MUSCLES, SURGICAL DISEASES OF. Strain and Rupture.
What is usually termed a "sprain" signifies an undue stretching of the mus cular fibres or their tendinous extrem ities. It may vary in severity from a slight overextension to absolute rupture. The rupture in severe cases may be par tial or complete, the latter being more likely to occur in long-bellied muscles. Rupture of the fibres is often attended by an audible snap, and gives rise to in stant pain, which may become excruciat ing in severe injuries,—the coup de fowl of French authors; the patient finds it impossible to perform movements in volving the use of the injured muscle. If the tear be marked and near the sur face a gap in the tissues may sometimes be felt, corresponding to the ecchyinosis, or fluctuating extravasation of blood, of which the injured region is the seat. When the rupture occurs at the knee, marked effusion of the joint soon follows, as in rupture of the quadriceps tendon at its insertion into the patella. When an abdominal muscle is the seat of rupture a ventral hernia may be developed.
Etiology.—Subcutaneous rupture only occurs when the muscle is submitted to the disintegrating action of great force, or when, through the influence of age or infectious general diseases (particularly rheumatoid arthritis, typhoid fever, etc.), the muscular and fibrous tissues have undergone some process of degeneration. tinder such circumstances spontaneous rupture may occur under the influence of slight muscular exertion,—indeed, with out any violence, sometimes, through the muscles' own contractile force. Thus, the rectus abdominis may be ruptured during labor merely through its own contractions. Tendons, especially the tendo Achillis, often give way when per sons of advanced age jump or dance.
Treatment. — Moderately severe in juries tend to recover without complica tions under appropriate measures. The torn ends should, as much as possible, be held in apposition by immobilizing the part in a position wherein the injured muscle or tendon is completely relaxed. New tissue is developed between the sep arated ends. At first the new tissues are adherent to adjoining structures, but the adhesions are gradually stretched and ab sorbed when the patient resumes the use of the muscle. Rupture of the temlo Achillis, for instance, is best treated by inunobilizing the leg in the fixed posi tion; a collar around the thigh serves for the attachment of a cord the other end of which is attached to the heel of a soft slipper; rupture of a thigh-muscle, on the contrary, requires full extension of the limb in a splint, etc. The parts should be given absolute rest hy the avoidance of all motion, runl slight com pression should be exercised upon them by means of a bandage. When the rupt ure occurs in healthy muscle, it may sometimes be necessary, to hasten the re covery or to prevent a long sojourn in .3 (1.1.11r.o.r( practite in aged sub- I ; t,. xfts, the parts tinder strict ' rk cautions. uniting the sep --..,-1 l.v suturks.
Hernia of Muscle.—Soinetimes the r slo ath ( rlying the muscle, - • (al. and a portion of the mus i!ukl,s. During its contraction • - Ines (specially marked, and an . t tumor is formed. The 7.. .1. cf the thiLdi and abdomen are •....-t roil( to this condition, especially -
;r rv(rcurtion too soon after the injnry void(d. Healed fascia under ! •- .-ir( mustanccs may also be torn w.
ular hernia may readily be recog z.,;(d bv the fact that it disappears or prominent according to the r..ximitv of the contraction imposed sit ,n tl_e muscle by motion.
TI:EATNIENT.—Rest and well-adjusted rt --Bre with £1 hernial bandage are usu ally suircient in recent cases. When h di-comfort is caused, or the hernia - at. ell rim, the skin should be incised a! I tl.e cdgcs of the torn fascia be fresh . n. I an I united with catgut sutures.
Ossification, ..alized strains, when repeated, ? n.c-inps give rise to local inflammation, tin.: in oss-ification of a part of •.t, mu- le. The "rider's bone" is an n-ian .e rf this complication which is n_lly observed in persons who do ,f1 lir rseback-riding. The process of takes place in the adductor lirre, but it may occur in any r.. •.! submitted to undue mechanical ? n. When located in a superficial ;,„'.e the "bone" may usually be de Tr.r•ril by pressure, but when deep seated is not recognized during life. Ossifica T.-n may also be due to syphilis. (See a'zr. MYO'ITIS 0:iSIFICANS under Mus (1.17F, DISEA;EF..• OF ) T It EATMENT.—TlIC bony growth does not occasion serious discomfort in the majority of cases, but at times it gives rise not only to local pains, but also. to impairment of the functions of the af fected muscle. It should then be re moved surgically, all Milder methods be ing futile.
31uscular Dislocation.
Dislocation of muscles and tendons are occasionally observed, when laceration of the fascia, synovial sheaths and vio lence concur to cause them to slip over the bony prominence. Dislocation of the peronei muscles over the external mal leolus may thus occur during severe wrenches or sprains. The long tendon of the biceps may also be displaced from its groove. The extensor tendons of the wrist are especially prone to this diffi culty. Considerable pain and inability to use the affected limb are at once ex perienced, and the use of the limb is more or less compromised until reduc tion is effected.
TnE.A.TmENT.—In recent cases reduc tion of the displaced structure is easily effected by,' relaxing the muscle and ma nipulating the member according to the nature and direction of the dislocation. Thus, in dislocation of the peronei, ro tating the foot outward is indicated; a retentive bandage is then applied and kept until complete recovery is obtained. When the tendon will not remain in situ, the groove in which it lies may be deep ened by exposing the bone and gouging it subperiostcally, as recommended by Albert.
Wounds of Muscles.
Subcutaneous, incised, or lacerated wounds of muscles are frequently met with, especially the latter. T_Tnder mod ern asepsis, unless the loss of tissue be very great or the supply of arteries anti nerves be seriously injured (when gan grene is apt to occur), resolution usually occurs promptly in small wounds through regeneration of muscular tissue, and in extensive ones through cicatricial con nective-tissue formation. The functions of the injured muscle are often restored under circumstances that would seem to preclude all hope.