Classes 1-4 Flashcards
1
Q
Definition of an injury?
A
Any occurrence, cause by various types of trauma that impairs tissue structure or function and thereby alters the cell’s ability to carry out its normal homeostatic mechanism
Any injury will cause the inflammatory response
2
Q
Direct (Contact) definition
A
Occurs because of blood trauma; soft tissue and bony trauma with visceral implications, neurological implications
Ex. Football, Rugby, hockey, Lacrosse, basketball
3
Q
Indirect (non-Contact) definition
A
Overuse/ Over stress injuries as a result of muscle imbalance; extension or hyperextension of muscles
Ex. Swimming, Tennis, Golf
4
Q
Acute definition
A
Sudden on set or a short duration; has a known etiology; can be traumatic/overuse
5
Q
Chronic definition
A
Injuries lasting longer than 6 weeks - 6months; small onsert and usually defined as -itis; pain subsides during injury (absent during exercise and present during rest/recovery periods)
6
Q
Microtraumatic definition
A
Less inflammation but still present
7
Q
Macrotraumatic definition
A
Larger scale injuries; significant inflammations
Ex. Fractures; sprains to ligaments, strains to tendons/muscle
8
Q
Force definition
A
is a push or pull acting on the body which results in acceleration and//or deformation
9
Q
Two primary factors determine the injury:
A
- Size of the force
- Properties of the involved tissue
10
Q
Response to Force: Steps
Graph
A
Elastic Region
Yield point
Plastic region
11
Q
The elastic region is which part of the graph
A
Small load
12
Q
Yield point is what exactly?
A
MAX load a material can handle without permanent deformation
13
Q
Failure defined in lecture
A
forces such that loss of continuity, rupturing soft tissue or fracturing bone results
14
Q
Three main forces causing the injury (comprehend from the chapter)
A
Compression
Tension
Shear
15
Q
Force which produces a crushing or squeezing type of force resulting in soft tissue or bony injury; Fractures,
A
Compression
16
Q
Forces that pulls or stretched tissue on bone in the opposite direction
A
Tension
17
Q
Parallel to a plane passing through the object which tends to cause sliding or displacement
A
Shear
18
Q
What three things is the inflammation response designed to do?
A
Protect, Localize, Rid
19
Q
How does the body protect against the injury?
A
Pain reaction, pain spasm cycle
20
Q
How does the body localize the injury?
A
Clotting, vasoconstriction
21
Q
How does the body get rid of the injury?
A
phagocytosis, WBC, replace the damaged cells,
22
Q
Can healing begin with the dead/injured cells remaining within the body?
A
NO! The inflammation has to heal and get rid go the old cells for effective healing to began
23
Q
How long do inflammatory responses last?
A
40-78 hours normally
24
Q
What are the cardinal signs of inflammatory response (characteristics)?
A
Swelling; Heat; Altered function; Redness; Pain
25
Reasons for having heat in the inflammatory response?
Results of increase in blood volume in the region of the inflammatory response; use the back of the hand to feel the heat
26
What is the acute care response to inflammation?
RICE
27
How is the body altered as a result of inflammation?
Natural protective Mechanical; how they are holding the injured body part and the reason is to less stress on the injured structure, more room and decreased amount of tension on the injured structures; aka Closed Packed position
28
What is the closed packed position?
The way the injured body part is held; the reason is to less stress on the injured structure, more room and decreased amount of tension on the injured structures
29
What are the reasons for the pain to occur?
- Chemical; released responses to the injured areas of the body (protective mechanism)
- Mechanical; putting pressure on the free nerve ending causing pain
Caused by anemia (lack of RBC)
30
Macrotraumatic injuries we talked about in class?
```
Contusion
Sprains
Strains
Dislocations and Subluxations
Nerve Injury
Fractures
```
31
Contusions (hematoma, Burise)
Compression injury without breaking the skin; usually clotting caused by break in a blood vessel
Involve the soft tissue or bone
32
How are contusion cause?
Contusions are cause by direct trauma from an object or an opponent;
33
What happen under the skin in a contusion?
The compressive force will damage the underlying tissues or structures
34
Are contusion self limiting?
YES! Due to pain and healing depending on the degree of the damage they prevent movement of the injury area
35
Can contusion penetrate the bone?
Yes, they cause, bone bruise, Periostitis or Myositis Ossificans
36
Are there more pain receptor in the muscle or on the bone?
The bone
37
What is the medical term for a bruise?
Ecchymosis
38
Periostitis:
inflammation of the covering of a bone (the periosteum
39
How does periostitis occur?
Results from sport traumas
40
How does periostitis appear on the skin when palpating?
Often appears as skin rigid of the overlying muscle and bone
41
Shin Splints is a result of?
Periostitis (contusion)
42
Myositis Ossificans:
inflammatory disease of a muscle marked by a bony deposit within the muscle in response to trauma
ex. Linebacker’s exostosis
43
What is Traumatic ossification referred to as?
Myositis ossificans
44
Where is the only place you will detect the myositis ossifican?
In an x-ray that separated the bone from the dark mass
45
The steps leading to myositis ossifican:
1. Contusion
2. Penetrating the bone tearing the periosteum
3. Leading to myositis ossifican
4. Calcificatin of the soft tissue may be seen in x-rays
46
Ecchymosis definition
the escape of blood into the tissue from ruptured blood vessels
47
What is this term applied?
Applies to subcutaneous discolouration resulting from the seepage of blood within the contused tissue
48
Sprains definition
occur to the ligaments and ligaments are found in joints by overstretching and tearing of the supporting connective tissue including the joint capsule and supporting ligaments
49
What is a ligament made of?
Mostly Collagen and elastin (strong fibrous connective tissue); have a hard end point
50
What is the role of ligaments in a joint?
They act as breaks for the joints; they join bone to bone preventing abnormal movements of a joint
51
Type of ligaments found (3)?
- Collateral ligaments: on the side of the joint
- Cross ligament: They cross the joint prevent forward or backward movement (anterior and posterior)
- Lateral collateral: found on the outside of the joint of a joint
52
How to grade sprains (large vs small ligaments)?
First way: mild/moderate/severe
Larger ligaments: mild/moderate/severe
Smaller ligaments: The number of the ligament torn (1/2/3)
53
What is the etiology of a sprain?
Direct/indirect trauma causing stress on the sprain
54
Joint classification:
Synarthrotic (cranial bones): non-moveable
Amphiarthrotic (slightly moveable): vertebrae joints
Diarthrotic (freely moveable): synovial joints
55
Joint characteristics:
```
Ligaments, through of outside the joint
Arterial supply
Nerve supply
Bursa: sac filled with fluid
Ephyseal plate: at the end of a long bone
Hyaline cartilage (articular cartilage)
Meniscus
```
56
What are inert structures?
Ligaments, joint capsule, bone; there are no contractile properties
Muscle and tendon are contractile
57
Atheros refers to?
refers to a joint
58
Effusion define
Swelling within a joint with minimal to no bleeding
59
Edema
the swelling in the soft tissue usually with the absence of blood
60
Hemarthrosis
Bleeding and swelling within a joint
61
How to differentiate between a hemarthrosis and effusion?
Pop-swelling (immediately); effusion come later on
62
Hematoma
swelling and bleeding within soft tissue, organ, bone
63
Differentiating between edema and hematoma?
The discolouration is present in hematoma with the swelling; absent on edema (only swelling)
64
S&S of 1st degree sprain?
- Micro Tear
- Slight is any swelling
- Transitory pain at the time of injury (able to perform)
- Mild point tenderness (size of dime)
- Little to no discolouration (ecchymosis)
- Transitory loss of function primarily due to SHARP
- Stress of ligament causes pain but little laxity
65
S&S of 2degree sprain?
- Partial tear
- moderate to severe swelling
- Moderate to severe pain
- Localiazed tenderness (size of a quarter)
- Ecchymosis
- Loss of function
- Stress of ligament causes pain and some degree of laxity but with a stoppage or “end feel”
66
S&S of 3rd degree sprain?
- Complete Rupture
- Moderate to severe swelling
- Severe pain at time of injury/no pain
- Diffuse palpable tenderness
- Ecchymosis
- Loss of function
- Stress of ligaments show complete loss of joint stability
Hear a pop-> immediate swelling
67
What are Strains?
Trauma occurring to the muscle and tendons from an excessive forcible contraction or overstretch; pulling of a muscle
68
What is the etiology of a strain?
- contraction
- Overstretch
- Chronic Overuse (tendonitis
69
SS of 1st degree strain?
```
Slight swelling
Pain is localized
Slight loss of strength (contractile structure)
Slight loss of ROM
Little to no Ecchymosis
```
70
SS of 2nd Degree strain?
```
Measurable swelling
Indefinable pain (more general)
Moderate loss of strength (strength is graded); Kendle Scale
Moderate loss of ROM
Ecchymosis visible
```
71
Ss of 3rd degree strain?
```
Visible, apparent swellling
Severe pain
Complete loss of strength
Complete loss of ROM/Excessive motion
Ecchymosis
Muscle bunching
Hear a snap at the time of injury
```
72
Four parameters to evaluate Strains:
Circumference
Extensibility; stretch gentle (bilateral)
Contractibility; muscle grading (0-5)
Palpation; 5Ts
73
How is manual muscle testing done?
```
isometric; done in midrange
bilaterally; unaffected side first
Begin and end the pressure slowly
Stabilize the joint
Instruction “meet my resistance”
Grade the strength
```
74
What are the 5Ts of palpation?
```
Temperature
Texture; grind in the muscle
Tenderness
Tone (spasm)
Trigger points
```
75
Circumference definition
The measurements of Girth and swelling at and around a joint and muscle
76
What is circumference used for?
Setting the baseline for the joint and the muscle
77
How is contractibility and extensibility tested?
Bilaterally
78
Degree of pain and restriction is measured in?
Extensibility
79
Contractibility is measures through?
The EMG machine
80
What is isometric contraction used for?
```
Strains
Detecting tendonitis
Never injuries (central/peripheral)
```
81
Dislocation definition
results from forces causing the joint to go beyond the joints normal anatomical limits
82
Subluxations are?
partial dislocation which is spontaneously reduced
83
First time dislocations should always be considered fractures (T/F)
True
84
PNS nerve injury
Sensory: Numbness, tingling, loss of sensation
Motor: weakness, pain
85
CNS nerve Injury
Smells, taste, hearing, sight, pain
86
How do entrapment of never occur?
Traction,
compression,
lacerations and
degeneration with or without sign and symptoms; can result in muscle atrophy
87
Nerve classification of nerve injury depend on the degree of damage (T/F).
True
88
What are ostiofites?
Bone Foist
89
Plexus injury is termed as ______
Plexopathy
90
Never root injury is called _______
Radiculopathy
91
Peripheral injury are called _______
Neuropathies
92
What are the cause of a compressed nerve?
Scar tissue can compress the nerves
Osteopathy
Trauma
Disk-herniation
93
Nerve injury classification
Neuropraxia, Axonotmesis, Neurotmesis
94
Neuropraxia cause
```
1st degree
Axon remain interacted
Scar tissues (repeated nerve injury)
```
95
SS of Neuropaxia
Tingling,
weakness and
atrophy (prolonged compression)
96
Axonotmesis cause
2nd degree
Axon damaged
Epi and Perineurium remian interacted
Temporary paralysis; can get 80% back
97
How long does it take to recover from Axonotmesis?
Months- years
98
Neurotmesis cause
```
3rd degree
Severance of nerve
60% loss of nerve
Everything GONE
Axon, myelin and connective tissue
Can only get 30-40% back
```
99
Fractures is symbolized as a # sign (T/F)
True
100
Fracture definition
complete or incomplete break in a bone resulting from the application of an excessive external force
101
Traumatic fracture
can cause the loss of continuity of bone and can be either partial or complete
102
Stats of fractures:
Up to age 50 men suffer more fractures
| Women suffer more due to falls, osteopenia, osteoporosis
103
Epiphysis: covered with articular cartilage (T/F)
True. it is articulated with other bones
104
Diaphysis contains the medullary cavity which is filled with marrow (T/F)
True
105
Type of Marrow?
red marrow forms the platelets and Red and White blood cells
Yellow marrow- stores fat
106
Apophasis
bone bumps
107
The function of an apophysis?
Site of attachment for a various structure such as ligaments and tendons
108
Fracture only occur to a few types of bones (T/F)
False. They can occur to any bone
109
```
Simple or complex
Partial or complete
Union of bone
Closed Fracture: under the skin
Open fracture: bone protruding through the skin
are example of what type of fractures?
```
General Classification of Fractures
110
```
Good union
Non union
Mal union (ORIF)
Delated union
These 4 are defined from which general classification?
```
Union of bone
111
What is ORIF?
Open Reduction/ Internal Fixation
112
When is an ORIF performed?
Mal union of the bone; comminuted fracture and
| Salter-Harris (3/4)
113
The specific type of fracture:
```
Transvers
Oblique
Spiral; soccer (ciliates)
Comminuted; ORIF
Avulsion (pre-adolescents)
Impact or Burst (compression/ load fractures)
Greenstick fractures
Stress (may not be seen on x-rays)l; bone scan; weight bearing bones
Growth plate (Salter/Harris)
```
114
Salter Harris fractures detected near?
The growth plate
115
Which of the growth plate fracture well for growth plate healing?
Type 1 & Type 2
116
Which are the worst to heal and require ORIF?
Types 3 and Type 4
117
When do have a loss of shock absorption in the muscle?
When the stress on the muscle is overloaded and muscle is fatigued results in bone bearing the weight of the muscle
118
Reasons for uses of x-rays to detect fractures?
Rule out fractures following soft tissue injury
Identify the type of fracture present; the union of the bone
Used as a baseline for the stages of healing
Stress Fractures
For bone loss to be evident or X-ray; 30-35% bone loss; bone density
Bone scan, CT scan and MRI
119
Fracture assessments
```
deformity
Swelling
Crepitus
Direct/indirect tenderness
False joint?
Shortened Limb
```
120
What is crepitus?
The grinding sensation of the fractured bone; can be felt in a tendon or a muscle
121
Why is a tuning fork is used?
To reproduce the pain
122
Complication of fractures
```
Improper healing
Improper alignment
Ostrochondritis Dissecans:
Myossitis Ossificans
Osteomyelitis: high risk of infection and condition
```
123
Myossitis ossificans is a result of joint locking from a fragmented cartilage or bone (T/F)
False. Ostrochondritis Dissecans causes joint locking from a fragmented bone
124
Joint Mice; common in knee, elbow and ankle (T/F)
True
125
The floating bone fragment can cause clicking or lock the affected joint resulting in a ‘Springy Block’ end feel (T/f)
True
126
Greenstick is a condition that occurs as the high risk of infection from a open fracture (T/F)
False. Osteomyelitis is an open fracture there is a high risk of infection
127
Osteomyelitis is not rare, it is a common fracture (T/F)
False. It is rare
128
Ways bone can be infected?
Infection in one part of the body may spread through the bloodstream into the bone, or an open fracture or surgery may expose the bone to infection
129
Staph bacteria causes what type of conditions?
Staphylococcus
130
X-rays help with the healing (T/F).
True.
131
Small bones take 6-8 weeks to heal while long bones take 3 weeks to heal (T/F)
False. Long take 6-8, small take 3 weeks for proper immobilization
132
Ottawa Ankle Rules
Distal Malleolar region
Base of the Fifth Metatarsal (Jone’s Fracture)
Navicular bone
Unable to weight bear both immediately following the injury and in the emergency department afterwards
133
Microtrauma injuries occur because
repetitive overload/ friction resistance injury
134
Force Cause Overuse in microtruamatic injuries
Frictional
Tractional
Cycle Loading (Etiology of stress fracture)
135
```
: affects tissue or bone
Impingement leads to loss of function (IT band friction syndrome)
Bony pathology (Patello-femoral pain syndrome: lock knee)
```
Friction Force
136
involves soft tissue or bony tissue
Plantar Fasciitis
Osgood Schlatter’s Disease (apophysis)
Tractional forces
137
Tendonitis
inflammation of collagen protein
138
Tendinopathy
degenration of collagen protein
139
Tendonosis
no significant inflammation but is progression of tendonitis
140
SS of Tendonitis?
Pain & point tenderness (self limiting)
Local thickening of the tendon
Crepitus
Tendon tear in 4 stages
141
What are the Tendinosis stages?
1. Symptoms of pain/ discomfort/ no performance disability
2. Symptoms during activity initially causing no performance but processing to vary degrees of disability
3. Symptoms during after activity with persistent performance disability
4. Symptoms all of the time
142
Etiology of Tendonitis
Excessive overuse of tendon
Direct trauma to the tendon
Excessive friction over the joint
143
inflammation of the bursa (small sac containing synovial fluid)
Bursitis
144
Cause of Bursitis?
Repetitive movement and frictional forces leading to pain and swelling
- Chronic irritation (overuse)
- Direct trauma
- Calcium deposits
- Infection
145
Acute bursitis needs healing and if this does not happen, it can lead to secondary thickening and scar tissues in the burial walls (T/F)
True
146
Bursitis commonly occurs in the shoulders, elbows, knees and ankle (T/F)
False. Not in ankles
147
Bursitis is most common in saddle joints (T/F)
True
148
Tenosynovitis
inflammation of the tendon and the fluid
149
SS of tenosynovitis include:
Pain, swelling, and difficulty moving the particular joint where the tendon inflammation occurs
150
De Quervani’s is a synovitis (T/F)
False: It is Tenosynovitis
151
Myositis
inflammation of the muscle tissue
152
Myositis occurs from:
Injury, infection or autoimmune disease
153
Bursitis occurs due to autoimmune disease (T/F)
False. Myositis occur due to autoimmune disease
154
Fasciitis
inflammation of the fascia
155
Role of a fascia?
Separated and supports muscles, tendons, blood vessels and nerves
156
Capsulitis
Chronic inflammation of the joint capsule
157
Capsulitis occur most commonly in _____ and _____ due to repeated joint sprains or micro traumas
toes and shoulders
158
Synovitis is the inflammation of the membrane lining the _____
Joint
159
Chronic synovitis involves chronic _____ pain and ______ (dimple), it is associated with capsulitis.
Joint and edema
