Something I didn't learn in podiatry school

[Creflo]

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So I've noticed a phenomenon postoperatively regarding the first mtpj (after hallux limitus repair, or bunionectomy, etc.). We all know it gets stiff, but I'd like to delve a little bit deeper. I'm trying to understand why the active range of motion decreases so much, even if the passive range of motion is more than the active range. Because I know the primary tendons involved, the FHL and the EHL, are powered by muscles located far far away from the surgery site. If the brain tells the Extensor hallucis to fire, and the extensor hallucis tendon has not been damaged, why won't it do its job postoperatively? I understand there is local swelling/inflammation, but what role does the connection between the CNS and muscle located in the leg have to do with this? It seems to me that there is not just a problem (inflammation, stiffness, etc.) at the surgery site, but something extra is happening to break the CNS connection to the firing muscle, both of which again are far away from the site of surgery. Any thoughts?

 

[Pronation]

I think it all has to do with scarring, fibrous tissue formation, and capsular contraction (combination from both surgical trauma and a period of immobilization). I don't think it has anything to do with the CNS or the extrinsic muscles.

 

[ldsrmdude]

So I've noticed a phenomenon postoperatively regarding the first mtpj (after hallux limitus repair, or bunionectomy, etc.). We all know it gets stiff, but I'd like to delve a little bit deeper. I'm trying to understand why the active range of motion decreases so much, even if the passive range of motion is more than the active range. Because I know the primary tendons involved, the FHL and the EHL, are powered by muscles located far far away from the surgery site. If the brain tells the Extensor hallucis to fire, and the extensor hallucis tendon has not been damaged, why won't it do its job postoperatively? I understand there is local swelling/inflammation, but what role does the connection between the CNS and muscle located in the leg have to do with this? It seems to me that there is not just a problem (inflammation, stiffness, etc.) at the surgery site, but something extra is happening to break the CNS connection to the firing muscle, both of which again are far away from the site of surgery. Any thoughts?

Interesting thought. I admit I haven't put much thought into the joint stiffness outside of the factors we all recognize (inflammation and scarring around the joint), but I think it's possible. I wonder if the pain and stiffness around the joint lead to disuse of the extrinsic muscles which could lead to neuromuscular inefficiency similar to the detraining effect for weightlifting.

 

[AttackNME]

look up arthrogenic muscle inhibition

 

[Pronation]

Nice, learned something new today.