Pathomorphological Changes after Intramuscular Injection: From Acute Needle Myopathy to Chronic Fibrous Contracture
Keywords:
intramuscular, muscle injury, needle myopathy, fibrosis, contracture, sciatic neuropathy, vaccine reactogenicityAbstract
Intramuscular (IM) injection is a ubiquitous procedure in clinical medicine, yet it induces a characteristic sequence of muscle and soft‑tissue pathomorphological changes that range from microscopic “needle myopathy” to disabling fibrous contractures.,,,, Experimental toxin models show that acute IM injury begins with myofiber necrosis, edema, and inflammatory cell influx, followed by activation of satellite cells and regeneration with central nucleation., In routine therapeutic injections, similar but usually milder lesions occur, with local myonecrosis and low‑grade inflammatory infiltrates even when normal saline is administered, and are amplified by myotoxic drugs such as local anesthetics, some NSAIDs, and certain biologics.,, Repeated or improperly sited injections can drive chronic fibrosis, collagen deposition, and muscle shortening, leading to gluteal or deltoid contractures, joint deformity, and occasionally nerve entrapment or sciatic injury.,,,, This review summarizes the temporal and structural spectrum of IM‑induced pathomorphology in skeletal muscle, subcutaneous tissue, and adjacent neurovascular structures, and compares acute necrotic–regenerative lesions with chronic fibrosing myopathy.
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