骨科学——运动系统慢性损伤+骨肿瘤

,Chronic injury of Locomotor system and Bone tumor,Department of Orthopedic SurgeryShanghai Sixth People's Hospital,Congfeng Luo,Chronic injury of Locomotor system,Classification,Soft tissue injury Bone injury Cartilagine injury Nervous peripheralis crush injury,Classification,Soft tissue injury: muscle / tendon / epitenon / ligament / bursa mucosa,Classification,Soft tissue injury Bone injury: fatigue fracture,Classification,Soft tissue injury Bone injury Cartilage injury: including arthrodial cartilage and epiphyseal cartilage,Classification,Soft tissue injury Bone injury Cartilagine injury Nervous peripheralis crush injury: for the special function of the nerves, the clinical manifestation and consequence after injury are different from other soft tissues,Clinical manifestation,Long-term pain; without history of injury Local tenderness No inflammation signs usually correlated to over-activity,Therapeutic principle,1 Key point: eliminating inducing factors 2 Physical therapy: massage etc. 3 Regional injection 4 NSAID 5 Operation,Prevention,Most of injuries can be prevented Physical exercises Timely change posture When the injury appear first-time, may remind patient that must breakdown short period,Chronic soft tissue injury,Lumbar muscle strain,Lumbar muscle strain is injury of lumbar muscle and attachment fascia or even periosteum,it is also a common cause of back pain,腰肌劳损,Lumbar muscle strain,lumbar part accepts the most body weight the spine is unstable bend ones back for long-time acute trauma changes to chronic phase,Etiology and Pathology,Chronic pain without obvious motivation Fixed pressure pain points which usually locate at starting point or insertion of muscle Musculus sacrospinous spasm,Clinical Manifestation,Lumbar muscle strain,Tenosynovitis stenosans,狭窄性腱鞘炎,TRIGGER FINGER / THUMB 弹响指和弹响拇,DE QUERVAINS TENOSYNOVITIS 桡骨茎突狭窄性腱鞘炎,Trigger finger / thumb,弹响指/弹响拇,Etiology and Pathology,The flexor profundus longus tendon （指深屈肌）is subjected to friction where it enters its tendon sheath and swelling can occur on the tendon at this point. As the swelling enters the tendon sheath it irritates the opening of the sheath and this can narrow it still further.,Trigger finger / thumb,Trigger finger / thumb,The swelling on the tendon, prevents the tendon moving easily and causes a pop as it enters the tendon sheath. This phenomenon is known as triggering. It is usually worse in the morning after sleeping with the fingers flexed, but improves during the day as soft tissue swelling subsides.,Clinical Manifestation,Trigger finger / thumb,Trigger finger / thumb,Elimination of the cause Steroid injection into the tendon sheath Fibrous opening of the flexor tendon sheath,Treatment,Trigger finger / thumb,Trigger finger / thumb,DE QUERVAINS TENOSYNOVITIS,桡骨茎突狭窄性腱鞘炎,The tendon swells, movements become painful, the fibrous bridge becomes thickened and forms a firm swelling on the lateral side of the radius just proximal to the wrist.,DE QUERVAINS TENOSYNOVITIS,Etiology and Pathology,the extensor pollicis brevis and the abductor pollicis longus pass beneath a tight fibrous bridge,Clinical Manifestation,DE QUERVAINS TENOSYNOVITIS,Elimination of the activity Steroid injection into the tendon sheaths Surgical release of the fibrous bridge,Treatment,DE QUERVAINS TENOSYNOVITIS,A ganglion is a collection of thick fluid, similar to synovial fluid, surrounded by a thin layer of synovium in the soft tissues around joints and tendons.,Ganglia 腱鞘囊肿,Sometimes rupture or disappear spontaneouslyIf the ganglion is causing neurological problems, early excision is indicated,Ganglia,TENNIS ELBOW (lateral epicondylitis of humer),网球肘,The common lesion of the insertion of muscle or tendon onto bone is tennis elbow in which a tear occurs in or near the insertion of the common extensor tendon on the lateral condyle of humerus.,Etiology and Pathology,The injury is caused by sharp flexion of the wrist while the extensors are contracted. The injury also occurs in everyday activities such as gardening and lifting.,TENNIS ELBOW,lateral epicondyle is tenderness stressing the extensor origin, by forcing the wrist into flexion with the extensors contracted, reproduces the patients symptoms.,Clinical Manifestation,TENNIS ELBOW,TENNIS ELBOW,Rest and avoiding contraction of the extensor muscles Injection of hydrocortisone acetate into the tender area A release of the extensor origin from the distal humerus,Treatment,TENNIS ELBOW,ADHENSIVE CAPSULITIS OF SHOULDER,粘连性肩关节囊炎,Etiology and Pathology,Unknown. May be a precipitating cause, such as a minor injury, but there is often none. One possible explanation is a localized autoimmune response to the tissues of the rotator cuff.,Adhensive capsulitis of shoulder,posterior view,Rotator cuff Supraspinatus m. Infraspinatus m. Teres minor m. subscapularis m.,Acromioclavicual joint,Coracoclavicular lig.,Acromiocracoid lig.,Adhensive capsulitis of shoulder,