From the Guidelines
Muscle strains are typically classified into three grades based on severity, with Grade 1 being mild, Grade 2 moderate, and Grade 3-4 severe, as outlined in the management of myositis alone, where Grade 1 involves mild weakness with or without pain, Grade 2 involves moderate weakness limiting age-appropriate instrumental ADL, and Grade 3-4 involves severe weakness limiting self-care ADL 1.
Grades of Muscle Strain
The grading of muscle strains is crucial for determining the appropriate management and treatment plan. The grades are as follows:
- Grade 1: Mild weakness with or without pain, where the patient may continue with immune checkpoint inhibitor therapy (ICPi) and may be offered oral corticosteroids, starting with prednisone at 0.5 mg/kg/day, and analgesia with acetaminophen or NSAIDs for myalgia if there are no contraindications 1.
- Grade 2: Moderate weakness with or without pain limiting age-appropriate instrumental ADL, where ICPi is held temporarily and may be resumed upon symptom control, and the patient may be initiated on prednisone or equivalent at 0.5-1 mg/kg/d, with referral to a rheumatologist or neurologist 1.
- Grade 3-4: Severe weakness with or without pain; limiting self-care ADL, where ICPi is held, and the patient is considered for hospitalization, urgent referral to a rheumatologist and/or neurologist, and initiation of prednisone 1 mg/kg/d or equivalent, with consideration of other immunosuppressant therapy including biologics, TNFa, or IL-6 antagonists if symptoms worsen or if no improvement after 2 weeks 1.
Management and Treatment
The management and treatment of muscle strains vary based on the grade of the strain. For Grade 1, the patient may continue with ICPi and may be offered oral corticosteroids and analgesia. For Grade 2, ICPi is held temporarily, and the patient may be initiated on prednisone or equivalent, with referral to a rheumatologist or neurologist. For Grade 3-4, ICPi is held, and the patient is considered for hospitalization, urgent referral to a rheumatologist and/or neurologist, and initiation of prednisone 1 mg/kg/d or equivalent, with consideration of other immunosuppressant therapy. The grading system helps healthcare providers determine appropriate treatment plans and recovery timelines based on the extent of muscle damage, with the goal of minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Grades of Muscle Strain
- Muscle strain is typically classified into three grades, although the provided studies do not explicitly mention these grades 2.
- The general understanding of muscle strain grades is as follows:
- Grade 1: Mild strain with minimal muscle damage
- Grade 2: Moderate strain with more significant muscle damage
- Grade 3: Severe strain with substantial muscle damage
- The study on muscle strain injury diagnosis and treatment mentions that the long-term outcome after muscle strain injury is usually excellent, and complications are few 2.
- However, the provided studies do not offer a detailed classification of muscle strain grades or their corresponding treatment protocols 3, 4.
Treatment and Management
- Initial treatment for muscle strain typically consists of rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy 2.
- As pain and swelling subside, physical therapy should be initiated to restore flexibility and strength 2.
- Avoiding excessive fatigue and performing adequate warm-up before intense exercise may help prevent muscle strain injury 2.
- The use of muscle relaxants may vary for the treatment of acute and chronic pain, but the provided studies do not specifically address their use in muscle strain treatment 4.