AFFECTIONS of MUSCLE AND TENDON

Normal muscle structure

 A layer of dense connective tissue, which is known as epimysium and is continuous with the tendon, surrounds each muscle. A muscle is composed of numerous bundles of muscle fibers, termed fascicles, which are separated from each other by a connective tissue layer termed perimysium. Endomysium is the connective tissue that separates individual muscle fibers from each other. Mature muscle cells are termed muscle fibers or myofibers. Each myofiber is a multinucleate syncytium formed by fusion of immature muscle cells termed myoblasts.

CONTUSION AND STRAINS

A contusion is a bruise of the muscle with varying degrees of

hemorrhage and fiber disruption.

A strain is a longitudinal stretching or tearing of muscle fibers or groups of fibers.

Contusions and strains cause disruption of the normal architecture of the muscle-tendon unit secondary to interstitial edema, hemorrhage, or overstretching.

DIAGNOSIS History Contusion and strain injuries frequently occur during strenuous activity. limp or inability to bear weight. In mild strains, the animal became reluctant
Physical examination Imaging

Physical Examination
With mild contusions the animal may exhibit minimal lameness

severe contusions, pain and swelling are present.

The majority of severe contusions occur in conjunction with fractures Severe muscle strains are recognized by swelling and pain of the affected muscle unit.

Imaging
Radiographs are necessary to

Diffferential diagnosis
Joint sprain Fracture Polymyopathies Polyarthopathies

rule out bone injury. Acute injuries may show soft- tissue swelling. Ultrasonography may show interstitial fluid accumulation.

MEDICAL MANAGEMENT
- The primary treatment rest. - With acute injuries, i.e, those in the initial 24 hours, cold compresses on the affected muscle - If old, topical heat application is recommended,. - Nonsteroidal antiinflammatory drugs and restricted activity.

Surgical treatment
Surgical treatment is advised only when the interstitial fluid accumulation is very high resulting in vascular compromise. Surgical technique: make the incision through the skin, cutis overlying the muscle to be exposed, when the muscle group is identified incision through the fascia is done to decompress.

MUSCLE-TENDON LACERATION
Lacerations are tears within the

muscle-tendon unit. Lacerations are usually the result of penetration of the muscle-tendon unit

by a sharp object.
These injuries most commonly involve the tendons near the carpometacarpal and tarsometatarsal joints, but they may involve muscle units in other parts of the body.

DIAGNOSIS
History. The animal usually has an open wound and a non-weight-bearing lameness Radiography- to check for bone

involvment
Physical Examination Findings- nonweight-bearing lameness.

SURGICAL TREATMENT
Lacerations require appositional sutures If the laceration has occurred

through tendon, delicate

manipulation and apposition with small-diameter suture are

recommended.

Muscle Laceration
debride the wound edges to freshen. Debride carefully to avoid excess removal of tissue, which will make apposition of the severed ends difficult. Place interrupted sutures in the outer muscle sheath around the circumference of the muscle.

Support the appositional sutures with heavy stent sutures placed in a cruciate pattern.

 Repair of muscle laceration with appositional sutures supported by tension stent sutures

Tendon Laceration
debride the tendon ends.

for small tendons, use small-diameter, nonabsorbable material placed in a series as interrupted vertical mattress or cruciate sutures.

For larger tendons, select the largest suture diameter that will readily pass through the tendon atraumatically. A locking-loop suture pattern is recommended
Alternatively, use a three-loop pulley, Bunnell-Mayer, or far-near, near-far suture pattern.

Far-near near-far

Bunnell-Mayer technique

Three loop pulley

Locking loop

Healing of muscle and tendon laceration

Similar to connective tissue healing Follows one wound one scar principle Strength is regained by one wound one scar principle and the function regained by active and passive use of the limb/ muscle

MUSCLE-TENDON UNIT RUPTURE

Rupture of the muscle-tendon unit

is a complete or partial loss of

integrity of the muscle-tendon unit caused by extreme overstretching.

Muscle ruptures are the result of a

powerful contraction occurring

during forced hyperextension of the muscle-tendon unit

DIAGNOSIS
History: Affected animals usually exhibit a weight-bearing lameness after strenuous activity. Physical Examination Findings

Imaging

Physical Examination Findings

Tarsal hyperflexion is frequently noted in affected animals. The animal will be unable to bear weight, and flaccidity of the Achilles tendon will be noted upon passive dorsal flexion of the tarsus when the stifle is extended. Postural changes associated with a palpable swelling of the Achilles tendon confirm the diagnosis.

Postural changes and careful palpation of the muscle-tendon unit confirm the diagnosis.

Imaging
Ultrasonography is helpful in
determining the extent of tendon fiber disruption. Standard craniocaudal and medial-tolateral radiographs are indicated to determine the presence or absence of bone avulsion from the tuber

calcaneus.

SURGICAL TREATMENT
Achilles Tendon Rupture Make an incision over the site of injury on the caudolateral surface of the limb. Identify the three tendons composing the Achilles complex and suture each tendon separately with an interrupted far-near, near-far pattern using nonabsorbable, small-diameter (3-0 to 4-0, depending the animal's size) monofilament suture.

 Then, sequentially remove sections of scar tissue from the center of the mass. Remove enough tissue so that tension is present in the Achilles complex when the stifle joint is in a normal standing position and the tarsus is slightly extended. If excess fibrous tissue is excised, apposition of the cut ends will be difficult. Suture the cut ends with a three-loop pulley pattern or maintain apposition with tendon plating.

 For tendon plating, oppose the cut ends of the tendon with nonabsorbable

monofilament suture.

Support the anastomosis by placing a small

bone plate adjacent to the tendon Place interrupted sutures through the plate holes into the body of the tendon. Use large-diameter, nonabsorbable

monofilament suture.

Tendon plating
Small bone plate

Appositional sutures

MUSCLE CONTRACTURE AND FIBROSIS

Muscle contracture may occur when there is replacement of normal muscle-

tendon unit architecture with fibrous

tissue resulting in functional shortening of the muscle or tendon. Muscle contracture is most commonly recognized in the infraspinatus and

quadriceps muscle-tendon units.

DIAGNOSIS
Any age, breed, or sex of dog may develop quadriceps muscle contracture; however, it most commonly occurs in immature patients following distal femoral fracture. Contracture of the infraspinatus muscle usually occurs in young, adult, sporting breeds of dogs. History Physical Examination Findings Radiography

 History. Animals with quadriceps muscle contracture usually are seen for evaluation of lameness 3 to 5 weeks after having sustained femoral trauma. Usually there is a history of acute lameness following strenuous activity in the 3 weeks prior to evaluation for infraspinatus muscle contracture

Physical Examination Findings

The stifle joint of animals with quadriceps muscle contracture has a limited range of motion Initially the joint can be fully extended but can be flexed only 20 to 30 degrees. Gradually the amount of flexion decreases to less than 10 degrees. Contracture may be such that the stifle joint appears hyper extended. Cranial thigh muscles are generally atrophied and palpate as a thickened cord.

 Animals with infraspinatus muscle contracture initially have a weight bearing forelimb lameness Soft tissue swelling in the region of the shoulder joint may be noted. The characteristic gait abnormality is secondary to progressive fibrosis and contracture of the infraspinatus muscle. As the muscle shortens from contracture, external rotation of the shoulder occurs, causing elbow abduction and outward rotation of the paw

Radiography
Standard radiographs do

not show abnormalities of

the muscle-tendon unit but

will help differentiate

fracture or neoplasia as the

cause of lameness.

SURGICAL TECHNIQUE
Quadriceps Contracture Expose the stifle joint and distal femur through a liberal craniolateral incision. Elevate and release adhesions between the quadriceps muscle group and femur with sharp dissection. Release adhesions between the fibrous joint capsule and femoral condyles. Luxate the patella medially and flex the joint to its full extent. If a functional range of motion (greater than 40 degrees) is not achieved after releasing the adhesions, perform a quadriceps muscle-tendon unit lengthening procedure.

Z-plasty. Make a longitudinal incision through the center of the muscletendon unit beginning 8 to 10 cm proximal to the patella. Extend the incision distally to a point 3 cm proximal to the patella. At the proximal extent of the longitudinal incision, make a transverse incision laterally through the muscle and fibrous tissue.

 At the distal extent of the longitudinal incision, make a transverse incision medially through the muscle and fibrous tissue. Flex the stifle and allow the cut edges of the longitudinal incision to slide on each other. When a functional range of flexion is achieved, place interrupted sutures across the longitudinal incision to maintain the desired length of the quadriceps muscle-tendon unit

 Muscle release. Extend the lateral incision to expose the proximal femur.
At the level of the third trochanter, elevate the quadriceps from the medial, lateral, and caudal surfaces of the femur. Incise through the origins of each muscle group to release the quadriceps and allow distal sliding of the muscle group. Release the vastus intermedius near its point of origin on the ilium. Close the surgical wound using standard methods.

Infraspinatus Muscle Contracture

Perform a craniolateral approach to the shoulder joint. Isolate the circumference of the infraspinatus muscle with sharp dissection. Transect the fibrotic muscle and any fibrous bands restricting movement of the joint. Once the fibrous contracture is incised, the limb will assume a normal position and a normal range of motion of the shoulder will be possible.