Diseases of the musculoskeletal system of an inflammatory nature

There are a large number of diseases of the musculoskeletal system and connective tissue. Some of them are independent diseases, the other part is a manifestation of some other disease.

Conventionally, all diseases of the musculoskeletal system can be divided into two groups: 1) diseases inflammatory nature; 2) degenerative diseases of the joints and spine.

By international classification diseases (ICD-10), diseases of the musculoskeletal system and connective tissue (section XII) include arthropathies (infectious, reactive, Reiter's disease, reactive arthropathies in other diseases); inflammatory polyarthropathies; arthrosis; systemic connective tissue lesions; osteopathy and chondropathy.

The morbidity rate with diseases of the musculoskeletal system was 10,922 per 100,000 people, and over 5 years it increased by 33% among children and by 30% among adolescents. Arthrosis in St. Petersburg, according to 2009 data, is 35.5 per 1,000 people, rheumatoid arthritis - 2.47, ankylosing spondylitis - 0.185 per 1,000 population. Among all persons recognized as disabled for the first time, 9.3% are persons with diseases of the musculoskeletal system. Of these, 76.1% are disabled people of working age, 36.4% are disabled people of groups I and II.

Signs of disorders of the musculoskeletal system are already present in children. The signs of correct posture in children include approximately the same depth of the cervical and lumbar curves of the spine, keeping the body straight with the head held high, shoulders straightened so that the lower corners of the shoulder blades are located at the same level. The child's legs should be straight, the iliac crests are at the same level, the stomach is tucked up, the waist triangles formed by the waistline and lowered arms should be symmetrical and equal in size.

There are a number of causes of posture disorders: the child sleeps on a soft mattress with a high pillow; putting the child to sleep on one side; carrying a child on one arm; driving a child by the same hand; seating a child under the age of six months, even if his torso is fixed with pillows; the use of a desktop and a chair that does not correspond in size to the height of the child; incorrect posture of the child at the table in the classroom or when preparing homework; carrying a bag with textbooks on one shoulder or in one hand for a long time; cycling for adults, when the child passes one leg under the frame; the habit of leaning on one leg; insufficient motor activity, which leads to poor muscle development and, as a result, a violation of posture; malnutrition with a decrease in the amount of protein, calcium and vitamin D; frequent respiratory diseases, the presence of chronic diseases of the teeth, tonsils, paranasal sinuses nose and gastrointestinal tract; decrease in immunity.

Types of posture disorders include: stoop, lordosis (anterior curvature of the spine), kyphosis (posterior curvature of the spine) and lateral curvature of the spine - scoliosis. Straightened posture is a condition when the natural curves of the spine are smoothed out. This type of posture occurs in 1-2% of school-age children. Flat feet also belong to disorders of the musculoskeletal system.

Risk factors in school-age children are: decrease in motor activity, intensification of training using technical training aids, irrational, unbalanced nutrition. 26.4% of schoolchildren eat irregularly; 18.7% do not eat vegetables, 9.9% of children do not like and rarely eat meat, 57.3% rarely eat fish. 4.5% of schoolchildren are underweight, 9.7% are overweight.

When studying the causes of posture disorders in schoolchildren, it was revealed that 93.6% carry a portfolio constantly with one right hand, 90.5% have an incorrect posture at the table, 83.6% do not go in for sports. In 72.6% of schoolchildren, gait was disturbed, and in 56.9%, an incorrect position of the torso and head during sleep was revealed.

In children with disorders of the musculoskeletal system, the frequency of anomalies and deformities of the dentition increases. With an increase in the severity of disorders of the musculoskeletal system, the prevalence of deep bite increases by 2.5 times: from 14.67% in children with impaired posture to 40.0% in children with grade III-IV scoliosis.

The causes of rheumatoid arthritis include hereditary predisposition, infection with streptococci, staphylococci, mycoplasmas, viruses; infection from foci of chronic infection and intoxication in complicated forms of dental caries, frequent tonsillitis, chronic tonsillitis.

Contributes to the development of the disease hypothermia, cold, humid climate, work in a damp room, frequent acute respiratory infections. Provocative moments of the onset of the disease, in addition to infections, include injuries, operations, food allergies, the introduction of sera or vaccines, childbirth, abortion.

In the pathogenesis of ankylosing spondylitis, or Strümpel-Marie-Bechterew's disease, adverse factors are diseases of the urogenital organs, organs of the gastrointestinal tract, stomatitis, chronic tonsillitis, dysentery.

The starting point of psoriatic arthritis may be chronic psychotrauma, viral hepatitis, shingles.

Drafts, systematic hypothermia, work in a damp room are not only a contributing factor in the development rheumatic lesions inflammatory nature and degenerative diseases of the joints and spine, but also reduce general and local immunity.

Osteoarthritis is based on a metabolic-dystrophic process with atrophy, destruction of articular cartilage, osteoporosis, degenerative changes in the epiphyses of articulating bones.

With gout, purine metabolism is disturbed, the content of uric acid in the blood, urates are deposited in the articular or periarticular tissues, inflammatory and then destructive sclerotic changes are observed. Risk factors are a tendency to profuse, systematic consumption of meat, alcohol, beer, wine, lead intoxication, overheating, hypothermia in the workplace, systematic long-term use of aspirin, a decrease in the excretion of uric acid by the kidneys and fluctuations in blood pH.

Rheumatoid arthritis

Rheumatoid arthritis- autoimmune rheumatic independent disease, characterized by symmetrical erosive arthritis, which is based on the inflammatory process in the synovial membrane of the cartilage of the joint and periarticular tissues. In rheumatoid arthritis, there is wide range extra-articular (systemic) manifestations. An inflammatory exudate accumulates in the joint.

Rheumatoid arthritis occurs in 0.3-2% of the population, of which 80% are at the age of 35-50 years. The disease occurs four times more often in women than in men. The highest percentage of rheumatoid arthritis occurs in first-degree relatives (5.1%).

Against the background of influenza, tonsillitis, periostitis of the jaw, body temperature rises, the joints of the hand increase, become hyperemic, pain appears during movements in the wrist joint, stiffness in movements is observed, especially in the morning. There are weakness, sweating, a feeling of weakness, fatigue, nausea, hyperemia of the skin over the joint.

In 33% of disabled people suffering from rheumatoid arthritis, movement restriction is diagnosed. Over time, muscle weakness, muscle atrophy, damage to the nervous system, eye pathology, and joint deformity occur. Patients have muscle pain, numbness, tingling in the feet and hands. In 40% of cases, one joint becomes ill, in 24% - two joints, in 36% arthritis of the small joints of the hands and feet develops.

In 10% of patients, the disease begins acutely: a person was healthy in the evening, and in the morning his joints hurt, their deformation sets in, a feeling of stiffness appears. In 15% of patients, the picture of polyarthritis develops within a few days. The early stages of the disease are characterized by damage to the joints of the hands, then the knees, less often the elbows and ankles are affected, even more rarely the shoulders, and the hips to early stage are not involved in the process.

There may be pain in cervical region spine and temporomandibular joints. Of the complications, there is anemia, in 19.6% of patients rheumatoid nodules appear that do not disappear within three months, in 28.6% - within 6 months and in 30.5% of cases - up to 12 months. In the elderly, "early" arthritis is characterized by morning stiffness (in 80% of patients), visceral manifestations (in 27%), damage to large and small joints (in 66.3%).

Acute and subacute onset occurs in 54.4% of cases. Rheumatic nodules are ranging in size from a few millimeters to 3-4 cm in diameter, painless, do not suppurate. Muscle atrophy occurs in 75% of patients, lung damage in the form of dry or exudative pleurisy occurs in 6% of patients who subsequently develop pneumonia.

In rheumatoid arthritis, there are manifestations of disorders of the cardiovascular system in the form of angina pectoris (in 8.6% of cases), ischemic changes on the ECG are detected in 45.7% of cases, cardiosclerosis - in 22.2% of cases, arrhythmias - in 76, 6% of patients.

2% of patients were diagnosed with disorders cerebral circulation, 16.3% - encephalopathy.

"Hungry" pain in rheumatoid arthritis was more pronounced than in gastric ulcer, in 16.6% of cases, gastritis - in 66.2% of cases, duodenitis - in 41% of cases, intestinal dysfunction in 42.8% of cases.

In 46.2% of patients, different kinds kidney pathology. Rheumatoid glomerulonephritis was detected in 28% of patients with rheumatoid arthritis.

10% of patients had keratoconjunctivitis.

The group of inflammatory-dystrophic lesions of the musculoskeletal system includes ankylosing spondylitis, or Strümpel-Marie-Bekhterev's disease. This is a chronic systemic disease of the joints, mainly of the spine, with limitation of its mobility due to ankylosing of the apophyseal joints, the formation of syndesmophytes and calcification of the spinal ligaments.

Ankylosing spondylitis affects 290,000 people in Russia, and men are more often ill. The disease develops mainly at the age of 20 years, in 15% of cases - at the age of 7 years.

Foci of chronic infection cause sensitization of the body with the development of inflammation in fibrous tissue tendons and cartilage of intervertebral discs, in joint capsules, especially intervertebral.

Characterized by lower back pain, stiffness chest, restriction of respiratory movements, restriction of movement in the lumbar region, damage to the organ of vision - iritis. Radiologically, the presence of syndesmophytes is established.

It should be noted a group of diseases affecting the periarticular apparatus: tendonitis, tendovaginitis, bursitis, tendobursitis, ligamentitis.

A type of arthritis is psoriatic arthritis. This is a chronic progressive systemic autoimmune disease with damage to peripheral joints, as well as joints of the spine, associated with psoriasis. Psoriatic arthritis affects 1 to 3% of the population. The disease begins between the ages of 20 and 50.

External manifestations are pink-red nodules on the skin with a tendency to merge into plaques covered with silvery-white, easily detached scales. Foci are localized on the scalp, extensor surface of the elbow and knee joints, around the navel, under the mammary glands, in the gluteal folds, on the nails (Koebner's syndrome). There can only be a skin form, skin-articular or skin-visceral form.

Basic principles of treatment of rheumatoid arthritis

Treatment rheumatoid arthritis long-term, complex with the use of medical, physiotherapeutic, surgical methods, individual, taking into account age, drug tolerance, concomitant diseases, with the correction of immunity.

The prognosis is favorable only if two or three joints are affected, and if more joints are affected, the prognosis is poor.

Disease prevention involves early diagnosis disorders of the musculoskeletal system, optimization of motor activity in order to ensure sufficient load on the joints. The second important factor in preventing the disease and its complications is diet, which involves limiting salt, spices, coffee, tea, but you need to drink up to two liters of water per day.

It is necessary to consume animal and vegetable proteins, fish, dairy products, egg yolks. Recommended consumption of cheese, fruit, cauliflower, bran, turnip, legumes, mushrooms, cod liver. Sugar is called a calcium robber, therefore, in order to prevent damage to the joints and bone tissue, it is necessary to reduce the consumption of refined carbohydrates as much as possible.

It is recommended to treat chronic lesions in the oral cavity and nasal appendages in time, avoid hypothermia of the body, remove teeth with complicated forms of caries, change the place of residence if the patient lives in a cold, humid climate and / or exclude work in a damp room. Requires treatment of the underlying disease and constant monitoring.

Systemic lupus erythematosus

Systemic lupus erythematosus- group disease systemic diseases connective tissue, which develops on the basis of a genetically determined imperfection of immunoregulatory processes, leading to the formation of antibodies to its own cells and their components and the emergence of immune complex inflammation, which results in dysfunction of many organs and systems.

The peak incidence is observed at the age of 14-25, 70% fall ill at the age of 14-40; The prevalence of the disease is 500 cases per 1 million people. They get sick more often in America, Europe and extremely rarely in West Africa.

Etiology of the disease

Against the background of hereditary predisposition, the presence of allergies in 52.5% of patients, the cause is hypersensitivity to ultraviolet rays; in 21.1% of patients - viral infection, in 39.1% of cases - stressful situations, in 8.7% of cases hypothermia, work in a damp room, in drafts contribute to the development of the disease.

Clinic of the early stage of the disease

The disease is characterized by the appearance of erythema in the form of a butterfly on the back of the nose and cheeks, on the skin of the body there may be an urticarial rash, in 50% - alopecia (baldness in the form of foci). Telangiectasias appear on the oral mucosa. Almost 100% of patients have manifestations of arthritis, arthralgia of the hand, wrist and knee joints. With this disease, aseptic necrosis of the bones can occur, of which the head femur affected in 25% of cases.

35% of patients have myalgia. In 81.7% of cases, patients develop pleurisy, 38% - myocarditis, 43% - endocarditis, angina pectoris develops in 6-15% of young women diagnosed with systemic lupus erythematosus. With this disease, 50% of patients develop erosive and / or ulcerative stomatitis, nephritis - in 10-12% of patients, neuropsychiatric disorders - in 25-75% of patients, cerebrovascular accident - in 28% of cases.

Systemic scleroderma

Systemic scleroderma is a progressive polysyndromic disease characteristic changes skin, musculoskeletal system, internal organs(lungs, heart, digestive tract, kidneys) and common vasospastic disorders, which is based on connective tissue damage with a predominance of fibrosis and vascular pathology in the form of obliterating endarteritis.

In the United States, the primary incidence of systemic scleroderma is 12 cases per 1 million people per year. Women get sick 3-7 times more often than men, the peak incidence is from 30 to 60 years. The disease is more common among workers in gold mines and miners, so it can be argued that silicon dust plays a predisposing role in the development of the disease.

Polyvinyl chloride and the drug bleomycin also adversely affect, since those taking this drug get systemic scleroderma in most cases. It was found that in 10% of the patients the vibration factor acted, in 6% - injuries, especially injuries of the skull. The development of the disease was affected by nervous overstrain in 7% of patients, 7% were affected by abortions and childbirth.

In some patients, the disease began after vaccination. A large percentage falls ill during the period of hormonal adjustment - at puberty and during menopause. Provoke the development of the disease stress, infection. In 25% of cases, the disease begins after suffering a sore throat, flu, tooth extraction or tonsils. Hypothermia is especially dangerous on the eve of operations.

Clinic

Because systemic scleroderma- this is a pathology of the connective tissue, therefore, with a disease, all internal organs are involved in the process, they have connective tissue and a vascular network.

At the onset of the disease is dominated by Raynaud's syndrome. In this syndrome, the skin of the fingers first turns pale, then becomes cyanotic, then reddens. Raynaud's syndrome is preceded by exposure to cold or a severe stress reaction, leading to persistent vasospasm. It may be the only sign of systemic sclerosis for anywhere from two weeks to 23 years and may develop suddenly or gradually.

In 21% of patients, the first manifestation of the disease was joint damage. In isolated cases, systemic scleroderma began with an isolated lesion of the internal organs - the heart, lungs or gastrointestinal tract.

The disease was named scleroderma (hard skin), since this symptom is leading in frequency and, if possible, make a diagnosis at the first glance at the patient. The manifestations of the disease on the skin may be minor, with localization on the fingers and face, and there may be severe hardening of the skin.

Changes begin with edema, then thickening of the skin develops, followed by atrophy. There may be focal or diffuse hyperpigmentation, sometimes with foci of hyperpigmentation, depigmentation, erythema, ulceration, necrosis of skin areas, hyperkeratosis, nail changes, and baldness. Skin hardening phenomena can spread throughout the body, with the exception of the legs. There is a mask-like face with stretched skin, deep wrinkles at the corners of the mouth, thinning of the lips, palate, and nose.

Limited mouth opening. There is a gradual depletion of the body, contracture of the fingers sets in, ulcers on them, bleeding from the nose, mouth and gastrointestinal tract periodically appears. In 43% of patients, multiple, long-term non-healing ulcers, necrosis, gangrene appear on bone protrusions, auricles, and eyelids. In 5% of patients, dry gangrene of the fingers develops.

The second sign of systemic scleroderma is polyarthritis and polyarthralgia. Pain is localized in the hands and large joints, there may be morning stiffness, stiffness and pain contractures. Over time, atrophy of the muscles of the shoulder girdle and pelvic girdle occurs.

In patients with systemic scleroderma, in 55% of cases, lung lesions are observed, in 13% - ischemic disease heart, 80% - changes detected on the electrocardiogram, 50% develop hypertonic disease, in 25% of cases, cardiac arrhythmias are detected.

Systemic scleroderma can be accompanied by damage to the digestive organs: 50% of patients have gastritis, 17% have duodenitis, 4% have esophageal ulcers, 4% have stomach ulcers, and 15.2% have duodenal ulcers. In 60% of patients with systemic scleroderma, biliary dyskinesia is observed, in 57% - chronic pancreatitis, in 37.5% - kidney disease.

The treatment of the disease is complex, with the use of drugs with antifibrotic action, vascular drugs, mainly for the treatment of hypertension. Widely used anti-inflammatory drugs and immunomodulators, physiotherapy, massage and physiotherapy.

Prevention- carrying out general recreational activities, including health education to educate the population of motivation for high level natural defenses. In the presence of systemic diseases, it is necessary to work in conditions that exclude risk factors for the disease: hypothermia, vibration, trauma, exposure to vinyl chloride, silicate dust, infections, allergens and stress.

Features of employment of patients with diseases of the musculoskeletal system and connective tissue

WHO in the "Declaration on the health of the entire working population" (2004) states that adverse factors in the workplace lead to occupational diseases. Unfavorable factors, which are the starting point in the development of diseases of the musculoskeletal system and connective tissue, include the impact physical factors(noise, vibration, irradiation, overheating, hypothermia), the overvoltage factor of individual organs and systems, as well as the infection impact factor.

Achievements in the field of reducing the incidence are explained not only by the level of medical care for workers with difficult or hazardous working conditions, but also by the successful implementation of a set of preventive and health-improving measures, taking into account the specifics of their professional activities.

The main directions of the state policy in the field of labor protection are ensuring at the state level the priority of maintaining the health of workers, state management of labor protection, and the provision of therapeutic and preventive nutrition. The production process is modernized, health-saving technologies are used. Specific medical and technical requirements for workers are being developed.

Before hiring is carried out medical examination with the definition of contraindications for work in difficult conditions. The frequency of medical examinations during clinical examination is established and carried out. Hygiene training and education of workers is carried out with an emphasis on the role of maintaining safety in the workplace, compliance rational nutrition, the dangers of alcohol and nicotine, overweight, excessive salt intake.

To preserve the health of employees of enterprises and organizations with diseases of the musculoskeletal system and connective tissue, it is necessary for employees to comply with following conditions: correct posture in the workplace; systematic gymnastics to strengthen the ligamentous apparatus; correct alternation of loading and unloading of the joints, muscle tension; avoiding fixed postures; swimming, water exercises.

At the next medical examination for workers of this profile, it is recommended to carry out dynamometry, tests for vibration sensitivity, cold test of hands, if necessary - capillaroscopy, electromyography, x-ray methods of examination.

The human musculoskeletal system is a complex of structures that form a frame that gives the body a shape, gives support to it, provides the ability to move in space and protect internal organs. This is a combination of the muscular system and the skeleton, which together carry out the movement of the human body and support for all organs. Integrated work The skeletal and muscular system provides work, running, walking, as well as the possibility of attaching all organs.

Function of the musculoskeletal system:

Protective - protection of important organs

Support - fixation of internal organs and muscles.

So, for example, the brain and spinal cord are located in a bone case, the spinal cord is protected by the spine, and the brain is protected by the skull. The ribcage covers the lungs and heart, large blood vessels and the esophagus, and the airways. Behind the organs of the abdominal cavity are protected by the spine, in front by the abdominal muscles, and from below by the pelvic bones.

Motor function - provides simple movements. Motor function is possible only with the interaction of the muscles of the skeleton and bones. Many bones of the skeleton are movably connected by joints. The muscle with its one end is attached to one bone and forms a joint, and the other end is attached to another bone. When a muscle contracts, it sets the bones in motion. Bones with the help of muscles of the opposite action can not only move, but also be fixed in relation to each other. Muscles and bones are involved in metabolism. The human motor apparatus is a self-propelled mechanism, which consists of tendons, bones and muscles.

The spring function is to mitigate shocks and shocks.

The vertical position of a person helps to ensure the musculoskeletal system, which consists of tendons, muscles and ligaments. Approximately two thirds of the weight of the human body falls on the musculoskeletal system. The appearance, physique and size of a person depend on it.

The basis of the human body is the skeleton, which consists of bones that are connected to each other with the help of joints. A joint is a movable articulation of bones. It is designed in such a way that the bones can move freely and be fixed in a certain position. There is a special lubricant in the joint that makes the joint mobile. The amount of such lubrication in some diseases may be reduced, as a result of which the joint becomes painful and inactive. The cartilaginous disk gives the fixed position and strength to the joint.

The supporting support of the human body is the spine, which is a vertebral flexible column that runs from the very base of the skull to the lower back along the entire back.

The spine consists of twenty-three spinal motion segments. Each of them is a mobile link that is involved in providing different functions of the spine. The components of the PDS are the bodies of two vertebrae, as well as the cartilaginous disc, which is located between them, the muscles and ligamentous apparatus that provide mobility and fixation of this complex. In an adult, the spine consists of twelve thoracic, seven cervical and five lumbar vertebrae, as well as two bones - the coccyx and the sacrum. It has four bends: sacral, lumbar, thoracic and cervical. The spine performs two functions: support for the arms, head and torso, as well as protection from external influences of the spinal cord. The vertebrae are connected by intervertebral discs. Each of the discs holds the adjacent vertebrae together in an almost immobile state. Also, the musculoskeletal system includes tendons, ligaments and muscles. With the help of tendons, almost a hundred different muscles are connected to the bones. The tendons are very strong, they contribute to the maximum tension of the muscle in the place where it is attached to the bones. Muscles, unlike tendons, can contract and produce different movements. Also, muscles can convert the energy of chemical reactions into mechanical energy, which is what ensures the work of the muscles.

The main functions of the muscles are the implementation of the movements of the human body, providing various movements that are located inside the structures and organs. There are three types of muscles: -smooth muscles, which are part of the walls of internal organs and blood vessels;

Striated muscles that are attached to the bones of the skeleton;

The cardiac muscle that forms the walls of the heart itself.

To a large extent, how a person feels depends on the state of the musculoskeletal system.

Some diseases of the musculoskeletal system.

Ankylosing spondylitis is manifested by pain and stiffness in the back, the spread of the pathological process to the periarticular tissues and joints of the cervical, thoracic and lumbar spine.

Arthritis is an inflammatory joint disease that affects the articular cartilage and synovium.

Arthropathy - trophic changes in the joints. Arthropathy is observed in diseases of the spinal cord and brain, as well as peripheral nerves, but may also have an endocrine origin.

On-line consultations of doctors

muscles

Human movements are provided by the musculoskeletal system, which consists of a passive part - bones, ligaments, joints and fascia, and an active part - muscles.

There are three main types of muscles. The first is the striated muscles, which are controlled by the brain. The contractions of these muscles are called arbitrary, because they are subject to the will. Together with bones and tendons, they are responsible for all our movements.

The second is smooth muscles, which got this name because that's how they look under a microscope. They are responsible for involuntary movements internal organs, such as the bladder or intestines.

And the third is the heart muscle, which almost entirely consists of the heart. The heart muscle does not stop its rhythmic work throughout life. The nervous system regulates the frequency, strength, rhythm of heart contractions.

Striated muscles are widely distributed throughout our body, even in a newborn baby making up a significant part of the weight - up to 25%. They control the movements of various parts of the skeleton - from the tiny stapedius muscle, which moves the stirrup in the ear, to the gluteus maximus, which forms the buttock and commands hip joint. The striated muscles are subdivided into the muscles of the trunk, head and neck, upper and lower extremities.

Muscles are attached to the skeleton by tendons. The end of the tendon closest to the center of the body is called the point of attachment of the muscle, and it is shorter than the tendon at the other end. Usually, with one tendon, the muscle is attached to the proximal end of the joint, and with the other - to the far end, due to which, by contracting, it sets it in motion.

A striated muscle can be thought of as a series of bundles of muscle fibers brought together. The smallest of them, and the main working element of the muscle, are actin and myosin filaments. They are very thin, you can see them only under electron microscope. They consist of a protein, which is sometimes called contractile. When all the myosin filaments slide along the actin filaments, the length of the muscle shortens.

All these threads are collected in bundles, or myofibrils. Between them, muscle fuel stores are stored in the form of glycogen and cellular energy generators, or mitochondria, are located, in which oxygen and the fuel that comes with food burns, producing energy. Myofibrils are collected into larger bundles or muscle fibers. These are already real muscle cells with a nucleus located along the outer edge.

Muscle fibers are also collected in bundles in a sheath of connective tissue, similar to the insulation of copper wires in a thick cable. A small muscle may consist of only a few bundles, while a large muscle may consist of many hundreds.

The entire muscle is enclosed in the same fibrous sheath, akin to the insulating coating of a multicore cable. In smooth muscles, we will not see such a geometrically ordered structure of filaments and fibers, but they also contract due to the sliding of filaments. At the same time, under a microscope, the heart muscle looks the same as striated, with the difference that individual bundles of fibers are connected in it by jumpers.

From the motor (control movements) areas of the cerebral cortex, the nerves pass through the spinal cord and branch into many muscle-controlling endings. Without signals from the nerve, the muscle loses its ability to contract and gradually atrophies.

Nerves are "connected" to muscle fibers in certain areas of the surface. The electrical force of the nerve impulse entering the muscle is negligible compared to the electrical changes occurring in it, so an amplifier is needed. The supply of a contractile impulse occurs at the motor ending, where the motor nerve joins the muscle fiber. An electrical impulse passing through the nerve releases the substance acetylcholine, which causes the muscle to contract.

The sliding of myosin filaments along actin filaments is a complex process during which a series of chemical compounds. This requires energy, which is produced during the combustion of oxygen and fuel ingested with food into the mitochondria. Energy is stored in reserve and transferred in the form of ATP (adenosine triphosphate), a substance rich in phosphates. Muscle contraction begins with an influx of calcium into the muscle cells through the many microtubules that flow between the myofibrils.

In addition, there are two more groups of fibers in the muscle. One registers the force of contraction, and the other, located inside the tendons, controls its stretching. This key information for controlling muscle activity is transmitted back to the brain.

Muscles have different shapes. They are: biceps, triceps, quadriceps, square, triangular, pyramidal, round, dentate, soleus muscles. According to the direction of the fibers, straight, oblique, circular muscles. Depending on the functions, the muscles are divided into flexors, extensors, adductors, abductors, rotating, straining, mimic, chewing, respiratory, etc.

The striated muscles have an auxiliary apparatus: fascia, fibrous canals, synovial sheaths and bags. Muscles are richly supplied with blood a large number blood vessels, have developed lymphatic vessels.

Muscles performing the same movement are called synergists, and opposite movements are called antagonists. The action of each muscle can occur only with the simultaneous relaxation of the antagonist muscle, such coordination is called muscle coordination.

The strength of the muscles depends on the number of myofibrils in the muscle fibers: in well-developed muscles there are more of them, in poorly developed ones less. Systematic training, physical work, with which myofibrils in muscle fibers increase, lead to an increase in muscle strength.

Diseases of the muscular system.

Muscle tumors are relatively rare.

Among the malformations of the muscles, there are violations of the development of the diaphragm with the subsequent formation diaphragmatic hernias. Muscle necrosis can occur as a result of metabolic disorders, inflammatory processes, trauma, exposure to a nearby tumor, as well as blockage of large arteries.

In muscle tissue, dystrophic processes of various origins can develop, including lipomatosis (excessive deposition of fat), which is observed, in particular, with general obesity.

The deposition of calcium salts in the muscles is observed as a manifestation of a general or local disturbance of mineral metabolism.

Muscle atrophy is expressed in the fact that their fibers gradually become thinner. The causes of atrophy are varied. As a physiological phenomenon, muscle atrophy can occur in older people due to their low physical activity. Sometimes atrophy develops due to impaired muscle function due to diseases of the nervous system. Muscle atrophy can also develop when the patient is immobilized, associated with severe trauma or diseases of the joints, with severe debilitating diseases, etc.

Hypertrophy (increase in muscle mass) of muscles is mainly of a physiological, working nature. May be seen with strong physical activity and also in some hereditary diseases.

Common diseases of the muscular system include the so-called. aseptic inflammation of the muscles - myositis. Muscle lesions associated with the inflammatory process occur in a number of systemic (collagen diseases, rheumatism) and infectious (myocarditis) diseases.

The development of purulent inflammation - an abscess - refers to severe forms of damage to the muscular system, requiring surgical treatment.

Muscle injuries come in the form of bruises or tears; both are manifested by painful swelling, induration as a result of hemorrhage.

Open muscle injuries (wounds) are usually accompanied by significant external bleeding, which requires urgent hospitalization of the victim.

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Musculoskeletal system.

A properly formed, well-functioning musculoskeletal system is one of the main conditions for the full development of a child. By the time of birth, its structural differentiation is far from complete. Very high rates of growth and restructuring, in particular, of bone tissue in early childhood, require a constant supply of:

2) vitamins

3) calcium, phosphorus and other trace elements, as well as

4) intensive blood supply

5) uninterrupted and error-free operation of the enzyme systems of the bone itself and other organs.

These processes are carried out in extremely difficult conditions:

1. age-restricted diet
2. functional imperfection of most organs
3. insufficient central and neuroendocrine regulation of metabolic processes.

The functioning of the musculoskeletal system largely depends on the state of the nervous system, which is functionally and morphologically undeveloped, often injured in utero or during childbirth.

All this creates a special vulnerability of the musculoskeletal system in early childhood, contributing to the emergence of pathological processes, the consequences of which are often difficult to correct. In addition, syndromes of damage to bones, muscles, joints can also accompany various acute and chronic infections, pathology of the kidneys and liver, and endocrine disorders.

Anatomical and physiological features and semiotics of lesions of the muscular system in children.

Muscle tissue (meaning skeletal muscle tissue) develops from the middle germ layer (mesoderm) to

3-4 weeks embryogenesis.

By birth, the musculature is relatively poorly developed. So in newborns, the relative mass of muscles is only

20 - 23%. During teething - 16.6%; at 7 years 22%; in adults, approximately 36%.

The total increase in muscle tissue mass during postnatal development is 37-fold, while the skeletal mass increases only 27-fold. No other tissue gives such growth after birth.

There is also a peculiarity in the distribution of muscle tissue in newborns and older children. In newborns, its bulk falls on the muscles of the trunk (40%), while in other periods - on the muscles of the limbs.

The morphological features of the muscular system in children include:

1) smaller thickness of muscle fibers (5 times)

2) relatively more loose intertitial tissue and vessels

3) and more rounded nuclei both in the cells of the muscles themselves and in the interstitial connective tissue

Each muscle is characterized by a more or less stable number of muscle fibers, which is established in the first months after birth and persists until adulthood.

Muscle growth that accompanies the postembryonic development of the organism is associated with the lengthening and thickening of existing muscle fibers, their growth is insignificant.

Muscles lengthen due to growth in the transition zones of muscle fibers into the tendon, where it is concentrated the largest number nuclei. In parallel with the growth of myofibrils, the number of nuclei per unit area of ​​tissue decreases (from 45 in newborns to 5 in

17 year old). At the same time, the formation of the connective tissue skeleton of muscles takes place, which reaches the final degree of differentiation by 8-10 years.

With the age of children, the chemical composition of muscles also changes: the amount of dense substances increases, the amount of water decreases, the amount of globulins remains almost unchanged, myostromin progressively increases, the amount of glycogen, lactic acid, nucleic acids decreases relative to the mass of muscle tissue. An important quantitative feature is the presence in the muscles of children of the fetal form of myosin - this is an enzyme that activates the conversion of ATP to ADP and the release of energy necessary for muscle contraction.

As the baby grows, fetal myosin disappears.

Innervation apparatus skeletal muscle by the time of birth it is basically formed, in the first years of life its differentiation continues, myelination of nerve fibers occurs.

Functionally The muscles of the child are characterized by a variety of features:

1) so the electrical excitability of the neuromuscular apparatus in children during the neonatal period is reduced compared to older children.

2) Mechanical muscle excitability in newborns is somewhat increased. They are characterized by a proboscis reflex, the presence of carpopedal spasm, tonic convulsions in the hand and foot. At a later age, these symptoms indicate pathology, in particular, tetany associated with hypocalcemia, alkalosis.

3) In children of the first months of life, there is an increased muscle tone that does not disappear even during sleep, the so-called physiological hypertension, it is associated with the features of the central nervous system function. A feature of newborns is the predominance of flexor muscle tone, due to which a specific posture of the fetus occurs in the prenatal period, and after birth, children usually lie with their arms and legs bent. Gradually, muscle hypertension disappears in 2-2.5 months. on the upper and in 3-4 months. on the lower limbs which is essential for the development of coordinated hand movements.

The motor ability of the muscles in a child first appears in the muscles of the neck and trunk, and after that the muscles of the limbs. Muscular strength in children with age clearly increases, as a rule, the right hand is stronger than the left.

Boys have slightly more muscular strength than girls.

It is believed that a rich blood supply and intensive metabolism contribute to the rapid leaching of lactic acid from the muscles, so the functional activity of the muscles of children is high, children are very mobile and get tired less than adults.

For normal muscle development in children and adolescents, moderate physical activity is necessary.

Both hypokinesia and excessive loads are unfavorable for physical development child.

The degree of muscle development depends on a number of exogenous and endogenous causes.

In thin children, especially in children with a microsomatotype, the muscles are always much less developed than in children with a macrosomatotype.

In children infancy, in very obese (obese) children, the muscles are also relatively poorly developed.

Some general underdevelopment of the muscles is most often found in children who have been bedridden for many years due to some chronic disease, as well as in children who do not go in for sports, lead a sedentary lifestyle, etc.

In pronounced cases of weak muscle development, we can talk about muscle atrophy.

Atrophic states are most pronounced in various forms progressive muscle atrophy, in which atrophy and hypotension of muscles develop in a certain sequence.

Severe muscle atrophy is noted in cerebral and spinal paralysis. Typical for spinal paralysis is muscle atrophy in poliomyelitis (this is a viral neuroinfection with damage to the motor neurons of the spinal cord), when there is a pronounced atrophy of the muscles of any group or the muscles of the entire limb.

Peripheral paralysis is flaccid, called. "flaccid paralysis". With central paralysis, muscle atrophy is not so pronounced, and the paralysis itself is spastic in nature. This is cerebral palsy.

reverse state- hypertrophy of certain muscle groups - most often it is a working hypertrophy. It can be observed in children engaged in any physical work or, for example, as a result of prolonged rigidity of individual muscles. It is necessary to distinguish pseudohypertrophy from true muscle hypertrophy, when the replacement deposition of fat simulates a picture of well-developed muscles.

Muscle tone. plays important role in the life support of the organism. Muscle tone is judged by the consistency of muscle tissue, determined by touch, and by the degree of resistance that occurs during passive movements.

General hypotension of the entire muscular system occurs with: rickets, chorea, congenital myopathy.

Limited hypotension usually dependent on peripheral neuron disease (poliomyelitis, neuritis).

General hypertension occurs as a result of damage to the central neuron ( residual effects after encephalitis, birth trauma, underdevelopment of the cortex, hydrocephalus).

In early childhood, hypertension and hypotension are also often observed in acute and chronic disorders of nutrition and digestion, and in certain infections (tetanus, meningitis).

Cause limited hypertension may lie in the muscles themselves - with myositis. Increased muscle tension in the abdominal wall is typical of peritonitis.

Anatomical and physiological features and semiotics of the lesion of the skeletal system.

Bone tissue also develops from mesenchyme - in 2 ways:

1) directly from the mesenchyme (dermal or connective tissue osteogenesis).

2) In place of previously laid cartilage (through the stage of cartilage - chondral osteogenesis). The development of bone directly from the mesenchyme without prior transformation into cartilage is typical for the formation of coarse-fibred bone tissue as a) integumentary bones of the skull; b) facial bones; c) the diaphysis of the clavicle.

The primary basis of the skeleton is cartilaginous tissue, which is gradually replaced by bone, and bone formation occurs both inside the cartilage tissue (endochondral ossification) and on its surface (perichondral ossification). Endochondral ossification is promoted by the pressure of the gravity of the body on the skeleton, perichondral - by the action of tendon and muscle traction. They go almost at the same time.

In young children, tubular bones are filled with actively functioning red bone marrow and consist of several parts - the diaphysis and epiphyses, interconnected by a layer of non-calcified cartilage. By the time of the birth of the child, the diaphyses of the tubular bones are already represented by bone tissue, while the vast majority of the epiphyses, all spongy bones of the hand and part of the spongy bones of the foot still consist only of cartilaginous tissue. By birth, only ossification points are outlined in the central parts of the epiphyses of the femur and tibia, in the talus, calcaneus and cuboid bones, in the bodies of all vertebrae and their arches, other ossification points appear after birth. Their sequence of appearance is quite definite.

The totality of the ossification points available in a child is an important characteristic of the level of his biological development and is called bone age.

The growth of tubular bones in length until the ossification points appear in the epiphyses is carried out due to the development of growth cartilage tissue, which forms the end sections of the bones.

After the appearance of ossification points in the epiphyses, growth occurs due to the development of sprout cartilage tissue in the metaphyseal zone, and the epiphyses increase as a result of the development of sprout cartilage tissue surrounding the corresponding ossification points.

In the metaphyseal zones of bone growth, there is a very rich blood supply and slow blood flow, providing active bone formation, therefore, microorganisms easily settle in these places, as a result of which metaphyseal osteomyelitis often occurs in children of 1 year of age. At the age of 2-3 years, when ossification nuclei are formed in the epiphyses, osteomyelitis is more often epiphyseal, in adults it is diaphyseal.

At the same time, the diaphyses of long tubular bones also increase in diameter due to the bone-forming process from the side of the periosteum, while from the side of the bone marrow space the cortical layer undergoes constant resorption. The consequence of these processes is an increase in the diameter of the bone and an increase in the volume of the bone marrow space, which is very small at birth.

The bone tissue of newborns has a coarse fibrous mesh structure. A few bone plates are located incorrectly, the Haversian canals are represented by randomly scattered cavities. The periosteum is thick, its intrauterine layer is especially well expressed, due to which the processes of bone growth in the diameter are going on, which explains the high frequency of subperiosteal fractures in 1-year-old children - according to the “green branch” type. The bones of children are poor in mineral salts, rich in water and blood vessels. Therefore, the bones of the child are soft, flexible, do not have sufficient strength, are easily distorted and acquire irregular shape with compression and bending, with a systematic wrong position: on the hands, on the bed.

It is unacceptable to plant a child early, to put on legs. At the same time, the resistance of a child's bone to injury is greater due to its elasticity.

Energy for bone growth and regeneration childhood much more than in adults, therefore, fractures in children require a shorter time to heal. As the child grows, the bone is restructured with the replacement of a fibrous, mesh structure with a lamellar one. The amount of water decreases, the ash residue increases. cartilage tissue gradually replaced by bone tissue. In the process of bone formation and remodeling of bone tissue, 3 stages are distinguished:

Stage 1 of osteogenesis - the formation of the protein base of bone tissue - the bone matrix. For this process, it is necessary to provide the child with protein, colloid, vitamins A, C, gr. C. Hormones take part in this process: thyroxine, somatomidins, activated pituitary growth hormone, insulin, parathyroid hormone.

Stage 2 - mineralization of the bone matrix, i.e. deposition of mineral salts. For this stage, the provision of the body with calcium, phosphorus, microelements (manganese, magnesium, zinc, copper), vitamin D is of decisive importance.

The course of this stage is disturbed by the development of acidosis in the child's body. Both of these stages are regulated by muscle tone, as well as movements, so massage, gymnastics, and motor activity are very important during this period.

Stage 3 osteogenesis is a process of remodeling and constant self-renewal of the bone, which is regulated by the parathyroid glands and depends on the supply of vit. "D".

By the age of 3-4, the bones of a child acquire a lamellar structure, and by the age of 12 they no longer differ from the bones of an adult.

Skull bones . cranial box a child, unlike an adult, is much more developed than the facial skeleton. This depends on the lack of teeth in a small child and on the poor development of the nose and its accessory cavities.

The skull of a small child is distinguished by the following features: it consists of bones separated from each other by sutures; at the junction of several bones there are gaps, completely devoid of bones - fontanelles.

Lateral fontanels (there are 2 of them): between the occipital, temporal and parietal bone. These fontanelles are normally closed at the time of birth, if they are open, then this indicates either prematurity of the child or head dropsy.

Small, or back, fontanel, lying between the occipital and parietal bones, also closes in most full-term babies by birth. However, it is open in about 20-25% of newborns and closes at 3-4 weeks.

The anterior, or large, fontanel (between the frontal and parietal bones) remains after birth in a full-term healthy child; its size is normally 2-2.5x3 cm. The size of the fontanel is determined by measuring the distance between opposite sides of the fontanel. You cannot measure it diagonally, because. in this case, it is difficult to decide where the suture ends and the fontanel begins. Later, the fontanel gradually decreases and closes normally by 1 year or by 1.5 years.

Later closure of a large fontanel may be due to: rickets, hydrocephalus, myxedema. Premature closure can be: with microcephaly (due to underdevelopment of the brain) or due to premature fusion of cranial sutures - craniostenosis.

It is necessary to pay attention to other properties of the fontanel: normally, the fontanel "breathes" - fluctuations in its surface are clearly visible simultaneously with the child's breathing and pulse. In this case, the fontanel remains at the same level with the bones of the skull.

At feverish conditions the fontanel usually protrudes somewhat and pulsates more strongly. And with a significant increase in intracranial pressure (hydrocephalus, meningitis), the fontanel protrudes above the level of the bones, becomes very tense. It should be remembered that the fontanel can be tense and healthy child while screaming.

When decreasing intracranial pressure(decline in the activity of the heart or dehydration of the whole organism due to loss of fluid during vomiting or diarrhea), the fontanel sinks and is below the level of the bones.

The seams between the bones of the skull in a healthy child are well palpable only in the neonatal period. When feeling the bones of the skull of a healthy child, hardness is felt above the middle. The pliability of bones that sag like parchment is called craniotabes, what is observed in rickets. This is especially common on the occipital and parietal bones. The shape of the skull is normally rounded. In some newborns, the so-called birth tumor is observed in the form of a soft, harsh swelling of the skin, depending on the serous impregnation of the soft tissues and spontaneously resolving within a few days. Another kind of tumor can form on the skull as a result of a more severe birth injury: this is a hemorrhage under the periosteum - cephalohematoma. It differs from the birth tumor in that it does not go beyond the sutures, while the birth tumor also goes through the sutures.

With rickets, also m.b. a change in the shape of the head - a quadrangular shape (an increase in the frontal and parietal tubercles), a buttock-shaped head, a tower skull.

Spine . The spine of a newborn child is devoid of physiological curvatures; it is almost straight, or rather, has a general bulge posteriorly.

When the child begins to hold his head, he develops cervical lordosis; later (on the 6th month), when he begins to sit, a thoracic kyphosis is formed; when learning, walking, lumbar lordosis is formed.

At first, these curves are unstable and smooth out when the child lies down. Lateral curvature of the spine is called scoliosis. Sharp degrees of scoliosis, as well as kyphosis, in young children usually occur with rickets.

In children of school and preschool age, a curvature of the spine of a different etiology is often noticed - the so-called "habitual" or "school" kypho-scoliosis.

The formation of such habitual or "school" kypho-scoliosis depends on insufficient tone and partly on insufficient development of the muscles in general and the back muscles in particular. This is observed both on the basis of late rickets, and with the wrong lifestyle. With these pathologies, it is recommended to use a bed with an orthopedic mattress, which slows down the process of deformation of the spine, and also reduces the load on it.

The chest in a child has a number of features. In a newborn and under the age of 1.5-2 years, it appears to be barrel-shaped in shape - the transverse size is almost equal to the anteroposterior. In the future, it takes the form of a cylinder and at school age the shape of a truncated cone.

In a child in the first year of life, the ribs depart from the spine at almost a right angle and have a horizontal direction. Such a structure of the chest leads to difficulty in breathing in young children - it is possible only by lowering the diaphragm down, while the ribs are always in the position of maximum inspiration. With rickets, the following deformations of the ore cell are possible:

"chicken breast", when the chest is, as it were, squeezed from the sides with the sternum protruding forward. Other deformation -

"cobbler's chest". In such cases, the sternum, especially the xiphoid process, is, as it were, depressed or sunk.

With an increase in the heart on the basis of congenital or early acquired heart defects, a heart hump develops - a bulging of those parts of the chest that cover the outside of the heart.

Costal rosaries, as a manifestation of rickets, are formed at the site of transition of the bone tissue of the rib into cartilage. Palpated approximately along the parasternal line.

The pelvic bones are relatively small in young children. The shape of the pelvis resembles a funnel. The growth of the pelvic bones relatively intensively occurs up to 6 years. From 6 to 12 years of age, there is a relative stabilization of the size of the pelvis, and later in girls - its most intensive development, in boys - moderate growth.

In children of the first months of life, an apparent curvature of the legs is often observed. This has no pathological significance and is not associated with the true curvature of the limbs, which can be with rickets (X-, O-shaped legs) or with syphilis, but depends on the peculiar development of soft tissues.

Teeth . Newborns don't have teeth. They are found in them as an exception and usually quickly fall out. Teething begins in healthy children at the age of 6-7 months. Teeth of the same name on each half of the jaw erupt simultaneously. The lower teeth usually erupt earlier. than the top ones. The only exceptions are the lateral incisors - here the upper teeth appear before the lower ones. At one year old baby d.b. 8 teeth. In the milk bite, 2 periods are distinguished: 1 to 3-3.5 years, orthognathic bite, 2 - from 3.5 to 6 years, straight bite.

The period of preservation of milk teeth and the appearance of permanent teeth is called the period of mixed dentition. All milk teeth erupt by about 2 years and there are 20 in total.

The formula for calculating milk teeth is n - 4, where n is the number of months of a child's life.

First permanent teeth erupt in about 5-5.5 years. These are the first molars. Then the sequence of appearance permanent teeth, approximately the same as with the appearance of dairy. After the change of milk teeth to permanent ones at the age of about 11 years, the second molars appear. Third molars (wisdom teeth) erupt at the age of 17-25 years, and sometimes later.

For an approximate assessment of permanent teeth, regardless of gender, you can use the formula:

X (number of permanent teeth) = 4n - 20.

The formation of both milk and permanent bite in children is an important indicator of the level of biological maturation of the child. Therefore, in assessing the biological maturity of children, the concept of "dental age" is used. There is a table for assessing the level age development by tooth age.

Of particular importance is the determination of dental age in assessing the degree of maturity of children of preschool and primary school age, where other criteria are more difficult to use.

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