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Side Strain: A Tear of Internal Oblique Musculature

David A. Connell1, Ash Jhamb and Trefor James

1 All authors: MRI Department, Victoria House Hospital, 316 Malvern Rd., Prahran, Victoria 3181, Australia.



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  		Fig. 1A. —Normal anatomy of anterolateral abdominal wall. Diagram shows internal oblique muscle arising from iliac crest and inserting into lower fourth rib under cover of external oblique muscle.

 


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  		Fig. 1B. —Normal anatomy of anterolateral abdominal wall. Diagram of coronal section through abdominal wall shows three flat muscles. Internal oblique muscle lies immediately underneath ribs.

 


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  		Fig. 2A. —Normal anatomy in 21-year-old volunteer. Surface marker has been placed over region of clinical concern and axial fast spin-echo image (TR/TE, 4,000/30) has been obtained. External oblique muscle (open arrow) lies superficial to internal oblique muscle (solid arrow). Sagittal oblique muscle scans are plotted from axial image.

 


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  		Fig. 2B. —Normal anatomy in 21-year-old volunteer. Sagittal oblique muscle fast spin-echo image (4,000/30) shows external oblique muscle (asterisk) running downward and forward from 11th rib and costal cartilage (arrow).

 


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  		Fig. 2C. —Normal anatomy in 21-year-old volunteer. Sagittal oblique muscle image (4,000/30) of slice adjacent to that shown in B shows internal oblique muscle (asterisk) passing upward and forward (small arrows) to insert into 11th rib (large arrow). These fibers run almost perpendicular to external oblique muscle (star).

 


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  		Fig. 3A. —23-year-old male javelin thrower with point tenderness and pain during competition. Axial STIR image (TR/TE, 5,300/38; inversion time, 120 msec) shows increased signal (solid arrow) around 10th rib (open arrow) corresponding to clinical site of tenderness.

 


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  		Fig. 3B. —23-year-old male javelin thrower with point tenderness and pain during competition. Sagittal oblique muscle STIR image (5,300/38; inversion time, 120 msec) shows high signal where internal oblique muscle arises from undersurface of 10th rib (arrow). Hematoma tracks along muscle fibers of internal oblique muscle (asterisk).

 


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  		Fig. 4A. —33-year-old male cricketer with bowling injury. Axial STIR image (TR/TE, 5,300/38; inversion time, 120 msec) identifies site of tear of internal oblique muscle (open arrow) with hematoma tracking between internal and external oblique muscles (solid arrows).

 


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  		Fig. 4B. —33-year-old male cricketer with bowling injury. Sagittal oblique muscle STIR image (5,300/38; inversion time, 120 msec) shows periosteal stripping (arrows) and hematoma filling defect (beneath rib).

 


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  		Fig. 4C. —33-year-old male cricketer with bowling injury. Axial fast spin-echo image (400/30) obtained 3 months after B shows hypertrophied mass of scar tissue (arrow) that was subsequently resected at surgery.

 


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  		Fig. 5A. —31-year-old male cricket bowler with onset of chest wall pain after completing bowling action. Sagittal oblique muscle fast spin-echo image (TR/TE, 4,000/30) shows detachment of internal oblique muscle fibers (short arrows) from undersurface of left 11th costal cartilage (long straight arrow). Hematoma fills defect created by detachment (open arrow). External oblique (asterisk) is shown.

 


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  		Fig. 5B. —31-year-old male cricket bowler with onset of chest wall pain after completing bowling action. Sagittal oblique muscle STIR image (5,300/38; inversion time, 120 msec) shows defect (open arrow) and hematoma tracking into internal oblique muscle (solid arrow).

 

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