Anterior shin muscle (tibialis anterior)

The tibialis anterior muscle is lateral to the TMSM above the ankle and posterior to it in the ankle region.

myositis

Head of the Pain Research Center, member of the Russian Society for the Study of Pain, the Association for Interventional Pain Treatment, the Russian Association of Rehabilitation Therapists and the International Association for the Study of Pain (IASP)

He is a neurologist-algologist, physiotherapist, rehabilitation therapist and a member of the Russian Association of Rehabilitation Therapists.

Myositis in adults refers to a whole group of pathological changes in skeletal muscles. In a narrower sense, it is an inflammation of the muscle tissue that is responsible for the musculoskeletal system. However, myositis in adults can be not only inflammatory, but also toxic or traumatic. The most common form is cervical myositis (more than 50 % of all myositis cases). In second place is muscle inflammation in the joints of the back, especially in the lumbar joints.

symptoms and signs

The symptoms and treatment of myositis in adults are completely interrelated. The therapy depends on the form of the disease. The symptoms of myositis vary depending on the spread of the disease. There are two main forms: localized and polymyositis. In the first case, the inflammatory processes affect only one muscle. If they spread to the entire group, it is polymyositis. It is much more common than the localized form of the disease.

Myositis of the neck muscles tends to occur more often than in other areas of the body. This type of myositis causes severe pain. It restricts the movements of the head. It affects not only the throat, but also the neck, ears or shoulder blades and can develop into muscle inflammation of the arms and chest.

Neck and back myositis is the most common form of the disease, but other forms such as myositis of the legs and calves and myositis of the jaw and hand are also common.

Myositis in the back is the second most common form of the disease. It affects the muscles in the lumbar spine. Symptoms of back myositis are less pronounced than those of the neck, and the pain is annoying. When palpating the problem area, the doctor will discover a lump. During this process, the pain of myositis only increases. This form of pathology is more common in people of retirement age.

Myositis of the legs and arms is also common, especially the generalized form. Localized forms are much more common, especially muscle inflammation in the arms or calves. With the generalized form, it is very difficult for the patient to move - to walk, to raise his arms above his head. Any tightening of these muscles causes pain.

Myositis can occur as an independent disease or as a symptom of another disease, e.g. For example, thoracic myositis may develop as a result of tuberculosis. Inflammatory processes in the muscles are often caused by an autoimmune reaction. One of the most severe forms is dermatomyositis or Wagner syndrome. In this case, not only the muscle and connective fibers are affected, but also the skin tissue.

symptoms

Trigger points in the anterior tibialis muscle cause pain in the upper and inner part of the big toe and in the anterior part of the ankle (Fig. 10,2). The pain increases when walking. In some cases it spreads down the foot along the shinbone (not shown) (1992, 356).

In such cases, gout or a deformity of the finger is often suspected, but pain in the big toe does not necessarily mean you have gout. The area of rebound pain, caused by trigger points in the anterior tibialis muscle and thumb extensor longus, affects the thumb and the head of the first metatarsal, which are the areas where the toe connects to the foot. It can give the impression that the pain is actually coming from the joint. Doctors unfamiliar with this effect tend to prescribe medication for gout, although research does not support this condition.

In fact, gout, which is the accumulation of urate salts in the joints, is caused by uricemia, which is a high level of uric acid in the blood. A high-meat diet with too little liquid contributes to this phenomenon. Gout and trigger points, which mimic gout symptoms, often coexist, and uric acid anemia makes trigger point control difficult. Vitamin C deficiency further aggravates both conditions.

Falls and perceived imbalances can actually be the result of weakened tibialis anterior muscles under the influence of trigger points, which in turn leads to involuntary dropping of the foot. The toes remain on a flat surface. Man stumbles on level ground and when climbing stairs. Elderly people are at serious risk of falling with broken bones or even more serious injuries. Regardless of your age, if you find yourself tripping over your own foot, you should look for trigger points on the front of your lower leg.

causes

The anterior tibialis muscles can become overloaded with very strenuous running or walking and climbing. But changing your usual way of running or walking also puts a strain on these muscles. Walking on uneven ground engages all of the shin muscles, including the anterior tibialis. Keeping your foot on the gas pedal for a long time is particularly harmful.

With trigger points in the calf muscles, the muscles on the front of the shin work harder and tire quickly; conversely, trigger points in the calf muscles overload the calves. Long-term overuse of these muscles encourages the development of 'compartment syndrome' in the front and back of the leg with the risk of permanent muscle damage. Chronic trigger points in the anterior tibialis muscle are themselves a cause of 'cleaved tibia' and tibia stress fractures.

General Points

The calves (regio suralis) are the rear upper muscle region of the tibia. However, not all calf muscles belong to the calf muscle. The most important muscle in the calf region is the M. triceps tibialis (M. triceps tibialis) (triceps surae muscle). Anatomically, it is correct to divide the muscles of the lower leg into the following parts:

For more information, see the topics: Superficial Tibialis Muscles and Deep Tibialis Muscles There are only two muscles called the calf muscles:

4+5 Triceps calf muscle? (triceps surae muscle).

Since the triceps surae is considered a two-headed calf muscle in combination with the soleus, it is one of the strongest muscles in the human body. The plantaris muscle can also be interpreted as the fourth head of the calf muscle.

4. the biceps calf muscle

The biceps calf muscle belongs to the posterior superficialis group. It is a muscle that largely determines the external appearance of the calf. Its two bulges are clearly visible when standing on tiptoe.

• Function: strongly compresses the leg and can rotate it outwards
• Origin: lateral head: femur and lateral condyle - medial head: medial condyle of femur
• Anchorage: through the tendon of the soleus muscle like the Achilles tendon on the heel bone (calcaneus)
• Innervation: Muscle branches of the N. fibularis profundus

In plastic surgery, this calf muscle has a double meaning. On the one hand, it can be used to repair a defect in the knee area. On the other hand, in the case of excessively large calves, it can be completely or partially removed without functional impairment (calf hypertrophy), with shortened calves. On the other hand, it can also be completely or partially removed without functional impairment by performing a calf reduction.calf muscle hypotrophy) it is possible to enlarge the calves with calf implants. This usually occurs between the gastrocnemius muscle and the tibial fascia. For more general information see the chapter on calf corrections.

Lateral ankle injuries

Ligament sprains are the most common ankle injury; a return to sport is possible between 2 weeks and 18 months.

Residual symptoms often persist for many months or years; these include pain, instability, occasionally swelling and stiffness.

Extension occurs when the foot rolls inward (inversion) or outward (eversion) from a position of sole flexion.

It often occurs when walking on uneven ground or when playing sports, stepping on someone else's foot.

Inversion injuries account for up to 85 % of all hip ligament dislocations, with PTMS being the first to be affected, followed by PMS and finally STMS.

Inversion injuries are less common; they more commonly end in tears of the lateral ankle, PTMS, and intercondylar ligament.

The most common hip inversion injury is a ligament strain, and the most common eversion injury is a lateral ankle fracture.

Regardless of the direction of the force, the outer part of the ankle is more likely to be injured.

Ankle ligament strains, where the ligaments that connect the tibia and fibula are torn.

This type of injury is often overlooked when there is no fracture or obvious diastasis because the swelling and hematoma subside quickly.

Lateral ankle on ultrasound examination

The tendons show signs of trauma, degenerative changes, and inflammation, while the ligaments are mostly damaged.

The bones and tendons should also be examined for cortical changes or joint displacements.

These include the lateral ankle, talus, calcaneus, the front and back of the tibia, and the bases of the first, second, and fifth metatarsals.

During the ultrasound examination of the ankle, it makes sense to change the position of the foot. The bands are better seen when they are stretched and the fibers are perpendicular to the ultrasound beam.

The foot in dorsal hyperextension weakens the anterior ligaments and stretches the posterior ligaments.

It is recommended to examine three ligaments and two tendons laterally: ligaments include PTMB, PNBB and PMS, tendons SJMM and SMMM.

The STMS is difficult to see and visualize on ultrasound because it is partially or totally obscured by the ankle.

The patient must be placed on the bed in a supine position with the knee bent and the soles of the feet flat.

PTMS: Sensor on the front of the lateral ankle so that the sensor surface is parallel to the sole of the foot (ie horizontal).

In the neutral position of the foot, the band is aligned exactly parallel to the sole of the foot;

The integrity of the band can be verified by gently turning the ankle.

The front drawer sign can be checked both while sitting and lying down. The anterior and posterior muscle groups surrounding the ankle should be relaxed. The knee joint should be slightly flexed to relax the calf muscle and the ankle joint should be at 90° to the lower limb axis, since soleus flexion often does not even show a clear positive sign. The physician places his hand on the anterior surface of the tibia, cupping the inside of the tibia with his fingers. With the other hand, he grasps the heel and moves the foot forward, putting pressure on the talofemoral ligament. Anterior displacement of the talus or tibia suggests a rupture of this ligament. Always check for this symptom on a healthy limb and, if necessary, take an X-ray to confirm the diagnosis. A reverse ankle ligament sprain is often characterized by pain along the medial line of the joint over the deltoid ligament. A partial tear of the anterior deep fibers of the deltoid ligament can occur with extreme inversion or soleus flexion of the foot. An oval-shaped swelling over the lateral ligaments of the ankle that occurs within the first 2 hours after injury is indicative of a Grade III sprain in most cases. Although most of this chapter has focused on the inversion injury, the same is true for the delta ligament extension injury.

Tendonitis in pregnant women and its characteristics

This condition is not an uncommon 'guest' among pregnant women. If there is a suspicion of tendonitis, it is better not to do an X-ray or CT scan during the examination. All medications that a pregnant woman takes should be prescribed by her doctor and discussed with her gynecologist. In this case, self-medication is dangerous not only for the patient, but also for her unborn child.

At the first signs of tendinitis, doctors recommend limiting treatment to physical therapy, rest, and cold compresses on the painful area. Pain-relieving ointments are prescribed to reduce inflammation and pain.

If the problem becomes acute, the doctor may need to immobilize the joint. Antibiotics may be prescribed, but only if a bacterial infection has been identified and other treatments have proved ineffective. In the most extreme cases, the joint is operated on.

Specificity of tendinitis in children

The disease is not as common in children as it is in adults. The 'most common' site for tendinosis is the knee joint. At the first signs of tendinitis in a child, a pediatric surgeon should be consulted. He or she will conduct an examination and make an accurate diagnosis. Then the young patient is prescribed the necessary medication. These usually include muscle relaxants and nonsteroidal anti-inflammatory drugs, which can be taken orally or in ointment form.

Movement must be restricted for a period of time and all physical activities must be avoided. If the pain is very severe, the joint is immobilized. Treatment may include various forms of physical therapy, including electrophoresis. After the acute phase of the disease, massage and physical therapy are performed.

causes

The tibial nerve is a continuation of the sciatic nerve. Its damage can occur in the following cases:

• Injuries to the lower limbs of various etiologies (fracture, ankle dislocation or sprain, tendon rupture, ankle ligament strain). Traumatic factors and the resulting swelling lead to direct damage or compression of the tibial nerve, which impairs the transmission of nerve impulses.
• Deforming changes in the foot (flatfoot, valgus).
• Pressure on the feet or uncomfortable positioning of the feet for a long period of time, e.g. B. by pushing the lower limbs with a heavy object.
• Diseases of the knee and ankle joint (arthritis, arthrosis).
• Endocrine disorders, thyroid disorders and diabetes.
• Benign and malignant tumors of the tibial nerve.
• Poor circulation in the lower limbs and feet (vasculitis).
• Poisoning of the body with toxic and chemical compounds, including products containing alcohol.
• Inflammatory pathologies of infectious etiology in various locations, including those affecting multiple nerve fibers.
• Prolonged treatment with drugs that negatively affect CNS function.
• Weakening of the body's defenses.
• Harmful working conditions.
• Tissue nutrition disorders in the lower leg and foot.
• Prolonged stay of the lower limbs at low temperatures.
• Inadequate nutrition, which reduces the absorption of B vitamins.
• Pathological processes affecting the spine.

• people who practice various sports professionally;
• working conditions that require constant standing, including walking;
• People prone to overweight or obesity – heavy loads on the lower limbs increase the risk of tibial nerve dysfunction;
• the choice of inappropriate footwear: high heels, thin soles.

symptoms

Neuropathy is associated with a clinical picture, the severity of which depends on the extent of nerve fiber damage.

Nerve dysfunction can be recognized by abnormalities in foot flexion and toe mobility. When walking, the foot is positioned abnormally - the foot strikes the heel. The musculature of the lower limbs and foot shows clear signs of atrophy and deformity.

With traumatic neuropathy, the ankle swells, blood circulation is disturbed, tissue sensitivity increases, and severe pain occurs, which intensifies when touching the damaged areas.

When the neuropathy of the nerve is caused by endocrine disorders or infectious lesions, the patient loses sensitivity in the lower leg and foot. The pain syndrome persists and can vary in type and severity. The pain intensifies when walking and during physical exertion. The patient may feel involuntary contractions of individual muscles or spasms in the lower limbs.

In addition, the patient suffers from neurotrophic disorders such as dryness of the epidermis of the lower legs and feet, keratosis of the upper dermis, brittle nails, pale skin and decreased local temperature and increased sweating.

Types of injuries and trauma.

The most common tendon injuries include:

• Tendonitis is a condition that causes inflammation and degeneration of tendon tissue. Tendonitis is most common in tendons that are subjected to regular and repetitive physical stress.
• A strain is the most common injury that occurs when tendons and muscle fibers are damaged by physical impact but their integrity is not compromised.
• Partial tendon rupture, the soft tissue is partially intact.
• Complete rupture of the tendon.

Main causes of injuries.

• Frequent physical exertion of the same muscle group
• About 40-45 years old
• Injuries at home, falls
• The weakening of the tendon is due to many factors: tendinitis, chronic diseases (rheumatoid arthritis, gout, diabetes, infections, etc.), prolonged immobility, taking steroid hormones, etc.

The characteristic and most important symptom of all tendon injuries is the sudden onset of severe pain. This is accompanied by the following symptoms

• Redness and swelling at the site of injury
• Increased sensitivity at the site of injury
• muscle cramps
• bleeding
• characteristic crunch at the time of injury
• Restricted movement of the injured limb
• Complete wounds are characterized by a clumsiness when walking

signs

There is usually a stabbing pain in the area of the muscle. A 'clicking' sound may be associated with pain in the event of a complete rupture. Attempts to move the muscle are also painful and ineffective for severe injuries. With small lesions, the function of the muscle can be partially or completely preserved, but muscle tension is painful and weakness is noticeable. The rupture is accompanied by a contraction of the ligament and its displacement towards the adjacent end. The result is a roll that can be seen visually and by touch. With abdominal tears, the presence and size of the defect is palpable.

Due to the massive blood supply, most muscle injuries are accompanied by a hematoma. The area of the hematoma swells. In addition to the general symptoms of a muscle injury, there are also specific symptoms, such as an inability to perform a specific movement, that the injured muscle is responsible for.

causes

The structure of the muscle can be damaged by an external blow (blunt blow or stab with a sharp object). Sport is a common cause of such injuries.

Muscles can be injured by overuse, abnormal movements, or active exercise without preparation (no warm-up). Some tears are caused by a violent contraction of the muscle.

Skeletal muscle injuries can be caused by a variety of conditions that alter the structure of ligaments or the properties of muscle fibers and tendons. This includes:

• old age and old age;
• degenerative diseases of the musculoskeletal system;
• connective tissue abnormalities;
• endocrine disorders.

A predisposing disease can damage a muscle with minimal exertion, such as a habitual activity or even a small effort.

What happens to the muscle when it is overloaded?

The most important signal for an overload is initially a strong or increasing throbbing pain. A characteristic feature of the latter dislocation syndrome is that it increases with any activity of the injured leg, and decreases with complete inactivity of the muscle.

• redness of tissue;
• Subcutaneous weeping - hematoma or bruising - may occur;
• Local temperature increase (the skin becomes hot and pulsates at the site of the dislocation);
• swelling of the leg.

How to distinguish between a muscle and a ligament?

The most important task for the trauma surgeon when dealing with complaints about a dislocation of the muscle tissue of the leg is the correct and quick differentiation between muscle fiber dislocations and tendon dislocations. There is no difference in the severity of the injury: the same three grades from mild to severe. However, the response to a muscle dislocation is not as complex and complicated as it is with joint components.

To diagnose a dislocation, an objective examination is carried out (the doctor can already draw the first conclusions from the appearance of discomfort in the leg). At the next stage, the part of the leg where the sprain occurred is examined with ultrasound to monitor the inflammation. Radiological monitoring is indicated for severe soft-tissue injuries of the leg.

Pain treatment - self and professional

The treatment of muscle injuries should initially be carried out by the patient himself or his environment. Initial treatment of the leg:

• immobilize;
• position leg over upper body;
• apply cold
• administer pain medication;
• 'Tightening the fibers of the affected muscle with a compression bandage to prevent inflammation and reduce leg swelling.

If after 2-3 days the pain has subsided and the swelling of the muscle has subsided, a warm bath can be taken. On the 4th or 5th day, you can gently massage the muscle, apply special patches (tapes) and do exercises.

If the leg still hurts badly, the muscles are changing (swelling, pulsation) and the swelling does not go down, a traumatologist should be consulted. This will prescribe an individual LoF program, appropriate pain medication and a referral for physical therapy. Acupuncture, acupuncture, and kinesio taping are commonly used to relieve the symptoms of the condition.

Muscle recovery usually takes between 2 weeks and a month. With appropriate support (massage, compresses, LOP), the dislocation has no consequences.

• Tendon of the tibialis anterior muscle.
• abdominal muscle.
• Tibialis posterior muscle.
• Tibialis muscle pain.
• Calf muscle cramps when walking.
• Exercises for the triceps tibialis muscle.
• lower leg muscles.
• Why does the galley muscle hurt?.