University:
Stanford University
Course:
MED 101 | Human Anatomy
Academic year:

2023
Views:

459

Pages:

1
Author:

larbi43100

MUSCULO-TENDINOUS PATHOLOGY Musculo-tendinous injuries are particularly common when playing handball. Musculo-tendinous pathology of the shoulder girdle concerns all of the muscles working on his mobility. However, the frequency of injured muscles and the location of their lesion depends greatly on the sport practiced and their function. Thus, if the rhomboids, the coracobrachialis, the pectoralis major, the angular of the scapula are only exceptionally affected, the biceps, the supraspinatus, the deltoid, the teres minor are quite frequently injured. The most delicate tendons to treat are those passing through a gutter due to areas of friction (long biceps, supraspinatus). We encounter these pathologies during very violent shots, or countered gestures. The diagnosis of these lesions is primarily clinical. The pain is localized next to the injured tendon, it increases during the opposite movement (palm test for the long biceps, opposed rotations for the supraspinatus, etc.). Often less violent when "hot", it increases in intensity when "cold" and at night. Untreated, tendonitis can cause tendon rupture or degenerate into tendinosis. Depending on the location, the imaging techniques used will be different: . Ultrasound for sufficiently large muscle and tendon injuries. . MRI for tendons sliding in a sheath (long biceps, supraspinatus) or damage to the muscular bodies. ➢ Supraspinatus tendonitis ❉ Etiology Supraspinatus tendonitis is a particularly common pathology when playing handball (repetition of passes, use of the medicine ball, off-axis shots, etc.); ❉ Diagnosis . Physical examination Supraspinatus tendinitis manifests itself as pain on the shoulder cuff when the arm is abducted. On palpation, the external part of the supraspinatus fossa and the end of the tendon can be examined under the deltoid if the patient's arm is placed in internal rotation and retropulsion (hand placed on the spine). Abduction of the arm is painful, mainly during the first degrees of abduction and when passing under the acromion-coracoid procession (from 0° of abduction). This pain is potentiated by the thwarted abduction of the arm. . Radiological examination The frontal and rotational x-ray examination (external and internal) can show an ascension of the humeral head, a sign of a process of self-protection of the painful area. Ultrasound is of little interest, however MRI shows very well the inflammatory nature of the tendon end of the supraspinatus. ❉ Treatment Treatment of the supraspinatus is both local (ultrasound, cryotherapy) and general (NSAIDs). The very particular physiology of this muscle (fixation of the shoulder during abduction very often requires immobilization during the first phase of treatment (it is practically impossible not to involuntarily contract this muscle during arm movements). The rehabilitation phase will include a significant part of shoulder decoaptation work.