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Trauma can cause bleeding and eventually scar tissue, which has been found to cause the bending

J Inherit.Metab Dis 2008;31(4):503-507

They received instructions to swallow it three times a day ( three capsules of 1 g each), after main meals, recording daily the quantity of capsules ingested on a specific form named Participants daily card. For each return visit to the site of research, aiming to receive, the participants answered to an adherence form, filled out by the pharmacist, immediately after medical appointment

Nevertheless, the combination of L-leucine, creatine, and L-Carnitine potentiated the development of muscle mass and increased strength in older adults supplemented with the L-Carnitine-combination product, likely through a common mechanism, such as promoting increase protein synthesis, increasing branched amino acid bioavailability, and decreasing protein degradation [43]