Diagram of palmar incisions.
Fig. 134
Diagram of dorsal incisions. (Burrell.)
SURGICAL DISEASES OF THE MUSCLES.
CONTUSIONS OF THE MUSCLES.
Muscles react like other tissues under the influence of contusions. Hemorrhages not too copious are gradually absorbed, and muscle tissue repairs itself, as indicated in the chapter on Wounds and their Repair. Much outpour of blood into a muscle will temporarily seriously impair its function, while pigmentation or ecchymosis may result after a few hours or days, according to the depth of the injury. There is the same liability to suppuration after infection of muscles as elsewhere. A large hematoma can scarcely form within a muscle, save in consequence of a rupture of a considerable portion of its substance. Strains and sprains of lesser degree of violence provoke impairment of function proportionate to their severity. In nearly every instance there is a certain amount of rupture of muscle fiber and outpour of blood.
RUPTURE OF THE MUSCLES.
Complete rupture across a muscle is unusual. It may occur in the belly of the muscle or near one of its terminations. A tendon may be torn out of a muscle or may itself snap. These accidents are almost invariably accompanied by symptoms that indicate both the nature and location of the injury. A severe strain followed by intense pain, with a sensation of yielding, leaves little doubt as to what has happened. Unless the muscle lie deeply its parting may be appreciated by palpation, though the depression or interval may be obliterated by the outpour of blood. The large tendons of the arm and shoulder have been ruptured by a violent effort, the abdominal muscles by contusions and by such efforts as wrestling, the sternomastoid by excessive traction during forceps delivery, and the tendons of the legs and ankles by jumps during such games as lawn tennis, etc.; while the frequency with which the muscles of the perineum and even the sphincter ani are torn during parturition is well known. It is also well known that muscles are weakened by the exanthemas and the infectious diseases.