MUSCLES OF THE HUMAN FOREARM anterior and posterior groups, their functions, innervation and blood supply (Table)

A tendon rupture is an injury characterized by a disruption of the integrity of the connective tissue fibers that attach the muscles to the bones. Most often, rupture of tendon structures is observed in the area of ​​extensors or flexors of the limbs, fingers, and feet and is the result of strong tension and exposure to a traumatic object. Most often in medical practice, open injuries of the tendon apparatus are encountered, but the integrity of connective tissue structures can be impaired even in the absence of open wounds on the skin.38

Tendon rupture can be caused by hormonal imbalances, enzymatic activity, metabolic processes, and endocrine diseases. Injuries of this kind often occur with arteritis and gout.38

Anatomy of the flexor tendons

Flexor tendons are divided into superficial and deep. The superficial flexor tendons are attached to the middle phalanges, and the deep flexor tendons are attached to the distal (ungual) phalanges. All tendons are located in channels in which they slide. When the muscles contract, the tendons pull the corresponding phalanges and the fingers bend. These muscles are located on the forearm.

The tendons on the back of the hand and forearm are known as extensor tendons.

The flexor tendons are held in the canals by annular ligaments. This ensures smooth bending without tension on the skin.

Damaged tendons in the forearm, wrist, palm or finger are characterized by an inability to bend.

Tendons can be damaged very easily due to the fact that they are located very close to the surface of the skin. And a fairly shallow wound to the hand will most likely result in damage to the flexor tendons.

Tendons are constantly under tension from their muscles. If the tendon is damaged, the contracted muscle pulls the proximal end (which is closer to the forearm). The damaged ends diverge far from each other, which makes it impossible for them to heal independently.

It is very important to suture the ends of the tendon in the first few days after the injury, otherwise the changes in the sheaths and tendons themselves will be irreversible and a two-stage repair will be required, which can take from 4 to 6 months of treatment.

Since the nerves and blood vessels in the hand and forearm are located next to the tendons, a shallow wound can damage them. Damage to the nerve will result in numbness on one or both sides of the finger, but damage to both digital arteries will lead to more serious consequences - severe ischemia of the finger (lack of blood supply), which can cause necrosis of the finger. This requires, of course, immediate surgery - revascularization of the finger (stitching of blood vessels).

Sprains of ligaments, tendons and muscles

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Damage to the tendon-ligamentous apparatus is one of the most relevant and common reasons that limit the physical activity of people leading an active lifestyle.
The main etiological factor is acute traumatic injury, called sprain, or excessive cyclic load for a long time - overexertion. Sprains of ligaments, tendons and muscles are acute and traumatic due to damage. There are three degrees of severity of a sprain:
Grade I – mild pain due to the tearing of several fibers of the ligament.

Grade II – moderate pain, swelling and disability.

III degree – severe pain due to ligament rupture and subsequent instability of the joint.

Muscle strain

in turn, is a traumatic injury to the muscle fibers themselves or the junction of the muscle and tendon and is also classified into three degrees of severity:

I – moderate.

II – moderate degree of damage, associated with weakness of the affected muscle and its painful contraction.

III - complete rupture of the connection between muscle and tendon, manifested by severe pain and the inability to contract the damaged muscle.

Overexertion is a non-acute, repeated damage to soft tissue structures due to constantly occurring microtraumas, which leads to changes in local microcirculation and, as a consequence, to degenerative processes in soft tissues, where microscopy shows a violation of the structure of local tissues with their lysis, leukocyte infiltration and extravasation of blood .

Repetitive movements during long-term work lead to “overuse” damage in some occupations. Approximately 10–20% of musicians, typists, cashiers and assembly line workers complain of relapses of sprain syndrome; among athletes, this percentage ranges from 30 to 50.

Damage due to overvoltage

(overtraining) are divided into four degrees:

I degree – pain only after physical activity.

II degree – pain during and after physical activity, which does not affect the result of work.

III degree – pain during and after physical activity, affecting the result of work.

IV degree – constant pain that interferes with daily physical activity.

It should also be noted that damage to the tendon apparatus can occur in the form of “tendonitis,” “tendinosis,” and “tenosynovitis.”

Tendinitis

occurs due to tendon injury and associated vascular destruction and acute, subacute or chronic inflammation.

Tendinosis

is a non-inflammatory atrophy and degeneration of fibers within the tendon, often associated with chronic tendonitis, which can lead to partial or complete rupture of the tendon.

Tenosynovitis

is an inflammation of the paratendon, which is the outer sheath of some tendons and is lined with a synovial membrane (for example, damage to the extensor tendon of the thumb in de Courvain's tenosynovitis).

In this review, it makes sense to focus specifically on stress injuries caused by frequently repeated monotonous movements, that is, overexertion, and also take into account mild degrees of sprain of ligaments, tendons and muscles, since injury accompanied by rupture of these structures in most cases requires surgical treatment (damage anterior cruciate ligament and collateral ligaments of the knee joint, rupture of the Achilles tendon).

The most common types of damage due to overexertion (overtraining):

ligaments
–
“baseball player’s elbow”, “swimmer’s knee”, iliotibial tract friction syndrome, “jumper’s knee”, plantar fasciitis;

tendons
–
Achilles tendonitis, suprapatellar tendinitis, biceps brachii tendinitis, tibialis posterior tendinitis, lateral epicondylitis (“tennis elbow”), supraspinatus (rotator cuff) tendonitis.

"Tennis Elbow"

This is lateral epicondylitis. This syndrome occurs as a result of overtraining and is manifested by pain along the lateral surface of the elbow joint. Patients usually associate its occurrence with playing tennis. Today, lateral epicondylitis is considered an inflammatory disease and/or microtear at the insertion site of the extensor carpi brevis. The provoking movement - forced extension of the middle finger of the hand against resistance - causes pain, as the muscle is attached to the base of the metacarpus of the middle finger.

"Golfer's Elbow"

– medial epicondylitis, occurs when the tendons of the pronator and flexor muscles of the forearm are damaged from overtraining at the site of their attachment to the medial epicondyle. This area is subjected to valgus pressure at the apex of the backswing, pain is noted over the medial epicondyle and increases with flexion and pronation of the forearm against resistance.

"Baseball Elbow"

(inflammation of the medial apophysis) - this disease occurs due to a valgus-directed force during frequent movement of the hand along the curve of throwing the ball. The victim experiences microtears in the tendons of the pronator and flexor muscles, and in severe cases, separation and fragmentation of the medial apophysis.

Iliotibial Tract Friction Syndrome

STITUS is pain along the lateral aspect of the knee due to irritation and inflammation of the distal portion of the iliotibial tract as it passes over the lateral femoral condyle. The pain intensifies with palpation of the distal part of the tract at the moment of extension of the leg at the knee joint. STI occurs when running too intensely or running over rough terrain.

"Swimmer's Knee"

– a condition that occurs in the knee joint when a valgus force is applied to the knee due to sudden movements of the leg during breaststroke. This is usually observed when the medial collateral ligament of the knee joint is stretched, which causes pain.

"Jumper's Knee"

– so-called patellar tendinitis. Often found in high jumpers, basketball and volleyball players. It is characterized by pain in the lower pole of the patella, at the site of attachment of the patellar ligament. It develops due to constant damage to this area when the injury does not recover and heal.

Biceps tendinitis

is manifested by pain in the anterior part of the shoulder joint, which intensifies with active movements in the shoulder joint and is less pronounced or absent with passive movements, and is also accompanied by local pain when palpating the area above the long head of the biceps tendon. In the case of concomitant myositis, biceps tendinitis is accompanied by severe muscle soreness.

Patellar bursitis

accompanied by pain, swelling and a local increase in temperature in the patellar bursa, which is located superficial to the patella. Bursitis is caused by repeated trauma or stress, such as kneeling.

Inflammation of the Achilles tendon

manifests itself as pain in the heel, sometimes pain along the back of the leg. Dorsal and plantar flexion of the foot increases pain, the area of ​​greatest pain is 2-3 cm proximal to the junction of the tendon with the calcaneus. The tendon may be swollen and thickened, most often caused by spondyloarthropathy affecting peripheral joints (Reiter's disease, ankylosing spondylitis), as well as trauma.

Plantar fasciitis or heel spur

anatomically arises from the insertion of the flexor digitorum brevis, which is localized along the anteromedial edge of the calcaneal tuberosity, somewhat deeper than the insertion of the plantar fascia. Overexertion of one of these structures is thought to result in reactive inflammatory bone production or spur formation secondary to traction on these structures. However, it remains unclear which mechanism is responsible for this. In any case, the spur is secondary to overexertion.

It is also worth mentioning such a pathology as “shin splints”

is an overtraining injury caused by chronic traction on the periosteum of the tibia. In this case, either the tibial muscles or m. soleus, which is characterized by gradually onset pain along the anteromedial or posteromedial surface of the leg. Pain occurs in athletes at the start of the race, subsides during the run and intensifies again after the end of the race. On palpation, tenderness is detected along the posteromedial edge of the tibia, usually at the border of the middle and lower third. The pain intensifies with dorsal flexion of the foot against resistance.

Treatment

Therapeutic treatment of ligament, tendon and muscle damage includes primary and secondary therapy.

Primary therapy:

• Load protection
• Rest
• Ice
• Pressure bandage
• Elevated position
• Bandage support

Secondary therapy

• Physiotherapy
• Rehabilitation
• Injections
• Physiotherapy
• Examination and re-examination
• Salicylates.

Thus, the basis of treatment is early pain relief and anti-inflammatory therapy for soft tissue injury

, especially in cases of concomitant myositis. Long-term inflammation impairs the healing process of soft tissues, which leads to their detraining and functional failure. With an active inflammatory process, relative rest for the affected area is important. Ice is effective as an anti-inflammatory agent only in the first hours after injury, then heat is preferable. Immobilization with a splint or bandage can be used to enhance protection of the injured limb or part of it from stress.

Corticosteroid injections for chronic processes do not provide a complete cure; moreover, they increase the rate of collagen degradation, reduce the synthesis of new collagen, and reduce the tensile strength of the tendon, which leads to its rupture if injections are performed incorrectly or very often. In this regard, their use is justified only in the acute period and no more than once every 2–3 weeks.

It is also necessary to use non-steroidal anti-inflammatory drugs (NSAIDs) per os, and in these situations drugs of different groups are approximately equally effective. Their long-term use is recommended for chronic conditions of overstrain; for acute injury, they are effective for 72 hours.

A very effective method of treating traumatic soft tissue injuries is local therapy using ointments and gels containing NSAIDs.

.
The use of local remedies is especially effective in elderly and senile people with a history of ulcers. These drugs can, if necessary, replace systemically used NSAIDs. For sprained ligaments and muscles, accompanying myositis, accompanied by irritation of the nerve roots and peripheral nerves, complex preparations containing NSAIDs and herbal components are used. In Russia, one of the most famous and well-proven drugs in this series is Efkamon
, which has a distracting, analgesic, warming, absorbable and anti-inflammatory effect. Methyl salicylate, which is part of the drug, has an anti-inflammatory and analgesic effect by suppressing the synthesis of prostaglandins at the site of inflammation. Capsicum tincture contains capsaicin, which has a strong irritant effect on skin receptors. The unique combination of natural components of the drug, the combined effect of the essential oils included in its composition, which provide a pronounced analgesic effect due to interaction with sensitive skin receptors, makes the drug especially effective for traumatic damage to soft tissues (bruises), myositis, ganglionitis, as well as arthritis and cervical sacral radiculitis, which is especially important in elderly and senile people. It should be noted that the drug does not have the immunosuppressive effect characteristic of almost all synthetic drugs.

The ointment is rubbed into the skin of the affected area in an amount of 3–4 g, 2–3 times a day and covered with a dry warming bandage. The duration of treatment depends on the nature and severity of the disease.

Thus, the use of modern drugs, especially local ones (Efkamon), is an effective method of relieving pain and accompanying inflammation in case of traumatic injury to the tendon-ligamentous apparatus, which contributes to the rapid restoration of physical activity and a return to the previous quality of life of patients.
Literature:
1. Mikheev S.M. The use of local agents in rheumatology. Russian medical journal 2000: v.8 no.7. - With. 300–302.

2. Nasonova V.A., Folomeeva O.M., Amirdzhanova V.N. Rheumatic diseases in the light of the international statistical classification of diseases and related health problems (tenth revision). Ter. arch. 1998: No. 5. – p.5–8.

3. Guide to rheumatology. By ed. V.A. Nasonova, N.V. Bunchuk. – M. – 1997.

4. Silin L.L., Brovkin S.V. The use of gels in the complex treatment of closed soft tissue injuries. Medical assistance 2001: No. 2.

5. Chichasova N.V. Local therapy of chronic diseases of the musculoskeletal system. Russian Medical Journal 2001: v. 9 No. 7–8. - With. 286–288.

6. Data from the American Association of Retired Persons, the Administration on Aging, and the US Bureau of the Sensus. A profile of older Americans, 1994.

Causes of flexor tendon damage

The main cause of flexor tendon damage is, of course, injury.

For example, when injured by a knife, circular saw, glass, and so on.

But there are also closed injuries - tendon ruptures at the time of heavy load. Sudden lifting of a heavy object, as well as a tram while playing any sport.

Rheumatoid arthritis, for example, can cause the flexor tendons to weaken, making them more likely to rupture. This can happen for no apparent reason or injury - the patient may simply notice that the finger no longer bends, but cannot remember how this could have happened.

Shoulder ligament rupture: causes and treatment

One of the reasons for rupture of shoulder ligaments and tendons in young patients is lifting heavy objects and performing sudden movements that are not typical for the joint. In other words, rupture of connective tissue structures occurs under strong physical impact that exceeds the capabilities of elastic fibers.64

In older people, the nature of such injuries is somewhat different. Most often, rupture of the ligaments and tendons of the shoulder joint in old age contributes to the loss of their elasticity, which is caused by degenerative changes.64

First aid for tendon injuries

If you seriously injure your hand, apply a pressure bandage and ice immediately. This will stop or dramatically slow down the bleeding. Raise your arm above your head to slow down the blood flow. Contact a traumatologist as soon as possible.

The doctor must perform primary surgical treatment of the wound, which includes washing the wound with antiseptic solutions, stopping bleeding and suturing. This is followed by a tetanus shot and antibiotics to prevent infection.

Further, if the doctor has diagnosed a tendon injury, then he will refer you to a specialist in hand surgery to treat the tendon injury, i.e. it is necessary to perform a “tendon suture” operation, otherwise the flexion function of the finger will be lost.

FOREARM EXERCISES WITH EXPANDER AND OWN WEIGHT

Isometric hang on the horizontal bar

You simply hang from the bar, keeping your grip tight. This exercise is performed for a while. Try to stay on the horizontal bar for as long as possible. If this seems easy to you, use weights or perform the exercise on one arm. You can also use a thicker crossbar to make the load heavier.

Rolling up - rolling up

You can simply hang on the horizontal bar and perform the so-called rolling up. Holding the horizontal bar with a closed grip, gradually open your grip, rolling down and hanging on the horizontal bar by your fingertips, after which you roll the grip back, again holding with a closed grip.

Squeezing a rubber ring or expander

The exercise is very simple. Take the expander in your hand and squeeze it for a while or as many times as possible. Hold in a compressed state for a few seconds so that the muscle receives a load. Remember that doing too many repetitions builds endurance. If you need strength and mass, you need to work in fewer repetitions. Therefore, select an expander according to the desired result.

Diagnosis of damage to the finger flexor tendons

These standard examination tests will help determine if there is damage to the flexor tendons.

Not every person will be able to understand whether there is damage to the tendon due to any injury. For an accurate diagnosis, it is better to entrust this to a specialist. During the examination, the doctor will ask you to bend and straighten your fingers to understand whether both flexor tendons in the palm of your hand (superficial and deep) or just one are damaged. While holding the proximal phalanx, the patient tries to bend the finger; if the middle phalanx does not bend, then both tendons are damaged. The middle phalanx is held in the same way and the patient tries to flex the distal phalanx; if the distal (ungual) phalanx does not flex, the deep flexor tendon is damaged. And so on for all the fingers (see picture below). If tendon damage is diagnosed, then surgery is required, which must be performed in the first 2 weeks from the moment of injury.

(Explanations for the figure in the text above)

To determine blood vessel damage, the doctor may palpate the pulses of the digital arteries, which run along both sides of each finger.

To determine nerve damage, you need to test the sensitivity of each finger. If damaged, sensitivity may be reduced (hypesthesia) or completely absent (anesthesia).

Additional tests

The doctor may also order x-rays to determine if there is any damage to the bone structures in serious injuries such as slash wounds, circular saw injuries, etc.

FOREARM EXERCISES WITH BARBERLESS AND DUMBBELLS

The standing barbell reverse curl is a conditioning exercise that targets the outer forearm muscles, specifically the brachioradialis. The load also falls on the brachialis and biceps.

Wrist curls with a barbell especially stimulate the development of the inner surface of the forearm muscles. The exercise loads the radial and ulnar flexors of the wrists, long palmaris muscles, deep and superficial flexors of the fingers.

Barbell wrist extensions work the large muscles on the outer forearms, especially the brachioradialis muscles. The work involves the extensor carpi radialis brevis and longus, the extensor digitorum, the extensor of the little finger, and the extensor carpi ulnaris.

Hammer curls are considered to be formative for the arm muscles. It affects the lateral (outer) head of the biceps and works well on the brachialis. The load also falls on the outer part of the forearm, the brachioradialis muscle.

For barbell exercises, the barbell can be replaced with dumbbells. In cases with wrist extension and flexion, it will be more effective to perform the exercise with each arm separately.

Treatment of tendon damage

As a rule, when tendons are damaged, the arm is cast before surgery to reduce movement in the projection of the wound, which can increase local swelling and inflammation.

Tendons cannot heal on their own , since the damaged ends do not touch!!!

The sooner the surgery is performed, the greater the likelihood of maximum recovery of finger movement.

Operation stages

To repair the tendon, a “tendon suture” operation is performed.

• The operation is performed under general anesthesia, under a tourniquet on the shoulder, so that there is not the slightest bleeding, otherwise it complicates the visualization of small structures of the hand. If the tendons are damaged as a result of injury, then the wound is treated with antiseptic solutions and lengthened so that the doctor can find the “spread” ends of the tendons.

• The skin on the palmar surface of the fingers is incised in a zigzag manner to prevent the formation of a constricting scar.

• Next, a special tendon suture is performed. There are several seam options that have proven themselves. It is very important to sew the tendon end to end so that there are no deformations, otherwise it will not slide in its rather narrow channel. In fact, this is a very complex operation. Indeed, if the tendon is stitched incorrectly, it will become scarred with the surrounding tissues and finger movements will be impossible.

• After this, the doctor sutures the wound.

The surgery is usually performed on an outpatient basis (you can go home after surgery). The doctor will apply a sterile bandage after surgery and secure the hand with a plaster splint or plastic splint. Splinting of the fingers and hand is performed in a flexed position to limit movements, in order to avoid rupture of the stitched tendon until they are completely fused, which lasts 3 weeks.

The video shows the result of treatment of damage to the flexor tendon of the 3rd finger of the left hand after 2 months of rehabilitation after two-stage plastic surgery.

The same patient after 6 months of rehabilitation after two-stage plastic surgery. As you can see in the video, the function of finger flexion has been completely restored.

Torn ligaments in the leg: how to treat?

One of the most common injuries, both in everyday life and in sports practice, is damage to the Achilles tendon, which can be open or closed. In people who play sports professionally, the destruction of connective tissue structures can occur asymptomatically, and only over time does weakness in the leg and decreased mobility appear. With a complete rupture of the ankle joint ligaments, the mobility of the limb disappears completely, and acute pain is observed upon palpation.64

Conservative treatment of such injuries involves immobilization of the limb, but if the ligaments are completely torn, surgery is required. After restoring the integrity of the connective tissue, the patient will undergo long-term rehabilitation, which includes local treatment (to relieve pain, inflammation), physiotherapy, exercise therapy.64

EXERCISE WELLS AND MACHINES FOR TRAINING FOREARMS

The “well” exercise, or rotating a handle with a weight suspended from it, is an isolation exercise for the forearm muscles. By rotating the handle in one direction or the other, you activate the extensors or flexors, respectively. The exercise is very effective, it must be performed to failure. Many apparatuses have been invented for this exercise. These can be either separate simulators or simply conveniently made devices. However, the main task of all these simulators remains the same - it is simply winding a rope around a stick, which is why the exercise received its name - “The Well”. You can make such a device yourself at home by tying a thin cable at one end to a short stick and tying the other end to a weight plate or dumbbell.

Hand bones

The hand consists of the bones of the wrist, as well as the bones of the fingers (phalanx) and metacarpus (tubular bones running from the wrist to the fingers). The wrist itself has eight spongy bones. They are short in size and arranged in 2 rows:

1. Upper. It includes such bones as: scaphoid, triquetrum, pisiform and lunate.
2. Lower. Consists of: trapezoid, capitate, trapezoid and hamate.

The bottom row connects to the top and the carpal bones. And also among themselves. And they form a low-moving joint.

After the carpus come the metacarpal bones. There are only five of them, one for each finger. Next they connect to the phalanges of the fingers. They have a short tubular shape. Each finger has three phalanges: main (proximal or lower), middle and upper (distal or terminal). The exception is the thumb; it consists of only two phalanges - lower and upper.