By Comité de Trauma del Colegio Americano de Cirujanos
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The underlying assumption is that pain perceived as in the arm should be caused by local tissue damage. This is presumably based on our early experience where for example if we hit our arm or damage the skin then we clearly associate the pain we feel with the obvious local lesion. Therefore if the heart then causes pain due to ischaemia we assume that pain should be felt in the region of the heart. Localization of the cutaneous sensation appears to be directly related to the cells in the post-central gyrus of the cortex.
The swelling of the inflammatory response tends to peak by 48 hours. If the symptoms are very acute, the patient is best to rest in a comfortable position for 2-3 days while the inflammatory process may still be increasing in intensity. After this time 'controlled activity' is more appropriate. This involves moving the affected part in a cautious and non-traumatic way to ensure that the area is not allowed to stiffen unnecessarily. This is particularly important when there is marked inflammation because, as the swollen area becomes more organized by connective tissue repair, unless it is stretched, it will become less mobile and rehabilitation will take considerably longer.
When lying down it is unlikely that they will lie in a position that stretches the muscle and thus the shortening is maintained by connective tissue. In addition persistent oedema in muscle and other soft tissues may also add to the reduction of elasticity and a consequent increase in apparent muscle tone. 4 Components of muscle contributing to myofascial tone. When a muscle is neurologically inactive there is residual passive connective tissue tension. As a muscle is stimulated by nervous impulses the passive tissue tension becomes of less significance.