muscle hernia
Introduction
Introduction to tendon Myocele refers to a kind of sputum formed by muscle tissue through the defect or weakness of the fascia sheath. It is rare in clinical practice, and it occurs in the calf. Most tendons are below 0.6cm, sometimes multiple. Sexual or bilateral. The symptoms are mild and disappear after rest or at rest, often overlooked or missed. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling
Cause
Tendon cause
(1) Causes of the disease
Lower extremity local myofascial dysplasia due to dysplasia, surgical injury or trauma, long-term chronic strain, etc., make the lower limb fascia defect or weakening is the pathological basis of this disease, the increase of local muscle pressure in the lower extremities is the cause of the disease.
(two) pathogenesis
1. Myofascial defects or weak common myofascial defects or weak reasons are as follows:
(1) Under normal circumstances, there are normal, physiological defects or weak areas in the muscle fascia. When the muscle pressure is increased, the muscles will be exuded. For example, the superficial temporal nerve is emitted from the lateral side of the sacral neck. , walking down the humerus long, between the short muscles, the terminal branch through the fascia at the junction of the lower third of the calf becomes a cutaneous branch, resulting in local defects or weakness, the calf tendon can be pulled out, muscles Fascia nerve outlets can cause nerve damage, compression, and then a series of symptoms.
(2) Surgical injury or sharp cutting can cause muscle damage and rupture of the fascia. For example, when the debridement is sutured, only the skin is sutured. When the muscle is swollen and the pressure is increased, it can bulge out of the fascia. For example, blunt injury or Fractures can damage muscles and puncture the fascia. As the muscles swell, the pressure increases and the tendon bulges out to form tendons.
(3) strenuous exercise or strong physical labor, uncoordinated movement or excessive load, and incorrect posture of the ground, unstable limbs and other factors, so that the muscles of the lower limbs are extremely contracted, resulting in damage to the muscle structure. Contraction, the epicardium is longitudinally torn, forming a gap, so that the muscle bulges from the epicardial space, and the invagination, a small amount of oozing, secondary edema, exudation and other traumatic inflammatory reactions and peripheral muscles can occur. .
(4) Long-term chronic injury makes the lower limb fascia weak or ruptured.
(5) The fascia itself causes a weak fascia in a certain part.
2. Increased muscle pressure
(1) After intense muscle exercise or excessive activity, local metabolism is enhanced, blood oxygen concentration is lowered, metabolite accumulation, microcirculation exudation is increased, interstitial fluid is increased, muscle can be swollen and hypertrophied; however, fascial wall is limited. The expansion of the hypertrophic muscle increases the pressure of the muscle compartment, which in turn causes the muscle to protrude from the weak or defective part to form the tendon.
(2) Trauma, surgery or muscle disease itself can cause muscle swelling, increased pressure, and bulging from the weak or fascia of the fascia to form tendons.
In recent years, it has been suggested that tendon is a compensatory manifestation of chronic myofascial compartment syndrome. Zhang et al. also found that in the chronic calf myofascial compartment syndrome, nearly half of the patients had tendon.
Prevention
Tendon prevention
Lower extremity local myofascial dysplasia due to dysplasia, surgical injury or trauma, long-term chronic strain, etc., is the pathological basis of the disease. The increase of local muscle pressure in the lower extremities is the cause of the disease. The main prevention is to pay attention to the surgery to be disinfected. Take care to prevent accidents from happening. Pay attention to rest to avoid fatigue, actively prevent chronic strain, and pay attention to the bad habits of smoking and drinking.
Complication
Tendon complications Complications swelling
Localized mass, mass of soft mass can disappear, generally less than 0.6cm, when the muscle contraction, the volume of the mass shrinks or disappears, the edge of the defect fascia can be touched sharply, and the muscle below the oval is not thickened. When the fascia is directly attacked or surgically incision, a large tendon that may have a large tendon is often not retractable. When the muscle is relaxed, it usually does not bulge, and when the muscle contracts, it can be obviously bulged. The patient's lower limbs are fatigued.
Symptom
Tendon symptoms Common symptoms Fatigue congestion edema
Most patients develop severe physical activity, physical exertion or trauma, and are mostly in the anterior muscle of the calf.
Pain
Under normal circumstances, the pain is not heavy. When the muscle is invaded by the fascia and ankle ring, localized congestion, edema, and other aseptic inflammation may cause localized pain. For example, muscle pressure is high, and the fascia ring is indented after sputum. The muscles that are released cannot be retracted, and inflammatory exudation and swelling may occur. If the compression time is too long, muscle ischemia may occur, but muscle necrosis generally does not occur.
2. Localized mass
The soft mass of the mass can disappear, generally less than 0.6cm. When the muscle contracts, the volume of the mass shrinks or disappears, and the edge of the defect fascia can be sharpened, oval, and the muscles below it are not thickened, and the fascia is directly hit. Or large tendon may occur after surgical incision. Large tendons are often not retractable. When the muscles are relaxed, they usually do not swell, and when the muscles contract, they can obviously bulge.
3. The patient's lower limbs are fatigued.
Examine
Tendon examination
Ultrasound examination can clearly show the structure of each layer and the echo of the fascia, and suggest the size of the fistula, whether there is exudate in the fascia, etc., can eliminate the hematoma, and provide a reliable basis for clinical diagnosis and treatment.
Diagnosis
Diagnosis of tendon diagnosis
Diagnostic criteria
1. Most patients have a history of trauma.
2. The anterior aspect of the calf or the outside of the thigh has a mass. The mass is soft, hemispherical, clear, and has certain elasticity. When the muscle contracts, it disappears and becomes smaller, and it can reach the oval and the sharp edge fascia defect.
3. Diagnostic puncture is negative.
4. Ultrasonography can assist in clinical diagnosis.
Differential diagnosis
1. Varicose veins of the lower extremities, aneurysms
Multiple tendons need to be differentiated from varicose veins and aneurysms in the lower extremities. The varicose veins of the lower extremities are not related to trauma. The lower extremity masses become smaller or disappear, and the diagnostic puncture can be identified. The aneurysms have fluctuations and vascular murmurs.
2. Cold abscess
Patients with cold abscess often have a history of tuberculosis, and the swelling of the mass can be identified.
3. ganglion cyst
It occurs in the tendon, the tendon sheath, and the muscle does not shrink or disappear when it contracts, which can be identified.
4. Lipoma
The mass is subcutaneous, soft, lobulated, active, and can be identified without becoming smaller or disappearing with muscle activity.
5. Other
In addition, it needs to be differentiated from muscle tear, tendon rupture, and hemangioma.
