Exam 6 soft tissue injury Flashcards
What are the mechanisms of ligamentous injury?
repetitive stress (overuse) and acute high-force injuries
What does a ligament injury present with?
Swelling, joint deformity, pain with palpation, limited ROM, joint instability with stress tests
What is the most commonly injured ligament in the body?
anterior talofibular ligament
What is the set rules when taking an xray for an ankle called?
Ottawa ankle rules
What do the ottawa ankle rules state?
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
What is the treatment of an injured ligament?
Relative rest, immobilization (brace, splint, cast), rehab of surrounding structures, surgical repair, surgical reconstruction
What are the consequences of a deficient ligament?
Early arthritis, secondary soft tissue injury, joint instability/disability
What are the three parts of a tendon that can be involved in an injury?
tendon, paratenon, tendon sheath
What is tenosynovitis? What is an example?
inflammation of the tendon sheath, De Quervian’s
What is the cause of most tendon injuries?
degenerative disease of the specific tendon
What is tendinopathy?
wear and tear of the tendon with an absence of inflammation
What is the treatment of tendinopathy?
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
What are risk factors of a tendon tearing?
Degenerative changes (age), malalignment, muscle imbalance, weakness, instability, inflexibility, glucocorticoids
What is a class of drugs that can predispose someone to a ruptured tendon?
fluorinated quinolones
What will a tendon injury present as on an exam?
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
What are some other pathways of treatment of a tendon?
non-operative (will spontaneously resolve), time, relative rest, activity modification, immobilization, physical therapy and eccentric training, anti-inflammatories, pro-inflammatories for some
What are some questions to ask before tendon surgery?
Can function be recovered without surgery, will loss of function be missed? will complete ruptures cause the muscle to retract?
What are the three types of cartilage found in joints?
Glenoid labrum, acetabular labrum, meniscus
What does the lack of fibrocartilage at a joint do to that join?
Loss of load bearing, may increase the probability and severity of a degenerative disease
What are the two ways a patient can have a fibrocartilage injury?
Traumatic tears (active population, sudden change in direction), degenerative tears (aging population, no specific injury, associated with age-related tissue changes (osteoarthritis)
What should a fibrocartilage injury exam look like?
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
what is a SLAP tear?
tear of glenoid labral tear of superior labrum anterior to posterior (10–>2)
What is a Bankart tear? what causes it?
caused by anterior dislocation of the head of the humerus, tear of labrum from 3 o’clock to 6 o’clock
What is a bucket handle meniscus tear?
tear of meniscus where it moves out of joint space and is not easily imaged
What is the treatment of fibrocartilage injury?
Benign neglect, can repair (but only in vascular zone tears of unstable flaps, partial meniscectomy, meniscal transplant
What causes a muscle strain?
powerful eccentric contractions
How do you prevent a muscle strain?
increased flexibility, warm up (temp and extensibility), conditioning (avoids fatigue), strength (able to absorb more energy
How do you treat a muscle strain?
Rest, ice, compression, elevation, NSAIDs, mobilization, rehab
What causes muscle cramping?
cause is uncertain, usually dehydration, electrolyte disturbances, muscle fatigue
What kind of medications can be given for a muscle cramp?
quinine sulfate (found in tonic water), chloroquine sulfate
What is a muscle contusion?
Direct trauma causing damage and partial disruption of muscle fibers, usually resulting is intramuscular hematoma
what will a muscle contusion present as?
tenderness, swelling/palpable hematoma, limits strength and ROM
What is the treatment of a muscle contusion/hematoma?
rest ice early return to gentle motion, can drain it but could lead to infection
What is a complication of a muscle contusion?
myositis ossificans
What is myositis ossificans?
tissue calcification or ossification at the site of an injury
What is compartment syndrome?
rise in intracompartmental pressure above capillary pressure caused by muscle edema
What is chronic compartment syndrome?
Usually resolves when person rests, diffuse pain over anterior or lateral leg after exercise, distal sensory changes are often present,
How do you diagnose compartment syndrome?
tested with a pressure gage
How can a patient injury their articular cartilage?
Acute traumatic injury (tear or osteochondral defect), repetitive excessive loading (chondromalacia)
How do you treat articular cartilage injuries?
shaving (often doesn’t help), microfracture w/ arthroscopic abrasion, cartilage grafts, allografts, chondrocytes
What is chondromalacia?
repetitive stress on joint, usually caused by muscle imbalance
How do you diagnosis chondromalacia?
Pain w/ palpation over joint, pain w/ movement, effusion is possible, x-ray may show malalignment, articular cartilage changes seen on MRI or arthroscopy
What is the treatment of chondromalacia?
ice, relative rest, NSAIDs, steroid injections, physical therapy for muscle balance
What is bursitis?
fluid-filled synovial-line sac structure that is inflamed
What causes bursitis?
direct trauma, prolonged pressure, overuse, crystalline arthropathy, inflammatory arthritis, infection
What are the common locations for bursitis?
subacromial space, greater trochanter, olecranon, prepatellar/infrapatellar, ilopsoas
How do you diagnosis bursitis?
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
What is the treatment of bursitis?
protection, ice, NSAIDs, steroids, bursectomy
