(精品) 临床骨骼肌肉学-软组织损伤课件

– Muscle Fibrosis (fibrous tissue in muscle) • Incomplete healing and overuse (Sports related) • Loss of blood flow (muscle necrosis)
– Myositis Ossificans 骨化性肌炎 • Bone being produced in the muscles
• Tendonitis • Tenosynovitis 肌腱滑膜炎
– Inflammation of synovium that surrounds a tendon
• Tenovaginitis 腱鞘炎
– Inflammation / Thickening of Fibrous Wall of the Tendon Sheath
• Tests
– Method 1 (Cozen’s test) • Therapist - stabilize elbow • Patient - make a fist - pronate forearm - radially deviate & extend wrist • Therapist - resist motion
elongation
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Soft Tissue Injuries / Damage
• Causesof Injury andDamage:
– External Forces • Strain (Lengthening) and Compressive Injury • Lacerations
– Internal Events • Contractures 挛缩 • Inflammations - “-titis” • Degeneration / Remodeling
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Contents
Soft tissue components Soft tissue injury Soft tissue treatment Practice
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Soft tissue components
• Soft Tissue Structures:
– Ligaments 韧带 – Tendons 肌腱 – Muscles – Nerves – Cartilage 软骨 – Facia 筋膜 – Skin – Fat – Synovial membranes 滑膜 – blood vessels
• Causes
– Extrinsic extensors at their origin – Extensor carpi radialis brevis is most commonly involved
– Lateral epicondyle 肱骨外上髁炎或桡侧腕短伸肌肌腱损伤
• Problems
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Golf elbow (Medial epicondylitis)
•Cumulative trauma disorders (CTD)
– Tennis elbow (TE) – Golf elbow – DeQuervain’s disease – Carpal Tunnel Syndrome (CTS)
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Cumulative trauma disorders 累积性 创伤
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Muscle Injury/Damage
•Muscle Tears:
– Quick / Unexpected Joint Motion • Joint Motion in Opposite Direction of
Concentric Muscle Contraction • Joint Suddenly Displaced when muscle not
with one another
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Soft tissue properties
• Response to Stretch:
The length changed: Tendon ＞ Ligament ＞ Blood vessels ＞ Nerve etc. • Nerve: little plasticity • Blood vessels: flow stops with about 15%
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Ligament Injury / Damage
•Causes
–Excessively stretched, or torn ligaments e.g. contact sports
When a force applied against the knee and the foot cannot move, ligament injuries are likely to occur
•Overuse syndrome • Repetitive strain injury •Causes
– Micro-trauma results from cumulative effect of repetitive stress on tissues – After long hours of repetitive use in unusual positions
commonly involved – Medial epicondyle
• Problems
– Pain – Pain with resisted wrist flexion & pronation – Tenderness & swelling –Tenderness & swelling – Reduced strength
• S &S
– Diffused & poorly localized pain – Swelling in muscle bellies & at musculo-tendinous
junction / muscle origin – Weakness
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Cumulative trauma disorders 累积性 创伤
• Possibly pathological ie. Rheumatoid Arthritis
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TendonInjury/Damage
• Tendon Entrapments
– Thickened Tendon, Narrowed Sheath – Adhesions
• Due to Infections / Immobilization
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Golf elbow (Medial epicondylitis)
• Small tears • Causes bleeding and the development of granules and calcium in the tissues • Collagen can leak out, cause inflammation aament Injury/Damage
•Causes
– During Pregnancy • Increase laxity → May cause subluxation /
dislocation of joints – Maturation / Aging • Collagen content decreases • Gradual decline in the mechanical properties – Immobilization • Decrease tensile张力 strength - ↓ ability of
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TendonInjury/Damage
•Maturation / Aging:
– Same as for Ligaments – Decrease Collagen / Strength
•Immobilization
– Same as for Ligaments –Contracture / Decrease Stiffness and Strength
？what role the patients may have? 网球运动员、家庭主妇、砖瓦工、木工 → wrist extension
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Golf elbow (Medial epicondylitis)
• Causes
–Extrinsic flexors at their origin – Flexor carpi radialis is most
– Method 2 • Patient - pronate forearm - flex wrist fully - extend elbow
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Tennis elbow ( l a t e r a l epicondylitis)
• Other assessment
– pain level – functional limitation – habits – work station
• Biomechanical deficits
–Muscular weakness –Inflexibility – Scar tissue
• Early treatment • Debates
– Related to work???
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Tennis elbow ( l a t e r a l epicondylitis)
– Pain / Swelling / Soft tissue tenderness • Secondary to fracture/trauma
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CommonConditions
•Muscle tear •Joint subluxation/dislocation • Tendoninjury •Nerve cut/palsy
– Pain – Tenderness & swelling – Reduced strength in gripping objects, heavy lifting, forearm rotation – Functional problems?