Intro to Orthopedic Injury Flashcards
Ex I
What are the three types of primary injury?
Direct: trauma at point of impact (contusion)
Indirect: force from trauma is transmitted to tissue (shoulder dislocated by falling on hand)
Overuse: acute repetitive friction or chronic repetitive microtrauma
What’s the difference between primary and secondary injury?
Primary: Injury caused directly by trauma
Secondary: Additional injury due to primary injury
What are the two types of secondary injury?
Enzymatic (enzymes released from damaged cells cause further local damage) and ischemic (loss of blood flow leads to local hypoxia and cell death)
What are three physiological problems caused by ischemia?
Hypoxia, inadequate nutrients, inadequate waste removal
Tension
A force that pulls tissues
Muscle-tendon issues like sprain and cramp
Compression
Forceful blow to tissues
Contusion, fracture
Shearing
Force move parallel to tissues
vertebral disc injuries
Torsion
Twisting or turning force
Bending
Horizontal force causing tissue to bend or strain
spiral or greenstick fracture
Stretching
Elongation of tissues, especially ligaments
Strain, sprain
What structures respond to the different forces?
Tendons and ligaments resist tension
Bones resist compression
Intervertebral discs resist tension, compression, shearing, and torsion
Bruise/contusion
Compression that causes hemorrhage under the skin
Muscle cramps
acute painful involuntary muscle contraction
caused by dehydration or electrolyte imbalance
Muscle spasm
reflex muscle contraction caused by acute trauma
serves to protect an area
Muscle hypertonicity
increased activity of an otherwise normal muscle
muscle tone is increased with no patent pathology
Muscle spasticity
increased muscle tone at rest
increased resistance to passive stretch, exaggerated DTRs, possible clonus
Result of upper motor neuron lesion
Sprain
stretching or tearing damage to a ligament and possibly associated tissues
Sprain grading
1 (0-20%) Minimal pain and loss of function, retains stability
2 (20-75%): moderate pain, loss of function, swelling, and instability
3 (>75%): extremely painful, major loss of function, severe instability. surgery indicated.
What causes a sprain, and what are some examples?
End range loading sudden load (whiplash) direct blow (lateral force to knee) repetitive overload (typing) sustained postural overload (long hours at workstation)
Clinical impression of sprain
Decreased active and passive range of motion with pain
No pain on isometric contraction
local tenderness, edema, bruising
Joint instability
Strain
acute stretch or tear in muscle or tendon
strain grading
1: 50% severe tear, loss of function, palpable, surgery indicated
what causes strain, examples?
sudden contraction (most likely) sudden stretch repetitive contraction sustained postural load blow to muscle
clinical impression of strain
isometric contraction is most provocative of pain and weakness
decreased active rom with pain
normal passive rom without pain
