyolysis is a rare condition characterised by muscle oedema and inflammation. Radiological imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in the diagnosis and management of patients with muscle injuries. Hereby, the authors present a case report of a 21-year-old male who recently joined a gym a month ago. After a recent upper body workout, he began experiencing vague pain around the posterior aspect of the entire right arm, radiating towards the shoulder and elbow. An MRI was performed to evaluate the musculature of the right arm and forearm. T2-weighted axial images revealed hyperintense signals within the long head of the triceps muscle. Short Tau Inversion Recovery (STIR) coronal and STIR axial sequences showed increased signal intensity in the short field of view sequences, consistent with the presence of subcutaneous inflammation. The patient was managed conservatively with anti-inflammatory medications. A follow-up scan after one month showed complete resolution of muscle oedema. The ability of MRI to accurately assess the degree and severity of muscle injury allows for appropriate treatment planning and monitoring of disease progression. In cases of suspected muscle injury, prompt radiological evaluation can facilitate early diagnosis and intervention, ultimately improving patient outcomes. | |||||||||||||||||
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| Keywords : Creatine phosphokinase, Exercise physiology, Follow-up scan, Muscle inflammation, Muscle oedema, Radiological imaging | |||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2024/71383.3014
Date of Submission: May 01, 2024 Date of Peer Review: Jun 12, 2024 Date of Acceptance: Aug 19, 2024 Date of Publishing: Sep 01, 2024 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: May 01, 2024 • Manual Googling: Aug 12, 2024 • iThenticate Software: Aug 17, 2024 (12%) Etymology: Author Origin Emendations: 6 |
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| Case Report |
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A 21-year-old male recently joined a gym a month ago. He regularly performs upper-limb and lower-limb workouts. After a recent upper body workout, he began experiencing vague pain around the posterior aspect of his entire right arm, radiating towards the shoulder and elbow. On clinical examination, mild diffuse tenderness was noted over the posterior aspect of the arm. Investigations revealed mildly elevated creatine phosphokinase levels, while blood parameters, including renal and hepatic parameters, were normal. An MRI was performed to evaluate the musculature of the right arm and forearm. T2-weighted axial images revealed hyperintense signals (Table/Fig 1) within the long head of the triceps muscle, indicative of muscle oedema and inflammation. Additionally, STIR coronal [Table/Fig-2a] and STIR axial [Table/Fig-2b] sequences showed increased signal intensity in the long head of the triceps, consistent with the presence of muscle oedema within the affected muscle compartment. These findings supported the diagnosis of rhabdomyolysis localised to the long head of the triceps muscle. PD fat-saturated axial and coronal (short FOV) views of the elbow joint showed a normal tendinous portion of the triceps muscle (Table/Fig 3)a,b. The MRI images of the right mid-arm showed a hyperintense signal on Proton Deficient (PD) fat-saturated axial and coronal {short Field of View (FOV)} views, indicative of subcutaneous oedema, while the rest of the elbow remained unremarkable [Table/Fig-4a,b]. The patient was then treated with anti-inflammatory drugs, specifically aceclofenac and paracetamol (100 mg+325 mg for 7 days), along with conservative treatment, including multivitamins (Tab Zincovit) for seven days. After a one-month follow-up, a scan showed complete resolution of muscle oedema (Table/Fig 5)a-d. | |||||||||||||||||
| Discussion |
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Rhabdomyolysis refers to the dissolution or disintegration of striated muscle. It results in the release of skeletal muscle cell constituents, including enzymes such as creatine kinase, lactate dehydrogenase, aldolase, and the heme pigment myoglobin, as well as electrolytes such as potassium, phosphates, and purines into the circulatory system (1),(2). Rhabdomyolysis can arise from a variety of causes, including alcohol, drugs, excessive muscle exercise, direct muscle injury, ischaemic injury, metabolic disorders, infections, heat stroke, inflammatory myopathies, or hereditary enzyme defects (Table/Fig 6) (3). The condition may lead to heart failure, arrhythmias, electrolyte imbalances, and serious complications such as renal failure, which can ultimately result in death (2). Symptoms of exercise-induced rhabdomyolysis resemble those of delayed onset muscle soreness, which can easily be overlooked. Despite its significance, rhabdomyolysis may go unnoticed by those who engage in physical activity (4). Weightlifters may experience rhabdomyolysis that is localised to their triceps and biceps muscles, the soleus muscle due to a lightning strike, or the bilateral adductor muscles in a hiker. For the early diagnosis of muscle injury, two diagnostic imaging techniques-ultrasonography and MRI- can be utilised. Compared to ultrasonography, MRI appears to be superior for diagnosing and predicting the outcomes of patients with muscle injuries (5). Radiological imaging, particularly MRI, plays a crucial role in evaluating rhabdomyolysis by providing detailed visualisation of muscle oedema, inflammation, and potential complications such as compartment syndrome. MRI measurements of lesion size, including height on longitudinal sections above the cross-sectional surface, may be useful in evaluating rhabdomyolysis (5). For these reasons, MRI is essential in confirming the diagnosis and assessing the extent of muscle involvement in rhabdomyolysis (6). Exertional Rhabdomyolysis (ER) is relatively rare; however, the consequences can be fatal, and therefore, appropriate treatment should be initiated to limit morbidity and mortality (7). In present case, MRI demonstrated characteristic findings of muscle involvement localised to the long head of the triceps muscle, aiding in the confirmation of the clinical diagnosis. The present patient was managed conservatively with anti-inflammatory medications and hydration. His renal parameters were monitored carefully and remained normal. The ability of MRI to accurately assess the extent and severity of muscle injury allows for appropriate treatment planning and monitoring of disease progression. Additionally, ultrasound may be utilised for real-time evaluation of muscle oedema and fluid collections, particularly in cases where MRI is contraindicated or unavailable. | |||||||||||||||||
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