intro to orthopedic injury Flashcards
- Primary Injury
Direct/ extrinsic
Indirect/intrinsic
Overuse
Secondary Injury
enzymatic
hypoxic
short term and long term
Ischemia Causes:
- Damaged blood vessels
- Hemostasis/clotting
- Inflammation induced hemoconcentration
- Thicker blood does not flow as well
- Increased extravascular pressure from expanding hematoma
- Pain induced muscle spasm
- Swelling of injured cells
Ischemia results in
- Hypoxia
- Inadequate supply of nutrients (glucose)
- Inadequate removal of waste
- Mechanisms of Injury:
Tension (tendons/ligaments) Compression (bone) Torsion (twisitjg) Shearing (parallel, vertebrae resist all of the above) Bending (greenstick, spiral fracture) Stretching (strain, sprain)
Common injuries
Bruise Contusion cramp, spasm muscle hypertonicity, spacticity sprain
spasm
a reflex muscle contraction caused by acute trauma; serves to protect or guard an area
muscle hypertonicity
increased activity of normal muscle. - No nerve or muscle pathology but resting tone is greater than normal
May cause muscle imbalance with an inhibited/weak antagonist muscle
muscle spacticity
- increase in muscle tone at rest
- Increased resistance to passive stretch, exaggerated deep tendon reflexes and possibly clonus
- Result of an Upper Motor Neuron Lesion
Sprain grading
ligament damage-Grade 1 (0-20%) - minimal pain and loss of function, little or no swelling, and no abnormal motion when tested; stability of the joint is intact
-Grade 2 (20-75%) - moderate pain, loss of function and swelling; moderate joint instability present
-Grade 3 (>75%) - extremely painful with a major loss of function, tenderness, swelling and severe instability; surgical repair is probably indicated
NO ISOMETRIC PAIN
Strain grading
an acute stretch, tear or rip in the muscle or tendon
- Grade 1 (50%) - severe tearing with pain, loss of muscle function and a palpable deformity; surgical repair is probably indicated
- *often caused by sudden contraction
- **ISOMETRIC CAUSES PAIN
Synovial Joint Injury:
- Acute Synovitis - inflammation of the synovial membrane
- Dislocation - a complete separation b/t two articulating bones
- Subluxation - an incomplete separation b/t two articulating bones
- Separation - an increase in joint space b/t articulating surfaces
-Intra-articular joiny injury
- Osteochondrosis - degenerative changes of bone epiphysis or apophysis
- Osteochondritis dissecans - avascular degeneration of articular cartilage
- Apophysitis - inflammation of the tendon-bone junctions
- Traumatic arthritis - inflammation causing thickness of the synovium of a joint and resulting in creptitis and grating
-Extra-articular injury
- Bursitis - inflammation of bursa
- Capsulitis - inflammation of joint capsule
- Paratenonitis - inflammation of the outside of a tendon or its sheath
- Tendinosis - degeneration of the collagen matrix or a tendon
- Peripheral Nerve Injury:
- Burner - irritation and pain from nerve traction or stretching
- Neuritis - inflammation of nerve cells
- Sciatica - stretch of sciatic nerve
- Carpal Tunnel Syndrome - compression of median nerve
- Mortons Neuroma - tumor of a neuron in the foot
Stages of Nerve Injury
Neuropraxia, Axontemesis, Neurotmesis
Neuropraxia
a. a transient physiological block is caused by ischemia of the nerve with no wallerian degeneration
b. Pain, none/minimal muscle wasting, muscle weakness, numbness, proprioception affected, recovery in minutes to days
Axontemesis
a. Internal architecture preserved, but axons are so badly damaged that wallerian degeneration occurs
b. Pain, muscle wasting evident, complete motor, sensory and sympathetic function lost, sensation is restored before motor function, recovery months (axons regenerate 1 inch/month)
Neurotmesis
a. Structure of the nerve is destroyed by cutting, severe scarring or prolonged severe compression
b. No pain, muscle weakness, complete motor, sensory and sympathetic functions lost, recovery months and only with surgery
