Achilles tendon

“ Little by little, but with much excelsior and twine, the muscles are gradually built up. Leave the bones bare at the points where nature does. The hind leg must have its tendon of Achilles before it can be finished. To make this, drill a hole through the end of the calcaneum, or heel bone; pass a long wire through for half its length, twist the two halves tightly together until they will reach half-way up the thigh, then wrap tow around the twisted wire from the heel bone up, making the tendon larger as you proceed. ”

“ Now, we have seen that the tendon of Achilles is the piston cord, and the heel the crank-pin, of the muscular engine represented by the gastrocnemius and soleus. In the standing posture the heel slopes downwards and backwards, and is thus in a position, as regards its piston cord, considerably beyond the point of maximum leverage. As the heel is lifted by the muscles, it gradually becomes horizontal and at right angles to its tendon or piston cord. As the heel rises, then, it becomes a more effective lever; the muscles gain in power. ”

“ Excludes2: injury of muscle, fascia and tendon at ankle (S96.-) injury of patellar ligament (tendon) (S76.1-) sprain of joints and ligaments of knee (S83.-) The appropriate 7th character is to be added to each code from category S86 A initial encounter D subsequent encounter S sequela S86.0 Injury of Achilles tendon S86.00 Unspecified injury of Achilles tendon S86.001 Unspecified injury of right Achilles tendon S86.002 Unspecified injury of left Achilles tendon S86. ”

“ Hunter ruptured [Pg 140] his tendo Achillis, whether while dancing, or in getting up from the dissecting-table after being cramped by long sitting, is not certain, occasioned him to study carefully the process by which ruptured tendons are healed. His method of treating himself was to keep the heel raised, and to compress the muscle gently with a roller, thus preventing any spasmodic contraction. He divided the same tendon in several dogs, killing them subsequently at different periods to examine the progress and nature of the repair ”

“ Tendons may be cut across accidentally, especially in those wounds so commonly met with above the wrist as a result, for example, of the hand being thrust through a pane of glass. It is essential that the ends should be sutured to each other, and as the proximal end is retracted the original wound may require to be enlarged in an upward direction. When primary suture has been omitted, or has failed in consequence of suppuration, the separated ends of the tendon become adherent to adjacent structures, and the function of the associated muscle is impaired or lost. ”

“ At the ankle it affects the peronei, the extensor digitorum longus, or the tibialis anterior. It is most often met with in relation to the tendo-calcaneus—Achillo-dynia—and results from the pressure of ill-fitting boots or from the excessive use and strain of the tendon in cycling, walking, or dancing. There is pain in raising the heel from the ground, and creaking can be felt on palpation. ”

“ After the inflammation has subsided, active and passive movements are employed to prevent the formation of adhesions between the tendon and its sheath. If the tendon sloughs, the dead portion should be cut away, as its separation is extremely slow and is attended with prolonged suppuration.
Gonorrhœal Teno-synovitis.—This is met with especially in the tendon sheaths about the wrist and ankle. It may occur in a mild form, with pain, impairment of movement, and œdema, and sometimes an elongated, fluctuating swelling, the result of serous effusion into the sheath. ”

“ In the peronei tendons, for example, it may result from disease of the fibula or of the ankle-joint.
When conservative measures fail, excision of the affected sheath should be performed; the whole of the diseased area being exposed by free incision of the overlying soft parts, the sheath is carefully isolated from the surrounding tissues and is cut across above and below. Any tuberculous tissue on the tendon itself is removed with a sharp spoon. Associated bone or joint lesions are dealt with at the same time. ”

“ Treatment is only called for when it is causing inconvenience, the muscle being exposed by a suitable incision, the herniated portion excised, and the rent in the sheath closed by sutures.
Dislocation of Tendons.#--Tendons which run in grooves may be displaced as a result of rupture of the confining sheath. This injury is met with chiefly in the tendons at the ankle and in the long tendon of the biceps.
Dislocation of the _peronei tendons_ may occur, for example, from a violent twist of the foot. There is severe pain and considerable swelling on the lateral aspect of the ankle ”

“ Therefore, in chronic tendinitis there is to be found at times the same conditions which characterize acute inflammation, except that there is usually a variance of symptoms because of the difference in the degree of inflammation and pain.
The diagnosis of contraction of tendons is an easy matter because of the fact that relations between the phalanges are constantly changed with tendinous contraction. If one bears in mind the attachments and function of the digital flexors, no difficulty is encountered in recognizing contraction of either tendon. ”

“ There are no aponeuroses exactly like the tendons, except those which are essentially formed by their expansion or which are at their origin, as those spread upon the anterior rectus of the thigh, those which are concealed in the fleshy fibres of a muscle, and afterwards go out of it to become a tendon. In certain parts of the limbs, as at the top of the arm, for example, the aponeuroses of general covering are insensibly lost in the cellular texture, without our being able to draw the line of demarcation. ”

“ The subject requires much more investigation, but there is every reason to believe that it is a tendon which has sunk into the joint, though whether that of the pectineus is doubtful, since the intra-capsular tendon comes from the ischium in Reptiles. In many Mammals, and among them the Orang, there is no ligamentum teres. In others, such as the Armadillo, the structure has not sunk right into the joint, but is connected with the pubo-femoral part of the capsule.
The Knee Joint is a hinge formed by the condyles and trochlea of the femur, the patella, and the head of the tibia. ”

“ Davis kept a good stock of tools, made his wheels, harrows, yokes, and other farming tools, and some for his neighbors. In working with an adze between his feet, the instrument glanced, and the corner of it severed the tendon of his left leg.
The Achillis tendon is large, and connected with a very strong muscle, as it sustains a great strain when the foot is thrown forward, and the weight of the body, perhaps with the addition of some burden on the shoulder, raised by it; and when broken or cut, the strong muscles of which it is a prolongation, cause it to contract very much. ”

“ As a rule, it is also advisable to fix with the splint the joint above or below the fracture. In cases in which a splintering of the bone into a joint has taken place, more especially in those cases in which tendons have been injured, there may be a good deal of effusion into the joint and the tendon sheaths, and this may be organized into fibrous tissue leading to permanent stiffness. This is particularly apt to occur in old people. Care must be taken in such instances by gentle exercises, and by passive movement during the process of cure, to keep the joint and tendons free. ”

“ There is no substance that could be used for this purpose that presents a harder, smoother surface than glass, and when in the shape of solid polished spheres, plying in perfectly fitted sockets, they are practically indestructible; there is no such thing as wearing them out. A linked steel rod and a back and front tendon securely connect the foot and ankle. The tendons, also the rubber springs, are the same as used in all of our legs, and are applied in the same manner. This is a somewhat lighter joint than the army and navy joint and is recommended for persons of light or medium weight. ”

“ In the process of repair, one or both ends of the muscle or tendon may become fixed by adhesions to adjacent structures, and if the distal portion of a muscle is deprived of its nerve supply it may undergo degeneration and so have its function impaired.
Rupture of a muscle or tendon is usually the result of a sudden, and often involuntary, movement. As examples may be cited the rupture of the quadriceps extensor in attempting to regain the balance when falling backwards; of the gastrocnemius, plantaris, or tendo-calcaneus in jumping or dancing ”

“ The affected finger becomes red, painful, and swollen, the swelling spreading to the dorsum. The involvement of the tendon sheath is usually indicated by the patient being unable to flex the finger, and by the pain being increased when he attempts to do so. On account of the anatomical arrangement of the tendon sheaths, the process may spread into the forearm—directly in the case of the thumb and little finger, and after invading the palm in the case of the other fingers—and there give rise to a diffuse cellulitis which may result in sloughing of fasciæ and tendons. ”

“ In a young and fat child, where the inner edge of the tibia cannot be distinctly felt, the best guide to the tendon is a point midway between the front and the back of the ankle. An incision in front of this point might injure the internal saphena vein; behind this point, the posterior tibial artery.
119. Tendons behind outer ankle.—Behind the malleolus externus we feel the two peroneal (long and short) tendons. They lie close to the edge of the fibula, the short one nearer to the bone. ”

“ Tendinitis.—German authors describe an inflammation of tendon as distinguished from inflammation of its sheath, and give it the name tendinitis. It is met with most frequently in the tendo-calcaneus in gouty and rheumatic subjects who have overstrained the tendon, especially during cold and damp weather. There is localised pain which is aggravated by walking, and the tendon is sensitive and swollen from a little above its insertion to its junction with the muscle. ”

“ Instead of being thus attached directly to the bone, they end in what we call tendons. These tendons are hard and strong, and a very small tendon will lift as much without breaking as quite a large muscle. The muscles are soft and would have to be attached over a large area in order to secure the required strength. The tendons, being so much stronger than the muscles, can be attached to a very small area and yet secure the same amount of power as would result from attaching the muscle itself.
The tendons pass directly into the periosteum, the thick, strong covering of the bones. ”

“ Wounds of tendon sheaths are similar to open joints in that there is an escape of synovial fluid, "sinew water." Where the tendons are simply punctured by a thorn, nail, or fork, we must, after a thorough exploration of the wound for any remaining foreign substance, treat with the flour-and-alum paste, bandages, etc., as for open joint. Should the skin and tendons be divided the case is even more serious and is often incurable. There is always a large bed of granulations (proud flesh) at the seat of injury, and a thickening more or less pronounced remains. ”

“ In some cases it can be produced at will by the patient or the surgeon. We have observed one such case in a professional cyclist in whom this capacity of partially dislocating the knee entailed no disability. When the child begins to walk, an apparatus which will prevent hyper-extension and lateral motion should be fitted to the limb.
Congenital absence of the patella usually complicates other abnormalities of the knee-joint. The tubercle of the tibia is prominent and the extensor tendon unusually thick. In flexion the tendon rises on to the lateral condyle of the femur. ”

“ We may then divide the lateral ligaments, and keep the fingers straight by means of an extension splint while the tendons are relaxed by flexion of the wrist, trusting to subsequent massage and passive motion, or, failing [56] this, to tendon lengthening (by a process to be described later) , to overcome the resistance of the shortened muscles. Section of tendons within the theca is useless, because no uniting material is thrown out between the divided ends. As a last resource, amputation may be demanded to remove a useless and inconvenient member. ”

“ Such injury happens often in horses, in what is called breaking down. In them the tendon is occasionally snapped entirely through, and the ends widely separated. The same occurs in the human subject. Separation of the muscular fibres, however, is rare; laceration of the tendon itself, or separation of the tendon from the muscle, is more common. The yielding of the broad tendons on the upper and fore, lateral and under parts of the abdomen, affords an example of laceration of tendinous fibre from violent exertion. ”

“ The result, then, is that the coronet bone forces the navicular hard against the flexor tendon, which, in turn, presses firmly against the navicular as the force of the contracting muscles lifts the tendon into place. It is self-evident, then, that the more rapid the pace and the greater the load, the greater must these contending forces be, and the greater the liability to injury. For the same reason horses with excessive knee action are more liable to suffer from this disease than others, concussion of the foot and intense pressure on the tendon being common among such horses. ”