Microtraumas are considered injuries. Is it necessary to investigate microtraumas at work? How dangerous are microtraumas for health?

> Microtrauma of muscle fibers

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What is microtrauma?

Microtrauma is damage that occurs as a result of the application of physical force, leading to disruption of the microstructure and function of tissues. Microtraumas of muscle fibers are very common. The cause of their occurrence is usually prolonged muscle work, muscle strain or injury.

Typical signs of acute microtraumas

Microtraumas are divided into acute and chronic. Acute microtraumas occur as a result of a single excessive load and are characterized by tears or ruptures of individual bundles of muscle fibers. These micro-tears are manifested by pain when the affected muscle is tense, a decrease in muscle strength, an increase in skin temperature over the site of damage, and in the case of a superficial location - the formation of a bruise. When palpated, pain is noted at the site of injury, and an area of compaction or a tissue defect in the muscle is determined, which increases in size as it contracts.

Features of chronic microtraumas

Chronic microtraumas occur when any area of the body is subjected to repeated and prolonged exposure to the same traumatic factor. They develop with repeated muscle bruises, as well as in people performing work with heavy physical exertion, and athletes involved in speed and power sports. When performing a large number of movements in a short period of time, individual fibers of the muscle become fatigued, causing them to spasm. Constant spasms of muscle fibers can lead to the development of a pathological condition in the muscles called myopathosis. With myopathy, muscle fibers become denser and become inelastic. In the future, with a minor injury or even without injury, a tear or rupture of these pathologically altered fibers may occur. At the sites of ruptures, blood circulation is disrupted and aseptic inflammation develops, which, with frequently repeated exposure, leads to muscle dystrophy and persistent impairment of its functions. After healing of tears, mechanically weak scars form in the tissue, which is fraught with spontaneous muscle ruptures. Chronic microtraumas most often occur in the biceps, quadriceps and adductor muscles of the thigh, and in the gastrocnemius muscle of the leg.

Methods for diagnosing microtrauma of muscle fibers

To diagnose microtraumas of muscle fibers, thermography, electrophysiological and ultrasound studies are used. Ultrasound examination is performed at rest and with muscle tension. With partial ruptures, ultrasonograms show areas of decreased echogenicity, which indicates the presence of a hematoma; with microtears, areas of increased echogenicity. Laboratory tests include determination of albumin and phosphorylases in the blood, which reflect the degree of muscle damage.

Basic principles of treatment

For acute microtraumas of muscle fibers, rest, cold (the first two days), relaxing massage, and physiotherapy are indicated. Medications used include analgesics and muscle relaxants. A gradual resumption of physical activity is allowed after 4–5 days. Their intensity is limited by the appearance of pain. Conservative therapy for chronic microtraumas includes a gentle motor regimen, compresses with ronidase, local thermal procedures (baths, paraffin applications, ozokerite), physiotherapy (phonophoresis of hydrocortisone, electrophoresis of novocaine), massage, therapeutic exercises, sanatorium treatment (preferably at mud resorts).

Prevention measures

To prevent microtraumas of muscle fibers, it is necessary to rationally organize sports training: warm up well before the load, increase it gradually, taking periodic breaks, pay due attention to muscle recovery after training, and use protective devices during exercise.

Microtrauma

Microtrauma (Greek mikros small + trauma) is damage caused by any impact, usually insignificant in its strength, but exceeding the limits of physiological resistance of tissues and leading to disruption of the function and structure of tissues after a single or repeated exposure of the same type. With prolonged exposure to a damaging agent on tissue, pathological conditions arise due to overstrain and overload of these tissues. The occurrence of microtrauma is facilitated by fatigue, overtraining, previous diseases, poor organization and improper equipment of work and physical education and sports.

A distinction is made between acute microtrauma, which occurs as a result of a single action of a traumatic agent, and chronic microtrauma, which is a consequence of repeated exposure. By localization, microtrauma is divided into microtraumas of the skin and subcutaneous tissue, adipose tissue, tendons, ligaments, muscles, cartilage and bone tissue. Microtraumas are also divided into open (with a violation of the integrity of the skin) and closed (without it).

Microtrauma of the skin and subcutaneous tissue. Acute microtrauma includes abrasions and bruises (see full body of knowledge). Abrasions - of varying length, violation of the integrity of the dermis and epidermis. With extensive abrasions, pain, burning, rapid infiltration and swelling of surrounding tissues occur due to contamination and infection. Acute microtrauma of the skin also includes scratches (linear damage to the epidermis), cuts (linear damage to the epidermis and dermis) and small-sized (point) wounds, most often from foreign bodies (see full body of knowledge) - splinters, sewing needles and others (see full body of knowledge) body of knowledge Wounds, wounds).

The consequence of chronic microtrauma of the skin is fibrosis of the skin and fibrosclerosis of the subcutaneous tissue - skin polyp, callus (see full body of knowledge). Along with the development of hyperkeratosis and hypertrophy of the subcutaneous tissue, painful cracks appear (see full body of knowledge). With a longer action of the damaging factor, the integrity of the skin may be damaged - the development of abrasion (see full body of knowledge). Microtrauma of the fingers can cause panaritium (see full body of knowledge).

Microtrauma of adipose tissue. Acute microtrauma is possible with bruises. Chronic microtrauma of adipose tissue can be an etiological factor in such conditions as lipomatous degeneration of the fatty body of the knee joint (see Hoffa's disease) and the ossifying process in the tissue (see Ossification).

Microtrauma of tendons. Tendon tissue, which has a large reserve of mechanical strength, is resistant to acute microtrauma. Chronic microdamage leads to the development of tendoperiostopathy (traumatic tendinitis, tendinosis). The disease develops most often at the site of attachment of the tendon to the periosteum, that is, where nutritional conditions are less favorable and the application of muscle force is most intense. Areas of fatty degeneration form in the tendon fibers, and microtears with hemorrhage occur in the places where the tendon fibers are woven into the periosteum. This reduces the strength of the tendon and creates the risk of tears and rupture. Tendoperpostopathy usually develops in manual workers, athletes, ballet and circus performers. Its most common localization is on the lower extremities at the point of attachment of the tendon of the rectus femoris muscle to the upper pole of the patella, in the area of the proximal attachment of the patellar ligament, at the points of attachment of the tendons of the adductor muscles of the thigh to the pelvic bones. On the upper extremities, tendoperiostopathies are more often observed in the area of the shoulder joint at the site of attachment of the tendons to the greater tuberosity of the humerus (for example, in weightlifters), in the area of the elbow joint at the site of attachment of the tendons of the radial and ulnar flexors of the hand - the so-called tennis elbow (see full body of knowledge Epicondylitis ). Clinically, tendoperiostopathy manifests itself as local pain; in advanced cases, swelling of the soft tissues and thickening of the periosteum at the site of tendon attachment are detected.

The group of tendoperiostopathies also includes primary traumatic epicondylitis of the shoulder, which develops as a result of microtrauma of the attachment sites of the tendons of the muscles of the hand and fingers to the epicondyles of the humerus. This process is considered local, in contrast to secondary epicondylitis, which is a symptom of cervical osteochondrosis.

Physical workers (mechanics, painters, carpenters, grinders), as well as athletes (tennis players, throwers) and musicians - violinists, pianists, are most often affected.

Clinically, epicondylitis is manifested by local pain in the area of the lateral and medial epicondyles of the humerus, and hardening of the soft tissues. The pain intensifies with certain movements of the hand and fingers, and muscle strength decreases. X-rays of the elbow joint and spine did not reveal any pathology.

The consequence of microtrauma of the peritendinous tissues is tenosynovitis (see full body of knowledge) - a disease that occurs with microtrauma of the tendon sheaths. Prolonged overload leads to trauma to the synovial membrane (see full body of knowledge) of the tendon sheath, microhemorrhages, edema and aseptic inflammation. Long-term tendovaginitis acquires a stenotic character, which worsens nutritional conditions and makes it difficult to move the tendon through its sheath. Along the course of the tendon, palpation reveals a painful ring-shaped thickening.

Paratenonitis is a disease of the peritendinous tissue. Most often observed in the area of the heel (Achilles) tendon (in skiers, runners), it is caused by microhemorrhage with subsequent fibrous deposits and scarring of the tissue. Manifested by pain in the tendon area. Inspection and palpation reveal pastosity, pain, and in the exudation stage - crepitus of the peritendinous tissue.

Closely related to the group of tendovaginitis is chronic bursitis (see full body of knowledge) - a disease of the synovial bursae that occurs during prolonged trauma. Clinically, bursitis is manifested by symptoms of aseptic inflammation (local pain, swelling, effusion, limitation of movements, sometimes crepitus in the area of the synovial bursa). In this case, it is necessary to differentiate bursitis caused by microtrauma from infectious and infectious-allergic inflammation of the bursae. With chronic microtrauma, inflammation of the subdeltoid bursa, ulnar subcutaneous bursa, subcutaneous prepatellar and deep subpatellar bursae, Achilles tendon bursa and subcutaneous calcaneal bursa most often occurs.

Microtrauma of ligaments. Acute microtrauma of ligaments includes their sprain (see full body of knowledge Distortion).

Chronic Microtrauma of the ligamentous apparatus (ligamentopathy, ligamentosis, ligamentitis) in its etiopathogenetic and clinical picture is similar to tendoperiostopathies. The characteristic localization of tears of ligament fibers is in the places of their attachment to bone tissue. The tibial collateral ligament of the knee joint, ligaments of the ankle joint and small ligaments of the foot are most often susceptible to chronic injury; on the upper limbs - ligaments of the joints of the hand.

Microtrauma of muscle tissue. Acute muscle microtrauma includes tears and ruptures of individual groups of muscle fibers that occur during sudden movements or bruises. They manifest themselves as local pain and, in case of superficial localization, the formation of a bruise.

Chronic microtrauma of muscles develops in people whose work involves heavy physical activity and when practicing strength and speed sports. Damage to muscle fibers occurs with repeated forced movements that exceed the limits of tissue elasticity, as well as with repeated bruises of the muscle. Microtrauma is observed more often in the quadriceps, biceps, adductor muscles and in the gastrocnemius muscle of the leg. Damage can be observed in all parts of the muscle, but their most typical localization is at the junction of the muscle part and the tendon part. In areas of damage as a result of injury and spasm of the capillaries, a disorder of local circulation occurs. Deviation from normal levels of albumin and phosphorylases in the blood reflects the depth of damage or the degree of muscle recovery. Determination of acid-base balance in the microtrauma area reveals subcompensated or compensated metabolic acidosis, the degree of which is directly dependent on the severity of the injury. Examination at the submicroscopic level of punctate muscle tissue taken at the site of greatest pain reveals a change in myofibrils in the form of a violation of their continuity with the filling of the defect with cytogranules.

In the initial stage, microtrauma is not diagnosed; with constant repetition of injuries and the development of a chronic process, pain occurs at the site of injury, which is revealed by palpation of the damaged area and when the muscle is tense.

Microtrauma of cartilage tissue. Acute microtrauma occurs as part of a joint injury - local cartilage bruises, hemorrhages. Against the background of General trauma, they usually go unnoticed clinically.

Chronic Microtrauma of cartilage tissue (chondropathy, chondromalacia, perichondritis) is observed in both hyaline and fibrous cartilage. Damage to the integumentary cartilage in some cases occurs as a result of repeated jerky compression of the articular surfaces, for example, in jumpers. Individual sections of the cartilage become wrinkled, show signs of fiber disintegration, lose their shine; with repeated injuries, they flake off and fall out into the joint cavity in the form of loose bodies. In other cases, constant excessive load leads to the formation of cracks in the cartilage, which can eventually deepen to the bone plate (see full body of knowledge Osteochondrosis). The most commonly damaged articular cartilage of the femur, articular cartilage of the patella, menisci of the knee joint (see full body of knowledge Knee joint, Articular menisci, Patella).

When examining cartilage tissue taken during a biopsy, electron microscopy reveals the transformation of cartilage cells into fibroblast-like cells, the proliferation of chondrocytes, changes in the properties of the cells themselves in the form of hypertrophy of the lamellar complex (Golgi complex), the formation of lysosomes and lysosomal sequesters in the cytoplasm.

Clinic Microtrauma of cartilage tissue is very scarce and uncharacteristic. The most persistent symptoms are synovitis (see full body of knowledge) and pain that occurs in the damaged joint after physical activity. When the patellar cartilage is damaged, its movements are accompanied by a slight crunching sound. In advanced cases of the disease, when cartilage damage becomes visible, the diagnosis can be made by arthroscopy (Figure 1).

In case of chronic microtrauma of fibrocartilage, the first clinical signs of the disease are first minor, and then, with continued stress, intense pain in the area of the bone junction. If the cartilage of the pubic symphysis is damaged (see full body of knowledge), symphysitis may develop; with damage to the sternocostal (II - III - IV ribs) joints - Tietze syndrome (see full body of knowledge Tietze syndrome). In the latter case, a dense, painful swelling is determined at the site of the lesion. Untreated microtrauma of cartilage tissue leads to the development of deforming osteoarthritis (see full body of knowledge Arthrosis). See the complete body of knowledge: Joints, Cartilage tissue.

Microtrauma of bone tissue. Of acute microtrauma, bruises of the periosteum are possible (see full body of knowledge), accompanied by subperiosteal hemorrhage and local (sometimes severe) pain. Treatment: rest, thermal procedures.

Under the influence of chronic microtrauma of bone tissue, local processes of bone restructuring occur. Subsequently, the integrity of the entire beam system is disrupted, which over time first causes hypertrophy of the cortical substance, and then the formation of a significant focus of pathological restructuring in the form of transverse areas of clearing - Looser's zones (see the full body of knowledge of Looser's zones). Areas of aseptic necrosis are formed in the cancellous bone, which are revealed radiographically in the form of urticaria or cyst-like formations. The restructuring process is most often observed in the tibia, metatarsal bones and tarsal bones. Pathological changes in bone tissue are clinically manifested by swelling and local pain, determined by palpation and load.

To diagnose microtrauma of bone tissue in the early period of the disease, a scanning method is used with an isotonic solution of the osteotropic isotope strontium-85 (see full body of knowledge Scanning). In the late period of the disease, radiographs reveal thickening of the cortex, and then areas of clearing, formed as a result of the replacement of bone plates with fibrous or cartilaginous tissue.

When the bones of the foot are overloaded (in track and field athletes, military personnel and others), their functional failure occurs. It can lead to the formation of Loozer fractures of the metatarsal bones (see the full body of knowledge Marching foot), as well as to the development of plantar neuritis (metatarsalgia, plantalgia), manifested by sharp localized pain in the area of the 3-4 metatarsophalangeal joints, caused by neuropathy of the 4th digital nerve ( see full body of knowledge Morton's metatarsal neuralgia). In advanced cases, fixed flat feet develop.

Microtrauma of bone tissue is one of the etiological factors of a large group of diseases - osteochondropathy (see full body of knowledge). See the complete body of knowledge Bone.

Treatment. In case of acute microtrauma of the skin, it is treated with antiseptic solutions (rivanol, iodine and others), and an antiseptic bandage is applied; for extensive abrasions, they are also treated with antiseptic solutions, an antiseptic bandage is applied, and tetanus toxoid is administered (see full body of knowledge Immunization); scratches, cuts, small abrasions are treated with antiseptic adhesives (for example, Novikov liquid), foreign bodies must be removed. For acute microtrauma of other localizations, rest, thermal, and physiotherapeutic procedures are indicated.

The main method of treatment is chronic microtrauma - conservative: rest, electrophoresis of novocaine, humisol, lithium with iodine, phonophoresis of corticosteroid drugs (hydrocortisone, prednisolone), radon, hydrogen sulfide, salt-pine baths, mud applications. Case blockades with a 0.5% solution of novocaine in an amount of 100-150 milliliters with the addition of vitamin B 12 and analgin, followed by application of a bandage, are effective. It is recommended to inject 1-2 milliliters of microcrystalline suspension of hydrocortisone into the painful area 3-4 times with a break of 3-4 days. A good therapeutic effect is achieved by introducing oxygen into the pathological focus in order to improve nutrition and blood circulation of local tissues. Oxygen therapy has become widespread for the consequences of chronic microtrauma and the development of degenerative processes in the joints. Oxygen is injected into the joints according to their capacity (15-20 milliliters into the ankle, 60-100 milliliters into the knee, and so on). Oxygen therapy can be combined with the simultaneous injection of 1-2 milliliters of hydrocortisone or 1 milliliters of vitreous humor (a mucopolysaccharide preparation) into the joint. The course consists of 5 injections with an interval of 3-4 days. For microtrauma of bone tissue, the use of thyrocalcitonin (TCT) is indicated. The drug has a positive effect on metabolic processes in bone. It is administered in solution intramuscularly or taken in the form of tablets 2 times a day, 15 conventional units for 4 weeks with one day break per week. Treatment with TKT must be combined with the use of calcium gluconate.

If conservative treatment is unsuccessful, in some cases surgical treatment is indicated, undertaken to improve local blood circulation, denervation of the pathological focus, and removal of hyperplastic tissue.

For chronic paratenonitis of the Achilles tendon, an operation is recommended - tenolysis of the tendon, in which the skin and fibrous sheath are cut along the lateral edge of the tendon at the site of pain and compaction, the latter is bluntly separated from the tendon along its entire length along the circumference. According to indications, tenolysis (see full body of knowledge) is combined with the removal of fibrous-modified pretendinous tissue. Sutures are placed only on the skin. Movements in the ankle joint begin on the 2nd day after surgery. For chronic bursitis of the Achilles tendon, excision of the mucous bursa is indicated.

In case of tendoperiostopopathy of the patellar ligament, tendoperiostotomy is indicated (Figure 2); The operation consists of making 4-6 longitudinal incisions of the ligament up to 1 centimeter long. If the lower pole of the patella is deformed, its resection is recommended. For subpatellar bursitis, removal of the deep bursa is indicated.

During the process of restructuring the bone tissue of the tibia at the stage of periosteal reaction, fasciotomy is indicated - separation of the fascia from the periosteum throughout the entire painful area. When Looser zones are formed in bone tissue, bone tunneling is used according to the Beck method in order to stimulate the growth of osteocytes into dense osteocyte-free bone through the formed channels.

In cases of chondropathy and chondromalacia of the articular surface of the patella or femoral condyles, removal of the plate of detached or dislocated cartilage gives a good result.

The prognosis for early and targeted treatment of Microtrauma is favorable.

Prevention. Necessary conditions for the prevention of microtrauma are the correct organization of work, mechanization of labor-intensive work, the use of protective devices and medical equipment, timely treatment of minor injuries in the acute period; clinical examination of patients, rational organization of sports activities, constant medical supervision in sports.

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Microtrauma(Greek mikros small + trauma wound, damage) - damage that occurs as a result of exposure to small-intensity forces and leads to disruption of the function and microstructure of tissues. A distinction is made between acute microtrauma - a single or short-term exceeding of the limits of mechanical strength of tissue, accompanied by a reversible change in its structure and function, and chronic - repeated and prolonged low-intensity exposure to the same traumatic agent on a certain area of the body. With microtraumatization of tissues, aseptic inflammation develops, which, with repeated prolonged exposure to a traumatic agent, leads to tissue degeneration and persistent dysfunction.

Depending on the cause, microtraumas are divided into exogenous, occurring under the influence of external mechanical agents, and endogenous, associated with physical activity that is inadequate in intensity and duration. Acute endogenous microtrauma is also called acute overstrain. As a rule, this pathological process simultaneously affects various structures of the musculoskeletal system. Depending on the conditions of injury, sports, professional and other microtraumas are distinguished.

Skin microtraumas are the most common type of damage. Among acute microtraumas of the skin, open (abrasions, scratches and small wounds) and closed ( bruises and abrasions, marks, etc.). Acute microtraumas of the skin with disruption of the integrity of the skin are the most common cause of development panaritium. As a result of chronic microtrauma of the skin, callus, skin fibrosis, fibrosclerosis of subcutaneous tissue (skin polyp). Hyperkeratosis and hypertrophy of the subcutaneous tissue, usually noted in these cases, are a favorable background for the occurrence of cracks, which become the entrance gates for infectious agents, which can cause phlegmon or felon. Treatment of skin microtrauma is conservative. In case of open microtraumas, the damaged area is treated with an antiseptic (for example, 5% alcohol solution of iodine, 1-2% alcohol solution of brilliant green, chlorhexidine solution), foreign bodies (splinter) are removed, and an aseptic bandage is applied to prevent infection. In case of chronic microtraumas, it is necessary to eliminate the traumatic agent (incorrectly selected shoes, tools), and carefully monitor skin hygiene. Treatment of chronic microtrauma includes anti-inflammatory, local absorbable therapy: electrophoresis of a solution of potassium iodide, lithium salts; with hyperkeratosis - keratolytic agents.

Microtraumas of adipose tissue can also be acute (bruises) and chronic (for example, lipomatosis of the infrapatellar bodies and ossification of adipose tissue; rice. 2 ). Acute microtraumas of the subcutaneous tissue often accompany damage to the skin. Treatment includes rest, local cold, and subsequently thermal and other physiotherapeutic procedures (see. Bruises). In case of chronic microtraumas of the subcutaneous tissue, it is necessary to stop exposure to the traumatic agent and prescribe local absorbable and anti-inflammatory therapy. In case of polyfocal lesions of the subcutaneous tissue, microtraumas should be differentiated from inflammatory (panniculitis) and non-inflammatory (cellulalgia, cellulitis) diseases (see. Rheumatic diseases of periarticular soft tissues).

Microtraumas of the fascia and aponeuroses, the so-called fibrous skeleton of the body, which plays an important role in muscle activity, are accompanied by serous-fibrinous aseptic inflammation with subsequent proliferation of fibroblasts and fibrous-scar changes, which lead to a significant decrease in their elasticity. Post-traumatic fibrositis of the fascia and aponeuroses is clinically manifested by slight pain and stiffness when contracting the muscles covered with the affected fibrous structures. On palpation, their pain usually intensifies; somewhat later, painful nodules and larger indurations are detected, which moderately limit the mobility of the affected area; they can then undergo reverse development. Fasciitis of the fascia lata of the thigh often develops after an injury or professional microtrauma (in porters, carpenters, etc.) associated with constant pressure or friction in the outer surface of the thigh. Treatment is conservative. The effect of a traumatic agent on the affected area is excluded, rest and limitation of physical activity are recommended. Painkillers, anti-inflammatory drugs, physiotherapy, massage, and therapeutic exercises are prescribed. In the future, to prevent relapse, protect the affected area of the body from damage.

Microtraumas to ligaments occur as a result of a single direct (bruise) or indirect impact during movement exceeding physiological limits (see. Distortion) or a sharp contraction of the muscle that tightens the ligament. Microtraumas of the ligamentous apparatus of the spine must be differentiated from pain syndrome in osteochondrosis. Chronic microtraumas of the ligamentous apparatus (ligamentosis) are similar in etiopathogenesis and clinical picture to tendoperiostopathies. The ligaments of the knee, ankle joints, and ligaments of the hand joints are most often affected. Treatment is conservative: limiting physical activity until the pain subsides, anti-inflammatory drugs, physiotherapy, and then dosed strengthening of the muscles that stretch the affected ligament, and massage.

Depending on the location of the damage due to microtrauma of the tendons (traumatic tendinopathy), there are microtraumas of the tendon itself (tears with the development of aseptic tendonitis), damage to the areas of the tendon where the fibers of the latter enter the periosteum (tenoperiostitis - enthesitis, insertionitis) and areas of the transition of the muscle into the tendon with the development of tenomyositis (myoenthesitis). Chronic microtraumas of the tendon lead to the development of tendinosis and tenoperiostosis (at the junction with the periosteum). Often, simultaneously with damage to various tendon structures, a pathological process develops in their mesentery and tendon sheaths (tenosynovitis, tendovaginitis). surrounding tissue (paratenonitis) or nearby synovial bursae (tenobursitis). With repeated injuries as a result of scar processes, degenerative-dystrophic changes in the tendons are possible. Tendopathies and tendoperiostopathies develop more often in physical workers, athletes, ballet dancers, etc. Often inflammation and degeneration of the peritendinous tissues leads to stenosis, which is accompanied by the development of crepitus tenosynovitis or stenosing tenosynovitis. For example, chronic microtrauma of the heel tendons can be combined with paratenonitis or subcalcaneal tendonitis. bursitis(Achilles bursitis), which is manifested by constant pain in the tendon, redness, swelling, and increased pain during physical activity.

With all tendon microtraumas in the acute period, local pain, local tissue swelling, limitation of active and passive movements are usually noted, and crepitus may be noted by palpation. The local temperature rises, which can be recorded using thermography, but a long-term pathological process leads to a significant disruption of blood flow, and in this case the local temperature is reduced ( rice. 3 ). To clarify the characteristic lesions of the tendon, an ultrasound examination is performed ( rice. 4, 5 ).

Treatment is aimed at eliminating the cause of the damage. For acute microtraumas of the tendons, a gentle loading regime is recommended for 1 1/2 months. During this period, local and general anti-inflammatory therapy, painkillers (electrophoresis of novocaine solution) and anti-inflammatory physiotherapeutic procedures (UHF therapy, hydrocortisone phonophoresis on the area of the affected tendon), compresses of dimexide solution, indomethacin ointment, etc. are prescribed. For torpid flow, injections of hydrocortisone and Kenalog are used (cannot be injected into the affected tendon). For chronic microtraumas of the tendons of surrounding tissues, the complex of treatment measures also includes limiting physical activity, a course of novocaine blockades, local administration of analgesics and anti-inflammatory drugs in combination with physiotherapeutic procedures that promote muscle relaxation and have a resolving effect. Massage, physical exercises in water and therapeutic exercises are prescribed. In the first period of treatment, measures are aimed at relaxation; after the pain subsides, do dosed stretching of the affected tissues, and then gradually restore muscle strength. If the indicated conservative measures are insufficiently effective, an operation is performed (tenolysis, incisions are made at the site of tendon attachment, etc.).

The prognosis for restoration of function is often favorable, however, when cysts form in the tendon, it may rupture after a minor injury, and with tendoperiostopathies, relapses of pain are often noted when the action of the traumatic agent resumes.

Microtraumas to muscles are very common. Usually the cause of their occurrence is prolonged muscle work, muscle bruise or strain, especially if the muscle is not previously prepared for such loads with the help of a warm-up or special training. In areas of damage, there is a disorder of local blood circulation, hemorrhages, and changes in myofibrils in the form of a violation of their continuity. There are acute and chronic microtraumas of muscles. Acute microtraumas may not be accompanied by disruption of muscle structure or may lead to damage (microtears) of muscle tissue. A unique form of muscle microtrauma is muscle contracture (see. Contracture). Severe paroxysmal muscle tension - cramp (eng. cramp, polymyalgia with muscle fatigue) occurs as a result of involuntary activity of the motor nerve during a period of high motor activity of the body. The accompanying pain syndrome can be of varying intensity and duration. Treatment - passive muscle stretching, thermal procedures, massage.

Polymyalgia develops when fatigue occurs as a result of intense muscle work. It is characterized by the occurrence of pain in most muscle groups after 12-24 h after exercise and the duration of the pain syndrome is up to 5-7 days. On palpation, pain, thickening and muscle tension are noted, and a decrease in the range of active and passive movements is observed. Treatment - a gentle motor regimen until the pain subsides, thermal procedures (hot baths, showers, saunas), anti-inflammatory drugs locally and internally (acetylsalicylic acid, butadione, etc.), massage of the affected muscles using ointments that cause tissue hyperemia and provide anti-inflammatory, improving blood flow action.

Microtears and partial ruptures of muscles are accompanied by pain when the affected muscles are tense, an increase in local temperature in the damaged area, and a significant decrease in muscle strength. During palpation, the pain in the damaged area intensifies, an area of compaction or a tissue defect in the muscle is identified, which can increase when it contracts. To clarify the diagnosis, thermography is used (the so-called zone of interest is determined - a local increase in heat production) and ultrasound. With microtears of muscles, ultrasonograms reveal areas of increased echogenicity, and with partial ruptures, signs of hematoma in the muscle (area of decreased echogenicity). For a clearer diagnosis of the localization of the rupture, an ultrasonographic picture is recorded at rest and during muscle tension. Treatment of this group of microtraumas in the acute period is conservative. A puncture of the hematoma is performed, a course of novocaine blockades of the damaged area, then physiotherapy, therapeutic exercises and massage are prescribed.

Repeated chronic microtraumas of the muscle are accompanied by the formation of scars and the development of a dystrophic process, which, due to a decrease in the mechanical strength of the scar, can be accompanied by so-called spontaneous muscle ruptures. Conservative treatment of chronic muscle microtraumas includes a gentle motor regimen, local thermal procedures (applications of paraffin, ozokerite, baths), physiotherapy (electrophoresis of novocaine, phonophoresis of hydrocortisone), compresses with ronidase, therapeutic exercises, massage, spa treatment (mud applications). Surgical treatment of muscle microtrauma is indicated only for complete spontaneous ruptures with significant impairment of function.

Clinical picture, diagnosis and treatment of microtraumas of synovial bursae - see. Bursitis, Synovial bursae, Joints, Tenosynovitis.

Acute microtraumas of the cartilage covering the articular surfaces are often asymptomatic, but in the future they often lead to significant impairment of joint function. Thus, after a knee joint injury (for example, a transchondral fracture), hemarthrosis or synovitis may be observed, not accompanied by clinical manifestations of a fracture, but after a few months chondromalacia may form and osteoarthritis subsequently develops (see. Knee-joint). Chronic microtraumas of cartilage tissue include perichondritis, chondropathy, and chondromalacia. Repeated traumatic effects on the articular cartilage lead to its disintegration and detachment. Microtraumas of the joints are often factors associated with the progression of osteoarthritis. In some cases, they provoke an exacerbation of a concomitant disease, for example, glenohumeral periarthrosis (see. Shoulder joint).

Chronic microtrauma of the perichondrium of the cartilaginous part of the ribs at the site of attachment of the pectoralis major muscle to them is characterized by pain, local swelling, increased pain when coughing, sneezing, contraction or stretching of the pectoralis major muscles (see. Tietze syndrome).

Acute M. of the periosteum occurs as a result of a bruise and is often accompanied by subperiosteal hemorrhages and local pain. Chronic trauma leads to hypertrophy and restructuring of the cortical bone with the subsequent formation of transverse areas of clearing - Looser zones (see. Loozera zone). Areas of aseptic necrosis form in the cancellous bone. Early diagnosis is possible with radionuclide testing. In subsequent phases of the process, radiographs reveal thickening of the cortex with areas of clearing. Clinical picture and treatment of microtrauma of bone tissue - see. Bone .

Microtrauma of bone tissue is one of the etiological factors in the development of a wide group of diseases - osteochondropathy. As a result of prolonged exposure of the bone to intense loads that do not exceed its strength limit, aseptic necrosis can occur. Depending on the location and degree of pathological changes, they have a unique clinical picture and course. Thus, aseptic necrosis develops at the age of 15-17 years. Patients report pain in the shoulder joint, which intensifies after exercise and subsides after a few days of rest. On palpation, the pain intensifies and swelling is revealed. The radiograph reveals aseptic necrosis of the epiphyseal nucleus of the acromion ossification.

Aseptic necrosis of the acromial part of the clavicle (develops at the age of 14-16 years) is characterized by pain with maximum abduction of the arm. On examination, swelling of the acromial end of the clavicle is noted, which may simulate subluxation in the acromioclavicular joint. To clarify the diagnosis, radiography is performed. Treatment in both cases is conservative, unloading the upper limb belt for up to 2 months.

Aseptic necrosis of the humerus trochlea (Hegemann's disease) is manifested by pain in the elbow joint, which intensifies with maximum flexion. An X-ray examination of the elbow joint reveals a successive change in phases of the pathological process (ischemia, revascularization and restoration of bone structure).

With aseptic necrosis of the head of the radial bone, pain increases with pronation or supination of the forearm, as well as with maximum flexion or outward deviation of the forearm. The pain intensifies with palpation and pressure on the area of the head of the radial bone. To clarify the diagnosis, radiography is performed. Treatment is conservative and lasts several months. With the formation of contracture and fragmentation of the head of the radial bone, after the end of growth, in some cases surgical intervention is indicated.

Aseptic necrosis of the olecranon is observed at an earlier age; bilateral damage is possible. It manifests itself as pain that intensifies when the forearm is extended. Treatment is conservative.

Aseptic necrosis of the head of the condyle of the humerus (Panner's disease) is manifested by pain localized mainly in the outer part of the affected elbow joint. To clarify the nature of the disease and its stage, radiography is performed. Treatment is conservative.

Other aseptic necrosis of bones as a result of microtraumas are described in articles Lower leg, ankle joint, knee joint, marching foot, shoulder joint, spine and etc.

The prognosis with early comprehensive treatment of microtraumas and exclusion of the traumatic factor is favorable. Prevention - proper organization of work, use of protective equipment and devices, timely treatment of microtraumas in the acute period, rational organization of sports activities. see also Damage.

Bibliography: Diseases and injuries during exercise Sports, ed. A.G. Dembo, L., 1984; Mironova Z.S. and Badnin I.A. Injuries and diseases of the musculoskeletal system in ballet dancers, M., 1976; Franke K. Sports traumatology, trans. with German, p. 12, 15, Sofia, 1986; Shoilev D. Sports traumatology, trans. from Bulgarian, p. 12, M., 1980.

More recently, it became known about the initiative of the Ministry of Labor of the Russian Federation to amend the Labor Code of the Russian Federation. We are talking about including in the law the obligation of the employer to record and investigate micro-injuries of workers. We have previously written about this initiative. As the active discussion of the material showed, the initiative received a sharply negative attitude among our readers.

The Ministry of Economic Development of the Russian Federation did not support the bill either. Recently, the department prepared a Conclusion on the assessment of regulatory impact on it. This document reveals why the Ministry of Economic Development considers it inappropriate to adopt amendments to the Labor Code of the Russian Federation. It notes that the ministry held public consultations with representatives of business and the public: the Russian Union of Industrialists and Entrepreneurs, the Ministry of Emergency Situations of Russia, PJSC Gazprom, PJSC NK RussNeft, PJSC MMC Norilsk Nickel and a number of others. Based on an analysis of current legislation and opinions received during consultations, comments on the draft law were prepared.

The Conclusion states that the bill involves the inclusion in the Labor Code of the Russian Federation of the concept of “microtrauma”, which is understood as a case of damage to the health of an employee in the performance of official duties, as a result of which a partially limited ability to work occurred, necessitating a transfer to another job during the working day and not requiring registration of a certificate of temporary incapacity for work.

The Ministry of Economic Development of the Russian Federation indicated that the developers of the bill did not provide a justification for the need to include this concept in labor legislation, which, according to its interpretation, allows such injuries to be classified as an accident, enshrined in the Labor Code of the Russian Federation. The draft law does not have a clear definition that would allow one to correctly classify microtraumas and distinguish them from other injuries received by an employee at the workplace.

It is also noted that the current legislation, as well as the proposed changes to it, do not provide for the investigation of cases of micro-injuries, which makes it impractical to organize their recording at the enterprise.

Taking into account the fact that the labor legislation of the Russian Federation clearly regulates the procedure for recording, registering and investigating facts of health damage in the workplace, and also contains a detailed classification of possible injuries, introducing amendments in terms of recording micro-injuries seems inappropriate, as well as “burdensome for employers.” In this regard, the Ministry of Economic Development of the Russian Federation recommended that the Ministry of Labor of the Russian Federation exclude from the bill the proposal on mandatory recording of microtraumas.

Let us note that this is not the only point of the bill that did not find support from the Ministry of Economic Development. The department also did not agree with the initiative of colleagues to impose responsibilities on employers to develop risk management measures in the workplace, in order to identify harmful or dangerous effects on the employee. The conclusion states that all these activities are carried out as part of a special assessment of working conditions, therefore, such an obligation will be unnecessary.

Let us note that a negative conclusion does not mean that the bill is finally rejected and will no longer be considered by the government. Its developers can revise it and, having eliminated the comments, resubmit it for consideration. So far there has been no reaction from the Ministry of Labor to the conclusion, so the further fate of the initiative “to count bruises” is currently unknown.

Microtrauma (Greek mikros small + trauma wound, damage) is damage that occurs as a result of exposure to small-intensity forces and leads to disruption of the function and microstructure of tissues. A distinction is made between acute M.—a single or short-term exceeding of the limits of mechanical strength of tissue, accompanied by a reversible change in its structure and function—and chronic M.—repeated and prolonged low-intensity exposure to the same traumatic agent on a specific area of the body. With microtraumatization of tissues, aseptic inflammation develops, which, with repeated prolonged exposure to a traumatic agent, leads to tissue degeneration and persistent dysfunction. Depending on the cause, M. is divided into exogenous, occurring under the influence of external mechanical agents, and endogenous, associated with physical activity that is inadequate in intensity and duration. Acute endogenous M. is also called acute overexertion. As a rule, this pathological process simultaneously affects various structures of the musculoskeletal system. Depending on the conditions of injury, sports, professional and other microtraumas are distinguished.

Skin, subcutaneous tissue, fascia, aponeuroses, ligaments, tendons, bursae and vaginas, muscles, cartilage, bones, peripheral and central nervous systems can be subject to microtrauma. Isolated damage (to one type of tissue) and damage to a specific structural and functional complex, for example, the extensor apparatus of the leg, the prepatellar synovial bursa and the infrapatellar fat bodies are possible. Skin microtraumas are the most common type of damage. Among acute skin M., there are open (abrasions, scratches and small wounds) and closed (bruises and abrasions, sores, etc.). Acute M. of the skin with a violation of the integrity of the skin is the most common cause of the development of felons. As a result of chronic M. of the skin, callus, skin fibrosis, and fibrosclerosis of the subcutaneous tissue (skin polyp) can develop. The hyperkeratosis and hypertrophy of the subcutaneous tissue usually noted in these cases are a favorable background for the occurrence of cracks, which become the entrance gates for infectious agents, which can cause phlegmon or panaritium. Treatment of M. skin is conservative.

When M. is open, the damaged area is treated with an antiseptic (for example, a 5% alcohol solution of iodine, a 1-2% alcohol solution of brilliant green, a solution of chlorhexidine), foreign bodies (splinters) are removed, and an aseptic bandage is applied to prevent infection. In case of chronic M., it is necessary to eliminate the traumatic agent (incorrectly selected shoes, tools), and carefully monitor skin hygiene. Treatment of chronic M. includes anti-inflammatory, local absorbable therapy: electrophoresis of a solution of potassium iodide, lithium salts; for hyperkeratosis - keratolytic agents. Microtraumas of fatty tissue can also be acute (bruises) and chronic. Acute M. of subcutaneous tissue often accompanies damage to the skin.

Treatment includes rest, local cold, and subsequently thermal and other physiotherapeutic procedures (see Bruises). In case of chronic M. of subcutaneous tissue, it is necessary to stop exposure to the traumatic agent and prescribe local absorbable and anti-inflammatory therapy. In case of polyfocal lesions of the subcutaneous tissue, M. should be differentiated from inflammatory (panniculitis) and non-inflammatory (cellulalgia, cellulitis) diseases (see Rheumatic diseases of periarticular soft tissues). Microtraumas of the fascia and aponeuroses, the so-called fibrous skeleton of the body, which plays an important role in muscle activity, are accompanied by serous-fibrinous aseptic inflammation with subsequent proliferation of fibroblasts and fibrous-scar changes, which lead to a significant decrease in their elasticity.

Post-traumatic fibrositis of the fascia and aponeuroses is clinically manifested by slight pain and stiffness when contracting the muscles covered with the affected fibrous structures. On palpation, their pain usually intensifies; somewhat later, painful nodules and larger indurations are detected, which moderately limit the mobility of the affected area; they can then undergo reverse development. Fasciitis of the fascia lata of the thigh often develops after an injury or professional injury (in porters, carpenters, etc.) associated with constant pressure or friction in the area of the outer surface of the thigh. Treatment is conservative. The effect of a traumatic agent on the affected area is excluded, rest and limitation of physical activity are recommended. Painkillers, anti-inflammatory drugs, physiotherapy, massage, and therapeutic exercises are prescribed. In the future, to prevent relapse, protect the affected area of the body from damage. Microtraumas to ligaments occur as a result of a single direct (bruise), indirect impact during movement exceeding physiological limits (see Distortion) or a sharp contraction of the muscle that tensions the ligament. M. of the ligamentous apparatus of the spine must be differentiated from pain syndrome due to osteochondrosis.

Chronic M. of the ligamentous apparatus (ligamentosis) is similar in etiopathogenesis and clinical picture to tendoperiostopopathies. The ligaments of the knee, ankle joints, and ligaments of the hand joints are most often affected. Treatment is conservative: limiting physical activity until the pain subsides, anti-inflammatory drugs, physiotherapy, and then dosed strengthening of the muscles that stretch the affected ligament, and massage. Depending on the location of the damage during tendon rupture (traumatic tendinopathy), a distinction is made between ruptures of the tendon itself (tears with the development of aseptic tendinitis), damage to areas of the tendon where the fibers of the latter enter the periosteum (tenoperiostitis - enthesitis, insertionitis) and areas of transition of the muscle into the tendon with development of tenomyositis (myoenthesitis). Chronic tendon malformations lead to the development of tendinosis and tenoperiostosis (at the junction with the periosteum).

Often, simultaneously with damage to various tendon structures, a pathological process develops in their mesentery and tendon sheaths (tenosynovitis, tendovaginitis). surrounding tissue (paratenonitis) or nearby synovial bursae (tenobursitis). With repeated injuries as a result of scar processes, degenerative-dystrophic changes in the tendons are possible. Tendopathies and tendoperiostopathies develop more often in physical workers, athletes, ballet dancers, etc. Often inflammation and degeneration of the peritendinous tissues leads to stenosis, which is accompanied by the development of crepitant tenosynovitis or stenotic tenosynovitis. For example, chronic M. of the calcaneal tendons can be combined with paratenonitis or subcalcaneal bursitis (Achilles bursitis), which is manifested by constant pain in the tendon, redness, swelling, and increased pain during physical activity. With all tendon malignancies in the acute period, local pain, local tissue swelling, limitation of active and passive movements are usually noted, and crepitus may be noted by palpation. The local temperature increases, which can be recorded using thermography, but a long-term pathological process leads to a significant disruption of blood flow, and in this case the local temperature is reduced (Fig. 3). To clarify the characteristic lesions of the tendon, an ultrasound examination is performed.

Treatment is aimed at eliminating the cause of the damage. For acute tendon injuries, a gentle loading regime is recommended for 11/2 months. During this period, local and general anti-inflammatory therapy, painkillers (electrophoresis of novocaine solution) and anti-inflammatory physiotherapeutic procedures (UHF therapy, hydrocortisone phonophoresis on the area of the affected tendon), compresses of dimexide solution, indomethacin ointment, etc. are prescribed. For torpid flow, injections of hydrocortisone and Kenalog are used (cannot be injected into the affected tendon). For chronic M. of the tendons of the surrounding tissues, the complex of therapeutic measures also includes limiting physical activity, a course of novocaine blockades, local administration of analgesics and anti-inflammatory drugs in combination with physiotherapeutic procedures that promote muscle relaxation and have a resolving effect. Massage, physical exercises in water and therapeutic exercises are prescribed. In the first period of treatment, measures are aimed at relaxation; after the pain subsides, do dosed stretching of the affected tissues, and then gradually restore muscle strength.

If the indicated conservative measures are insufficiently effective, an operation is performed (tenolysis, incisions are made at the site of tendon attachment, etc.). The prognosis for restoration of function is often favorable, however, when cysts form in the tendon, it may rupture after a minor injury, and with tendoperiostopathies, relapses of pain are often noted when the action of the traumatic agent resumes. Microtraumas to muscles are very common. Usually the cause of their occurrence is prolonged muscle work, muscle bruise or strain, especially if the muscle is not previously prepared for such loads with the help of a warm-up or special training. In areas of damage, there is a disorder of local blood circulation, hemorrhages, and changes in myofibrils in the form of a violation of their continuity. There are acute and chronic M. of muscles. Acute M. may not be accompanied by a violation of the muscle structure or may lead to damage (microtears) of muscle tissue. A peculiar form of M. muscles is muscle contracture (see Contracture). Severe paroxysmal muscle tension - cramp (eng. cramp cramp, polymyalgia with muscle fatigue) occurs as a result of involuntary activity of the motor nerve during a period of high motor activity of the body. The accompanying pain syndrome can be of varying intensity and duration. Treatment - passive muscle stretching, thermal procedures, massage.

Polymyalgia develops when fatigue occurs as a result of intense muscle work. It is characterized by the onset of pain in most muscle groups 12-24 hours after exercise and the duration of the pain syndrome up to 5-7 days. On palpation, pain, thickening and muscle tension are noted, and a decrease in the range of active and passive movements is observed. Treatment - a gentle motor regimen until the pain subsides, thermal procedures (hot baths, showers, saunas), anti-inflammatory drugs locally and internally (acetylsalicylic acid, butadione, etc.), massage of the affected muscles using ointments that cause tissue hyperemia and provide anti-inflammatory, improving blood flow action. Microtears and partial ruptures of muscles are accompanied by pain when the affected muscles are tense, an increase in local temperature in the damaged area, and a significant decrease in muscle strength. During palpation, the pain in the damaged area intensifies, an area of compaction or a tissue defect in the muscle is identified, which can increase when it contracts. To clarify the diagnosis, thermography is used (the so-called zone of interest is determined - a local increase in heat production) and ultrasound.

With microtears of muscles, ultrasonograms reveal areas of increased echogenicity, and with partial ruptures, signs of hematoma in the muscle (area of decreased echogenicity). For a clearer diagnosis of the localization of the rupture, an ultrasonographic picture is recorded at rest and during muscle tension. Treatment of this group of M. in the acute period is conservative. A puncture of the hematoma is performed, a course of novocaine blockades of the damaged area, then physiotherapy, therapeutic exercises and massage are prescribed. Repeated chronic muscle contractions are accompanied by the formation of scars and the development of a dystrophic process, which, due to a decrease in the mechanical strength of the scar, can be accompanied by so-called spontaneous ruptures of the muscle. Conservative treatment of chronic M. muscles includes a gentle motor regimen, local thermal procedures (applications of paraffin, ozokerite, baths), physiotherapy (electrophoresis of novocaine, phonophoresis of hydrocortisone), compresses with ronidase, therapeutic exercises, massage, sanatorium treatment (mud applications). Surgical treatment of M. muscles is indicated only for complete spontaneous ruptures with significant impairment of function.

Clinical picture, diagnosis and treatment of M. synovial bursae - see Bursitis, Synovial bursae, Joints, Tenosynovitis. Acute M. of cartilages covering the articular surfaces are often asymptomatic, but in the future they often lead to significant dysfunction of the joint. Thus, after an injury to the knee joint (for example, a transchondral fracture), hemarthrosis or synovitis may be observed, not accompanied by clinical manifestations of a fracture, but after a few months chondromalacia may form and osteoarthritis subsequently develops (see Knee joint). Chronic diseases of cartilage tissue include perichondritis, chondropathy, and chondromalacia. Repeated traumatic effects on the articular cartilage lead to its disintegration and detachment. Joint pain is often a factor associated with the progression of osteoarthritis. In some cases, they provoke an exacerbation of a concomitant disease, for example, glenohumeral periarthrosis (see Shoulder joint). Chronic M. of the perichondrium of the cartilaginous part of the ribs at the site of attachment of the pectoralis major muscle to them is characterized by pain, local swelling, increased pain when coughing, sneezing, contraction or stretching of the pectoralis major muscles (see Tietze syndrome).

Treatment is conservative; in case of severe pain, novocaine blockade is performed at the sites of greatest pain. Non-steroidal anti-inflammatory drugs (butadione, indomethacin, reopirin, etc.) and, if necessary, local administration of hormonal drugs (kenalog, triamcinolone, dexamethasone) are prescribed. With the development of degenerative-dystrophic processes in the joints, oxygen therapy (injection of oxygen into the joint) is used, and drugs that improve the metabolism of cartilage tissue (rumalon, mucarthrin, arteparon) are used. Physiotherapeutic and sanatorium-resort treatment is widely used. Acute M. of the periosteum occurs as a result of a bruise and is often accompanied by subperiosteal hemorrhages and local pain. Chronic trauma leads to hypertrophy and restructuring of the cortical bone with the subsequent formation of transverse areas of clearing - Looser's zones (see Looser's zones). Areas of aseptic necrosis form in the cancellous bone. Early diagnosis is possible with radionuclide testing.

In subsequent phases of the process, radiographs reveal thickening of the cortex with areas of clearing. Clinical picture and treatment of M. of bone tissue - see Bone. Microtrauma of bone tissue is one of the etiological factors in the development of a large group of diseases - osteochondropathy. As a result of prolonged exposure of the bone to intense loads that do not exceed its strength limit, aseptic necrosis can occur. Depending on the location and degree of pathological changes, they have a unique clinical picture and course. Thus, aseptic necrosis develops at the age of 15-17 years. Patients report pain in the shoulder joint, which intensifies after exercise and subsides after a few days of rest. On palpation, the pain intensifies and swelling is revealed. The radiograph reveals aseptic necrosis of the epiphyseal nucleus of the acromion ossification. Aseptic necrosis of the acromial part of the clavicle (develops at the age of 14-16 years) is characterized by pain with maximum abduction of the arm. On examination, swelling of the acromial end of the clavicle is noted, which may simulate subluxation in the acromioclavicular joint.

To clarify the diagnosis, radiography is performed. Treatment in both cases is conservative, unloading the upper limb belt for up to 2 months. Aseptic necrosis of the humerus trochlea (Hegemann's disease) is manifested by pain in the elbow joint, which intensifies with maximum flexion. An X-ray examination of the elbow joint reveals a successive change in phases of the pathological process (ischemia, revascularization and restoration of bone structure). With aseptic necrosis of the head of the radial bone, pain increases with pronation or supination of the forearm, as well as with maximum flexion or outward deviation of the forearm. The pain intensifies with palpation and pressure on the area of the head of the radial bone. To clarify the diagnosis, radiography is performed. Treatment is conservative and lasts several months. With the formation of contracture and fragmentation of the head of the radial bone, after the end of growth, in some cases surgical intervention is indicated. Aseptic necrosis of the olecranon is observed at an earlier age; bilateral damage is possible. It manifests itself as pain that intensifies when the forearm is extended. Treatment is conservative. Aseptic necrosis of the head of the condyle of the humerus (Panner's disease) is manifested by pain localized mainly in the outer part of the affected elbow joint.

To clarify the nature of the disease and its stage, radiography is performed. Treatment is conservative. Other aseptic necrosis of bones as a result of M. are described in the articles Shin, Ankle joint, Knee joint, Marching foot, Shoulder joint, Spine, etc. Microtrauma of the peripheral nervous system develops directly as a result of repeated mechanical impact on the nerve trunks in places of their superficial location, for example on the ulnar nerve, located in the bone canal, with repeated falls on the elbow, on the cutaneous branch of the anterior tibial nerve when wearing socks with a tight elastic band or improper lacing of shoes, as a result of which neuritis of this branch develops. Clinical picture, diagnosis and treatment of M. of peripheral nerves - see Tunnel syndromes. M. of the peripheral nervous system due to prolonged vibration leads to the development of vibration disease. M. of the central nervous system are observed in violation of safety regulations in a number of professions and in some sports (boxing, heading in football, etc.). See also Traumatic brain injury. The prognosis with early complex treatment of M. and exclusion of the traumatic factor is favorable. Prevention - proper organization of work, use of protective equipment and devices, timely treatment of M. in the acute period, rational organization of sports activities. See also Damage.

Bibliography: Diseases and injuries during sports, ed. A.G. Dembo, L., 1984; Mironova Z.S. and Badnin I.A. Injuries and diseases of the musculoskeletal system in ballet dancers, M., 1976; Franke K. Sports traumatology, trans. with German, p. 12, 15, Sofia, 1986; Shoilev D. Sports traumatology, trans. from Bulgarian, p. 12, M., 1980.