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LeFebvre > 6. Sprain/strain > Flashcards

6. Sprain/strain Flashcards

1
Q

What are the 5 injuries that can happen to muscle?

A
  • strain
  • DOMS
  • spasm
  • MFTP
  • short/hypertonic
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2
Q

What is a lumbar strain?

A

Painful tear of large posterior muscles of the back

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3
Q

What muscle in the back are more prone to strain?

A

Longer muscles that span several joints such as QL and erector spinae

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4
Q

How common is extensor strain?

A

Likely rare in general population but is the most common diagnosis among athletes with LBP

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5
Q

What is the natural history of DOMS?

A

Peak pain around 24-48 hours and resolves within a few days. Should not last more than a week. If it does, then it isn’t DOMS

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6
Q

What are the two definition of strain?

A
  • tear in muscle

- the load that deforms any tissue in biomechanics

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7
Q

What are the possible mechanisms of injury for muscle strain in the low back?

A
  • sudden eccentric load (heavy lifting, forceful twisting)
  • direct impact trauma (MVA, football)
  • blunt trauma (can cause contusion also)
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8
Q

How common is referred leg pain with extensor muscle strain?

A

Rare

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9
Q

What movements will aggravate a muscle strain?

A

Anything that contracts or stretches the muscle. This means that the patient may have antalgic position that keeps muscle lax and have restricted AROM to avoid stretching. Resisted muscle testing is diagnostic for muscle strain

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10
Q

Using muscle testing, how do you distinguish between strain and sprain?

A

Strain is more aggravated by resisted testing while sprain is more aggravated by passive stretching at end range

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11
Q

Describe the tenderness grading scale

A 
0 = no tenderness
1 = tenderness, no grimace
2 = tenderness + grimace/flinch
3 = tenderness + jump sign
4 = non-noxious stimulus causes jump sign
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12
Q

What is spinal muscle compartment syndrome?

A

When physical activity causes elevated intramuscular pressure that does not normalize after 20 minutes of rest. Causes hypolordosis and can be relieve by rest

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13
Q

What is a lumbar sprain?

A

A painful injury of the lumbar ligaments

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14
Q

What are the most common ligaments in the lumbar spine to be sprained? What other ones can become sprained?

A

Those most posterior sprain more: Supraspinous and interspinous

ALL and PLL can become sprained also

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15
Q

What are the mechanisms of injury for sprains in lumbar spine?

A

Same as for strains:

  • high load traumatic event
  • repetitive microtrauma
  • sustained postural end range load
  • injuries are often the result of couple movements (lateral bending + rotation/flexion/extension)
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16
Q

A slip and fall on the buttock is more likely to cause a sprain or a strain?

A

Sprain, especially of the interspinous ligaments due to significant shear forces.

17
Q

What is postural syndrome?

A

Micro disruptions in ligaments that are caused by sustained postures such as prolonged sitting, that hold joint at end range for prolonged periods

18
Q

What would the physical exam findings be with postural syndrome?

A
  • local LBP only
  • not aggravated by orthopedic tests
  • normal and pain free AROM
  • longer duration static loading in one direction will provoke pain
19
Q

How are sprains graded?

A

Mild, moderate and severe

No attempt is made to be more specific as is done with strains

20
Q

Describe the physical exam findings with low back sprain?

A
  • guarded/antalgic posture
  • possible bruising if sprain is severe and superficial enough
  • limited and painful AROM and joint play
  • loads in direction of injury is painful
  • end range loading is more provocative than active or resisted muscle testing
  • palpable defect with severe supraspinus tear only
21
Q

What are negative exam findings with low back sprains?

A
  • neuro normal
  • no pain centralization with repetitive loading
  • isometric contraction of global muscles is less painful or pain free
22
Q

What is iliac crest pain syndrome?

A

Sprain of the iliolumbar ligaments that can cause spinal instability and/or DDD and/or herniation. Presents with lumbosacral pain and sometimes butt, groin and leg referred pain.

23
Q

What physical exam test would be positive with iliac crest pain syndrome?

A

FABERs test which is Flexion of the knee, ABduction and External Rotation of the thigh to form a #4 shape with the legs. Practitioner presses down on knee while stabilizing contralateral hip at ASIS.

24
Q

What is the treatment or iliac crest pain syndrome (AKA iliolumbar ligament syndrome) during the acute phase?

A

Ice, rest and analgesics

25
Q

What is the treatment or iliac crest pain syndrome (AKA iliolumbar ligament syndrome) during the chronic phase?

A

STM: US, heat and cross friction massage
Ex: core strengthening
Medical: anesthetic and/or corticosteroid injection, PRP/prolotherapy

26
Q

What ancillary studies are indicated for sprains/strains?

A

In the case of trauma, X-rays should be done to rule out fracture.

27
Q

What is the management plan for sprains/strains during the acute phase?

A
  • Pain control: ice, US, E-stim, NSAIDs, etc.
  • light muscle massage and joint mobilization as needed
  • lumbosacral corset optional for pain control
  • heat but not until 48 hours after injury
  • neutral pelvis, hip hinging and other strategies to help with painful motion
  • maintain some level of activity but not sport
  • adjust postural behavior
28
Q

What is the management for sprains and strains in the sub acute phase (2-14 days after injury)?

A

CMT: joint manipulation as needed
STM: deeper massage, PRI, CRAC, pin and stretch, cross fiber, IASTM
Ex: home stretching, extension endurance exercises, core stabilizing
BM: remain active but avoid sport until full, loaded ROM is pain free

29
Q

What is the prognosis for sprains and strains?

A
  • Mild cases resolve in a couple days
  • Severe cases resolve in 2 weeks or more but may have some low level flare ups for 4-6 weeks
  • sprains have poorer prognosis due to less nerve and blood supply to ligaments

LeFebvre (29 decks)

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