Amputation, Compartment Syndrome, Ligament Tendon Injuries (sprains, strains, ruptures)

Question 1

bundle of connective tissue that binds two or more bones together at a joint

every joint has two supporting ____

fairly avascular and tend to heal slowly

Answer 1

ligament

Question 2

a tearing injury of one or more ligaments leaving a joint unstable

Answer 2

sprain

Question 3

fibrous structures connecting a voluntary muscle to bone, cartilage or ligament

enable muscles to effect motion in the joint or body area to which they are attached

Answer 3

tendon

Question 4

tearing injury to muscle fibers resulting in excessive tension or overuse

Answer 4

strain

Question 5

minor tear in fibers w minimal swelling, minor discomfort (pain may be delayed 24 hrs) and absent/minor ecchymosis

ROM usually not affected

tx - compression dressing

Answer 5

1st degree strain/sprain

Question 6

partial tear, joint intact, more severe swelling w visible ecchymosis, pain present at time of injury

moderate muscle spasms are common

pain on stretching or contraction of there affect muscle/tendon

tx - may require splint and PT referral

Answer 6

2nd degree strain/sprain

Question 7

complete disruption of a ligament, join may be open w palpable defect

minimal to severe swelling, separation of muscle from muscle, muscle from tendon or tendon from bone

severe muscle spams

small avulsion fx may be seen on X-ray, patient may describe a snapping noise at time of injury

tx - splint/cast, often requires surgical consultation for repair, PT referral

Answer 7

3rd degree strain/sprain

Question 8

sudden forced plantar flexion or unexpected dorsiflexion (jumping or pushing off)
use of fluoroquinolone (levaquin, cipro, avelox)
directe steroid injection into the tendon

patient feels sharp pain or pop in heel
walks flat footed
unable to stand on balance of foot or climb stairs
unable to plantar flex foot
swelling in calf area

splint in plantar flexion

Answer 8

achilles tendon rupture

Question 9

internal causes: bleeding, edema, insertion of external substances, recent surgery, tissue damage, edema and bleeding secondary to crush injuries

external causes: circumferential casts, splints, tape, elastic bandages and military anti shock trousers (MAST pants), circumferential burns causing inelastic skin around the muscle compartment, vascular or arterial blood loss outside the compartment w hematoma putting pressure on the compartment

Answer 9

compartment syndrome

Question 10

earliest indicator of compartment syndrome is deep, throbbing, unrelenting pressure which is out of proportion to the injury

may have ____ on passive stretch

Answer 10

pain

Question 11

along the distribution of the compressed nerve

the loss of sensation is most dense distally

Answer 11

paresthesia

Question 12

a later sign of compartment syndrome and ofter a poor indicator of outcome, may be described as a sensation like the “limb is giving out”

Answer 12

paralysis

Question 13

as microcirculation is obstructed, the extremity will begin to lose its color appearing pale (will appear dusky if dependent)

extremity may feel cool and become warmer proximal to the affected compartment

Answer 13

pallor

Question 14

last sign to develop, probably Tony be evident until pressures within the compartment are close to systolic pressure, preventing arterial flow through the compartment

Answer 14

pulselessness