Focal myopathy
1, injection myoclonus: It is the most common type of focal myopathy caused by intramuscular injection. The occurrence of this disease is closely related to the local repeatedly receiving intramuscular injections. Myoinjection has both local oozing and edema caused by needle trauma; there is also local irritation and malabsorption of drugs. This traumatic and chemical stimulation leads to local myofilaments and aseptic inflammatory changes in muscle tissue, which in turn leads to periosteal thickening, muscle fibrosis and scar contracture, resulting in local dysfunction.
Due to the different sites of muscle injection, various types of intrinsic hand contracture, deltoid contracture, and gluteus contracture can occur at the tiger’s mouth. In recent years, domestic data reported that the incidence of the disease has increased, and the prevalence of the disease in only children is significantly higher than that in non-only children, which is worth noting. The disease was not well recognized in China in the past, but has gradually attracted attention in recent years. However, there are still many delays in diagnosis and treatment at the grassroots level, which should be given sufficient attention.
The symptoms of this disease usually appear gradually 2-3 years after repeated local injections, so the key to prevention is to minimize and avoid the abuse of intramuscular injections, to master the depth of injection, and to avoid injecting the drug on the muscle membrane. For those who really need repeated intramuscular injections, drugs with light local irritation should be used, and necessary local hot compresses, massage, TDP irradiation, and local ion introduction method of blood circulation and blood stasis relaxing solution can prevent and reduce the occurrence or development of the disease.
Repeated injections at the Hegu point, Quchi point and deltoid muscle should be avoided in children, and the injection process should be strictly aseptic, which are all ways to prevent the occurrence of myoclonus in other areas.
Once myoclonus occurs, patients with mild cases have little impact on life and activities, and can be expected to return to normal or get better with non-surgical treatment and functional exercise. For patients with obvious symptoms and serious functional impairment, early surgical treatment should be performed. Cutting and partial excision of the local contracted tissue can effectively loosen the adhesions and cure most of the patients.
2, local hard nodes: this disease occurs in all age groups, especially in patients who repeatedly perform intramuscular injections for a long time. Local injection of irritating and difficult to absorb solution, injection depth is not deep enough to reach the muscle tissue, but only in the subcutaneous or muscle membrane resulting in malabsorption, all these factors cause local irritation and produce hard nodules. In order to prevent the occurrence of this disease, we should avoid the abuse of myoinjection, avoid or use less irritating drugs, master the depth of myoinjection, and avoid repeatedly injecting drugs at the same injection site.
Once the hard nodules occur, the following measures can be used to deal with them
1.Fresh Malingots foil patching method: take fresh Malingots, wash it, cut foil patching on the surface of hard nodes, and replace the new foil when it is dry, 4-6 times a day;
2.Ion introduction of localized saffron wine, 1～2 times a day;
3.Wet application of hot vinegar to the affected area for 30 minutes each time;
4.TDP local irradiation, 2 times a day, 30 minutes each time;
5.Inject 2% procaine 2ml plus dexamethasone 2~5mg around the nerve, once every other day, 4 times for a course of treatment.
Peripheral nerve injury
Incorrectly selected position during intramuscular injection, or due to abnormal local nerve direction, can cause direct injury to the nerve. If the injection site is too close to the peripheral nerve, the nerve injury can be caused by the osmotic stimulation of the drug when the irritating drug is injected. Because the gluteal muscle injection is the most frequent, the chance of sciatic nerve injury is also the most frequent, and it is more likely to be encountered in pediatric patients, which should be taken seriously. Sciatic nerve injury, older people can complain of radiating pain in the affected limb, but the younger ones only show irritable crying, refusal to move the affected limb, passive activity every time the child cries suddenly or intensify.
The affected limb is impaired in movement, limping, and weakness in knee and ankle flexion, and the affected limb muscle atrophy and limb thinning may occur in long term disease. The key to prevent the occurrence of this disease is to master the exact site of myoinjection and avoid using irritating solutions. Once the disease occurs, first of all, local myoinjection should be stopped, while local infrared or electromagnetic wave irradiation, massage physiotherapy and other treatments, combined with the use of systemic nerve-nourishing drugs, is an essential treatment measure. Chinese herbal medicine can be used to activate blood circulation, soothe the tendons and activate the joints of the soup for internal use or fumigation for external use.
Local infection
It mainly occurs when the local cleaning and disinfection of injection is not strict, so the aseptic operation should be emphasized, and in rural health stations or individual medical stations with poor aseptic conditions, the importance of aseptic operation should be emphasized. Patients who are bedridden or incontinent or diabetic should pay more attention to local aseptic disinfection because they are prone to bacterial infection, and it is better to use the disinfection method of tincture of iodine followed by alcohol to ensure safety. Once the infection occurs, in addition to local anti-inflammatory closed treatment, it should be actively combined with systemic antibiotic treatment and local infrared irradiation, which can accelerate the cure.
Local sterile inflammatory reaction
This phenomenon is more easily encountered when penicillin oil was used in the past; it can also be encountered in some cases where a more difficult-to-absorb drug solution is repeatedly injected in the same site. This is due to incomplete local absorption of the injected solution, which stays in the area and forms pseudocysts. The key to prevent this disease is to avoid long-term repeated local injection of difficult-to-absorb solution, and to master the selection of position and depth of injection. Once aseptic pseudocyst occurs, local puncture and aspiration or incision should be made as early as possible to exclude the retained local drug, once the retained drug is cleared, the pseudocyst cavity will be closed.
Hemorrhage and broken needle
Bleeding: mostly caused by the injury of local blood vessels when injecting, therefore, attention should be paid to avoid superficial veins when injecting, once bleeding occurs from the puncture needle, sterilized cotton swabs can be used to compress the local area for 2 to 3 minutes, which can generally stop the bleeding and is not a big problem. In case of patients with bleeding tendency (hemophilia, scurvy, other diseases of coagulation dysfunction), if local compression cannot control bleeding, intravenous procoagulant should be injected, and if necessary, whole blood transfusion can be used for treatment.
Broken needles: myocardial injection can be due to the patient (especially children) restlessness, so that the needle twisted and broken; can also be due to the use of needles for a long time, the needle pedicle and the needle bolt junction cracks and broken; very few can be due to poor operator basic skills, into the needle method error and broken needles. Once the needle is broken, first of all, the patient should be quiet, to prevent the patient panic, body agitation and the broken needle displacement;
At the same time with the hand to fix the skin at the broken needle, so that the proximal end of the broken needle as much as possible exposed outside the body, and pull out with hemostatic forceps clamp. If a high strength magnet is available, the broken needle can be quickly sucked out, and to avoid the broken needle with muscle contraction (especially the gluteus) run deep into the tissue. The key to preventing this disease is to master the correct injection method, do not use cracked, hooked bald needles or bent needles, into the needle should make the needle pedicle as long as possible 13 to 14 stay outside the skin, try to make the patient limb quiet.
Necrotizing fasciitis
This is a sinister complication that, once it occurs, can cause great pain to the patient and even endanger life. The disease occurs due to poor local aseptic technique, resulting in bacterial penetration from the injection port into the fascial tissue and causing fascial infection and necrosis, or even sepsis. Local injection of irritating drugs and insufficient depth of injection to reach the muscle layer but only the fascial layer are also factors that lead to necrosis of fascial fingerprint.
In order to prevent this disease, we should focus on aseptic operation, correct depth of injection so that the drug does not remain in the fascial layer, and use less irritating drugs. In case of necrotizing fasciitis, systemic anti-infection and anti-shock treatment should be given first, and necrotic fascial tissues should be actively and thoroughly removed to prevent reabsorption of toxins.