Fasciitis
Introduction
Introduction to fasciitis Fasciitis refers to the aseptic inflammation of muscles and fascia. When the body is stimulated by external factors such as cold, fatigue, trauma or improper sleeping position, it can induce acute exacerbation of muscle fasciitis, shoulder and neck and waist. Acute or chronic injury or strain of muscles, ligaments, and joint capsules is the basic cause of the disease. Some patients can be relieved by resting symptoms. Hot compresses and massages can dissipate nodules, and the closure of pain nodules is also quite effective, but the exercise of the psoas may be the most important. A few patients with stubborn symptoms, long-term treatment of patients need surgery, surgery can be found in the local fascia with fissures, fat from the cracks, which is the clinically involved nodules. Fat adheres to surrounding tissues including the fascia and adjacent cutaneous nerve branches, which may be the cause of pain. Surgery should remove nodules, repair fascia, separate adhesions and remove cutaneous nerves. The effect is often good, but because of the often multiple lesions, surgery can only solve one symptom, so surgical indications should still be strictly controlled. basic knowledge The proportion of illness: 0.0065% Susceptible people: no special people Mode of infection: non-infectious Complications: pleural effusion, pericardial effusion, synovitis
Cause
Cause of fasciitis
The environment is humid (25%):
A damp and cold climate is one of the most common causes. Wet and cold can cause vasoconstriction of the lower back muscles, ischemia and edema cause local fiber slurry to exude, eventually forming fibrositis, and chronic strain is another important factor. In the lower back muscles, fibrotic changes occur after the fascia is damaged, so that the soft tissue is in a high tension state. As a result, tiny tearing damage occurs, and finally, fibrous tissue is increased and contracted, and local capillaries and peripheral nerves are compressed. Other muscle allergies such as viral infections and rheumatism are all causes.
Long-term exercise (30%):
Frequent long walks include hiking, hiking, shopping, and other activities. After a few days of continuous walking, it is easy to cause chronic damage to the soles of the feet, leading to plantar fasciitis. In addition, the heel is too hard to cause compression on the heel, which can also cause plantar fasciitis. Wearing high heels often increases the damage to the soles of the feet.
Pathogen infection (15%):
Necrotizing fasciitis is a rare and serious soft tissue infection that is different from streptococcal necrosis and is often a mixed infection of many bacteria. Pathogenic bacteria include Gram-positive hemolytic streptococcus, Staphylococcus aureus, Gram-negative bacteria, and anaerobic bacteria. In the past, anaerobic bacteria were often not found due to the backward anaerobic culture technology. However, in recent years, it has been confirmed that anaerobic bacteria such as Bacteroides and Streptococcus pneumoniae and cocci are often one of the pathogens of this disease, but few are simply anaerobic. Bacterial infection.
Prevention
Fasciitis prevention
1. Remove the inducement of the disease, pay attention to hygiene, strengthen physical exercise to improve immunity and prevent infection.
2. Early diagnosis and early treatment, do not give up treatment easily when the disease is relieved.
Complication
Fasciitis complications Complications, pleural effusion, pericardial effusion, synovitis
This disease can cause joint contracture and dysfunction at the lesion. Pleural effusion, pericardial effusion, multi-joint synovitis, proteinuria, etc. can also occur. Can also be associated with aplastic anemia, thrombocytopenic purpura, periodic neutropenia, leukemia and so on.
Symptom
Symptoms of fasciitis Common symptoms Muscle spasm pain Muscle tone pain Muscle soreness Chest pain after chest and back pain
Muscular fasciitis is often manifested as pain at the site of the disease, mostly soreness and discomfort, muscle stiffness and stagnation, or a feeling of heavy pressure, sometimes with subcutaneous and degenerative myofascial and fibrous nodules. Symptoms worsen in the morning or in the weather and after the cold, and the pain is relieved after the activity, often repeated. In acute exacerbations, local muscle tension, paralysis, and limited activity.
Neck and shoulder muscle fasciitis
Wide neck and shoulder pain, soreness, heavy feeling, numbness, stiffness, limited mobility, can be released to the back and upper arms. The pain is persistent and can be aggravated by factors such as infection, fatigue, cold, and dampness. Physical examination of the neck muscle tension, tender points often in the spinous process and paraspinal paraspicious muscles, rhomboid muscles, etc., tenderness limitations, do not run along the nerves. The disease is slow and has a long course. X-rays are mostly negative results.
Eosinophilic fasciitis
Eosinophilic fasciitis is a disease characterized by diffuse swelling and hardening of the fascia. Therefore, it is advocated to use "sclerosing fasciitis". The disease is rare in the clinic.
Nodular fasciitis
Nodular fasciitis, also known as pseudosarcoma fasciitis, is a reactive, self-limiting, superficial fascia of nodular fibroblastic hyperplasia. The cause of the disease is unknown and may be related to trauma or infection.
Lumbar back muscle fasciitis
Low back muscle fasciitis refers to a series of clinical symptoms caused by edema, exudation and fibrosis of the fascia and muscle tissue of the lower back due to cold, damp and chronic strain. It is a non-specific change in the body's white fibrous tissue, such as fascia, sarcolemma, ligament, tendon, tendon sheath, periosteum and subcutaneous tissue. It is a pain that is common in the clinic and often overlooked or misdiagnosed.
Plantar fasciitis
Plantar fasciitis occurs when the muscles of the plantar are subjected to external force violence or long-term walking causes local muscle strain to cause local fascia inflammation, which is characterized by local pain and the heaviest walk. The most common symptom of plantar fasciitis is the pain and discomfort of the heel, and it is also the most common cause of heel pain. In general, the first step in pain when getting out of bed in the morning is most obvious. This is mainly because after a night's rest, the plantar fascia is no longer loaded and will be in a shorter state. Therefore, when the bed is stepped on the ground in the morning, a large and faster pulling of the plantar fascia is caused, which causes pain. However, after walking for a while, the plantar fascia will become looser and the symptoms will be relieved. However, if you walk too much, the number of times the plantar fascia is pulled is increasing, and the symptoms will reappear.
Examine
Examination of fasciitis
The following checks are possible to confirm the diagnosis:
1. Blood routine: Red blood cell and platelet counts can be slightly reduced, and eosinophils are increased in about 47.6% of cases.
2. ESR: About half of the patients have increased erythrocyte sedimentation rate. If hematologic disorders are complicated, the corresponding blood cell abnormalities and bone marrow abnormalities can be seen. Occasional proteinuria.
3. Blood biochemistry and immunological examination: ANA positive rate was 30.8%, anti-dsDNA antibody was 33.3% positive, RF36.4% positive, -globulin increased by 73.3%, IgG, IgA, IgM were 60%, 26.7%, 20 respectively % increased, CIC was 85.7% positive.
Histopathology: The current diagnosis of EF mainly depends on histopathological examination. The biopsy of the disease should reach the depth of the muscles and fascia. EF lesions are mainly in the fascia, which is characterized by collagen fibrosis, thickening and fibrosis. Collagen is transparent, hyalinized or homogenized, and there are focal lymphocytes, tissue cells and plasma cells infiltrated around the blood vessels. Eosinophil infiltration, visible vasodilation and hyperplasia. The hyperplastic collagen tissue in the fascia can extend into the subcutaneous fat leaflet interval, and some of the fat lobules are wrapped in the sclerotic lesion. It can also affect the underlying muscles, inflammation of superficial muscles occurs, and lymphocytes, plasma cells and eosinophils infiltrate around the blood vessels. In a few cases, the dermis may also have the above mild lesions; the epidermis is normal, and a few may have mild atrophy and basal pigment cells.
Direct immunofluorescence of the skin showed deposition of IgG and C3 in the fascia and muscle compartment. IgG and C3 were deposited around the blood vessels in the deep dermis and subcutaneous fat, and IgM deposition was observed at the junction of the dermis. But these changes are non-specific and do not help much in the diagnosis of EF. gM deposition. But these changes are non-specific and do not help much in the diagnosis of EF.
Diagnosis
Diagnosis and differentiation of fasciitis
It should be differentiated from the following conditions:
1. Scleroderma: Need to be differentiated from localized scleroderma and systemic scleroderma (apod type). Localized scleroderma is characterized by three stages of skin undergoing localized swelling, subsequent hardening, and finally atrophy. The skin texture of the skin hardening area disappears, the hair is absent, dry and sweat-free, and the touch is hard and tough. Systemic scleroderma (extremity type) begins with edematous swelling and hardening at the extremities and facial skin, while the hardening of the limbs is mostly stopped at the lower third of the elbow and knee joints, almost all of which have Raynaud's phenomenon. Peripheral telangiectasia and fingertip ulcers, often accompanied by visceral involvement, the most commonly involved organs are the esophagus and lungs, leading to weakened esophageal peristalsis, pulmonary interstitial fibrosis. Histopathological changes, whether localized or systemic scleroderma, are mainly in the dermis and epidermis.
2. Adult scleredema: often on the neck, later extended to the face, trunk, and finally involved in the limbs or not involved in the limbs. The range of damage is wide, the skin is hard and non-depressed, can not be lifted, and there are often infectious diseases and other infections before the disease. Histopathology showed thickening of the dermis, swelling and homogenization of collagen fibers, widening of the gap, and filling with an acidic mucopolysaccharide matrix.
3. Dermatomyositis: The muscles involve a wide range of symptoms and severe symptoms, and the scapula and the proximal limbs of the extremities are predominant. The upper eyelids have edematous purplish red spots and Gottron signs on the back of the hands and knuckles. Serum muscle enzymes such as CPK, LDH And AST and 24h creatinine excretion significantly increased.
