4/12 Soft Tissue Injury - Womack Flashcards
soft tissue
what is it?
types of injuries?
NOT BONE
components: tendons, muscles, ligaments!!
injuries: sprains, strains, contusions!
ligaments
tough band bw joins that limit excessive separation of the joint
- mostly collagen organized in parallel into fibrils
- proteoglycans and glycoproteins also present
high force across a ligament?
intersubstance tears or avulsions
tendons
cordlike structures attaching muscle to bone
parallel collagen bunches
macro vs microtrauma
- macro: single tensile force with failure typically occuring at muscle/tendon interface
- micro: repetitive trauma leading to anatomical deformity
sprain vs strain
strain: injury to muscle and tendon
- grade I : stretch of underlying structure
- grade II : partial tear
- grade III : full thickness tear
sprain: injury to ligamentous structure
soft tissue injury repair
1. reparative infl response
- hemorrhage and infiltration of cellular elements
- incr cell motility, directed cell movement to injured area
- degradative enzyme hydrolysis of tissue components
*initial infl is reparative, continued infl can be destructive!
2. collagen deposition with fibroblasts → matrix to bridge the repair
- early tensile loading promotes collagen healing/proper alignment
- no stress? scar formation and lower ligament strength
tendinopathy
raw spaghetti vs boiled spaghetti (disordered, not parallel)
care of acute injuries
immediate
early
late
immediate: PRICE
- protect, relative rest, ice, compression, elevation
early care
- mobilization, ROM, protected fx, stretching/strengthening, cross training for CV fx, neuromuscular reeduc
late care
- develop protocol for return to activity including return progressions
ankle injuries
lateral
medial
twisting
most common: lateral ligaments/INVERSION injuries
- ATFL (anterior talo-fibular ligament) fails first
- next: CFL (calcaneo-fibular ligament)
- PTFL (posterior talofibular ligaments) fail w ankle dislocation
medial ligaments/eversion injuries
- deltoid ligament complex is v strong → eversion injury is v rare
twisting: high ankle sprain (aka syndesmosis)
- twisting injury damaging the anterior tibiotalar ligament → can extend superiorly to disrupt the interosseous membrane too!
ankle sprain examination
palpation over ligaments
palpation over:
- 5th metatarsal: peroneus brevis inserting on 5th metatarsal → check for avulsion fracture
- navicular bone can be injured in twisting injury
- posterior aspect of each malleoli
special tests:
- anterior drawer → checks stability of ATFL
- talar tilt → checks stability of TFL
shoulder dislocation
at time of injury: arm typically in external rotation and abducted position (ex. clothesline)
injury causes anterior and inferior translation of humeral head (“down and out”)
- damages anterior glenoid/labrum
- axillary nerve injury
why so commonly dislocated?
- high mobility = decr stability!
- 90% dislocate anteriorly
- risk of bony, nerve, vascular injury
- recurrence?*
- under 20yo → 80-90% chance of redislocation
shoulder: static vs dynamic stabilizers
static
- ligaments
- labrum
- joint capsule
dynamic
- rotator cuff muscles SiTS
- supraspinatus: ABduct
- infraspinatus: EXT rot
- teres minor: EXT rot
- subscapularis: INT rot
idea
impingement in rotator cuff
pinching of rotator cuff tendons in subacromial space
constrains movement of arm over head
RC:
tendinopathy
rotator cuff tear
strain
calcific tendinopathy
adhesive capsulitis
acromioclavicular strain
type I - III
knee anatomy
ACL: fx
ACL fx:
- prevents anterior translation of tibia on femur
- prevents internal rotation of tibia
- controls pivoting
ACL injuries
mechanisms:
1. low energy: rotational and cutting maneuver, deceleration
- common
2. contact: hyperextension/valgus stress
- less than 1/3 of injuries
immediate pain, instability, effusion, joint line tenderness, laxity
ACL tear image
meniscal injuries
problem: blood flow is lousy! once injured, might just be injuired
FOOSH injuries
fall on outstretched hand
