Exam 6 soft tissue injury

Question 1

What are the mechanisms of ligamentous injury?

Answer 1

repetitive stress (overuse) and acute high-force injuries

Question 2

What does a ligament injury present with?

Answer 2

Swelling, joint deformity, pain with palpation, limited ROM, joint instability with stress tests

Question 3

What is the most commonly injured ligament in the body?

Answer 3

anterior talofibular ligament

Question 4

What is the set rules when taking an xray for an ankle called?

Answer 4

Ottawa ankle rules

Question 5

What do the ottawa ankle rules state?

Answer 5

ankle xray is required only if there is any pain in malleolar zone or any pain in the midfoot zone with some zones of tenderness

Question 6

What is the treatment of an injured ligament?

Answer 6

Relative rest, immobilization (brace, splint, cast), rehab of surrounding structures, surgical repair, surgical reconstruction

Question 7

What are the consequences of a deficient ligament?

Answer 7

Early arthritis, secondary soft tissue injury, joint instability/disability

Question 8

What are the three parts of a tendon that can be involved in an injury?

Answer 8

tendon, paratenon, tendon sheath

Question 9

What is tenosynovitis? What is an example?

Answer 9

inflammation of the tendon sheath, De Quervian’s

Question 10

What is the cause of most tendon injuries?

Answer 10

degenerative disease of the specific tendon

Question 11

What is tendinopathy?

Answer 11

wear and tear of the tendon with an absence of inflammation

Question 12

What is the treatment of tendinopathy?

Answer 12

Pain relief: relative rest, activity modification, bracing, ice, tylenol/NSAIDs.
Tendon restoration: Time!!, eccentric motions for strengthening, pro-inflammatory injections/procedures (prolotherapy, PRP, autologous blood, needle tenotomy), Tendon debridement

Question 13

What are risk factors of a tendon tearing?

Answer 13

Degenerative changes (age), malalignment, muscle imbalance, weakness, instability, inflexibility, glucocorticoids

Question 14

What is a class of drugs that can predispose someone to a ruptured tendon?

Answer 14

fluorinated quinolones

Question 15

What will a tendon injury present as on an exam?

Answer 15

Focal pain, swelling, contusion, muscle retraction, pain provoked with ACTIVE motion, possible loss of active motion, certain tests will be positive if a specific tendon is injured

Question 16

What are some other pathways of treatment of a tendon?

Answer 16

non-operative (will spontaneously resolve), time, relative rest, activity modification, immobilization, physical therapy and eccentric training, anti-inflammatories, pro-inflammatories for some

Question 17

What are some questions to ask before tendon surgery?

Answer 17

Can function be recovered without surgery, will loss of function be missed? will complete ruptures cause the muscle to retract?

Question 18

What are the three types of cartilage found in joints?

Answer 18

Glenoid labrum, acetabular labrum, meniscus

Question 19

What does the lack of fibrocartilage at a joint do to that join?

Answer 19

Loss of load bearing, may increase the probability and severity of a degenerative disease

Question 20

What are the two ways a patient can have a fibrocartilage injury?

Answer 20

Traumatic tears (active population, sudden change in direction), degenerative tears (aging population, no specific injury, associated with age-related tissue changes (osteoarthritis)

Question 21

What should a fibrocartilage injury exam look like?

Answer 21

joint inspection is typically normal, may have pain with palpation over joint line, there are some provocative tests but they don’t work very well, imaging is necessary

Question 22

what is a SLAP tear?

Answer 22

tear of glenoid labral tear of superior labrum anterior to posterior (10–>2)

Question 23

What is a Bankart tear? what causes it?

Answer 23

caused by anterior dislocation of the head of the humerus, tear of labrum from 3 o’clock to 6 o’clock

Question 24

What is a bucket handle meniscus tear?

Answer 24

tear of meniscus where it moves out of joint space and is not easily imaged

Question 25

What is the treatment of fibrocartilage injury?

Answer 25

Benign neglect, can repair (but only in vascular zone tears of unstable flaps, partial meniscectomy, meniscal transplant

Question 26

What causes a muscle strain?

Answer 26

powerful eccentric contractions

Question 27

How do you prevent a muscle strain?

Answer 27

increased flexibility, warm up (temp and extensibility), conditioning (avoids fatigue), strength (able to absorb more energy

Question 28

How do you treat a muscle strain?

Answer 28

Rest, ice, compression, elevation, NSAIDs, mobilization, rehab

Question 29

What causes muscle cramping?

Answer 29

cause is uncertain, usually dehydration, electrolyte disturbances, muscle fatigue

Question 30

What kind of medications can be given for a muscle cramp?

Answer 30

quinine sulfate (found in tonic water), chloroquine sulfate

Question 31

What is a muscle contusion?

Answer 31

Direct trauma causing damage and partial disruption of muscle fibers, usually resulting is intramuscular hematoma

Question 32

what will a muscle contusion present as?

Answer 32

tenderness, swelling/palpable hematoma, limits strength and ROM

Question 33

What is the treatment of a muscle contusion/hematoma?

Answer 33

rest ice early return to gentle motion, can drain it but could lead to infection

Question 34

What is a complication of a muscle contusion?

Answer 34

myositis ossificans

Question 35

What is myositis ossificans?

Answer 35

tissue calcification or ossification at the site of an injury

Question 36

What is compartment syndrome?

Answer 36

rise in intracompartmental pressure above capillary pressure caused by muscle edema

Question 37

What is chronic compartment syndrome?

Answer 37

Usually resolves when person rests, diffuse pain over anterior or lateral leg after exercise, distal sensory changes are often present,

Question 38

How do you diagnose compartment syndrome?

Answer 38

tested with a pressure gage

Question 39

How can a patient injury their articular cartilage?

Answer 39

Acute traumatic injury (tear or osteochondral defect), repetitive excessive loading (chondromalacia)

Question 40

How do you treat articular cartilage injuries?

Answer 40

shaving (often doesn't help), microfracture w/ arthroscopic abrasion, cartilage grafts, allografts, chondrocytes

Question 41

What is chondromalacia?

Answer 41

repetitive stress on joint, usually caused by muscle imbalance

Question 42

How do you diagnosis chondromalacia?

Answer 42

Pain w/ palpation over joint, pain w/ movement, effusion is possible, x-ray may show malalignment, articular cartilage changes seen on MRI or arthroscopy

Question 43

What is the treatment of chondromalacia?

Answer 43

ice, relative rest, NSAIDs, steroid injections, physical therapy for muscle balance

Question 44

What is bursitis?

Answer 44

fluid-filled synovial-line sac structure that is inflamed

Question 45

What causes bursitis?

Answer 45

direct trauma, prolonged pressure, overuse, crystalline arthropathy, inflammatory arthritis, infection

Question 46

What are the common locations for bursitis?

Answer 46

subacromial space, greater trochanter, olecranon, prepatellar/infrapatellar, ilopsoas

Question 47

How do you diagnosis bursitis?

Answer 47

Boggy, warm, erythematous bump that is tender to palpation, can image for local tendon tears in deep bursa, consider aspiration to rule out septic, inflammatory or crystaline bursitis

Question 48

What is the treatment of bursitis?

Answer 48

protection, ice, NSAIDs, steroids, bursectomy