Acute and Overuse Injuries Flashcards
Cartilage Function
Shock absorber, joint lubrication
Cartilage types
Hyaline e.g. joint surface
Fibrocartilage e.g. meniscus, vertebral disc
Elastic e.g. outer ear
Joint function
Stability on bony configuration and soft tissues
Bursa
Facilitates the movement of the tendon over the bony surface
Bone fracture
Acute
Transverse, oblique, comminuted, spiral, avulsion
Open or closed
Displaced or non-displaced
Sx - pain, tenderness, bruising, swelling, deformity, ROM
Periosteal injury
Acute
Bleeding in periosteum due to direct blow
e.g. tibia from stick/ kick
Wolff law
Bone remodels in response to the direct force/stress applied to it, using osteoclasts and osteoblasts
Bone strain
Overuse
Non-tender
Mildly increased uptake on bone scan
XR/CT Normal
Stress Reaction
Overuse
Tender
Mildly increased uptake on bone scan
XR/CT Normal
Stress Fracture
Overuse Microfracture due to repetitive loading that over time exceeds bone's ability to repair Due to impact forces or muscle pull Tender Increased uptake on bone scan XR/CT Abnormal
Osteochondral injury
Acute
Damage to articular cartilage +/- subchondral bone
Poor healing capacity due to inadequate blood supply
May predispose to ealy OA
E.G. metatarsal dome with inversion injury
Meniscal Tear
Acute (fibrocartilage)
Intervertebral disc prolapse
Acute (elastic cartilage)
Patellofemoral Syndrome
Overuse - Microscopic inflammation of cartilage
inflammation leads to softening => fibrillation => fissuring =>gross disruption
Osteochondritis Dissecans
Separation of bone and cartilage from normal surrounding structures
e.g. medial femoral condyle - Axial CT of the knee demonstrates a completely detaches
Joint Dislocation
Acute
Complete disassociation of the joint surfaces
Joint Subluxation
Acute
Partial disassociation of the articulating surfaces
Sinus Tarsi Syndrome
Overuse injury causing chronic inflammation
following inversion injury
lateral ankle pain
Osteoarthritis
Overuse
Fraying of cartilage +/- loose fragments, bony cysts, subchondral bone sclerosis, osteophtes, thickening of synovium
RF - age, FHx. congenital/ developmental joint alterations, alterations of supporting structures, injury, obesity, occupational overuse
Ligament Sprain
Acute GRADE 1 - Stretching of fibres, minimal tearing - No laxity, normal end feel - Mild/mod pain
GRADE 2
- Partial tear
- Laxity, normal end feel
- Mod/sev pain
GRADE 3
- Complete tear
- Laxity, no end feel
- May be pain free
MCL Knee inflammation - Breaststroke swimmers
Overuse
repetitive valgus loads across the knee
MCL Elbow Inflammation
Overuse
Repetitive throwing with valgus loading
Plantar Fasciitis
Overuse syndromes of the foot
Muscle Strain
Acute
GRADE 1
- Small no. of muscle fibres torn, fascia intact, minimal bleeding
- Mild pain, FROM, full strength
GRADE 2
- Significant no. of muscle fibres torn, increased bleeding
- Increased pain, swelling, decreased ROM and strength, palpable haematoma
GRADE 3
- Complete tear (usually at musculotendinous junction)
- Bleeding & swelling +++, no active contraction
Cramps
Acute
painful involuntary contraction
sudden and temporarily debilitating
Contusion
Acute
Direct blow to muscle cause bleeding with haematoma formation
can lead to MYOSITIS OSSIFICANS - bone tisse formation inside the muscle or other soft tissue
e.g. dead leg in footballers
Focal Fibrosis of muscle
Overuse
repetitive microtrauma
cause inflammation and adhesions
Chronic compartment syndrome
Overuse
Exercise causes increased intra-compartmental pressure; tight fascia does not allow for expansion and impairs blood supply => pain
Delayed Onset Muscle Soreness (DOMS)
Overuse
24-48hrs post exercise, esp eccentric
Secondary to inflammatory cell/metabolite build up
e.g. downhill running
Myofascial Pain
Overuse
due to injuries, stress, inflammation and poor posture
Trigger points
hardening of muscle upon palpation of trigger points
subjective weakness
referred pain from trigger point
shared Sx with fibromyalgia (but fibromyalgia = widespread, systemic, associated with fatigue)
Tendon Tear
Acute
Usually at site of least blood supply (e.g. 3cm above achilles tendon insertion) or musculotendinous junction
complete or partial
Tendinosis
Overuse
Collagen degeneration
neovascularisation
causes pain
Tendinitis
Overuse
inflammation
e.g. inflammatory arthritides
Paratenonitis
Overuse
Inflammation of paratenon/ tendon sheath
e.g. deQuervain’s tenosynovitis (APL and EPB) in rowers
Traumatic Bursitis
Acute
direct knock causes bleeding in bursa
Bursitis
Overuse
e.g. greater trochanteric bursa (gluteus medius attachment)
Neuropraxia
Acute
due to direct blow
pain, tingling, numbness +/- weakness - along distribution
e.g. common peroneal nerve at the neck of fibula
Nerve Entrapment
Acute or Chronic
e.g. prolapsed IV disc and nerve root compression
Adverse Neural tension
Chronic
irritation of nerve due to local inflammation
pain on stretching nerve
e.g. RSI (carpal tunnel)
Abrasion/Laceration
Acute
common
complications - bleeding, infection
Blisters/Callus
Chronic
common
