1、肖骏肖骏（教授、主任医师）（教授、主任医师）同济医院骨科同济医院骨科运动系统慢性损伤运动系统慢性损伤Prof.Dr.Xiao Jun Department of OrthopedicsTongji HospitalChronic Musculoskeletal Disorders Bones Joints Bursa(滑囊)Muscles Fascia(筋膜)Tendons(肌腱)Ligaments(韧带)Blood vessals NervesMusculoskeletal SystemClassification1.Chronic injury of soft tissue2.Chroni
2、c injury of bone:fatigue fracture3.Chronic injury of cartilage4.Chronic peripheral nerve entrapmentClinical Manifestations1.chronic regional pain¬ triggered by a clear history of trauma or injury2.Tender point and lump in specific area and usually accompanied by radiating pain and other physical
3、signs3.No local inflammation4.Correlated to excessive activity history5.Occupational history,unhealthy habitsTreatment principles1.Eliminating inducing factors2.Physical therapy3.Regional injection:Steroids4.NSAIDs5.OperationPrevention1.Most of injuries can be prevented2.Physical exercises3.Timely c
4、hange posture4.Reducing the activity Lumbar muscle strain（腰肌劳损）Bursitis（滑囊炎）Stenosing tenosynovitis（狭窄性腱鞘炎）Ganglia（腱鞘囊肿）Tennis elbow（“网球肘”）Periarthritis of shoulder（肩周炎）Etiology and Pathology1.Lumbar part accepts the most body weight 2.The spine is unstable3.Bend ones back for long-time4.Acute traum
5、a changes to chronic phaseClinical Manifestations1.chronic pain without obvious causes2.Stable tender points always locate in the starting point and ending point of the muscle3.Sacrospinous muscle spasm（骶棘肌痉挛）Treatment1.Rest2.Medications3.Physical therapy/exercises4.Steroids injection Bursae that ac
6、t as cushions among your bones and the tendons and muscles near your joints.Bursitis occurs when bursae become inflamed.Bursitis is a painful condition that affects the small fluid-filled pads Clinical Manifestations1.Pain-the pain increases with movement or pressure2.Tenderness3.Swelling4.Loss of m
7、ovementTreatment1.PRICEM(Protection Rest Ice Compression Elevation Medication)1.Inject a corticosteroid drug into the bursa to relieve inflammation.2.Chronic bursitis can be amenable to bursectomy and aspiration.De Quervains tenosynovitis(桡骨茎突狭窄性腱鞘炎)Tenosynovitis of hand flexor tendons/Trigger finge
8、rs（手指屈肌腱腱鞘炎/扳机指）Etiology and Pathologythe extensor pollicis brevis(拇短伸肌腱)and abductor pollicis longus tendon（拇长展肌腱）run in a compartment beneath the extensor retinaculum（伸肌支持带）Clinical Manifestations1.Pain near the base of your thumb2.Swelling near the base of your thumb3.Difficulty moving your thumb
9、 and wrist when youre doing activities that involve grasping or pinching4.A sticking or stop-and-go sensation in your thumb when trying to move itFinkkelsteins TestTreatment Elimination of the activity Steroid injection into the tendon sheaths Surgical release of the fibrous bridgeEtiology and Patho
10、logy 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.Clinical Manifestations1.The
11、 swelling on the tendon,prevents the tendon moving easily and causes a pop as it enters the tendon sheath.2.This phenomenon is known as triggering.3.It is usually worse in the morning after sleeping with the fingers flexed,but improves during the day as soft tissue swelling subsides.Treatment Elimin
12、ation of the cause Steroid injection into the tendon sheath Fibrous opening of the flexor tendon sheath 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.Sometimes rupture or disappear spontaneousl
13、y If the ganglion is causing neurological problems,early excision is indicated(Lateral epicondylitis of humerus，肱骨外上髁炎)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
14、 of humerus.Etiology and Pathology1.The injury is caused by sharp flexion of the wrist while the extensors are contracted.2.The injury also occurs in everyday activities such as gardening and lifting.Clinical Manifestations1.lateral epicondyle is tenderness2.stressing the extensor origin,by forcing
15、the wrist into flexion with the extensors contracted,reproduces the patients symptoms.Treatment1.Rest and avoiding contraction of the extensor muscles2.Injection of hydrocortisone acetate into the tender area3.A release of the extensor origin from the distal humerusEtiology and Pathology The bones,l
16、igaments and tendons that make up shoulder joint are encased in a capsule of connective tissue.capsule thickens and tightens around the shoulder joint,restricting its movement.Usually recently experienced prolonged immobilization of their shoulderClinical Manifestations painful restriction of extern
17、al rotation.first painful,then stiff.difficult to bring the hand to the mouth,behind the head to comb hair or behind the back to fasten buttons or hooks.Treatment1.Medications2.Physical therapy3.Surgical and other procedure Steroid injections Joint distension:Injecting sterile water into the joint c
18、apsule Shoulder manipulation:receive a general anesthetic,moves your shoulder joint in different directions,to help loosen the tightened tissue.Surgery:remove scar tissue and adhesions from inside your shoulder joint with a arthroscopy Fatigued fracture long-term accumulation of minor injuries secon
19、d metatarsal bone(第二跖骨),tibia,ribs Chondromalacia patellae（髌骨软骨软化症）Osteochondrosis of the tibia tubercle（胫骨结节骨软骨炎）Legg-Calve-Perthes（股骨头骨软骨病）Softening of the articular cartilage of the patella It is commonly used as a synonym for anterior knee pain in an adolescent.Osgood-Schlatters disease most com
20、monly occurs in teenagers who play sport.causes pain and swelling just below the knee.It is not serious and usually goes away in time Commonest in 412 years Presents with limp and pain in the hip The goal of treatment us to preserve movement and to create a congruent joint The younger the onset,the
21、greater the scope for remodeling and the better the prognosis Carpal tunnel syndrome（腕管综合征）Cubital tunnel syndrome（肘管综合征）Paresthesia,pain,numbness,and other symptoms In the distribution of the median nerve due to its compression at the wrist in the carpal tunnel.Commonest in peripheral nerve entrapm
22、ent syndromeTreatment1.Rest and diuretics2.Hydrocortisone injection3.Operation:a longitudinal incision 4.The tunnel is decompressed by dividing the flexor retinaculum throughout its length1.Cubital tunnel syndrome is the effect of pressure on the ulnar nerve2.It can result in a variety of problems,including pain,swelling,weakness or clumsiness of the hand and tingling or numbness of the ring and small fingers.3.It also often results in elbow pain on the side of the arm next to the chest.
