—An injury of this kind and of moderate degree seen early may be treated by physiological rest and position. (See chapter on [Treatment of Wounds].) When, however, there is marked impairment of function, such as will follow the yielding of one or more tendons or muscle insertions, then suturing offers the greatest promise of a cure. When the quadriceps tendon is torn away from the patella or the tendo Achillis from the heel, prompt suture under aseptic precautions will save a long period spent in partial recovery of function.
Occasionally one or more tendons will be completely avulsed, as when a finger is torn out of the hand and brings with it one or more of the tendons belonging to it. In accidents of this kind six to twelve inches of tendon and muscles may be lost. In such a case nothing can be done except to care for the wound resulting from the injury.
DISLOCATION OF TENDONS AND MUSCLES.
Tendons and muscles are occasionally dislocated, that is, forced from their normal positions. Accidents of this kind usually occur with the long tendon of the biceps, which is torn from its bicipital groove; the peronei and the posterior tibial in the leg, the extensor muscles of the thigh, and those of the back of the wrist. The lower angle of the scapula is normally held down by a small portion of the latissimus dorsi; should this be displaced the scapula rises somewhat in wing form. These injuries lead to more or less loss of function, and, when they become disabling, may justify operation, which would include incision, exposure of the tendon in its abnormal position, and its restoration to its proper place where it should be held by sutures. Such operation should be followed by enforced physiological rest of the part.
HERNIA OF MUSCLES.
Hernia of muscle is the name applied to the escape of muscle through a ruptured fascial or aponeurotic covering. Such a protrusion will be recognized only during the contraction of the muscle and will disappear at other times. When the diagnosis is made the edges of the rent in the fascia should be united by sutures and the part put at rest.
WOUNDS OF MUSCLES.
Wounds of muscles in no way differ from other wounds which have been considered in the chapter on Wounds and their Treatment. If circumstances permit there is every indication for the suture of a divided muscle in order that its function may be less impaired after the wound is healed. These sutures, when inserted, should be made to separately include the divided fascia or aponeurosis with which the injured muscle is in relation.
MYALGIA.
There are numerous painful affections of muscles known as myalgia. It is questionable whether a rheumatism of muscle fiber ever occurs. That which patients describe as muscular rheumatism is not that which it is termed. Sometimes it is the result of previous exudate between muscle fibers, sometimes the result of hemorrhage of interstitial type. Muscles thus affected are more or less tender and give pain when used. It will usually be found that there is some marked toxic condition, such as uric acid, syphilis, or lead poisoning, behind it.