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. 2022 Jan 20;57(1):1–13. doi: 10.1055/s-0041-1731417

Table 1. Summary of 17 currently existing muscle classification models, divided between systems based on clinical and imaging findings, systems based on image evaluation, and systems based on clinical presentation 11 .

1. Classifications based on clinical and imaging findings
Author Description
Lopes, A. 1993. Classification based on etiology and ultrasound findings
Type I: muscle injury caused by extrinsic factors: muscle contusion
Type II: muscle injury caused by intrinsic factors without muscle rupture
Type III: muscle injury caused by intrinsic factors with muscle rupture
Verrall, J. 2003. Clinical parameters Image findings - MRI Classification of the lesion
Beginning Insidious Abrupt
Circumstance Playing Training Positive Negative
Pain (0–10) visual analog scale
Malliaropoulos, N. 2010. Clinical Grade - ROM Deficit Image findings (US)
I < 10 th Degree
0 to 3
(based on Peetrons)
Injury area:
II 10 th –19 th < 25%
III 20 th –29 th 25–50%
IV > 30 th > 50%
Pollock, N. 15 (British athletics muscle injury classification) Degree of injury Description MRI
Grade 0: referred pain
0a Local pain Normal
0b Generalized muscle pain normal or with signs of delayed pain
Grade 1: small muscle injuries (< 5 cm or < 10% of total muscle area)
1a Fascial pain Intermuscular fluid
1b Muscle or JMT pain Intermuscular fluid
Grade 2: moderate muscle injuries (5–15 cm or 10–50% of total muscle area)
2a Fascial pain high perspherical signal
2b Muscle or JMT pain high signal in JMT
2c Tendon pain high sign on tendon
Grade 3: extensive muscle injuries (> 15 cm or > 50% of total muscle area)
3a Fascial pain high perspherical signal
3b Muscle or JMT pain high signal in JMT
3c Tendon pain high sign on tendon
Grade 4: complete muscle injuries
4a Fascial pain high perspherical signal
4b Muscle or JMT pain high signal in JMT
4c Tendon pain high sign on tendon
Mueller-Wohlfahrt, H. 8 (The Munich consensus statment) A. Indirect muscle injury
Functional muscle injury
Type 1: Overload-related muscle disorder
 Type 1A: Fatigue-induced muscle disorder
 Type 1B: Late-onset muscle pain (DMIT)
Type 2: Neuromuscular disorder
 Type 2A: Related to the spine
 Type 2B: Related to muscles
Structural muscle injury
Type 3: Partial muscle injury
 Type 3A: Minimal partial muscle injury
 Type 3B: Moderate partial muscle injury
Type 4: Injury (sub)total
 Subtotal or complete muscle injury
 Tendinous avulsion
B. Direct muscle injury
   Bruise
 Laceration
Maffulli, N. 16 - Direct muscle injury
  Bruise
 Laceration
- Indirect muscle injury
Nonstructural muscle injury
Type 1: Fatigue muscle injury
 Type 1A: Fatigue-induced muscle disorder
 Type 1B: Late-onset muscle pain (DMIT)
Type 2: Neuromuscular disorder
 Type 2A: Related to the spine
 Type 2B: Related to muscles
- Indirect muscle injury
Structural muscle injury
Type 3: Partial muscle injury
 Type 3A: Minimal partial muscle injury
 Type 3B: Moderate partial muscle injury (< 50%)
Type 4: Injury (sub)total
 Subtotal or complete muscle injury
 Tendinous avulsion
Structural lesions can be proximal (P), middle (M), and distal (D)
Valle, X. 7 Clinical findings
Injury mechanism (M) Location of the lesion (L) Degree of injury (G) Rescan number (R)
T - Direct lesion of the hamstrings P Lesion located in the proximal third of the muscle belly
M Lesion located in the middle third of the muscular belly
D Lesion located in the third of the muscular belly
0–3 0: 1 st episode
1 s t reinjury
2: 2 nd reinjury
I - Indirect injury of the hamstrings, plus index s if it is by stretching (stretching), or index p if it is run. P Lesion located in the proximal third of the muscle belly. The second letter is index p or d, describing whether the lesion is proximal or distal to JMT, respectively
M Lesion located in the middle third of the muscle belly, plus the corresponding index
D Lesion located in the middle third of the muscle belly, plus the corresponding index
0–3
N - Negative MRI injury N p Lesion in the proximal third
N m Injury in the middle third
N d Lesion in the distal third
0–3
Magnetic resonance findings
Grade 0 Negative MRI
Grade 1 Hyperintense muscle fiber edema without intramuscular hemorrhage or change in architecture
Grade 2 Hyperintense edema of muscle fiber and/or paratendon with minimal intramuscular hemorrhage without gaps or minimal alteration in muscle architecture.
Grade 3 Any gap between muscle fibers in the craniocaudal or axial plane. Hyperintense focal defect with partial retraction of muscle fibers ± intermuscular hemorrhage.
(r) code overwrite Used when there is intratendinous injury or affecting JMT or intramuscular injury with retraction or loss of normal tension.
2. Classifications based on image findings
Pomeranz, S. 1993. MRI assessment
Muscle group involved Injury area Location Superficial Involvement
Semimembranosus < 50% Tendineous Yes
Semitendinosus > 50% JMT No
Femoris biceps Total
Femoris square
Takebayashi, S. 12 US findings
Type 1 Normal
Type 2 Hyperecoic infiltration
Type 3 Mass
Type 4 Complete lesion (Infiltration + mass)
Peetrons, P. 13 US findings
Grade 0 Normal
Grade 1 Hyperecoic area, < 15 mm on the longest axis; < 5% of muscle.
Grade 2 5–50% of muscle. Partial muscle rupture.
Grade 3 Complete muscle or fascia injury, with collection extravasation from the injured muscle.
Slavotinek, J. 2002. MRI image of hamstring injury
Affected muscle Location Total area of the lesion
Femoris biceps Proximal to short biceps head 0–100%
Semitendinosus Distal to short biceps head
Semimembranosus
Bordalo-Rodrigues, M. 2005 MRI image of Proximal Rectus Femoris - anatomical location
Avulsion injury of the apophysis
Musculotendinous junction injury (JMT)
Muscle contusion and laceration
Cohen, S. 2011. MRI-based graduation system
Item Description 0 points 1 point 2 points 3 points
1 N° of muscles involved No 1 2 3
2 Location Proximal Middle Distal
3 Insertion No Yes
4 Total area of injury in % of the muscle involved 0% 25% 50% ≥ 75%
5 Retraction No > 2 cm
6 Longitudinal axis involvement 0 cm 1–5 cm 6–10 cm > 10 cm
Chan, O. 2012 Graduation based on imaging findings and lesion site
Degree MRI US Local
I (distension) < 5% fiber rupture; Normal; without distortion of architecture . Proximal to JMT
II (Partial loom) < 5% fiber rupture; high intramuscular signal; edema and bleeding of the muscle or JMT extending to the fascial planes between the muscle groups Discontinuity of muscle fibers Muscle
A. Proximal B. Medium
C. Distal
III (Complete loom) Complete discontinuity of muscle fibers, hematoma, and muscle retraction Comparable with MRI Distal to JMT
Corazza, A. 2013. Combined US-MRI assessment
Degree MRI US
0 No pathological findings No pathological findings
I Muscle edema without tissue alteration Altered echotexture at the site of pain, without rupture
Ii Partial muscle injury Lesion with associated hematoma
Iii Complete muscle injury Complete muscle injury
3. Classifications based on clinical findings
Bass, A. 1969. Classifies muscle injuries by etiology and location
Type Etiology Location
I Direct external contact Intramuscular
Ii Twitch Intermuscular
Wise, D. 1977 Classification based on cause, severity, and location of leg muscle injury
Indirect lesions - inflammation
Direct injuries - trauma
Degree Pain Circumference difference Arc of motion During contraction
Pain Loss of strength Function disorder
I Minimum; < 6 mm 100% Minimum No Moderate
Ii Substantial 6–12 mm 50% Middle Middle Important
Iii Intractable > 12 mm <5 0% Serious almost total Don't step

Abbreviations: JMT, myotendinous junction; MRI, magnectic resonance imaging; US, ultrasound.