Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

[Illustration:  FIG. 108.—­Avulsion of Tendon with Terminal Phalanx of Thumb.

(Surgical Museum, University of Edinburgh.)]

Avulsion of Tendons.—­This is a rare injury, in which the tendons of a finger or toe are torn from their attachments along with a portion of the digit concerned.  In the hand, it is usually brought about by the fingers being caught in the reins of a runaway horse, or being seized in a horse’s teeth, or in machinery.  It is usually the terminal phalanx that is separated, and with it the tendon of the deep flexor, which ruptures at its junction with the belly of the muscle (Fig. 108).  The treatment consists in disinfecting the wound, closing the tendon-sheath, and trimming the mutilated finger so as to provide a useful stump.

DISEASES OF MUSCLES AND TENDONS

Congenital absence of muscles is sometimes met with, usually in association with other deformities.  The pectoralis major, for example, may be absent on one or on both sides, without, however, causing any disability, as other muscles enlarge and take on its functions.

Atrophy of Muscle.—­Simple atrophy, in which the muscle elements are merely diminished in size without undergoing any structural alteration, is commonly met with as a result of disuse, as when a patient is confined to bed for a long period.

In cases of joint disease, the muscles acting on the joint become atrophied more rapidly than is accounted for by disuse alone, and this is attributed to an interference with the trophic innervation of the muscles reflected from centres in the spinal medulla.  It is more marked in the extensor than in the flexor groups of muscles.  Those affected become soft and flaccid, exhibit tremors on attempted movement, and their excitability to the faradic current is diminished.

Neuropathic atrophy is associated with lesions of the nervous system.  It is most pronounced in lesions of the motor nerve-trunks, probably because vaso-motor and trophic fibres are involved as well as those that are purely motor in function.  It is attended with definite structural alterations, the muscle elements first undergoing fatty degeneration, and then being absorbed, and replaced to a large extent by ordinary connective tissue and fat.  At a certain stage the muscles exhibit the reaction of degeneration.  In the common form of paralysis resulting from poliomyelitis, many fibres undergo fatty degeneration and are replaced by fat, while at the same time there is a regeneration of muscle fibres.

Copyrights
Project Gutenberg
Manual of Surgery from Project Gutenberg. Public domain.