Soft Tissue Injuries - PDF

Orthopaedic Approach to Soft Tissue( muscle,tendon ligament) Doç.Dr.Samet Erinç İstanbul Aydin University Orthopaedic and Tarumatology department • Muscle Types • Skelatal Muscles (striated muscle) • Cardiac Muscle(miyocard - ınvoluntary striated muscle) • Smooth Muscles (involuntary) • Muscle...

Orthopaedic Approach to Soft Tissue( muscle,tendon ligament) Doç.Dr.Samet Erinç İstanbul Aydin University Orthopaedic and Tarumatology department • Muscle Types • Skelatal Muscles (striated muscle) • Cardiac Muscle(miyocard - ınvoluntary striated muscle) • Smooth Muscles (involuntary) • Muscle properties • Excitability- ability to respond to stımulu • Contractibility • Extensibility-ability of a muscle to be stretched • Elasticity- ability to return normal shape • Skletal Muscle • more than 600 • Adults %40 body weight • Childs %50 body weight • Skeletal Muscle consist • %75 water • % 20 protein • % 5 organic ve inorganic components Muscle Structure • Endomisium • Muscle fiber • Perimisium • Muscle fasicule • Epimisium • Outher surface muscle • Skeletal Muscle Fibrils • One muscle fibril, one muscle cell • Cylindrical shape • Excitablity membrane • Consist myofibrils bundle • Multinuclear structures • Glycogen storage Fibril Basic Components • Sarkolemma: muscle cell membrane • Sarkoplazma: Cytoplasm of the muscle cell • Sarkotübüler sistem: • Transvers tube (T-tubes) • Sarkoplazmik retinaculum • Ca++ uptake, regulation, • Myoflamants • Conctractil part of the muscle cell • Functional unit of the muscle contraction • Consist of myoflaments • Thin filaments (aktin) • Thick filaments (myozin) • Both consiist many sarcomers Sarcomer • Main unit of the contractibility • Distance between Z-Z line • Consist contractile units • Actin ( Thin filaments) • Miyosin (Thick filaments) • Troponin-tropomiyosin compund (over actin filaments) Muscle pathology 1-Traumatic ınjuries 2-Neurogical muscle diseases not inside muscle pathology 4-metabolic-systemic muscle diseases 5-Tumors •Muscle Injuries •Delayed Onset Muscle Sorenes(DOMS) •Contuusion •Compartman Syndrome •Miyositis ossificans •Muscle Strain •Facial Tear DELAYED ONSET MUSCLE SORENESS= DOMS • Delayed Muscle Pain • Usually 24-48 hour later sportive activity • No any trauma history • Pain between 1-10 score • Agonist-Antagonist coordination reflex not works CONTUSiON: •Usually after contact sportive activity •Direct trauma to muscle or extremity •Mostly pain is the major complaint is ther only musle injury o footprint injury if foot[rint patint cant move the sepcific thing if only muscle injury u can move but very painful •Moderate contusion consist muscle hematoma •Not easy to distinguish muscle tear with severe contusion Traumatic Myositis Ossificans: •Bone formation in the muscle tissue •After muscle ınjury • Continue to sevre sportive activity, muscle injury and u dont rest nor use nsaid nor use ice u willl get ossification inside musle that looks likke bone tissue • Massage to the ınjured region • Hot-pack application, • Had ınjury same region will increase the risk of myositis ossificans • Most complaint soft tissue swelling with pain • With time sweling and pain decrease in myosistis ossificans Compartman Syndrome • • • • • Bone, İnterosseoz membran, Fascia Neurovascular structures Closed anatomical areas MUSCLE-STRAIN Tumors Of The Muscle 1-LEİYOMYOSARKOMA in adults mostly 2-RABDOMYOSARKOMA (mostky seen ın children) • LİGAMENTS Function: Restrict the joint movement Stabilisation of the Joint Help the proprioseption with mechanoreceptors varsus and vagus is a ligemnt thing Extracelluler components • Water • Tip I kollajen (% 70 of dry weight) • Elastin • Lipids • Proteoglıcans Cell • Main cell type fibroblast • Both tendons and ligaments has low vascularity and cellularity •Adhesion Types •indirect (fibrous insertion) • Mostly • Sharpey fibers • MCL •direct (fibrocartilaginous insertion) • Zone 1 (tendon or ligament proper) • Zone 2 (fibrocartilage) • Zone 3 (mineralized fibrocartilage) • Zone 4 (bone) •Ligaments Injuries • Grade I • Mild-sprain • Grade II grade 1 and 2 mostly consrvative treatmant • Moderate-sprain/partial tear • Grade III • Tear TENDONS Tendon Functions; 1- Help to joint movement, joint stability 2- Help to body posture 3- Help to position of the muscle Endotenon ile ayrılmış ve Epitenon tarafından çevrelenmiş kollajen demetleri (fasiküller) grupları Structure; btw in bone type 1 coolgen is moslty • Water • Type I collagen, % 85 of dry weight, • Type III collagen, % 0-5 of the dry weight • Proteoglıcans % 0-5’ of the dry weight Decorin mostly seen proteoglican of the tendons •Tendon Bone Transition 1.Tendon 2.Uncalcified fibrocartilage 3.Calcified fibrocartilage 4.Bone •Tendon İnjuries • Grade I • Edema and degeneration • Grade II • Partial tear • Grade III • Tear