Delayed onset muscle soreness (DOMS)

Case contributed by Daniel Martin
Diagnosis almost certain


Pain in left upper limb after intense sports effort 48 hours previously. Swelling at the level of the right brachial biceps.

Patient Data

Age: 40 years
Gender: Female



Right brachial biceps and brachialis muscle increased in echogenicity and volume compared to the contralateral arm with alteration of the normal ehcotexture. No sonographic signs of muscle rupture or deep vein thrombosis.

Case Discussion

Delayed onset muscle soreness (DOMS) manifests as pain after the practice of intense and lasting predominantly eccentric muscular exercise. The pain resolves quickly and muscle strength is preserved.

The lesion is located in the Z lines of the sarcomere. 

In severe cases of DOMS, the CK-NAC is elevated. Our patient presented an increase in muscle enzymes (CK-NAC: 39147 U/L) without kidney damage.

Imaging findings are:

  • ultrasound (US): usually US findings are normal. Severe cases (as in our patient) may have ultrasound changes such as:
    • loss of normal muscle structure
    • diffuse increase in echogenicity
    • increased muscle volume
  • MRI: marked diffuse edema in the injured muscle groups can persist up to 3-4 weeks

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