Chapter 10. Soft tissue injury

General principles of diagnosis and treatment

Muscle lesions can be open or closed. Diagnosis of open injuries does not present any particular difficulties: they are detected during the initial examination and primary surgical treatment; at the same time, the integrity of the muscles is restored by stitching them with separate U-shaped and interrupted sutures. After the surgery, immobilization is carried out with a plaster cast in the position of apposing attachment points of the restored muscle.

Closed muscle injuries are more difficult to diagnose. They occur because of direct action of a blunt trauma or are the result of a sharp muscle tension. The rupture occurs in the muscle belly or more often at the place of its transition to the tendon, which is facilitated by degenerative changes in muscle tissue in people over 30 years old.

On the upper limb, the biceps, supraspinatus, triceps muscles of the shoulder and forearm muscles are most often damaged, on the lower limb - the calf, quadriceps, and adductor muscles of the thighs. However, in practice, injuries of a wide variety of muscles are known: abdominal (direct and external oblique), large thoracic, scapular, deltoid, long plantar, etc.

Clinical manifestations depend on the severity of the injury.

In case of partial rapture of muscle (parts of its fibers), main complaint is the pain in the area of damage (usually moderate), aggravated by muscle tension. Temporary loss of muscle function and strength is observed. In the area of damage, swelling, hematoma, local soreness is determined. However, as a rule, there is no impaction. Impaction or bulging does not appear even during muscle tension.

For complete rupture of muscle, pain syndrome is very intensive. There is a complete loss of muscle function, which is sometimes camouflaged by the work of synergists. In the area of the rupture, a large hematoma is determined. An "impaction" can be palpated in the place of rupture, which increases with muscle tension. At the same time, there is swelling, especially in cases of a rupture in the zone of transition of the muscle to the tendon.

Radiography sometimes reveals the separation of bone fragments at the site of muscle attachment. In difficult cases, ultrasound, MRI, electromyography help to establish a diagnosis.

In case of partial muscle rupture, conservative treatment is carried out: immobilization with a soft elastic bandage, on a functional splint, or with a plaster cast in the position of relaxation of the injured muscle for 2-4 weeks. Physiotherapy is prescribed, and after removing the bandage - TE.

In cases of complete rupture or detachment of the muscle, surgical treatment is indicated. If the muscle belly is damaged, the muscle is sutured with U-shaped and interrupted sutures. In case of rupture at the place of transition to the tendon part, the muscle is stratified, and the severed tendon is sewn into it. After the operation, a plaster cast is applied for 4-6 weeks in the position of apposing attachment places of the damaged muscle. In the post-immobilization period, a gradually increasing load, TE, physiotherapy treatment (PTT) are recommended (Table 10.1).

Table 10.1. Diagnosis and treatment of closed muscle rupture

The most frequent localizations of damage

Damage of quadriceps muscle of thigh

The rupture of the quadriceps of thigh along its entire length most often occurs with the hitting of tense muscle accompanied by sharp pain, sometimes crunching. Throughout the muscle, swelling, hematoma, sometimes impaction limited by bulging under tension are determined (Fig. 10.1).

Fig. 10.1. Deformation at the rupture of the femoral quadriceps

The function of extension of the lower leg is impaired in varying degrees. However, the strength of extension is always reduced, which is most easily detected when the lower leg is extended with resistance or when descending a ladder. At the same time, the pain at the site of the rupture increases sharply.

Partial rupture of the fibers is treated conservatively by imposing a long plaster cast or orthosis with the grasp of the knee joint for 4-6 weeks, PTT. In the post-immobilization period, therapeutic exercises (TE) is prescribed, gradually increasing the load.

Complete ruptures, which are rare, are treated surgically: the damaged muscle is sutured with U-shaped and interrupted sutures. Immobilization with a plaster splint for 6 weeks.

Injuries to the biceps and adductor muscles of the thigh

Damage to the femoral biceps and adductor muscles (sartorius, semitendinosus and semimembranosus) most often occurs as a result of their forced tension during resistance (for example, when jumping, running). Local pain is noted in the area of injury aggravated by stress; hematoma, soreness are also observed.

Partial ruptures are treated conservatively: immobilization for 3-4 weeks, PTT, followed by TE. Complete ruptures, which are much less common in young people, are treated promptly according to the general rules: stitching with subsequent immobilization.