Download Distal Clavicle Resection

Sports Physiology
韓偉 醫師
美國加州大學洛杉磯分校助理骨科教授 (UCLA)
台北新光骨科運動醫學中心主任
台北中山醫院骨科部主治醫師
肌
肉
(Striated Muscle)
Largest tissue mass (40 - 45 %)
Generate force to move joint and limb
Origin (direct or tendon) & insertion (tendon)
Crosses joint
One joint : deep, postural, more forceful, slower contraction
Two joints : superficial, faster contraction
肌
肉
(Striated Muscle)
Fusiform : greatest ROM
Pennate : more force, less work, resist elongation
肌
肉
(Striated Muscle)
Force determination
1) Cross-sectional area
2) Fiber orientation
3) Length of fiber
Energy absorption
1) Innate passive component
2) Active contractile property
Viscoeslatic behavior
1) Repetitive stretching : reduced tension in muscle
2) Warm-up : increased temperature → less tissue failure
肌
肉
(Striated Muscle)
Isometric
1) Constant muscle length (no joint movement)
2) No ↑ muscle endurance function
3) Strength gain determined by joint angle
4) Do not improve motor performance
Isotonic (eccentric or concentric)
1) Variable speed, constant force (+ joint movement)
2) Improved motor performance
3) Machine or free weight, theraband, push-up
Isokinetic
1) Constant speed, variable force (+ joint motion)
2) Generate maximum force during exercise (max strength gain)
3) Improved motor performance
肌
肉 (Striated Muscle)
Structure of Striated muscle
1) Myofiber
2) Fiber (endomysium)
3) Fascicle (perimysium)
4) Muscle (epimysium)
Proteins of Striated muscle
1) Myosin
2) Actin
3) Tropomyosin
4) Troponin
肌 肉 (Striated Muscle)
Muscle Fiber Type
I
II a
II b
Contraction
(Twitch)
Slow
Fast
Fast
Fatique
Resistant
High
Moderate
Low
Glycolytic Enzyme Low
Moderate
High
Mitochondria
High
Moderate
Low
Postural
Deep
Endurance
Phasic
Superficial
Sprinter
Phasic
Superficial
Sprinter
II c
Super Fast
Transition
(I and II a)
肌 肉 (Striated Muscle)
Force Generation
1) Rate of neurons discharge (higher force)
2) Muscle fiber recruitment (low force)
Cross-Reinnervation
Compensatory Hypertrophy
Exercise
1) Overload
2) Specificity
3) Reversibility
肌 肉 受 傷
Laceration (肌 肉 裂 傷)
1) Scar tissue formation
2) Denervation of distal segment
3) Repair with tendon / connective tissue
Cramp (肌 肉 抽 筋)
1) Hyperexcitable motorneuron in spinal cord
2) Dehydration (sweating or diuresis)
3) Metabolic (sodium, calcium, Mg)
Delayed-Onset Muscle Soreness
1) Hours after exercise, prominent after 24 hours
2) High intensity, rhythmic contraction, minimal fatique
3) Rupture in connective (collagen) tissue (↑hydroxyproline excretion)
肌 肉 受 傷
Muscle Soreness
1) 12 Hours to 24 hrs after exercise
2) More with eccentric exercises
3) Muscle fatique and metabolic disturbance
Delayed-Onset Muscle Soreness
1) Hours after exercise, prominent on first and second days
2) High intensity, rhythmic contraction, minimal fatique
3) Pain at tendon or fascial connection within muscle
4) Ruptures in connective (collagen) tissue (↑hydroxyproline excretion)
肌 肉 受 傷
Muscle Contusion (肌 肉 挫 傷)
1) Direct trauma (quadriceps or gastrocnemius)
2) Hematoma in muscle tissue
3) Treatment:
1. Rest
2. Immobilization (120° of flexion) for 24 hrs
3. Ice
4. ROM exercises
4) Myositis Ossificans (ossification at injury sites)
1. 2 to 4 weeks post-injury
2. Connected to tissue (histologically similar to OsteoSarcoma)
3. Resorb spontaneously
4. Surgical excision (symptomatic)
肌 肉 受 傷
Compartment syndrome
1) Acute
Direct trauma or fracture
Elevated compartment pressure → decreased tissue perfusion
Signs:
Pain, pulseless, pallor, paresthesia
Treatment: Fascial release
2) Chronic
Occur after prolong exercise → stop or reduce intensity
Elevated pressure during exercise, slow return to normal after rest
Treatment: Fascial release
肌 肉 拉 傷 (Strain)
1. 肌腱交接處
2. 常見於雙關節肌肉
3. 離心收縮 (Eccentric Contraction) > 向心收縮 (Concentric)
4. 運動傷害
1) High velocity sports
(soccer, football, basketball, track)
2) Type II fiber (fast twitch)
5. 病理上可分: 第一、第二 、 第三度
肌 肉 拉 傷 (Strain)
Location
1) Gastronemius (medial head)
2) Rectus femoris
3) Triceps
4) Adductor longus
5) Pectoralis major
6) semimembranosus
Symptoms and signs
1) Pain with passive stretcing and active contraction
2) Subcutaneous bleeding
3) Hematoma (muscle and fascial compartment)
肌 肉 拉 傷 (Strain)
Prevention:
1) Stretching
2) Warm-up
3) Avoid fatique
Treatment :
1) Rest
2) Ice
3) Compression
4) Medication (NSAID, muscle relaxant)
5) PT: ROM / strengthening exercises
6) Surgical repair (第三度常需開刀治療)
第三度肌肉拉傷
肌 肉 受 傷
Warm-up (↑ muscle extensibility)
Stretching (↓ tissue failure)
Strengthening (↑ energy absorption)
Conditioning (avoid fatique)
肌 腱
Connect muscle to bone
85% collagen
Transmit load
Bend at joints
Absorb shock
肌 腱
Tropo-collagen
Microfibril
Fibril
Fascicle
Endotenon
(continuous with perimynium / periosteum)
Tendon
Peritendon
1) Paratenon
2) Epitenon
肌 腱
Biochemistry
Tenocytes
Collagen (type I Triple helix) – resist tensile stress
Elastin – elastic potential
Ground substance (proteoglycan) – resist compression
water
肌 腱
Mechanical Property
Creep
(Time-dependent deformation)
Stress relaxation
(History-dependent deformation)
肌 腱
Age
1) ↓tensile strength (↓ collagen)
2) ↑stiffness (↑cross-link)
3) ↓ water and GS
Training
1) ↑ tensile strength (↑ collagen)
Immobilization
1) ↓tensile strength (↓ collagen)
2) ↓stiffness (↓ cross-link)
Corticosteroid
1) 2 weeks: ↑ tensile (↑ collagen cross-link)
2) Long term: ↓collagen synthesis (↓ collagen size)
NSAID
1) ↑ tensile strength ( ↑ collagen)
肌 腱
Tendon Healing
Inflammatory Phase (7 days)
1) Blood clot formation
2) Migration of fibrobalst and capillary buds↑
Reparative Phase (1 to 4 weeks)
1) Collagen synthesis
2) Increased tensile strength ( 1st phase plateau at 16th day)
Remodeling Phase (2 weeks ~ )
1) Perpendicular to parallel collagen orientation (2 months)
2) Collagen maturation and remodeling ( 3 weeks to 2 years)
3) Increased tensile strength ( 2nd phase at 19th day)
肌 腱
Factors Affecting Tendon Healing
Active mobilization (after 3 weeks)
Early movement leads to tendon gap
Stress
↑ collagen re-orientation
Controlled passive mobilization
↑ gliding
↑ tensile strength
Corticosteroid
↓ tensile strength
(↓ collagen cross-link and formation)