injury and healing p2 - soft tissues Flashcards
what are soft tissues?
ligaments, tendons + muscle
what are soft tissue made up of?
type 1 collagen
what are ligaments
soft tissue which connect bone to bone
what is the function of ligaments
- restricts joint motion
- hence provides stability
- has proprioception
what do tendons do
connect muscle to bone
what is the function of tendons
it transmits force
what is the typical cause of ligament and tendon injuries?
usually sport related
what are the causes of soft tissue injuries?
- pivoting forces (e.g rolling/twisting joints)
- eccentric contraction (force placed on muscle too high, causing muscle to snap)
- trauma (e.g car accident)
- laceration (cuts)
- avulsion injury
what is an avulsion injury?
occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
how is the severity of a soft tissue injury determined?
using the grading system
what are the different categories of severity of soft tissue injuries?
- grade 1
- grade 2
- grade 3
what happens in a grade 1 tear?
slight incomplete tear, no notable joint instability
what grade tear is this?
grade 1
what happens in a grade 2 tear?
- moderate/severe
- incomplete tear
- some joint instability
what grade tear is this?
grade 2
what happens in a grade 3 tear?
- complete tearing of 1 or more ligaments
- obvious instability
- surgery may be requried
what grade tear is this
grade 3
what are the 4 stages of healing soft tissue injuries?
- bleeding
- inflammation
- proliferation
- re-modelling
how do soft tissues heal differently to bones?
- they heal much slower
- maximum strength of recovery >6 months
- tissue may never fully recover full tensile strength
what anatomical features does the knee consist of
- bones
- muscles
- ligaments
- cartilage
what is this?
anterior cruciate ligament - ACL
what is the role of the ACL in the knee?
gives rotational stability
what are some symptoms of an ACL tear?
- knee feel unstable during sports
- painful
- swelling
what 3 tests can you do on physical examination to determine whether patient has an ACL tear?
- lachmann’s test
- anterior drawer test
- pivot shift test
what is a very broad + generic way of managing an ACl tear?
using PRICE protocol
Protect
Rest
Ice
Compress
Elevate
what are the 2 options of managing ACL tear?
- non-operative
- operative
If you have a ruptured ACL, will it heal to the way it was before?
- no, heals awfully (as avascular tissue)
- means you will permanently have an unstable knee
if ACL ruptures heal so badly, why do many people not get operative treatments?
As ACL is only really needed for rotational stability, meaning ppl without ACL would be fine with day 2 day activities, would only struggle with pivoting sports e.g football/skiing
what is the management process if patient opts for non-operative approach of ACL rupture?
- put in brace
- Use phsyiotherpay/rehab to strengthen muscles to compensate for loss of ACL
If a patient opts for operative approach for ACL rupture, what are the 2 ways it can be treated?
- repaired
- replaced (more common)
what 3 things do you need to consider when determining a management strategy for a patient with ACL tear?
- functional demands
- patient factors
- compliance
what are the risk factors for ruptured achilles?
- 30-50s M
- anabolic steriod users
- ppl taking fluroquinolone
- weekend warrior - only participate in activity in free time
which antibiotic put you at risk of future soft-tissue injuries?
fluoroquinolone
what are some findings on physical examination of patient with ruptured achilles?
- difficulty walking/limp
- unable to stand on tip toes
- swelling/thickening of ankle
- feet will sit up when you lying down
what are some findings on physical examination of patient with ruptured achilles?
- difficulty walking/limp
- unable to stand on tip toes
- swelling/thickening of ankle
- feet will sit up when you lying down
what are some findings on physical examination of patient with ruptured achilles?
- difficulty walking/limp
- unable to stand on tip toes
- swelling/thickening of ankle
- feet will sit up when you lying down
what kind of test can you do on patients to see if they have ruptured their achilles?
simmonds calf squeeze test
essentially squeeze calf and foot goes down if achilles is present
do you repair or replace tendon injuries in surgery?
repair it, cant really replace it
what are some general complications of performing surgery on achilles tendon?
- DVT
- infection
- prolonged immobility
