What is aponeurosis of the abdominal muscle? Aponeurosis - what is it? Signs and symptoms of the disease. Symptoms of a hernia of the Spigelian line of the abdomen

Using pedicled flaps

Surgeries for femoral hernia

G. G. Karavanov (1952) proposed a method of operation that consists in closing the femoral ring with a “curtain septum”, which is formed from the aponeurosis of the external oblique muscle under the inguinal ligament at the level of the femoral canal. The aponeurosis flap is cut out 1-1.5 cm wide with its base at the superficial inguinal ring and, after retracting the spermatic cord or round ligament of the uterus, it is grabbed with a forceps from the side of the thigh and brought out to the thigh through the femoral canal. This flap is sutured to the lacunar ligament, to the pectineal fascia and muscle, and to the pupart ligament. At the same time, the lateral edge of the flap is sutured to the sheath of the vessels, which we consider unacceptable due to the possibility of wounding the vein and unjustified as an event strengthening the femoral ring. After excision of the flap, the gap in the aponeurosis is sutured with knotted sutures.

P.Ya. Ilchenko (1955) fixes an aponeurotic flap 8-10 cm long and 1.5 cm wide in front of the inguinal ligament to the pectineal ligament, followed by suturing the remaining part of the aponeurotic flap to the inguinal ligament.

Currently, operations are not used in which the inguinal ligament is brought closer to the upper branch of the pubic bone using U-shaped metal staples (Ru's operation, 1899).

The method of passing a bronze-aluminum wire through the inguinal ligament and specially drilled holes in the pubic bone to close the femoral ring (P. A. Herzen, 1904; A. P. Morkovitin, 1904) also did not become widespread.

Proposed by R.R. Vreden, placing a flap of the aponeurosis of the external oblique muscle using a Deschamps needle or a curved forceps under the pectineus muscle from the medial edge of the femoral vein to the medial edge of the pectineus muscle, followed by suturing it to the pubic tubercle, is practically inapplicable due to its high morbidity and technical complexity.

The proposals of V. N. Shevkunenko and N. F. Mikuli are similar. All these methods, tested in the section, turned out to be complex and physiologically unfounded. These also include the operation proposed by T. S. Zatsepin (1903), the essence of which is to fix the inguinal ligament with a silk thread carried around the horizontal (upper) branch of the pubic bone. After tying the two ends of the thread, the inguinal ligament should be pressed tightly against the bone and close the femoral ring.

The principle of T. S. Zatsepin was used by T. V. Zolotareva (1961), who proposed passing a flap of the fascia lata of the thigh through a hole made in the soft tissues covering the obturator foramen. P. A. Herzen considered it important for the patient to operate behind the horizontal branch of the pubic bone with sutures through the bone or, even worse, under this bone through the obturator foramen.

These modifications were also tested in the dissection room, and we were convinced of their anatomical groundlessness and extreme traumaticity.

Intraperitoneal operations for femoral hernias. For free, uncomplicated femoral hernias, intra-abdominal operations did not spread. A recommendation for an intra-abdominal approach is given by Sudeck (1928). He also joins Elecker’s demand that all laparotomies in the lower abdomen also include the removal of the existing hernia. However, A.P. Krymov believed that transsection for intervention for a femoral hernia has always been and will be more dangerous than simple herniotomy. We fully agree with the opinion of A.P. Krymov.

Before we begin to consider the topic of aponeurosis of the abdominal muscles, it is worth having an idea of their structure as a whole. The abdominal muscles are involved in the formation of posture in children and adults. In addition, this muscle group helps keep the internal organs in the physiologically correct position. Performs a protective function, forms the abdominal wall.

The abdominal muscles are represented by the following:

straight;
oblique – divided into external and internal;
transverse

For convenience, these muscles are additionally divided into groups:

front;
lateral;
rear

The division occurs in accordance with the anatomical location of the muscle fibers.

Internal oblique muscle

The intrinsic abdominal muscle belongs to the group of broad abdominal muscles. Participates in tilting the body to the sides, performing rotational movements, tension (compression) of the abdomen, and causes the chest to move towards the bottom.

Pathologies, poor development of the zone leads to:

limitation of body mobility;
problems with posture;
decreased respiratory functions (shallow breathing, which further provokes oxygen starvation of tissues and organs);
problems with digestion, stool.

The muscle starts from the pubis, continuing to the inner costal arch. The direction of the fibers occurs inferiorly from the region of the iliac crest. The arrangement of the structures resembles a fan. The internal aponeurosis is connected to the same one on the opposite side, forming a reliable fixing weave.

The aponeurosis of the internal oblique muscle is woven into the linea alba. Pathological changes in the cellular structure of collagen fibers cause the formation of hernias in this area. Interesting read - .

The external muscle is directed from top to bottom. The upper edge is attached in the area of ribs 5-12, the lower - at the iliac crest, linea alba, and symphysis pubis. This is another representative of the group of vast intrinsic abdominal muscles. It is a continuation of the external intercostal muscles, the direction of the fibers is oblique. The tendons and aponeurosis of the external oblique muscle are involved in the formation of the white line.

The linea alba is formed by tendon fibers and aponeuroses of the broad abdominal muscles. These include:

external oblique;
internal oblique;
transverse.

The width of the line is not constant, ranging in size from 0.2 to 2.5 cm. In the center, in the area of the navel, there is a hole - the umbilical ring. Low mobility of the skin in the navel area is ensured by connective tissue bridges - fascia, originating from the tendons and aponeurosis of the white line.

A defect, congenital or acquired, of the aponeurosis of the anterior abdominal wall leads to the formation of hernias. Pinching of sections of the intestine and other vital organs in the hernial ring requires immediate medical intervention. In 98% of cases surgery is required. Unfortunately, only inguinal hernias can be operated on using a closed method; in other cases, open surgery is performed. In modern surgical practice, correction using the tissue tension method has been abandoned; the defect is eliminated with specially designed medical meshes, a kind of patches.

The aponeurosis of the external abdominal muscle is represented by wide collagenous compounds that provide the muscles with support and fixation on the bony skeleton.

Pathologies of this structure manifest themselves in the form of divergence of fibers, which entails pain and perforation of organs into the hernial rings.

Anatomical features

The aponeurotic system has a denser integral structure, and is practically devoid of blood vessels, compared to muscle fibers.

Due to its histological similarity to tendons, it helps the body perform lateral tilts of the body.

The aponeurosis of the internal oblique muscle of the abdomen fixes muscle fibers from the costal arch to the pubis.

The aponeurosis of the external abdominal muscle connects a wide layer of muscles between the midline, the iliac crest and the pubic bone in the direction of the external inguinal ring.

In this case, both structures are woven into the body of the white line, thereby supporting the abs.

Diseases

The most common defect of aponeurotic tissue is stretching and separation up to rupture.

The most common cause of the disease is sports injuries caused by overexertion during training, or congenital degenerative changes.

At the same time, it is very difficult to establish a diagnosis due to the extensive symptomatic picture:

The pain is localized in the groin area;
Increased pain when sneezing, sudden movement or turning of the body;
Difficulty with regular digestion;
Posture deteriorates;
An inguinal hernia forms. In this case, vital organs enter the hernial ring, which requires prompt surgical treatment.

Also, the aponeurosis of the internal oblique abdominal muscle can provoke a decrease in respiratory function, causing oxygen starvation and deterioration of tissue trophism.

Differential diagnosis requires excluding pathologies of nearby organs. This requires examination by specialized specialists:

Urologist;
Andrologist or gynecologist;
Gastroenterologist;
Orthopedist.

The final diagnosis is established based on medical history, examination and ultrasound.

The only method of eliminating the defect is surgery. In this case, early detection of the disease and timely surgical treatment are of great importance.

Operation technique

The procedure involves suturing the dislocated areas while maintaining mobility. At the same time, it is important to avoid the formation of transverse duplication, which can lead to dangerous postoperative complications in the form of repeated ruptures.

Operative access is created in the area of pain.

The surgeon repairs the dissection by placing sutures in a staggered pattern at a distance of 0.5 to 2 cm to avoid tension on the tendons.

Compliance with the intervention technique allows you to eliminate pain and limitations in mobility. Patients begin exercise therapy within two weeks.

Deformity of the anterior abdominal wall- symptoms and treatment

What is anterior abdominal wall deformity? We will discuss the causes, diagnosis and treatment methods in the article by Dr. V.V. Manshetov, a plastic surgeon with 15 years of experience.

Definition of disease. Causes of the disease

Aesthetic deformation of the anterior abdominal wall- discrepancy between the mental image of the shape of the abdomen and its present state.

The ideal shape of a woman’s abdomen seems to us to be as follows. Retracted lateral surfaces (flanks) of the body, which pass into the groin and lumbosacral areas, emphasizing the waist. The lateral surfaces of the abdomen smoothly transform into grooves running from the costal arches to the inguinal ligament along the semilunar line on both sides. Below the umbilical ring, a slightly convex surface merges into a less convex surface above the umbilical ring. The latter is divided along the midline from the xiphoid process to the umbilical region by an indistinct and smoothed groove.

Changes in the anterior abdominal wall normally occur with age; the degree of their severity is influenced by the nature and diet, metabolism and hormonal levels (during pregnancy), and individual characteristics of the body. In addition, injuries and diseases can lead to changes in the shape of the abdomen. All causes of abdominal wall deformation can be divided into direct and indirect.

Indirect reasons are:

obesity of internal organs;
bloating, etc.

Direct causes of abdominal deformity include:

skin condition (stretching, sagging, scars, gravitational sagging);
subcutaneous tissue (local fat deposition, skin-fat fold, scars);
muscular-aponeurotic complex of the abdomen (stretching, discrepancy and hernia defects).

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Classification and stages of development of deformity of the anterior abdominal wall

According to the classification of prolapse of the tissues of the anterior abdominal wall (abdominoptosis) in a standing position according to A. Matarasso, the following degrees are distinguished:

I degree (minimum)- stretching the skin without forming a skin-fat fold;

II degree (medium)- formation of a small fold of skin and fat, which hangs clearly in the “diver” position;

III degree (moderate)- a skin-fat apron within the flanks, hanging in a vertical position, “pinch” less than 10 cm;

IV degree (pronounced)- a skin-fat apron within the lumbar region, “pinch” more than 10 cm, combination with skin-fat folds in the subscapular areas.

Complications of deformation of the anterior abdominal wall

Diastasis (separation) of the rectus abdominis muscles called weakening and widening of more than 2 cm of the white line, which leads to an increase in the distance between the rectus abdominis muscles. The indication for surgery is the expansion of the linea alba by more than 4 cm. Externally, muscle diastasis manifests itself as a longitudinal roller-like bulge along the midline in the middle and upper abdomen with tension in the rectus muscles and an increase in intra-abdominal pressure.

Hernia of the anterior abdominal wall is a chronically developing defect in the muscular-aponeurotic complex of the abdomen with the release of organs from the abdominal cavity without its depressurization. A hernia looks like a protrusion on the surface of the abdomen, and there may be a feeling of discomfort and pain in its area when walking, running and other physical activity. According to the origin, hernias are congenital and acquired (primary, postoperative, recurrent). The causes of hernia disease and weakening of the white line are a combination of factors, the main one of which is an increase in intra-abdominal pressure (physical activity, frequent cough and chronic constipation, pregnancy, etc.). Weakening of the structure and protective function of the muscular aponeurotic complex in obese patients develops due to a decrease in reparative processes, the development of muscle tissue dystrophy, and loosening of connective tissue (diabetes mellitus, connective tissue dysplasia).

Diagnosis of deformation of the anterior abdominal wall

The diagnosis takes into account constitutional, gender, age, features of the abdominal wall and internal organs of the abdomen. The configuration of the abdomen is assessed when examined in a straight standing position with arms raised on the shoulders and a fixed clockwise rotation, as well as in the “diver” position and lying down.

The turgor and elasticity of the skin of the anterior abdominal wall are assessed by palpation. The condition of the subcutaneous tissue is assessed by a pinch test, as well as by measuring the volume of the waist and hips. It is convenient to diagnose diastasis of the rectus abdominis muscles with the patient lying down. In this case, you need to ask him to raise his upper shoulder girdle and his head, resting on his elbow joints. Assessing weak areas of the abdominal wall allows us to identify hernia defects. It is possible to study the condition of the tissues in more detail using instrumental examination methods (ultrasound of the soft tissues of the anterior abdominal wall and computed tomography).

Treatment of anterior abdominal wall deformity

Preoperative markings are performed on the day of surgery in an upright position. To prevent surgical infection, broad-spectrum antibiotics (III generation cephalosporins) are administered 30 minutes before surgery. Deformation of the anterior abdominal wall of the I-II degree (A. Matarasso), without changes in the muscular-aponeurotic complex of the abdomen, allows you to adjust the volume of subcutaneous tissue and give the desired shape through liposuction. Liposuction is one of the popular areas in plastic surgery; the number of these operations in the world is increasing. One of the most modern methods of liposuction is ultrasonic, or VASER (“Vibration Amplification of Sound Energy at Resonance”) liposuction, the obvious advantages of which are: the effect of skin contraction after the procedure, the possibility of engraving it (detailed elaboration of the relief), deeper correction of the figure, preservation high viability of fat cells for lipofilling, short recovery period. The essence of the technology is based on the fragmentation of adipose tissue due to cavitation of a tumescent solution (the tumescent liposuction method was described in 1985 by Jeffrey Klein and Patrick Lillis and is based on the introduction of Klein's solution, consisting of saline, a solution of adrenaline and lidocaine, into the surgical area).

The VASER (liposuction) procedure consists of three stages: infiltration, fat emulsification and aspiration. At these stages, special instruments are used: infiltration and aspiration cannulas, ultrasound probes. Intraoperatively, after infiltration, fat cells are treated with ultrasound energy in a special mode. Due to the cavitation effect of the solution, the released energy separates fat cells from the stroma and from each other, which facilitates their easier aspiration and reduces the aggression of the procedure on surrounding tissues. At the same time, the membrane of the adipocytes themselves remains intact during fragmentation, which increases their engraftment after lipofilling.

Abdominoplasty is one of the most common operations in aesthetic and general surgery. The success of aesthetic plastic surgery of the anterior abdominal wall largely depends on the correct choice and adherence to the technology of performing the operation. Taking into account the individual mobility of the skin-fat layer, the surgeon marks the line of surgical access, the proposed boundaries of tissue excision, and the midline. The surgical intervention is performed under anesthesia and consists of mobilizing the subcutaneous tissue with the skin of the anterior abdominal wall, excision of the skin-fat apron, and restoring the integrity of the abdomen.

Classic abdominoplasty includes correction of a skin-fat flap with transplantation or formation of an artificial aesthetic navel, and work on the muscular aponeurotic layer. For a more expressive correction of the waistline, with grade III-IV abdominoptosis (A. Matarasso), classic abdominoplasty can be supplemented with liposuction of the flanks and lumbar region. After the operation, the length of the patient’s stay in the clinic is determined individually; it usually ranges from 3 to 5 days. Postoperative sutures are removed 7-10 days after surgery. The full course of rehabilitation lasts 2 months, while postoperative compression garments must be worn continuously for 1 month, then daily for 12 hours a day. During this period, physical activity is excluded.

A correctly executed aesthetic postoperative suture is usually located in the form of a thin line at the skin level of the lower abdomen in the transverse direction, this allows it to be easily covered with underwear. The navel is a naturally occurring retracted scar located in the area of the umbilical ring. The artificially formed navel appears to us as a vertically located oval-shaped, small funnel-shaped depression in the anterior abdominal wall. It should be in the midline and equidistant between the xiphoid process and the pubis or 3 cm above the line connecting the anterior superior spines of the pelvic bones. In this case, the postoperative suture located inside is hardly noticeable, which attaches the low column of the navel to its funnel.

Detection of hernia defects and diastasis of the rectus abdominis muscles involves their elimination during surgery. The presence of a hernia in patients with abdominoptosis significantly increases the morbidity of abdominoplasty due to the need to close the hernia defect of the abdominal wall. The use of a mesh prosthesis makes it possible to redistribute and thereby reduce the load on weak points of the anterior abdominal wall, which significantly reduces the risk of hernia recurrence. In prosthetic hernioplasty of ventral postoperative hernias, SUBLAY, ONLAY, and INLAY technologies are distinguished. The final choice of hernioplasty method is determined intraoperatively depending on the condition of the tissues of the anterior abdominal centrum, the size of the hernial orifice, and the degree of tissue tension when comparing the edges of the hernial defect.

ONLAY technology involves suturing the defect of the anterior abdominal wall edge to edge with the location and fixation of a mesh prosthesis over the aponeurosis.

SUBLAY technology consists of placing a mesh prosthesis preperitoneally or on the posterior layers of the sheaths of the rectus abdominis muscles, after which the edges of the aponeurosis are sutured edge to edge above the prosthesis.

INLAY method - a synthetic prosthesis is fixed to the tissues that form the hernial orifice, while the mesh is a continuation of the tissues of the abdominal wall. An important feature of this technique is to prevent the mesh from contacting the abdominal organs to prevent the formation of adhesions and intestinal fistulas between them. For this purpose, tissues of the hernial sac are used. For prosthetic hernioplasty, SUBLAY technology is more preferable. This method eliminates contact of the mesh prosthesis with the subcutaneous tissue and abdominal organs, which, in turn, reduces the risk of complications (seroma, adhesions to the abdominal organs, intestinal fistulas), and maintains the possibility of adequate elimination of diastasis of the rectus abdominis muscles.

The use of various approaches, options for mesh placement and its fixation require not only detailed knowledge of the classical and endoscopic anatomy of the anterior abdominal wall, but also appropriate technical equipment in the operating room and highly qualified surgeon.

Forecast. Prevention

In the early postoperative period, the following complications may develop from the postoperative wound of the anterior abdominal wall: seroma, hematoma, suppuration, marginal necrosis of the skin and subcutaneous tissue.

Seroma- accumulation of free fluid (exudate) between tissues in a postoperative wound. The reasons for the formation of seroma include: a large area of detachment of subcutaneous tissue with damage to blood and lymphatic vessels, lack of outflow of exudate, residual space and (or) displacement of wound layers during movement. In this case, disturbances in laboratory parameters (hypocalcemia) are accompanied by longer seroma formation. The accumulation of exudate in the wound leads to the separation of wound surfaces adjacent to each other and prevents their fusion, creating conditions for the development of purulent complications. Prevention of the formation of seromas in a postoperative wound is: adequate drainage of a large postoperative wound, wearing compression garments or a bandage, normalization of homeostasis indicators.

Hematoma. Ultrasound of the soft tissues of the anterior abdominal wall, puncture with a thick needle and aspiration of its contents help to diagnose a hematoma of a postoperative wound. Upon receipt of lysed blood, it is removed followed by ultrasound control. If a hematoma occurs, the edges of the wound are separated, blood clots are removed, and the wound is drained. Antibacterial and anti-inflammatory drugs and physical therapy are prescribed.

Suppuration, marginal necrosis of the postoperative wound. To prevent infectious complications, patients are given antibiotic prophylaxis 1 hour before surgery. To improve microcirculation, reduce swelling and stimulate reparative processes, starting from the 2nd day, the healing area is exposed to an alternating low-frequency magnetic field. For 3-5 days after surgery, all patients receive broad-spectrum antibiotics. In case of suppuration of a postoperative wound, marginal necrosis of the skin and subcutaneous tissue, treatment is carried out according to the principles of purulent surgery.

In order to prevent pulmonary complications after surgery, breathing exercises, early activation of the patient, and inhalations are performed. Prevention of pulmonary embolism includes variable pneumatic compression during surgery, elastic compression of the lower extremities, and administration of anticoagulants after surgery until the patient is fully active.

The abdominal muscles are formed from the abdominal muscles. They, in turn, are divided into straight, oblique and transverse. Classification is carried out on the basis of the anatomical location of muscle fibers in the anterior abdominal wall.

A feature of the aponeurosis is that it is even visually different from the surrounding tissues. The tendon plate has a shiny, whitish-silver color. This structure contrasts against the background of red muscle fibers. Their color is caused by excellent blood supply and nutrition to tissues that bear enormous loads.

Participates in many important functions of the human body:

tilting the body to the sides;
rotational movements;
abdominal tension.

The internal oblique muscle also “forces” the rib cage to move downward. It starts from the womb and ends near the costal arch. The direction of its fibers is downward from the iliac crest, in appearance it resembles a fan.

The internal aponeurosis on the opposite side is connected to the same structures, forming a reliable weave to fix the muscle. It is also attached to the linea alba.

Directed from top to bottom. It is attached near the ribs, on the opposite side - at the iliac crest, pubic symphysis. The direction of the fibers is slightly inclined relative to the axis.

The aponeurosis and tendons of the external oblique muscle form the linea alba. The width of this structure is variable, ranging from 0.5-2.5 cm. The linea alba is also formed by the internal oblique and transverse muscles.

There is a hole in the center - the umbilical ring. In this area there is minimal motor activity of the skin. This is achieved by the presence of fascia - bridges formed from connective fibers.

According to the classification of prolapse of the tissues of the anterior abdominal wall (abdominoptosis) in a standing position according to A. Matarasso, the following degrees are distinguished:

I degree (minimal) - stretching of the skin without the formation of a skin-fat fold;

II degree (medium) - the formation of a small fold of skin and fat, which hangs clearly in the “diver” position;

III degree (moderate) - a skin-fat apron within the flanks, hanging in a vertical position, “pinch” less than 10 cm;

IV degree (severe) - skin-fat apron within the lumbar region, “pinch” more than 10 cm, combination with skin-fat folds in the subscapular areas.

Diastasis (separation) of the rectus abdominis muscles is a weakening and widening of more than 2 cm of the linea alba, which leads to an increase in the distance between the rectus abdominis muscles. The indication for surgery is the expansion of the linea alba by more than 4 cm. Externally, muscle diastasis manifests itself as a longitudinal roller-like bulge along the midline in the middle and upper abdomen with tension in the rectus muscles and an increase in intra-abdominal pressure.

A hernia of the anterior abdominal wall is a chronically developing defect in the muscular-aponeurotic complex of the abdomen with the release of organs from the abdominal cavity without its depressurization. A hernia looks like a protrusion on the surface of the abdomen, and there may be a feeling of discomfort and pain in its area when walking, running and other physical activities.

Based on their origin, hernias can be congenital or acquired (primary, postoperative, recurrent). The causes of hernia disease and weakening of the white line are a combination of factors, the main one of which is an increase in intra-abdominal pressure (physical activity, frequent cough and chronic constipation, pregnancy, etc.).

The aponeuroses of the muscles of the anterior abdominal wall form the sheath of the rectus abdominis muscle. The vagina has an anterior and posterior plate, while the posterior wall of the vagina at the level of the lower third of the rectus muscle is absent, and the rectus abdominis muscles with their posterior surface are in contact with the transverse fascia.

In the upper two-thirds of the rectus muscle, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle and the anterior plate of the aponeurosis of the internal oblique muscle; the posterior wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

Plantar aponeurosis: features

Plantar aponeurosis - what is it? The popular name for this disease is heel spur. The definition is accurate because the site of the lesion is located at the junction of the plantar aponeurosis and the calcaneus. Manifests itself in the form of severe pain in the heel area. As a rule, pain is provoked by supporting the leg or walking.

Plantar aponeurosis attacks people 40–60 years old or those who, due to the nature of their work, spend a lot of time on their feet.

The cause of the disease can be argued by the fact that in a normal state the aponeurosis is assigned the function of a shock absorber, supporting the arch of the feet. But when there is a strong load on the legs, small cracks and tears appear at the location of this formation. They can take a long time to heal. It is from them that the pain comes.

In most cases, such pathologies can only be corrected through surgery. Although sometimes they resort to conservative therapy. Under no circumstances should you try to prescribe treatment for yourself.

Painful sensations occur frequently. Typically, the pain worsens when trying to stand on your feet and when walking. Plantar aponeurosis can cause the inability to move and also lead to loss of ability to work. Thanks to therapeutic effects, pain can be reduced. Then remission occurs. Some cases even ended in clinical recovery. Only the bone growth that appears will remain until the end of life.

Possible pathologies

Description: Aponeurosis: what is it, what does such an anomaly lead to? It is a tendon plate that can be located in different parts of the body. Its anomaly causes various complications that significantly complicate a person’s life. They are rarely cured with conservative therapy; surgery is often necessary.

When they talk about aponeurosis, they mean a tendon plate that has considerable dimensions and consists of dense elastin and collagen fibers. Regardless of their type, all aponeuroses have a silvery-white tint.

If we talk about their structure, then it is in many ways similar in structure to tendons, but there are almost no nerves or vessels in them.

There are a certain number of such zones in the human body, but only a few of them are considered particularly significant.

Aponeurosis of the palm

The palmar aponeurosis is the cords that cover the surface of the palm of the human hand. When a patient is diagnosed with a pathology such as Dupuytren's contracture, this often indicates an abnormality of the tendon plate.

A person with this problem experiences cicatricial contraction of the aponeurosis, which occurs as a result of the formation of nodes and cords on it.

This is why contracture occurs, due to which a finger (or several) is constantly in a bent position.

As a rule, palmar aponeurosis is found in men, but the cause of its occurrence still remains unknown. Most experts are of the opinion that the pathology is provoked by hand injuries, but in this case, by the age of forty, everyone would have such a contracture.

The disease progresses slowly, affecting both hands over time. The only effective treatment is surgery involving excision of the palmar aponeurosis.

If we consider other serious anomalies of the upper extremities of this type, then no less problems are caused by the pathology of the biceps brachii muscle, against the background of which the shoulder joints also lose their normal functions.

Often, surgeons, gynecologists, and urologists deal with complaints of pain in the groin area. It is worth noting: in almost 50% of complaints the cause lies in a defect in the aponeurosis of the abdominal muscles.

This anomaly is congenital or acquired. Most complaints of people with this problem boil down to constant pain, which, in addition, tends to intensify after intense physical activity, as well as during coughing or sneezing.

Often the aponeurosis causes particular discomfort:

oblique abdominal muscle;
transverse abdominis muscle.

As a rule, pathology of the external oblique muscle is especially unpleasant. It should be noted: the transformation of muscles into the aponeurosis occurs diagonally, running from the costal arch to the pubis. The muscles provide strength to the peritoneal wall and are located in front, in the groin area.

The structural threads of the aponeurosis run horizontally, intertwining into the whitish line of the abdomen. In addition, they form a certain layer of the vagina.

Only in 10% of cases with such a problem is it discovered that the structural threads of the aponeurosis are combined with the transverse muscle, which leads to the formation of a joint aponeurosis.

The muscles are transformed into an aponeurosis along a line that unites the costuro-ureteral angle with the inguinal ring.

The transition area often varies in such a way that, as a result, one of the levels simultaneously includes muscle fibers and structural components of the aponeurosis.

However, in practice, diagnosing this defect is not easy, since doctors from different fields must take part in making the diagnosis.

Only surgical treatment guarantees tissue restoration, as a result of which it can be said with a high degree of probability that the pain will disappear. Statistics indicate that surgical treatment in 95% of cases leads to a complete recovery of the patient.

Aponeurosis of the external oblique muscle is the most common cause of pain in the groin area. Naturally, if a person does not have such a pathology, there will be no manifestations of it either.

If the symptoms are ignored from the very beginning, you should be prepared for the pain to intensify over time.

Head trauma

Traumatic brain injuries are very common in humans. However, it is often believed that if the skull is not broken or there is no concussion, then nothing serious has happened.

However, during a head impact, damage to the tendon helmet is possible (this is how the aponeurosis of the head is called), as a result of which a rather large hematoma is often formed, resembling a dent on the skull.

With such an anomaly, a person feels quite a bit of pain, and the hematoma itself has a dark red color, then it turns blue, then green, and at the final stage it turns yellow. These metamorphoses are associated with the breakdown of hemoglobin accumulated in the hemorrhage area.

The supracranial aponeurosis (this is the second designation of the tendon helmet, which in its shape resembles a helmet) connects the frontal, occipital, and supracranial muscles into one whole. It is attached to the skin above the nose and eyes and is very important for facial expressions (for example, it helps raise eyebrows, wrinkle the skin of the forehead).

Foot ailments

If we consider plantar aponeurosis, it should be noted that this is a common pathology of runners or people who love long walks. Inflammation in the area of the heel and sole is associated with plantar aponeurosis.

Often, the disease manifests itself in people aged 40-60 years, as well as in those who, due to professional duties, spend all day on their feet.

The main sign of the problem is pain in the heel, which bothers you when you put stress on the lower limbs and at complete rest.

In almost all cases of such a disease, the only effective treatment is surgery (dissection, resection, removal of the pathological area). Only in some cases is it possible to use conservative treatment methods. Self-medication in such cases is not at all acceptable.

A defect of the aponeurosis of the anterior abdominal wall is a common problem among surgeons, urologists, and gynecologists. The pathology is both congenital and acquired. Requires careful diagnosis for successful treatment.

If symptoms of aponeurosis of the external oblique abdominal muscle or a peritoneal-perineal defect appear, the patient must undergo a detailed examination. Such signs are also characteristic of muscle damage with myofascial syndrome.

Aponeurosis defects are usually found among professional athletes - football players, hockey players, dancers. The appearance of groin pain is associated with microtraumas in the abdominal muscles. The development of aponeurosis of the anterior abdominal wall occurs after operations:

with ectopic pregnancy;
appendectomy;
C-section.

The appearance of pathology after surgery is explained by the patient’s failure to comply with the doctor’s recommendations regarding the recovery period. A person exposes the body to intense physical activity or lifts weights too early. As a result, the cut fibers do not have time to recover, which most often leads to the formation of hernias.

The problem also arises when surgical intervention is performed unprofessionally. If the operation is performed to treat a hernia, a special mesh is applied to the weakened area of tissue. It strengthens the abdominal wall. The mesh is installed “with a reserve”, covering healthy areas of the body. If its edge does not extend far enough, it may become dislodged or function ineffectively.

How to treat heel spurs?

Treatment is conservative in nature and will require a lot of time. If all procedures are done on time, a stable remission will occur.

During therapy it is prohibited:

long walk;
stand on feet;
carry heavy things;
make movements when experiencing pain.

You will have to temporarily use special orthopedic products. Along with this, the doctor will prescribe an analgesic, a non-steroidal anti-inflammatory drug.

An aponeurosis is a wide tendon with parallel connecting fibers. In the human body, it is designed to connect muscles with a broad base or attachment to bone and other tissues.

Symptoms of aponeurosis pathology most often include severe pain at the location of this tendon. Different types of diseases have their own causes.

Plantar aponeurosis can develop in people who engage in active training for a long time (running, group programs, gymnastics, dancing), as well as in those who constantly wear high-heeled or thin-soled shoes. The risk group includes older people and those who spend the whole day on their feet.

Cranial aponeurosis can be a consequence of traumatic brain injuries and head hematomas.

The cause of aponeurosis of the anterior abdominal wall may be a congenital defect in this area.

Aponeurosis of the foot

Depending on the type of disorder, you should choose a specific treatment regimen in order to forget about the unpleasant sensations in the future. Those who constantly feel pain in their feet after a long walk know firsthand what aponeurosis of the lower extremities is, but not everyone is in a hurry to go to the doctor for advice and treatment.

Symptoms of aponeurosis are most often severe pain

The disease often begins with the appearance of a heel spur, and only then develops into plantar fasciitis. If left untreated, the disease can lead to weakness in the lower extremities, lameness and impaired movement.

Important! If a patient feels pain in the heel for a long time, which increases and gradually covers the entire area of the foot, this indicates a disease of the aponeurosis of the foot.

The disease can be determined using X-rays, MRI and computer diagnostics. Based on these procedures, the doctor identifies the cause of the disease and selects the optimal treatment regimen. Often, common causes of foot pathology are heel damage and pinched nerves.

If left untreated, plantar aponeurosis can cause serious consequences. The pain will rise higher, and accordingly, the inflammation will increase the coverage area.

Treatment of this disease begins with the elimination of pain. To do this, you need to provide your legs with rest for a while, up to complete bed rest. If this is not possible, it is advisable not to step on and avoid putting pressure on the affected area, and stop playing sports and any physical activity for a while.

The patient also needs to take painkillers prescribed by the doctor in the form of tablets or apply gels. These include Naproxen, Ibuprofen, Prednisolone, Diclofenac and others.

The next step in treatment will be physical therapy. This includes all procedures that warm the foot, as well as laser therapy and ultrasound. Due to the heat, blood circulation in the foot becomes more intense, the inflammation gradually goes away.

On your own, you can numb the affected area using ice cubes. If drug treatment does not help the patient, doctors recommend using a shock wave. Using this procedure, the accumulated salt area in the foot is broken up.

Traditional medicine is also widely used to relieve heel pain. Here the emphasis is on compresses from decoctions of medicinal herbs. The compress should be applied to the sore spot. After a few hours the pain should go away. The duration of the course of compresses is from 7 days.

Prevention

To prevent foot aponeurosis and prevent recurrence of the disease, pay attention to the following rules:

if the work involves stress on the legs, you need to find time to rest;
after training, athletes can massage their heels and soak their feet in a bath of warm water;
If you experience strange pain in your legs, the first thing you should do is consult a doctor.

By following these rules, you can significantly reduce the likelihood of developing foot aponeurosis.

Attention! With a prompt response, the disease can be quickly and effectively treated, as well as prevent future development.

Aponeurosis of the skull

Another area of the human body where aponeurosis is present is the skull. The aponeurosis covers almost the entire area of the cranial vault and grows tightly to the scalp. This area moves with the supracranial muscle. Most often, cranial aponeurosis occurs due to head injuries.

Palmar aponeurosis: signs of the disease

In addition to plantar aponeurosis, there are other types of this disease. For example, there is a palmar aponeurosis. What is it and how does this type of disease manifest? This disease occurs on the palmar part of the entire human hand. And if the patient has a disease such as Dupuytren’s contracture, then it makes sense to talk about the pathology of the palmar aponeurosis.

With this disease, cicatricial contraction of this formation is observed. This happens due to the fact that cords and knots appear on it. As a result, contracture develops. This is when one or more fingers are bent at all times. Representatives of the stronger sex are most susceptible to this disease. Only the reason has not been established to this day. Some people are used to thinking that it lies in hand injuries. But then every person over forty would be the owner of such a disease.

The development of the disease is slow. The affected area covers two hands. There is only one way to cure palmar aponeurosis - surgery. So, if you experience pain in your palms, you should contact a specialist and not self-medicate.

Aesthetic deformation of the anterior abdominal wall is a discrepancy between the mental image of the shape of the abdomen and its present state.

The ideal shape of a woman’s abdomen seems to us to be as follows. Retracted lateral surfaces (flanks) of the body, which pass into the groin and lumbosacral areas, emphasizing the waist. The lateral surfaces of the abdomen smoothly transform into grooves running from the costal arches to the inguinal ligament along the semilunar line on both sides. Below the umbilical ring, a slightly convex surface merges into a less convex surface above the umbilical ring. The latter is divided along the midline from the xiphoid process to the umbilical region by an indistinct and smoothed groove.

Indirect reasons are:

obesity of internal organs;
bloating, etc.

Direct causes of abdominal deformity include:

skin condition (stretching, sagging, scars, gravitational sagging);
subcutaneous tissue (local fat deposition, skin-fat fold, scars);
muscular-aponeurotic complex of the abdomen (stretching, discrepancy and hernia defects).

Many people have probably heard the medical term “aponeurosis”. Not everyone knows what it is. Aponeurosis is a tendon plate that has a large width. It consists of dense collagen fibers and elastin.

Whatever the aponeurosis is, it will be a shiny white-silver color. If we talk about its structure, it is similar to tendons, but they lack blood vessels and nerves.

The human body has several places where aponeurosis can occur, but only a few are considered important.

The palmar aponeuroses cover the muscles of the palmar surface of the hands.

Painful sensations in the groin

Urologists, gynecologists and surgeons sometimes have to observe the patient’s condition when pain in the groin area appears. Most often, there is only one diagnosis - aponeurosis of the abdominal muscles. The problem can be acquired or congenital.

Patients with this diagnosis complain of pain. Most often, painful sensations appear throughout the entire period. Unfortunately, detecting aponeurosis of the abdominal muscles is not so easy. Doctors of various specialties should participate in the diagnosis of the disease.

Many people think that such a problem can be solved exclusively by conservative methods. Practice says the opposite; in this case, surgery is inevitable. When the tissue goes through a period of surgical recovery, we can talk about the fact that the person will not have to experience pain again. According to statistics, abdominal aponeurosis can be completely cured only through surgery. At least in 95% of cases this happens.

The aponeurosis of the external oblique abdominal muscle causes the most trouble.

The aponeurosis of the external oblique abdominal muscle causes the most trouble.

External oblique muscle

The abdominal muscles are represented by the following:

straight;
oblique – divided into external and internal;
transverse

The division occurs in accordance with the anatomical location of the muscle fibers.

What is aponeurosis

Aponeuroses of the anterior abdominal wall (indicated in blue) and the linea alba.

The word aponeurosis is of ancient Greek origin. The literal translation sounds complex and confusing, but in fact it is an extensive plate consisting of collagen fibers, the structure of which resembles tendons.

The peculiarity of this tissue is that it has practically no blood vessels or nerve endings. The aponeurosis of the white line of the abdomen can be determined even visually. The reason for such a vivid visualization is the color. Muscle tissue is colored red, heavy loads require good nutrition, nutrition is provided by blood vessels.

The part of the abdominal muscles called the aponeurosis is white.

The main function of the structure is to attach muscles. An aponeurosis is not just a continuation of the muscles; in the complex biomechanism of our body, everything is interconnected. Every department interacts. A complex aponeurotic mesh envelops the muscles of the peritoneum, layers, intertwines, thereby providing a reliable muscular framework of the area.

Diagnosing the pathology is difficult; consultations with doctors of various specialties are required. Conservative treatment is ineffective in most cases.

The use of surgical treatment methods helps to cope with the situation. There is also a plantar aponeurosis.

Pathologies, poor development of the zone leads to:

limitation of body mobility,
problems with posture,
decreased respiratory functions (shallow breathing, which further provokes oxygen starvation of tissues and organs),
problems with digestion, stool.

The external muscle is directed from top to bottom. The upper edge is attached in the region of ribs 5-12, the lower edge is attached to the iliac crest, linea alba, and symphysis pubis. This is another representative of the group of vast intrinsic abdominal muscles. It is a continuation of the external intercostal muscles, the direction of the fibers is oblique. The tendons and aponeurosis of the external oblique muscle are involved in the formation of the white line.

The linea alba is formed by tendon fibers and aponeuroses of the broad abdominal muscles. These include:

external oblique,
internal oblique,
transverse.

The width of the line is not constant, ranging in size from 0.2 to 2.5 cm. In the center, in the area of the navel, there is a hole - the umbilical ring. Low mobility of the skin in the navel area is ensured by connective tissue bridges - fascia, originating from the tendons and aponeurosis of the white line.

The transition of the muscle to its aponeurosis occurs along an oblique line that runs from the pubis to the costal arch. The muscle is responsible for the strength of the abdominal wall; it is located in front, in the groin area. The fibers of the aponeurosis are located in a horizontal position. They are also woven into the linea alba and form one of the layers of the rectus sheath.

Only in 10% of cases do the aponeurotic fibers have a connection with the transverse muscle. This leads to the formation of what is called a joint aponeurosis.

It represents the area of the third and deepest layer of the abdominal muscles and occupies an important place in the formation of an inguinal hernia. The muscle passes into the aponeurosis along the line that connects the costoxiphoid angle with the deep inguinal ring. The transition zone can vary so that one level can contain both muscle fibers and aponeurotic ones.

Aponeurosis - what is it and where can it develop? We talked about this in detail in the article. So if you feel pain in these areas, be sure to visit a doctor. The sooner you find yourself on the operating table, the better for you.

Symptoms

Plantar aponeurosis can be detected as a result of pain when walking, prolonged vertical position with support on the legs. In extreme cases, the disease makes it impossible to move independently, and the person partially loses his ability to work.

accompanied by scarring and the formation of contracture, preventing the extension of the fingers. Externally, the symptoms of palmar fasciitis manifest themselves in constantly half-bent fingers and tight palmar tendons.

The scarring gradually progresses and spreads to both palms. A person experiences pain when trying to perform grasping and extension movements. The ability to use fine motor skills of the hands is noticeably lost.

The aponeurosis of the abdominal muscles makes itself felt by a characteristic pain syndrome in the groin, which intensifies during physical activity, coughing and sneezing, in women during the period of ovulation.

Damage is typical to the internal oblique, anterior abdominal and transverse muscles. Due to a violation of the integrity of the tendons and fascia that hold the muscle corset, hernial protrusions are formed, which pose a danger to the patient’s life.

The supracranial aponeurosis is formed as a result of head trauma and provokes severe pain on the surface of the skull. As a result of the injury, a hematoma and a dent are formed at the site of injury, facial expressions become difficult, and the mobility of the neck and head becomes limited.

Treatment

Plantar aponeurosis, palmar, supracranial, and abdominal muscles require surgical intervention in 95% of cases.

taking non-steroidal anti-inflammatory drugs, corticosteroids, intramuscular injections.

To restore the motor ability of the arms, legs, abdominal wall, head and neck, physiotherapy is prescribed at the rehabilitation stage: massage, electrophoresis, gymnastics.

Physiotherapy does not stop even after the patient has fully recovered and is carried out regularly as a preventive measure.

is carried out to remove the healed area of fascia and give an anatomically correct position to the damaged surface.

If the aponeurosis is the result of tissue rupture, the surgeon will restore the integrity of the tendon plate.

As a result of surgery, a person may become unable to work for a recovery period of up to 4-6 months.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully finances the treatment for each patient