Needle knife clinical understanding and treatment of misunderstanding a muscle injury in our needle knife clinical diagnosis and treatment, often diagnosed as a muscle injury, such as scapularis muscle injury, head clip muscle injury, etc.; but in our clinic is really a muscle injury? In fact, no, first of all, let’s start from the muscle injury, muscle injury includes contusion, laceration, tear, ischemia, osteofascial compartment syndrome and loss of innervation, etc., these injuries can lead to a significant reduction in muscle function. Blunt muscle injuries can result in decreased muscle strength, limited joint motion, and eventually ossifying myositis. Muscle lacerations, surgical incisions, trauma, and denervation can lead to a severe decrease in muscle strength, and lacerations can also lead to a decrease in muscle strength. These injuries are direct causes of injury, but muscle contractions can lead to tearing of the muscle tissue during resistance contractions, and acute ischemia of the muscle and osteofascial intercompartmental syndrome can lead to The acute ischemia of the muscle and osteofascial compartment syndrome can lead to extensive muscle necrosis, and all the etiologies of osteofascial compartment syndrome can lead to increased pressure within the interfascial compartment, and this can lead to serious complications if the pressure is not relieved quickly, ranging from decreased muscle strength or limited mobility, to loss of the entire limb in severe cases. Through the above analysis, it can be learned; muscle injury – adhesion – spasm – contracture – blockage – increased pressure within the interstitial chamber changes. Second, tendon – ligament – joint capsule injury We know that the role of the skeletal system is to protect the internal organs, to provide rigid support and connection of the locomotor system, as well as muscle attachment, and participate in muscular activities and body movement, the unique structure and mechanical properties of the skeleton is to achieve the basis of these goals, the muscles are the driving force of the human body’s joint movement, and tendon – ligament – joint capsule is the main tissue structure that covers, connects and brakes the joints. The tendons, ligaments and joint capsules are the main tissues covering, connecting and braking the joints. Although they are not actively contracted like the muscles, they play an important role in the movement of the joints. 1, ligaments – joint capsule – bone movement unit composition [static restrictions] ligaments – joint capsule is to provide the connection between the bone and the bone, thus increasing the stability of the joint movement, to guide the joint movement, to prevent excessive flexion and extension of the joint movement, ligaments – the joint capsule are to the joint movement [static restrictions], the formation of static stabilization of the joint movement. 2.Muscle – tendon – bone and bone movement unit composed of [dynamic restriction] muscle connection tendon in the bone, the muscle contraction force to the bone, so as to make the joint movement, and to maintain the balance of the body and the movement posture, muscle – tendon composed of muscle – tendon movement unit, constituting the joint movement of the [dynamic restriction], the formation of joint movement of the dynamic stabilization mechanism. In addition, another function of the muscle-tendon is to ensure that the optimal contraction length is maintained between the attachment points of the two ends of the muscle, so as to avoid overstretching of the muscle. Tendon injuries – Inflammation of the paratendinous tissue of the tendon – Tendinopathy – Osteochondritis dissecans of the tendon attachment, inflammation of the attachment point —- eventually leads to tendon degeneration, calcification, rupture or partial rupture. Ligament injuries – ligament mechanical properties decline – resistance to muscle contraction, mechanical viscoelasticity decline, the cross sectional area is reduced, and the strength of the resistance to muscle stretching force is greater than the load borne by the tendon – the final ligament rupture. Tendon and ligament injury rupture and their attachment point on the bone has a direct relationship with the nature of the attachment point, tendon and ligament attachment on the bone is very similar, there are about four different areas; tendon and ligament end attachment [1] collagen and fibrocartilage mixing zone; [2] tissue mineralization zone; [3] into the dense zone; [4] tendon and ligament gradually transformed into bone change zone; tendon and ligament and harder bone hierarchically by the Fibrous tissue into osseous tissue, that is, tendons and ligaments in the osseous attachment with the periosteum, osseous fusion together, so it can reduce the stress concentration in a small attachment point above the stress effect value. Normal human activity, tendons and ligaments only bear less than a quarter of the limit load of tendons and ligaments. The most common factors affecting tendon and ligament injuries are growth and aging, pregnancy, activity and braking, diabetes, history of hormone medication, hemodialysis, etc. All of these factors cause the mechanical properties of tendons and ligaments to deteriorate, causing the common functions of tendons and ligaments to be reduced, such as [guiding joint motion, guiding motor conduction, fixing and restricting joint motion, and participating in motor control]. Tendon and ligament injuries and incoordination is very common, but the nature of the injury injury mechanism is basically the same, tendon and ligament injuries are generally divided into three levels; 1, first-degree injuries; tendon and ligament injuries are clinically manifested as a small number of fibers of the tendon and ligament rupture, the joints locally manifested as a localized joint micro-pain, the joints did not show instability of the joint movement. 2, second-degree injury; the affected area feels severe pain, and joint instability symptoms, tendons and ligaments within the fiber rupture, presenting a half-tear state, tendons and ligaments, the strength and stiffness of the tendons and ligaments reduced by half, clinical examination of joint instability may be masked by excessive muscle contraction, the test must be done under anesthesia in order to correctly examine the degree of injury. 3.Third degree injury; the affected area feels severe pain at the moment of injury, but the severe pain will be reduced immediately, clinical examination will find that the joint is very unstable, most of the fibers have been ruptured, only a small number of fibers are continuous, the whole tendon and ligament has completely lost its loading function, but on the outside it may not look like it has been completely ruptured. At this time, if the injured tendons and ligaments of the joint weight, then, these abnormal gravity falls on the joint capsule, articular cartilage, increasing the burden on the joint capsule, articular cartilage, early degeneration of the joint. In summary ; tendon , ligament injury – partial fracture of fibers , half-tear or complete rupture changes . 1, muscle injuries are mostly acute injuries. Tendon and ligament injuries are mostly violent acute injuries 2, muscle injuries are mostly caused by direct factors, is overstretched. Tendon and ligament injuries are mostly partial or complete rupture of fibers. 3.Muscular injuries and tendon and ligament injuries, the nature of different, inaccurate naming of the disease. 4.Muscular injuries are mostly acute, short course, relatively superficial, light, fast recovery, almost no sequelae. Tendon and ligament injuries are mostly violent, the disease recovery is relatively slow, or can not be fully recovered, leaving sequelae. Third, the joint capsule, articular cartilage injury The joint capsule is composed of dense fibrous tissue membrane, attached to the bone surface around the joint, there are two layers, inside and outside, the outer layer is connected to the periosteum, part of the thickening to form ligaments, the inner layer consists of loose connective tissue, close to the inner surface of the fibrous cartilage, attached to the peripheral edge of the cartilage of the joint, the joint capsule can produce a small amount of synovial fluid, lubrication of the articular cartilage, nutritive cartilage effect. Articular cartilage belongs to an independent organization, in normal young joints, the articular surface of the movable joints at the end of the cover there are about 1 – 6 mm, dense and transparent white connective tissue to become hyaline cartilage, articular cartilage is a very special tissue, usually found in some of the movable joints of the periphery of the joint capsule, and ligaments and tendons and the attachment of the bone, the articular cartilage is a kind of special material that can withstand high stresses. Articular cartilage can be regarded as a biphasic material, consisting of two groups, 1, intertissue fluid liquid phase, 2, porous permeable solid phase, they are incompressible, not fused, unique properties, under normal circumstances, the surface of the articular cartilage is seldom abraded, the normal cartilage can withstand a variety of loads, but only the smallest amount of wear and tear, the surface of the articular cartilage during joint activities to produce relative motion, the intensive stress concentration on the contact surface, the degradation of tissues play an important role, when the ligaments and tendons and bone attachments. When ligaments and tendons are injured and the injured joint is weight-bearing, this abnormal stress falls on the articular cartilage of the joint and increases the load on the articular cartilage. Therefore, injuries to ligaments and tendons, instability of the injured joint, weight-bearing of the injured joint, injuries to the joint capsule, which affects the nutrient metabolism of articular cartilage, and overloading of articular cartilage are the main reasons for the early deterioration of articular cartilage.