Tendon sprain on the leg: symptoms, why it is dangerous and what to do. Tendon sprain, rupture and tear: instructions for diagnosis and treatment How to treat a tendon sprain on the leg

Tears, tears and sprains of ligaments and tendons are, unfortunately, common injuries among professional athletes and ordinary people, at any age.

A tendon tear is considered very common. Typically the tendons of the shoulder, knee or foot are affected. The term “tear” refers to an incomplete tear, although in the popular dictionary such problems appear most often under the name “stretching.”

Awkward movements when running, active games, or in simple everyday situations (for example, when lifting weights) can lead to such damage to the tendon.

If a tendon is torn, treatment under the supervision of a specialist is required.

What is a tendon tear: treatment?

What are tendons

Visually, the tendon is a bundle of threads. This is the part of the muscle with which it is attached to the bone. Often ordinary people confuse tendons and ligaments, the first of them are located between the muscles and bones, and the second fix the bones in the joint.

Ligaments provide mobility to the joint. The function of tendons, or hamstrings, is to transmit forces from muscles to bones.

Tendons are made up of connective tissue made up of different types of collagen fibers. They come in various shapes and have a specific structure, due to which they have high strength, but have little stretch.

With age, there is a weakening of the tendons, which can even with minor loads lead to tears - that is, partial disruption of the integrity of the tendon bundles. This can occur in both the central and peripheral areas of the tendon.

Treatment of tendon injuries is carried out by a traumatologist, surgeon, and osteopath.

Partial tendon rupture: causes

If we talk about people who engage in intense training or professional sports, the cause of such damage most often lies in insufficiently warmed muscles. Every athlete knows that before exercise it is necessary to warm up their muscles. However, it is not always possible to complete this fully, and as a result, the tendons may suffer.

Muscles that are not ready for increased loads and sudden movements contract irregularly and too strongly. As a result, during a particular exercise, such muscle tension leads to tendon damage.

Also, athletes and workers of heavy physical labor constantly experience microtraumas of the tendons from overexertion. Bundles of collagen fibers “wear out” and partially break. The situation gets worse if treatment is not carried out immediately and fully. Over time, the muscle whose tendon has been damaged shortens, and each repeated injury worsens its physical and functional condition. In such cases, it is difficult to restore the anatomical integrity of the tendon using therapeutic methods.

There is a high probability that a complete rupture of the tendon will occur; treatment will then be carried out surgically.

In addition to the above negative factors, tendon fibers can tear for the following reasons:

·impacts with a blunt object (direct mechanical damage);

jumping and unsuccessful landing;

falling on an outstretched arm;

sudden movements, jerks;

lifting loads;

weakening of tendons due to general aging of the body.

Partial tendon ruptures also occur due to the individual characteristics of the body. These may be pathologies such as, for example, a congenital abnormality of connective tissue or other degenerative processes in tendon bundles, muscles and joints.

The condition, degree of strength and functionality of the tendons is influenced by nutrition, the level of immunity, and the use of alcohol and tobacco.

Separately, mention should be made of the open type of damage, in which the tendons are torn due to open wounds. For example, workplace injuries often occur in which the hands are partially or completely damaged.

Signs and methods for diagnosing partial tendon rupture

Regardless of the location of the damage, with injuries of this type, patients complain of the same symptoms:

pain of an acute, sharp nature;

weakening of the joint;

redness of the skin;

·limitation of mobility of the injured limb;

tumor, edema, hematoma;

· in some cases – a local increase in temperature.

Since similar signs are observed with sprained ligaments, various dislocations and subluxations, only a qualified specialist should diagnose the damaged tendon and treat it.

The doctor must examine the site of injury, ask the patient about the nature of the injury and sensations, and examine the area using palpation. In most cases, with a partial rupture of the hamstring, the victim can move the injured limb, so the specialist can conduct something like testing: he will ask you to perform some exercises and evaluate the result.

In addition, an x-ray will be taken, the results of which will refute or confirm the presence of a tendon rupture.

Other examinations if such injuries are suspected:

·angiography;

Ultrasonography

Common tendon injuries

Most often, this type of damage occurs in the following areas:

shoulder (biceps muscle);

·hands (finger joints, finger flexor tendons);

knee (knee joint);

ankle (Achilles tendon);

thigh (quadriceps muscle).

Shoulder tendon injuries: treatment

The shoulder joint is the most rotating joint in our body. Stability and mobility of the shoulder is provided by the so-called rotator cuff (a structure of muscles and tendons). Due to the peculiarity of their structure and functioning, damage to tendon bundles in this area occurs most often when a person receives a strong blow to this area or frequently lifts heavy objects. Such injuries also occur among teachers who have to write a lot on the board, tearing the shoulder joint.

Falling on an elbow or an outstretched arm also leads to a sharp contraction of the shoulder muscles, which can ultimately cause damage to the tendon.

With such injuries, in some cases an oval-shaped swelling appears, visually noticeable when the patient flexes the forearm. The doctor makes a diagnosis of partial tendon rupture based on clinical signs and the results of an ultrasound or x-ray.

Minor tendon end divergence can be successfully eliminated with conservative treatment. First aid for such injuries is cryotherapy. Ice or (in camping conditions) a bandage moistened with cold water is applied to the damaged area. Cold compresses should be applied 4-5 times a day for the first three days after the injury.

Immediately, the joint should be immobilized using an immobilizing bandage. Fixation of the limb using this method should last 3-4 days. In some cases, you will also need a special outlet bus.

To eliminate pain, patients are prescribed analgesics (NSAIDs).

The rehabilitation period includes a complex of physical procedures and therapeutic massage (according to indications).

In case of complete rupture of the tendon, surgery to stitch the tissue is prescribed.

Achilles tendon injuries: treatment

Achilles injuries are professional injuries of tennis and basketball players. It is in these sports that repeated and sharp jumps are required, the incorrect execution of which leads to tendon rupture. Excessive loads in this area also undermine the condition of the tendon bundles.

In addition, the Achilles tendon can lose its integrity as a result of a person falling from a height or sudden bending of the foot (for example, when the toe falls into a hole).

Football players often suffer from injuries of this nature. This is due to the fact that during the game you can receive a random but strong blow from the opponent on the back of the shin.

At the moment of rupture, a crash is heard, the victim experiences acute pain, and the leg in the indicated area rapidly swells. With such injuries, a person is not able to bend the foot down and lean on the injured limb.

Treatment first requires immobilization of the affected leg. The doctor, having ascertained a partial rupture of the Achilles tendon, applies a plaster cast or fixes the foot using a special orthosis. In this case, the heel should be raised (this position will help the torn ends of the tendon bundles recover faster).

Therapy consists of using cold compresses in the first days after injury and taking non-steroidal anti-inflammatory drugs. Next, physiotherapy, exercise therapy, massage, and other activities aimed at developing the joint are prescribed.

In some cases, patients are prescribed to wear special orthopedic shoes for some time after the injury.

Treatment of tendon ruptures occurs almost the same way, regardless of the location of the damage. The differentiation of therapeutic methods depends on the individual characteristics of the injury and the general condition of the patient. Age, gender, degree and nature of damage, the presence of old injuries of this kind, and the condition of the musculoskeletal system as a whole are taken into account.

Methods of fixing joints also differ. In some cases, a bandage is sufficient, in others a splint or orthosis is required.

Preventing tendon injuries

The tendon bundles are protected from tears and overstrains by elastic fabric. Accordingly, to prevent injuries and strengthen the muscular system (and, separately, tendons), it is necessary to lead an active lifestyle, eat right, and avoid bad habits, thereby developing tissue plasticity. In addition, specialists at the Osteopolyclinic Medical Center recommend regularly performing a certain set of exercises aimed at strengthening and developing tendon flexibility.

As a rule, this is a complex consisting of static exercises, without much physical effort and sudden movements. Muscles require active, intense training, but before you begin, you need to prepare the tendons through various types of stretching. Pilates is very good in this sense. Regular charging, carried out carefully and smoothly, is also suitable for these purposes. At this time, the tendons are filled with oxygen, blood supply improves, nutrients are better absorbed and give the collagen fibers sufficient elasticity.

Take care of your tendons, but do not limit their mobility, but try to move as flexibly as possible.

The pain caused by a sprained leg is familiar to everyone: there is hardly a person who has not received this type of injury at least once. Damage to muscles, tendons or ligaments in the leg is quite simple - just fall awkwardly due to ice or going down the stairs. Typically, a sprain is not life-threatening, but timely treatment is important for faster treatment and relief from pain.

What is a leg sprain?

Leg sprain (distortion) is an injury caused by maximum tension in muscles or ligaments and tendons (fibers connecting muscle and bone). If there is excessive load on the leg, its tissues cannot withstand the pressure exerted, resulting in stretching of the limb. In fact, in this case, individual fibers in the bundle break while maintaining the integrity of others.

Tendon fibers have very high strength, but they are designed for a certain direction of movement and cannot withstand loads in an abnormal direction

Unlike a sprain, a tissue tear is the destruction of all muscle fibers, ligaments or tendons at once.

Sprains can vary in severity. In reality, these are small tears in the tissue, which are classified depending on the magnitude of the deformation and location.

Typically, the load on the ankle ligaments increases during movement when the heel sharply turns inward

The most common cause of injury is active sports, a fall or jump from a height, or violation of the rules of warming up before high physical activity. Also, some diseases of an inflammatory nature can affect the elasticity of fibers and lead to stretching (tendinitis, paratenonitis).

Traumatic tendon injuries are often diagnosed due to various mechanical impacts and excessive force load, in particular during sports.

When you sprain, you can often feel like something has burst or ruptured in your leg. The injury is always accompanied by severe pain, which can be felt for up to one and a half months, while the acute phase lasts from 5 to 8 days. In addition, the site of the sprain swells, a hematoma appears, and the leg becomes less mobile.

Often, pain in the leg can be caused not only by a sprain, but also by a pinched nerve. In this case, redness, swelling and restriction of freedom of movement of the limb are also observed. Unlike a sprain, a pinched nerve is often caused not by injury, but by a disease (osteochondrosis, radiculitis).

Video: Sprain: Definition and Treatment

Classification of distortions

Leg sprains are primarily divided according to the type of injured fibers:

• Crick;
• sprain;
• tendon sprain;
• combined stretching of several types of fabrics at once.

Depending on the severity of the damage, three degrees of distortion are distinguished in each group:

1. I degree: characterized by minor pain, preservation of mobility of the joints of the leg and simultaneous rupture of several fibers while maintaining the integrity of the tissue.
2. II degree: in this case, swelling of the injured area, loss of ability to work, hemorrhage, and inability to step on a limb are typical. The pain is moderate. There are significant fiber breaks in the fabric.
3. III degree: manifested by rupture of fibers, severe and sharp pain, as well as impaired stability of the damaged joint in case of ligament rupture. Extensive bruising appears at the injured site. When a muscle is torn off, it is impossible to use it under load, and characteristic muscle weakness appears.

For grades 1 and 2 injuries, conservative treatment is most often prescribed, and for grade 3 injuries, surgical intervention is often required

Classification of sprains

Traumatologists also systematize sprains depending on the group of damaged ligaments. Thus, the ankle joint, which is most susceptible to distortion, is fixed by three groups of ligaments:

1. The outer surface of the joint: ligaments are located here that help fix the talus from lateral displacement:
   1. Calcaneofibular ligament.
   2. The anterior talofibular ligament is the most commonly injured of all the other ligaments.
   3. Posterior talofibular ligament.
2. Inner surface of the joint: the deltoid ligament runs here, connecting the talus and scaphoid bones.

In second place in terms of injury are the ligaments connecting the tibia:

1. Interfibular ligaments (posterior, anterior, posterior transverse).
2. Interfibular syndesmosis.

Classification of muscle strains

The calf muscles, thanks to which a person maintains balance during movement and bends the knees and feet, are at greater risk of injury:

• calf muscle;
• soleus muscle.

Thigh muscle strain is a very common injury in athletes.

Stretching of the thigh muscles (biceps, membranosus, anterior) occurs mainly during sports training, while in more severe cases the muscles lose the ability to contract and are subject to long-term recovery.

Classification of tendon sprains

Depending on the location, there are several types of tendons that are more susceptible to stretching:

1. The Achilles tendon is the most powerful in the entire body, but at the same time the most injured, which is associated with significant loads.
2. Patellar tendon - a sprain is accompanied by pain localized above the knee.
3. Hamstring strain - occurs when the tibia rotates abnormally and is characterized by pain under the knee and a characteristic protrusion in this area.
4. The tendon of the hip joint - provides its fixation, connecting the pelvic bones and the upper part of the thigh. Any excess load associated with tension in the thigh muscles leads to injury to the tendon tissue.

Classification by location of injury

Both single and combined sprains most often occur in the ankle and knee joints.

However, there are other locations that are at risk of distortion from the influence of a traumatic factor. In total, there are 6 areas in which this type of tissue damage can occur:

1. Foot - in this place and tendons occurs due to the high load on the joint, the injury significantly limits movement.
2. Ankle (ankle) - is a complex articulation of the bones of the lower leg and foot; a complex sprain of the tendon and ligaments can occur in this place.
3. The shin is the area from the knee to the heel, the muscles of which are often susceptible to injury.
4. Knee - The knee joint is susceptible to sprained muscles and ligaments, which, if damaged, can lose stability.
5. Thigh - the internal muscles are especially vulnerable in this place, the fibers of which rupture most often.
6. Buttocks - in this area, stretching of muscle fibers and ligaments may occur; tendons are less susceptible to impact.

The most common types of ligament injuries in the leg are ankle and knee sprains.

Causes of leg sprains

Typically, this type of injury occurs as a result of sudden falls or intense stress. When a sudden movement of a joint occurs that exceeds its physical capabilities, a muscle, ligament or tendon sprain occurs. The reason for this may be:

• a fall;
• slipping;
• wearing uncomfortable shoes, including high heels;
• turning the foot in or out;
• running on uneven surfaces;
• incorrect landing after a jump;
• active sports:
  • tennis;
  • volitional struggle;
  • basketball;
  • football, etc.
• incorrect lifting technique;
• a sharp blow to the leg.

There are also factors that predispose to stretching of leg tissues:

• clubfoot;
• flat feet;
• arthrosis;
• O-shaped curvature of the legs;
• connective tissue diseases;
• excess weight;
• poor warming up of muscles before training;
• incorrect gait, placing the foot on the back of the heel;
• the presence of previous leg injuries that cause weakening of the ligaments.

With constant stretching of leg tissues (for example, in the case of professional sports activities), this type of injury becomes chronic.

Muscle strains can occur in everyday life, without calculating the load and effort due to sudden lifting of heavy objects, during sports or when performing work tasks.

Symptoms of a Leg Sprain

When the leg muscles are strained, the following signs are observed:

• pain in a stretched muscle both during exercise and at rest;
• muscle weakness in the leg;
• hypersensitivity to touch at the site of sprain;
• lack of performance of the damaged muscle;
• the presence of swelling at the site of a sprain, bruise or hematoma;
• in case of severe injury - painful shock, loss of consciousness, increased body temperature.

In any case, no matter which muscle is injured, severe pain occurs, and if it is completely torn, a characteristic pop is heard

When a ligament is sprained, the symptoms are similar, characterized by pain, bruising and the development of swelling. The joint becomes inactive, and difficulties arise in walking.

A distinctive sign of a sprain is a feeling of instability in the joint, its incorrect position when moving.

When a ligament is sprained, the swelling lasts for a week, and after it subsides, a hematoma remains

A tendon sprain is accompanied by acute pain in the case of lightning-fast and extensive injury, or minor pain if the affected area is not so large. In addition to pain, tendon stretching is accompanied by tissue swelling and limitation of limb movement. In the absence of medical care, even with a slight stretch of the tendons, an inflammatory process can develop, reducing the elasticity of the tissue, which contributes to the complete rupture of the tendon and depressing consequences.

If the Achilles tendon is damaged, pain will be observed in the area approximately 5 cm above the heel bone notch, accompanied by swelling of the ankle tissue and difficulty in flexing the foot when trying to lift the toes. The patient cannot stand on his toes or run.

It is unacceptable to ignore even the slightest signs accompanying an Achilles tendon strain.

Diagnosis and differential diagnosis

Diagnosis includes a physical examination to determine the area of ​​damage and determine the severity of the leg sprain. Detection of partial or complete rupture of fibers determines the further course of treatment and the duration of the recovery period, as well as the need for surgical intervention.

If visual examination is insufficient, ultrasound diagnostic methods of the damaged joint are sometimes used, as well as MRI and arthroscopy (taking a biopsy to determine connective tissue disease).

Rupture of the medial collateral ligament of the knee joint, detected using ultrasound

When diagnosing sprains, radiography methods are not applicable, since only soft tissue formations can be subject to such deformation.

However, an x-ray can help in the differential diagnosis of a fracture, since sprain and disruption of the integrity of the bone are accompanied by similar signs and are sometimes combined in one injury.

In addition to radiography, clinical signs are taken into account to clarify the diagnosis: in the case of a sprain, there is no sharp pain when palpating the bone, no fragments are felt, and crepitation (a sound that occurs when bone fragments rub against each other) is not diagnosed. At the moment of injury, you can hear a characteristic pop, not a crunch of bones.

Also during the differential diagnosis of sprains, the latter is excluded based on data obtained after radiography. During a visual examination, the deformation of the joint is assessed, as well as the possibility of resistance when trying to move and a decrease in the length of the limb - with a sprain, the above symptoms are atypical.

Treatment for a sprained leg

The choice of treatment method directly depends on the diagnosis, associated complications and the severity of the injury. With the first two degrees of distortion, treatment at home is possible, and only the latter has indications for hospitalization of the victim.

If you have any doubts about visiting a doctor, you should consider the following warning signs that require a visit to the doctor:

• there is no mobility in the area of ​​the damaged joint, due to severe pain it is impossible to lean on the leg;
• the leg looks unnatural, the position of the joints is disturbed;
• pain does not decrease, swelling does not decrease for more than three days, bruises increase in size;
• increased body temperature, signs of inflammation and redness of the injured area;
• home treatment does not have a positive effect.

After visiting a traumatologist, it is important to follow all the doctor’s recommendations, only then the treatment will be faster and more effective and will not leave any unpleasant consequences. When prescribing bed rest, you should not neglect this advice and, as a last resort, use crutches when walking to relieve the load on your sore leg.

For any degree of leg sprain, the patient is advised to rest

First aid for sprains

Before contacting medical professionals, you can help the victim to avoid more serious consequences caused by sprains and reduce the rehabilitation period.

Emergency care consists of several simple but effective actions:

1. Applying a cold compress to the sprained area. For this, food from the freezer is suitable, or just ice, which should be wrapped in a towel and applied to the injured area. This will ensure vasoconstriction and reduce swelling, and also relieve pain. The cold should be kept for 15 minutes every hour.

   Cold compresses should be applied on the first and subsequent three days after injury

2. Creating conditions for maximum immobility of the leg in the joint. For this purpose, it is possible to use tight bandaging with an elastic material, as well as the application of an orthopedic bandage (bandage, splint) made of synthetic lightweight fabrics. At the same time, immobility is ensured and, as a result, pain and swelling are reduced, protection from further injury and aggravation of the situation (vascular rupture, hemorrhage). When bandaging a leg, do not wrap the limb too tightly to maintain adequate blood supply. The bandage should be removed at night.

   Long-term immobilization is also required in the case of complete tendon rupture until the mechanical strength of the connecting structures is restored

3. Providing rest for the injured limb. The less the victim disturbs the sore joint, the better. For the first three days, any physical activity on stretched tissues is prohibited in order to avoid worsening the prognosis of recovery.
4. The injured leg must be positioned so that it is above the level of the heart (on a bolster or pillow). This will help ensure blood flow away from the sprain site, reducing pain and swelling.
5. In case of severe pain, you can give the victim an analgesic: paracetamol or ibuprofen.

When spraining your leg, the following actions are prohibited:

1. Carrying out warming procedures (applying a heating pad, compresses, going to a bathhouse or sauna, rubbing with warming ointments). This will provoke the formation of more severe edema, hemorrhage, as well as a worsening prognosis of the disease.
2. Drinking alcohol, which will also provoke the above-mentioned consequences.
3. Activity of the injured limb, attempts to walk, massage the sprained area. In the acute period, this can lead to further rupture of the fibers.

Active movements are allowed during the recovery period, but not during the acute phase

Video: correct application of an elastic bandage for a sprained ankle

Drug therapy

Treatment with medications comes down to pain relief and local application of ointments (gels, creams, etc.), which help reduce swelling, reduce hematomas, restore tissue and impaired blood microcirculation. Taking painkillers is most important for the first 3–4 days after receiving a sprain, then you can reduce therapy only to local application of ointments. Among the analgesics, Aspirin, Analgin, Ibuprofen, Ketanov, and Paracetamol are most often prescribed.

Among the ointments, two groups can be distinguished that help in the treatment of sprains:

1. Cooling ointments. The use of these drugs is especially important in the first days of injury, as they have an analgesic and sedative effect. When applying the ointment, do not rub it into the damaged area; you need to wait until the drug itself is absorbed into the skin.
2. Warming ointments. These products are applicable during the rehabilitation stage and are applied to the skin after the acute period, 4–5 days after injury. The drugs make muscles more elastic, have an anti-inflammatory effect and promote faster healing.

Photo gallery: cooling pain-relieving ointments and creams for the treatment of leg sprains

Ibuprofen has a local anti-inflammatory and analgesic effect Reduces and relieves pain, swelling of the joints, and also helps to increase range of motion Quickly relieves both spontaneous pain and pain during movement, reduces inflammatory swelling at the site of sprain Voltaren relieves inflammatory swelling and post-traumatic pain Heparin ointment - anti-inflammatory drug, local anesthetic Ketonal relieves pain, swelling and inflammation at the site of a leg sprain

Ointments should be applied 2-3 times a day, with an amount of 3-4 g per application. The duration of treatment is determined by the doctor and depends on the severity of the leg sprain. A good therapeutic effect is achieved by simultaneous use of ointments and taking Troxevasin in tablet form.

NSAIDs should be used for a limited time due to their effect on the body as a whole. Long-term use of non-steroidal drugs can have a negative effect on the function of internal organs.

Photo gallery: warming ointments used during the rehabilitation period

Finalgon has a vasodilating effect, which is accompanied by an intense, long-lasting sensation of warmth. Apizartron is a combination preparation based on bee venom for external use. Natural components of the balm stimulate blood circulation and lymphatic drainage, help improve metabolism in the injured area, relieve inflammation and swelling. Nikoflex is a combination preparation that has a local irritant, analgesic and absorbable effect Causes irritation of sensitive receptors of the skin and subcutaneous tissue, dilates blood vessels, improves tissue trophism Analgesic and warming ointment, contains substances that have a local irritant, hyperemic and analgesic effect

It is worth remembering that any ointments are not applicable in places where the integrity of the skin is damaged. In addition, contraindications to the application of warming ointments are:

• pregnancy, lactation period;
• oncology;
• exacerbation of chronic diseases;
• individual intolerance.

Video: treating sprains with ointments

Physiotherapy

Physiotherapy refers to therapeutic measures prescribed after the acute phase of the patient’s illness.

Table: physiotherapy for sprains

The number of necessary physical procedures is selected by the treating traumatologist; usually 3 to 10 sessions are prescribed. Depending on the severity of the condition, several methods of physical treatment may be prescribed simultaneously.

Massage helps reduce pain, improve blood and lymph flow in the damaged area, and restore normal joint activity.

It is forbidden to massage the sprained area through pain, this can lead to a worsening of the patient’s condition.

First, massage the area that is located above the injured area on the leg (for example, if you sprain the ankle joint, the massage should begin by rubbing the shin). The massage time is gradually increased from 5 minutes to 15.

The massage consists of two parts: preparatory and main. Before the procedure, it is necessary to ensure that the leg is positioned in such a way that all muscles and ligaments are relaxed (place bolsters and pillows). During the first week of massage, the session consists mainly of stroking the injured area; kneading and squeezing are performed on the upper area. In the second week, you can add more active movements in the area of ​​damage.

Video: restoration of injured ligaments with massage

Surgery

Therapy with surgery is a last resort method of treatment, which is used if other methods do not bring the desired positive effect. Also, in particularly difficult situations, for example, complete rupture of the ligament and, as a result, the formation of joint instability, the intervention of a surgeon is required to ensure further full function of the leg.

If a ligament ruptures, the doctor may resort to one of two methods:

1. Applying sutures to the ligament.
2. Fixation of the damaged ligament with the help of another, neighboring ligament.

In case of complete separation of the muscle from the bone, it is also believed that conservative treatment is less effective than surgical treatment, primarily for the posterior thigh muscles. To return the muscles to their original place, special clamps are used, which are attached to the bone and then sutured with threads to the tendon of the torn muscle.

Surgery technique for avulsion of the posterior thigh muscles (hamstring) - suturing the common tendon of the posterior thigh muscles to the ischium using anchor clamps

After the operation, the patient wears special correction belts that help relieve stress on the muscle and speed up healing. The recovery period after surgery is 4–6 weeks.

When a tendon ruptures, they generally resort to conservative treatment. However, if there is no positive dynamics within 2 weeks, or if the rupture occurs again, the doctor may decide to perform surgery. The tendon is sutured with one of the many types of tendon sutures, the most used type being the Krackow suture.

Krackow suture: with this suture both ends of the torn tendon are sutured, after which the threads are tied together

After the operation, the patient’s leg is immobilized (fixed) using an orthosis or other similar devices. This period lasts 3–4 weeks, followed by further rehabilitation therapy.

Folk remedies

Therapy with traditional methods when combined with medications helps speed up recovery.

Raw potato compress

To treat, you need to wash and peel the potatoes and grate them. Transfer the resulting mass to gauze and apply to the sprain site 3-4 times a day for 20 minutes.

Pour 4 tablespoons of chamomile flowers into a liter of boiling water and cook for 15 minutes. After this, infuse the resulting decoction for an hour and add it to the water when taking a bath. In addition to chamomile, you can similarly prepare a healing decoction of oak bark and St. John's wort.

If there is a hematoma, the use of warm compresses is prohibited.

Photo gallery: folk remedies for sprained legs

Hot milk compresses are considered the most effective for sprains Potato tubers have an anti-inflammatory and anti-ulcer effect When applied externally, onions have a wound-healing effect Chamomile has an anti-inflammatory and healing effect Decoctions and infusions from oak bark are used as lotions for skin inflammation, wounds and sprains St. John's wort decoction is anti-inflammatory and wound healing for external use

It must be remembered that folk remedies cannot fully replace drug therapy and are used only as a component of complex treatment.

Treatment prognosis and possible complications

With timely therapy and first aid, the prognosis for treating the disease is favorable: the sprain completely heals, the elasticity of the fibers is restored. The rehabilitation period takes from 3–4 weeks to six months, depending on the severity of the injury, but it is important to carry out full treatment and not ignore the doctor’s prescriptions and recommendations.

In the absence of proper care, the consequences of a sprained leg can be:

• instability of the damaged joint;
• development of inflammatory diseases (arthritis);
• re-stretching damaged fibers;
• in more severe cases - limb defects, transition of the disease to the chronic stage.

The above complications can also arise during self-treatment: the victim often cannot make a correct diagnosis and miss a more serious injury.

Preventing leg sprains

To prevent muscle and ligament strain, you should strengthen your muscles by regular sports without excessive physical activity (jogging, swimming). It is also recommended that you wear appropriate walking shoes and be careful when walking in high heels.

It is important to pay attention to nutrition and a healthy lifestyle: excess weight contributes to excessive stress on the joints.

When you receive an injury such as a sprained leg, recovery may not be quick. The minimum period for restoration of full functionality is 3 weeks. You shouldn’t be inactive and put off visiting a doctor - timely diagnosis and the right approach to treatment will speed up recovery and relieve you from unpleasant consequences.

A tendon is a part of a muscle consisting of connective tissue, necessary for attaching the muscle to the bone and providing the full range of motor activity of the muscle. Tendon rupture is a common injury of an open or closed type, resulting from cuts, significant sudden or systematic tensions, blows, or other injuries, leading to disruption of its structure.

A distinctive feature of such injuries is the impossibility of self-healing of the injury due to the separation of fibers and the presence of constant contractile activity of the muscle. In the absence of the necessary treatment for a rupture, a possible outcome may be loss of motor function of the injured muscle, which leads to the loss of the person’s ability to work.

The causes of injury can be different, mainly, ruptures occur due to excessive sprains and stress due to improper exercise due to sudden lifting of weights, squats with significant weight, incorrect movement of the joint when pulling up on the horizontal bar.

Damage can also occur due to deep tissue cuts or falls and impacts due to industrial accidents, walking in icy conditions, or road traffic accidents. In such cases, the formation of open tendon injuries often occurs, which combine, among other things, bone fractures, injuries to soft tissues and blood vessels.

As a result of a tendon rupture, symptoms characteristic of most traumatic injuries occur:

• acute pain at the time of injury;
• limited functional mobility and instability of the joints in which the injury occurred;
• crack;
• swelling and hematomas at the site of injury;
• in some cases, blood accumulates in the joint capsule.

There are also local symptoms that are characteristic of each type of injured tendon, depending on its location.

Kinds

A tendon rupture can be:

• complete and incomplete (partial);
• single and multiple;
• open and closed.

Depending on the complexity of tendon rupture, the following degrees are distinguished:

• I degree - microtears, in which the main functions of the joint are preserved, there are no hemorrhages in the tissues and joint capsule;
• II degree – rupture of less than half of the fibers, resulting in pain and stiffness of movement;
• III degree - complete rupture or separation with the presence of acute pain, instability of the joint structure and the injured limb as a whole.

The most common injuries occur to the Achilles and shoulder tendons, as they are subject to the greatest physical stress. The tendons of the hand and fingers, the patellar ligament and the quadriceps femoris may also be affected.

Tendons of the hand and fingers

In the medical practice of traumatology, we often encounter fingers that can be complete or partial. Such injuries occur in the workplace due to cuts or tears while working with mechanical equipment. Often the injuries are open in nature, when the ends of torn tendons are visible from the damaged upper tissues, and the victim’s arm is in an extended state - all these symptoms help to establish the correct diagnosis. In addition, general symptoms such as swelling, hematoma, and increased skin temperature are observed. Tendon rupture is characterized by the absence of active flexion-extension functions of the fingers. When the deep flexor muscle is injured, there is little activity in the distal interphalangeal joints of the hand. If there is no activity at all, this indicates an injury to the superficial and deep flexor muscles of the fingers.

Treatment methods for ruptures of the tendons of the hand and fingers include conservative and surgical measures. Conservative treatment involves immobilization of the limb using a fixing (plaster) bandage for a period of 1.5-2 months. For open wounds, surgical treatment is used, which includes wound disinfection and suturing. In cases where there is an old rupture, surgical intervention is required in the form of replacing the damaged tendon with an artificial or donor graft.

Achilles tendon

The root cause of rupture of the patellar tendon may be excessive flexion of the knee joint due to degenerative changes. The rupture can be complete or partial. Manifestations of injury in such cases are:

• impaired knee functionality;
• displacement of the patella to the upper part of the joint;
• swelling, in some cases, the presence of hemarthrosis.

Treatment of a complete rupture is carried out using a surgical operation, by suturing the ligament with mattress sutures on the extended knee joint, and in the case of rupture of the ligament along with part of the bone, using transosseous sutures. The leg is fixed after surgery for several weeks. During this time, the patient is prescribed antibiotics and painkillers, and after the wound heals and the fixing bandage is removed, physiotherapy, massage and therapeutic exercises are prescribed.

Biceps brachii

Causes of biceps tendon ruptures include sudden heavy lifting and forceful movements of the shoulder joint, which can be aggravated by degenerative muscle changes. Other tendons of the shoulder girdle are located in places less accessible to damage. Symptoms of injury include pain, weakness of the injured limb, and swelling of the forearm.

To establish an accurate diagnosis, hardware studies such as MRI, radiography, and ultrasound are used. An effective method of treating this type of injury is surgery, by which the tendon is sutured with a mattress suture and the wound is drained. The limb is fixed using a wedge-shaped bandage for a period of up to a month. After the wound has healed, the patient is prescribed massages, physiotherapy and exercise therapy.

Quadriceps femoris

Injury to the tendons of the quadriceps femoris muscle is not widespread, usually has a transverse tear and occurs during sports training, if preliminary warming up of the muscles is not performed, or as a result of everyday falls. The injury is aggravated by the presence of degenerative changes in body tissues, for example, due to the abuse of steroid drugs or blood flow disorders.

Symptoms of damage:

• cracking and sharp pain above the knee joint at the time of injury;
• the quadriceps muscle loses its tone, a spherical protrusion is visualized when trying to tense the thigh muscles;
• visible tissue retraction;
• hemorrhage and swelling.

In case of partial rupture, conservative treatment is prescribed in the form of immobilization of the leg using a plaster cast for a period of 1 to 1.5 months. If the tear is complete, an operation is indicated to stitch the torn ligament together using mattress sutures. If the rupture is old, then the tendon is replaced. After the operation, the leg is subject to immobilization for a period of up to 6 weeks, after which exercise therapy, physiotherapy and massage are prescribed.

Treatment

The main approach to treating tendon injuries is to restore their integrity and functionality.

First aid in such cases involves ensuring complete rest of the injured part of the body, immobilizing it with a fixing bandage and applying a cooling compress.

Complete tendon rupture is treated with surgery. Conservative methods before surgery are not effective and begin to be used after the operation.

For tears, on the contrary, conservative treatment is indicated, which includes the following steps:

• applying a plaster cast for a certain period (usually from 10 days to 1.5 months), until the tendon structure is restored, and the use of analgesics to relieve pain;
• undergoing a set of physiotherapeutic procedures that help relieve swelling and improve blood supply to damaged tissues (ozokerite applications, paraffin therapy, baths, massage, etc.);
• performing a set of therapeutic physical exercises.

With timely implementation of the entire complex of therapeutic and rehabilitation measures, the patient’s full recovery is achieved in 2.5-3 months.

Muscle and tendon strains are the most common injury. Athletes and people whose work involves heavy physical activity are especially susceptible to it. But the cause of a sprain can be a careless, sudden movement, a twisted leg while walking, or any household bruise or injury.

The most dangerous injury is a sprain of the spinal ligaments. Most often it occurs in the cervical and lumbar region. Causes: heavy loads, sports, heavy lifting, careless movements.

How to recognize a sprain

Typically, symptoms of ligament damage appear immediately after the injury, but initially they may be mild:

• increasing pain;
• impaired motor function of the damaged part of the body;
• hemorrhage (often subcutaneous);
• swelling;
• unusually high mobility in the damaged joint indicates a ligament rupture.

What types of sprains are there?

There are three degrees of severity of a sprain:

• Grade I - slight pain due to rupture of several fibers of the ligament.
• Grade II - moderate pain, swelling and disability.
• Grade III - severe pain due to ligament rupture and subsequent instability of the joint.

A muscle strain, in turn, is a traumatic injury to the muscle fibers themselves or the connection between muscle and tendon, and is also classified into three degrees of severity:

• I - moderate.
• II - moderate degree of damage, associated with weakness of the affected muscle, its painful contraction.
• III - complete rupture of the connection between muscle and tendon, manifested by severe pain and the inability to contract the damaged muscle.

Complications of sprains

If you do not see a doctor in time when you sprain, joint instability, arthrosis, and myositis subsequently develop.

Complications from spinal sprains can include concussion of the spinal cord or hemorrhage into it.

How do we treat sprains?

Treatment of both complete and partial ligament injuries is aimed at restoring their integrity and mechanical strength.

In some cases, a tight bandage of the joint is necessary to immobilize it.
The mainstay of treatment is early pain relief and anti-inflammatory therapy for soft tissue injury, especially in cases of concomitant myositis. Methods used for this

Definition of tendons

Tendons connect muscles to bones. They come in the form of jumpers that divide the muscle into several sections. And also short, long, wide, narrow. There may be cord-like, round, ribbon-like and lamellar tendons. The digastric muscles have intermediate tendons. They pass along the lateral surface of the muscle body and penetrate into its thickness.

Like a muscle, tendons are made up of parallel bundles. First-order bundles are surrounded by layers of loose connective tissue and form a second-order bundle. A group of second-order beams forms a third-order beam. Tendons are composed of dense fibrous connective tissue; they contain more fibrous elements than cellular elements.

Due to this, their distinctive properties are high strength and low elongation. The tendon part of the muscles grows faster from 15 to 25 years than the muscle belly. Until the age of 15, the tendons are poorly developed, their growth has the same intensity as muscle growth. In the body of older people, changes occur in tissues, the elasticity of tendons is impaired, which often leads to injury.

The longitudinal elasticity of the tendon tissue protects the tendons from rupture during sudden movements and overexertion. Therefore, in order to prevent tendon injuries, it is necessary to activate, develop and strengthen them; regular exercise and performing certain, special exercises will restore their elasticity and strength.

There is a great saying that contains great wisdom: “He who exercises his sinews in his youth will receive vigor in his old age.” If physical effort is needed to train muscles, then tendons are trained using static tension. With physical stress, tendons and fascia are enriched with oxygen and become elastic, gaining endurance and strength.

Tendons must be elastic; the loss of this property leads to displacement of internal organs, changes in natural shapes, and the formation of knots and compactions. The strength of the tendons was known to the hero Zass Alexander Ivanovich, who created his own training method.

Commander Grigory Ivanovich Kotovsky, sitting in captivity, practiced static exercises and was famous for his unprecedented strength and endurance.

To identify tendon pathology, methods are used - palpation, thermography, ultrasonography, biopsy.

When tendons inside a joint are damaged, arthroscopy is effective. Anomalies in the development of tendons are a consequence of malformations of the musculoskeletal system, atypical movement or unusual attachment.

Tendon inflammation

There are several types of inflammatory tendon diseases, accompanied by disruption of the musculoskeletal system.

1. Tendonitis is an inflammatory process that occurs quite often. The reasons for its occurrence are always the same and therefore, during diagnosis, identifying this pathology is quite simple. Tendonitis occurs from prolonged chronic overexertion, which causes degenerative changes and tears in the tendon. This type of inflammation helps reduce the strength of the tendon and increases the risk of rupture.

Tendonitis can also be infectious. Athletes mainly suffer from the dystrophic type due to heavy physical stress on muscles, ligaments and tendons. Various rheumatic diseases of the joints also contribute to the development of such inflammation.

2. Paratenonitis - aseptic inflammation of the peritendinous tissue. It occurs when there is repeated trauma in the joint area. In this case, in the connective tissue, between the fascia and the tendon, after pinpoint hemorrhages and the appearance of swelling, fibrous tissue deposits occur. Nodular seals lead to painful sensations, movements are limited, and activity is lost.

The disease damages the Achilles tendon, extensors of the forearm, and the lower third of the leg. Paratenonitis can have an acute and chronic course. Treatment for tendon inflammation is immobilization of the hand or foot. Traditional physiotherapeutic procedures are also effective.

Treatment of acute inflammation of the tendon (tendinitis) involves antibacterial and restorative methods. In the case of aseptic tendonitis, non-steroidal anti-inflammatory drugs are used.

Local treatment consists of fixing the diseased limb. After the acute manifestations of the disease pass, physiotherapeutic procedures can be prescribed. Warming up should be performed after the acute manifestations of the disease have passed.

This set of procedures includes UHF, microwave therapy, ultrasound, ultraviolet rays. Special therapeutic exercise is useful. Soft heat and magnetic fields, improving blood circulation, relieve inflammation, tissue swelling goes away, and damaged parts of the tendons are restored.

Tendon sprain

Sprains are the most common type of injury, usually occurring in the ankle and knee joints from a sudden movement that exceeds their amplitude. Tendons connect muscles to bones, and ligaments connect bones. These two definitions are often confused. A sprain is in fact always a microscopic tear with a small stretch; with a moderate degree of injury, individual collagen fibers may rupture; if the injury is severe, the entire ligament is torn.

Having a high ability to regenerate, ligaments are restored at any degree of injury. The strongest muscles in humans are found in the lower extremities. This also means that the tendons that attach the muscles to the bones in the legs must withstand enormous forces. But, unfortunately, unsuccessful movements and falls occur, causing sprained tendons in the leg.

Achilles tendon strain occurs when muscles are not warmed up enough during sports, when wearing uncomfortable shoes, or when walking on uneven, rocky surfaces. Tendon sprains can be divided into three degrees of difficulty:

• The first degree is minor pain after injury, aggravated by physical impact.
• Second degree – severe pain, swelling of the skin over the damaged tendon. Muscle weakness and increasing pain during physical activity are detected.
• Third degree - complete or partial rupture of the tendon, muscle contraction occurs. At the moment of rupture, there may be a sensation of popping, sharp, severe pain, etc.

Typically, third degree tendon damage is repaired surgically. Many victims of the first and second degrees do not pay special attention to treatment and in vain, a weakening of muscle strength may occur, the development of inflammation in the tendon and in the “case” - where there are several of them. This phenomenon is mainly observed in the tendons of the foot muscles and is called tenosynovitis.

Chronic inflammation is complicated by the atrophic process, which affects the thinning of tendon fibers; they can easily be torn under light loads. When the tendons on the leg are sprained, first aid consists of immobilization and fixation in an elevated position. Then you need to apply ice for 20-30 minutes (repeat 4-5 times a day), after which each time apply a pressure bandage using an elastic bandage to limit the spread of swelling.

Ice will stop bleeding from damaged vessels. Severe pain is relieved by drugs such as diclofenac, analgin, ketanov. On the second day, after inflammation and swelling have subsided, if there is no development of a hematoma, the next stage of treatment is applied, namely thermal procedures. The effect of heat normalizes blood flow and the damage heals. The use of anti-inflammatory ointments is effective, among which Finalgon, Efkamon, Voltaren have become popular.

The tendon recovers faster at rest, thanks to the consumption of foods rich in animal and plant proteins. After a week, under the supervision of a specialist, a set of exercises is gradually applied to the sore muscle. Mechanical damage occurs as a result of the direct or indirect action of a traumatic agent.

Direct action - impact with a blunt object. Indirect action - sharp muscle contraction. There are closed injuries, among which there are ruptures and much less often dislocations. Closed injuries include spontaneous ruptures; they usually occur with chronic injury and dystrophic changes in the structure of the tendons. Also, the cause of rupture can be infectious-toxic and metabolic-toxic factors, for example, diabetes, infectious diseases.

There are subcutaneous partial or complete ruptures without damaging the skin. Tendon dislocation as a result of ligament rupture ends in hemorrhage, swelling and pain when moving. The displacement can be so strong that the defects are visible upon visual inspection. Especially if it concerns the extensors of the fingers. Treatment of a dislocation is its reduction, immobilization with a plaster cast for a 3-4 week period.

Surgical intervention is indicated for chronic and habitual dislocations, with pain constantly reminding of the damage, and with an obvious change in functional activity. A tendon rupture is usually signaled by a loud cracking sound, unbearable pain and impaired motor function of the ruptured muscle. Open injuries are observed with stab, cut, chopped wounds, and with severe injuries. Damage levels:

• Separation of the tendon from its insertion site.
• Rupture along the entire length of the tendons.
• Tendon rupture in the area where it transitions into muscle. Such phenomena are most likely to occur in older people, and in those whose profession involves muscle strain or in athletes.

Rupture and damage to hand tendons

Open injuries (puncture, cut, chopped wounds) are observed in severe injuries, for example, after a hand gets caught in working machinery in production. Damage to the tendons of the muscles of the upper limb at the level of the hand and forearm is mainly observed, most often the flexors. Both individual tendon injuries and combinations with damage to nearby vessels and nerves are noted.

When the hand finds itself between the moving parts of the unit, it is crushed, lacerations are obtained, the muscles contract and the ends of the tendons diverge. A puncture wound completely cuts the tendons in a limb. Here, surgical restoration is required; the operation is quite complex and lengthy because it is necessary to sew up all the damaged tendons in order to normalize the function of the hand. The application of an extensor dynamic splint accelerates the healing process of tendon wounds.

Rupture and damage to finger tendons

When the tendons of the fingers are torn, a lack of active flexion in the distal interphalangeal joints of the hand can be detected. This is evidence that the deep flexor muscle is damaged. If the absence of active movements in the interphalangeal joints is determined, then the superficial and deep flexors of the fingers are damaged. But the function of the lumbrical muscles, which provides active flexion at the metacarpophalangeal joints, may be preserved.

By examining the sensitivity of the fingers, nerve damage is detected. The X-ray method for bruised and crushed ones will definitely show the degree of damage to the bones and joints. Open injuries to the flexor tendons of the fingers are more common. If there is damage in the area of ​​the distal interphalangeal joint, flexion of the nail phalanx by 60° is possible, but extension is impossible.

If the tendon-aponeurotic stretch of the extensor fingers of the hand is affected at the level of the proximal interphalangeal joint, even if the integrity of its central part is damaged, extension of the nail phalanx is possible, sometimes the middle one can be in a flexed position. It is quite common for the nail and middle phalanges to be in a bent position while all three parts are affected. The extensor finger can be damaged in the area of ​​the main phalanx, then active extension in the joints between the phalanges occurs, but there is no activity of extension of the main phalanx.

Damage to the flexors and extensors of the fingers has to be treated surgically. The exception is fresh tears in the area of ​​the distal interphalangeal joint; here, fixing the nail phalanx in a hyperextension position and bending the middle phalanx at a right angle for 1 to 1.5 months effectively helps.

As for open injuries, first aid consists of stopping the bleeding, after which it is advisable to cover the wound with a sterile bandage and apply a transport splint. At the trauma center, the diagnosis will be clarified, the wound will be treated, and a tendon suture will be made, which, by the way, is contraindicated for lacerations, bruised wounds, bone fractures and joint injuries. Modern surgeons recommend plastic surgery for chronic injuries of the flexor and extensor tendons of the fingers.

Rupture and damage to foot tendons

Degrees of damage to the tendons of the foot:

• First degree – slight pain, slight swelling of the ankle. You can step on your foot. Unpleasant sensations disappear after a few days of treatment with special ointments and compresses.
• Second degree – medium-sized joint, sharp pain when moving the foot.
• Third degree – tendon rupture, severe persistent pain, significant swelling of the joint.

Rupture and damage to the Achilles or calcaneal tendon (triceps muscle of the leg), which is attached to the heel tubercle and is very thick, appears as a result of severe tension. Usually the gap in this zone is complete. Causes of damage include direct trauma after being hit by a hard object and indirect impact resulting from a sharp contraction of the triceps surae muscle.

The risk group includes athletes; injury can occur, for example, in runners with a sudden load on the tendon when the foot lifts off the surface at the start, in track and field athletes with sharp dorsiflexion of the foot during a fall from a height. Partial damage to the Achilles tendon occurs due to direct trauma with a cutting object. The victim experiences acute pain, a sensation of a blow to the tendon.

Hemorrhage and swelling are observed on the back surface of the lower third of the leg. You can see a dent in the rupture area. The patient cannot stand on the balls of his feet and plantar flexion of the foot is impossible. First aid consists of pain relief with medications and delivery to the trauma department.

Treatment for fresh ruptures (no more than two weeks) is a closed percutaneous suture. A plaster cast is applied to the affected area for 4 weeks, the leg remains in one position all the time. After removing the thread from the suture, the leg is fixed for 4 weeks in a different position.

If the injury is old (more than 2 weeks), usually scar tissue has already formed at the ends of the tendons, it is removed, a skin incision is made over the tendon, and the ends of the tendon are sutured with a special suture according to Dr. Tkachenko’s method. If there is a tissue defect, plastic surgery is performed, followed by the application of a plaster cast for a period of 6 weeks. Full recovery is guaranteed with the use of special exercises and physiotherapy.

The Achilles tendon is the strongest; when the muscles are tense, it stretches and allows you to stand on your toes or perform a jump. For diagnosis, radiography of the ankle joint in a lateral projection, magnetic resonance imaging, and ultrasound equipment are used. Damage can also be determined using traditional palpation.

Rupture and damage to tendons in the legs

In the legs, there is a rupture of the quadriceps tendon. The quadriceps femoris tendon attaches to the surface and sides of the patella and tibial tuberosity. This is a very strong connection, but the muscle also has strength, so its sharp contraction causes the tendon to rupture in the transverse direction in the area just below the attachment to the patella. At the moment of rupture, a crack is heard and a sharp pain is felt above the knee.

Retraction occurs, hemorrhage occurs, and tissues swell. The quadriceps muscle loses its tone, its tension leads to a hemispherical protrusion. Attempts to straighten the lower leg become unsuccessful. First aid - splinting and transport to hospital. To treat a rupture of the quadriceps tendon, pain relief is used and the ends of the tendon are sutured with threads made of absorbable material. A plaster cast is applied for 6 weeks. Then physical therapy and physiotherapy are indicated.

Tendon pain

Many people experience pain in the tendons of their legs and arms. Doctors state that they have to deal with such complaints in their practice every day.

Pathogenic processes in tendons such as tendonitis, tendinosis and tenosynovitis are not uncommon. Tendinitis develops with incorrect posture, prolonged sitting in an uncomfortable position, and lack of warming up of the muscles during sports. Infectious diseases, arthritis of the joints and diseases of the musculoskeletal system, different lengths of the limbs increase the load on the muscles and tendons.

If there is pain in the tendons, then it is also noticeable in the neighboring tissues. Soreness may occur suddenly or gradually increase. Unbearable pain is characterized by the presence of calcium deposits, impaired mobility and capsulitis of the shoulder. Sharp pain is observed with tendinosis, because it is associated with tendon rupture. Tenosynovitis also causes tendon pain. The cause of pain in the tendons may be excessive force of the organ. With prolonged stress, tissue degeneration develops and metabolism is disrupted.

Expert editor: Mochalov Pavel Alexandrovich| Doctor of Medical Sciences therapist

Education: Moscow Medical Institute named after. I. M. Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".