Intro To Ortho Injury PPT

Question 1

What is a primary injury?

Answer 1

Injury that results directly from the initial, immediate trauma associated w/ a particular mechanism of insult

Question 2

What are the 3 types of primary injury?

Answer 2

Direct/Extrinsic, Indirect/Intrinsic, Overuse

Question 3

What is a direct primary injury? Give example.

Answer 3

trauma occurs @ place of impact where force meets body

i.e. contusion from direct force

Question 4

What is an indirect primary injury? Give example.

Answer 4

Force meets the body in such a way that energy is transmitted to another part of the body where the trauma is concentrated & the injury occurs
(i.e. dislocated shoulder from falling on outstretched hand)

Question 5

What is an overuse injury?

Answer 5

Acute repetitive friction OR chronic repetitive microtrauma

Question 6

What is secondary injury and what are the 2 types?

Answer 6

Additional injury that occurs as a result of primary injury.

Secondary enzymatic & hypoxic/ischemic

Question 7

What is the difference between short & long term secondary injury?

Answer 7

Short: results from sequelae of injury, if not managed properly; affects uninjured cells on periphery of the primary lesion

Long: over time may lead to degenerative conditions; increases total quantity of tissue damage; potentially increases healing time

Question 8

What are characteristics of secondary enzymatic injury (4)?

Answer 8

1. lysosomes release enzymes
2. enzymes damage surrounding cells
3. cell membrane loses integrity & polarity
4. swelling -> cell death

Question 9

What are characteristics of secondary hypoxic/ischemic injury (6)?

Answer 9

1. failure of vasculature to supply enough blood = ischemia
2. vascular & inflammatory changes cause a period of hypoxia
3. shift to anaerobic metabolism
4. inability to produce adequate ATP
5. failure of membrane ion pumps
6. swelling -> cell death

Question 10

Where can ischemia come from (7)?

Answer 10

1. damaged blood vessels
2. hemostasis/clotting
3. inflammation induced hemoconcentration
4. thicker blood does not flow as well
5. increased extravascular pressure from expanding hematoma
6. pain induced muscle spasm
7. swelling of injured cells

Question 11

What are the 3 physiological problems that ischemia causes?

Answer 11

1. hypoxia
2. inadequate supply of nutrients
3. inadequate removal of waste

Question 12

What are 6 general mechanisms of injury?

Answer 12

Tension, compression, shearing, torsion, bending, stretching

Question 13

What is tension?

Answer 13

force that pulls tissues (i.e. muscle tendon injuries, sprain/cramp)

Question 14

What is compression?

Answer 14

forceful blow to tissues (i.e. contusion/fracture)

Question 15

What is shearing?

Answer 15

Force that moves parallel to the tissues (i.e. vertebral disc injuries)

Question 16

What is torsion?

Answer 16

twisting/turning force, 1 end of object is twisted in 1 direction & the other end is stabilized / twisted in the opposite direction

Question 17

What is bending?

Answer 17

horizontal force causing the tissue to bend/strain (i.e. spiral fracture/greenstick)

Question 18

What is stretching?

Answer 18

elongation of tissue (i.e. ligaments, strain/sprain)

Question 19

Tendons & ligaments resist _____ force.

Answer 19

tensile

Question 20

Bones resist _____ force.

Answer 20

compressive

Question 21

Discs resist ______

Answer 21

tension, compressive, shear, & torsion forces

Question 22

What is a bruise?

Answer 22

compression that causes bleeding under the skin

Question 23

What is a contusion?

Answer 23

acute compression causing hemorrhage of a muscle tissue

Question 24

What are muscle cramps?

Answer 24

acute painful involuntary muscle contraction caused by dehydration or an electrolyte imbalance

Question 25

What is a muscle spasm?

Answer 25

reflex muscle contraction caused by acute trauma (serves to protect an area)

Question 26

What is muscle hypertonicity?

Answer 26

Increased activity of an otherwise normal muscle (no nerve/muscle pathology present, resting tone of muscle = greater than normal)

Question 27

What could muscle hypertonicity cause?

Answer 27

muscle imbalance w/an inhibited/weak antagonistic muscle

Question 28

What is muscle spasticity?

Answer 28

increase in muscle tone @ rest, result of Upper Motor Neuron Lesion (UMNL) (increased resistance to passive stretch, exaggerated deep tendon reflexes, & clonus)

Question 29

What is a sprain?

Answer 29

stretching/tearing damage to a ligament (if ligament fibers torn, assume other fibers are likely to have been torn… muscle/joint capsule/disc annulus)

Question 30

What are the differences btwn grades 1-3 sprains?

Answer 30

1. 0-20%: minimal pain & loss of function, mild point tenderness, little/no swelling, & no abnormal motion when tested (stability of join intact)
2. 20-75%: moderate pain, loss of function & swelling, moderate joint instability present
3. 75+%: extremely painful w/a major loss of function, tenderness, swelling, & sever instability (surgical repair is probably indicated)

Question 31

What are 4 causes of sprains w/examples?

Answer 31

1. sudden load (whiplash)
2. direct blow (later force to knee causing MCL sprain)
3. repetitive overload (keyboard/typing)
4. Sustained postural overload (long hrs @ workstation/studying)

Question 32

What are 6 clinical impressions of sprains?

Answer 32

1. decreased active/passive range of motion w/pain (esp. in direction that stretches the ligament/capsule)
2. isometric muscle contraction causes NO pain
3. local tenderness & occasionally edema/bruising
4. may have pain on weight bearing (esp. grade 1/2)
5. Palpatory defect may be present in more severe sprains
6. may produce joint instability

Question 33

What are 5 residual/late effects of sprains?

Answer 33

1. fibrosis
2. subluxation
3. instability
4. proprioceptive & coordinating/control problems
5. atrophy of related muscles

Question 34

What is a strain?

Answer 34

acute stretch, tear, or rip in the muscle/tendon

Question 35

What are grades 1-3 of strains?

Answer 35

1. -10%: minimal tearing w/ tenderness & decreased strength (function of muscle is intact but painful)
2. 10-50%: moderate tearing w/ pain & impaired muscle function (function of muscle is painful & limited)
3. 50+%: severe tearing w/pain, loss of muscle function & a palpable deformity (surgical repair is probably indicated)

Question 36

What are 4 causes of strains?

Answer 36

1. sudden contraction/stretch
2. repetitive contraction
3. sustained postural load
4. blow to a muscle

Question 37

What are 5 clinical impressions of strains?

Answer 37

1. Isometric muscle contraction = most provocative for pain & weakness
2. decreased active RoM w/ pain (concentrically/eccentrically)
3. norm. passive RoM w/o pain until end range in the direction that stretches the muscle/tendon
4. Local tenderness & occasionally edema
5. palpatory defect may be present in more severe tears

Question 38

What are 6 residual/late effects of strains?

Answer 38

fibrosis, subluxation, MFTPs, proprioceptive & coordination/control probs, atrophy, myositis ossificans

Question 39

What are 6 types of synovial joint injuries?

Answer 39

acute synovitis, dislocation, subluxation, separation, intra-articular injury, extra-articular injury

Question 40

What is acute synovitis?

Answer 40

inflammation of the synovial membrane

Question 41

What is a dislocation & subluxation?

Answer 41

complete & incomplete separation btwn 2 articulating bones

Question 42

What is separation synovial joint injury?

Answer 42

increase in joint space btwn articulating surfaces

Question 43

What is an example of 4 intra-articular injuries?

Answer 43

1. osteochondrosis - degenerative changes of bone epiphysis/apophysis
2. osteochondritis dissecans - avascular degeneration of articular cartilage
3. apophysitis - inflammation of the tendon-bone junctions
4. traumatic arthritis - inflammation causing thickness of the synovium of a joint & resulting in creptitis & grating

Question 44

What is an example of 4 extra-articular injuries?

Answer 44

1. bursitis - inflammation of a bursa
2. capsulitis - inflammation of a joint capsule
3. paratenonitis - inflammation of the outside of a tendon/ its sheath
4. tendinosis - degeneration of the collagen matrix of a tendon

Question 45

What are 5 examples of peripheral nerve injury?

Answer 45

1. Burner - irritation & pain from nerve traction/stretching
2. Neuritis - inflammation of nerve cells
3. Sciatica - stretch of the sciatic nerve
4. Carpal Tunnel Syndrome - compression primarily of median nerve
5. mortons neuroma - tumor of a neuron in the foot

Question 46

What are the 3 stages of nerve injury?

Answer 46

1. Neuropraxia
2. Axontemesis
3. Neurotmesis

Question 47

What is the definition of neuropraxia?

Answer 47

transient physiological block = caused by ischemia from pressure/stretch of nerve w/no wallerian degeneration

Question 48

What are symptoms of neuropraxia (6)?

Answer 48

Pain, none/minimal muscle wasting, muscle weakness, numbness, proprioception affected, recover: minutes-days

Question 49

What is the definition of axontemesis?

Answer 49

Internal architecture of the nerve = preserved, but axons are so badly damaged that wallerian degeneration occurs

Question 50

What are symptoms of axontemesis (5)?

Answer 50

pain, muscle wasting evident, complete motor/sensory/sympathetic functions lost, sensation = restored before motor function, recover: months

Question 51

What is the definition of neurotmesis?

Answer 51

structure of the nerve is destroyed by cutting, severe scarring, or prolonged severe compression

Question 52

What are symptoms of neurotmesis (4)?

Answer 52

No pain (anesthesia), muscle wasting, complete motor/sensory/sympathetic functions lost, recover: months & only w/surgery