Intro to STIs Flashcards
Types of injury
Traumatic Injury
‘Overuse’ Injury (cumulative ‘load)
Not just Sports Injuries!
Types of Soft Tissue Injury
ligament - sprain/tear
Bursa -bursitis
Joint capsule - joint dislocation/subluxation
Muscle - strain/tear, contusion
Tendon - partial/complete rupture, tendinopathy, tensosynovitis
soft tissue injury of synovium
synovitis
soft tissue injury of fascia
fasciitis
soft tissue injury of menisci
menisci tear
fat pad soft tissue injury
inflammation
soft tissue injury labrum
tear
soft tissue injury of nerve
compression, irritation,sensitisation
inflammatory phase of acute/traumatic injury
Vasodilation
Plasma proteins/exudate of tissue fluid/ oedema
Stimulation of pain fibres
Cellular response
proliferative phase of acute/traumatic injury
Elimination of debris
Revascularisation
Fibroblast proliferation
remodelling phase of acute/traumatic injury
Contraction of wound
Maturation of collagen fibres
Continues up to 6 months
aims of treatment of injury in the inflammatory phase
Minimise traumatic exudate,
Minimise pain, loss of function,
Promote rapid acceleration to subsequent phases
aims of treatment in the proliferation phase
Facilitate removal of debris
Optimise fibroblast production
promote revascularisation
aims of treatment in remodelling phase
Ensure mobile and well conditioned scar
general factors that delay healing
Age Protein deficiency Vitamin deficiency Steroids (inhibitory effect) Colder Temperature
local factors which delay healing
Type and size of injury Poor blood supply to the area Continued inflammation Infection Excessive movement too early
function of ligaments
reinforces a joint capsule
attaches bone to bone
provides passive stability to joint - allow movement to take place in certain planes
restrain too much movement
what kind of impulses are sent from the ligaments what is its purpose
Proprioceptive impulses are transmitted from the ligament to Central Nervous System (CNS), where muscles are recruited to provide dynamic support
mechanism of injury in ligament injury
force beyond its tensile strength is applied due to Trauma Collision Direct blow Sport
what characteristics does connective tissue have to have
pliable and strong
when longitudinal stress is applied to connective tissue
Elongation: straightening out of crimping
Microfailure: e.g. in cumulative overload
Failure (tearing): e.g. macrofailure or clinical strain.
grade I ligament sprain
stretching small tear
little to no loss of structural integrity
Grade II ligament sprain
moderate but incomplete tear of ligament collagenous fibres
less structural integrity
Grade III ligament sprain
complete tear
loss of structural integrity
signs of grade I ligament sprain
Solid end-feel on stress testing
Little or no swelling
Localised tenderness
Minimal bruising
implications of grade I ligament sprain
Minimal functional loss
Treatment progress guided by pain
Return to full activity within 10 days to 2 weeks.
Early return to activity/training- some protection may be necessary.
signs of grade II ligament sprains
Significant structural weakness
Some loss of ROM 2 to pain
Solid end-feel to stress testing.
More bruising and swelling.
Implications of Grade II ligament sprain
Increased tendency for healed ligaments to stretch out with time leading to functional instability.
Tendency for recurrence
treatment and timeframe of Grade II ligament sprains
modified rest and rehabilitation - careful intro to increasing stress
6-8 weeks
may take 2-3 months before full physical activity
rehab focus on proprioception/balance toprevent recurrence
signs of grade III ligament sprain
Altered end feel/stress tests/abnormal motion
Significant bleeding +/-bruising
treatment of grade III and possible time frame
May require complete or modified immobilisation of the ligament for between 3-6 weeks.
Or may require surgical repair
Prolonged rehabilitation
aims of treatment for ligament sprain
Treat pain/ swelling POLICE Promote healing Restoration of function ROM/Strengthening Prevention of recurrence Balance/Proprioceptive rehab Sports/Activity specific rehan
2 layers of joint capsule
Outer fibrous layer-strong, flexible but relatively inelastic. Supported by ligaments
Inner synovial layer: synovial membrane
POLICE
Protect - prevent further tissue damage, use crutches
Optimally Load - load, mobilise and use area as pain is tolerated
Ice - apply ice 15-20 mins every 2-3 hours
Compress - area with elastic or tubular bandage to reduce swelling
Elevate - injured area to reduce swelling
injuries of join capsule
dislocation
dislocation
complete dissociation of the articulating surfaces
subluxation
where the articulating surfaces remain partially in contact with each other.
causes of dislocation
Can be caused by a fall, blow or other trauma
Some joints more vulnerable than others
Results in injury to capsule and associated ligaments
injuries in muscle
muscle strain/tear - some or all of the fibres fail to cope w/ demands place on them
contusion/haematoma - bleeding a muscle from direct blow
Grade I muscle sprain
Small number of muscle fibres
Localised pain
No major loss of strength/Endurance may be reduced
grade II muscle sprain
Tear of significant number of fibres with associated pain and swelling. Pain is reproduced by muscle contraction Strength is reduced Movement is limited by pain. Contained bleeding
Grade III muscle sprain
complete tear of muscle, often at musculotendinous junction. Function severely impaired. Greater bleeding with tracking
predisposing factors in development of muscle strains
Inadequate warm up before activity, sport Insufficient ROM Excessive muscle tightness Fatigue/Overuse Muscle imbalance
most common muscle injuries
contusions
common areas of contusions
quads, gastracs, hams
causes of haematoma
direct blow causing trauma and tearing of muscle fibre proportionate to the severity
types of haematoma
intramuscular and intermuscular
signs of haematoma
Bleeding within the tissues
Formation of inflammatory exudate
Tissue death/ phagocytosis/ proliferation/healing
Rare complication – myositis ossificans
main function of tendon
to transmit load
all tendons are surrounded by
fibroelastic paratenon to facilitate gliding
what connective tissue can withstand greater tensile strength tendon or ligament?
tendon
what are SOME tendons surrounded by
synovial sheath
tendon injuries
rupture - partial or complete
tendinopathy
where does tendon rupture occur
Occurs at the point of least blood supply
examples of tendon rupture
Achilles (lower limb)
Supraspinatus (upr limb)
Long Head of Biceps (upr limb)
contraction of partial tendon rupture
weakness, pain
stretch of partial tendon rupture
pain
palpation of partial tendon tear
tender
contraction of complete tear of tendon
no contraction (0/5 Oxford) no pain
stretch of complete tendeon tear
increase in ROM
no pain
palpation of complete tear of tendon rupture
gap
tendinopathy
Overuse condition which can become chronic
Collagen disarray & separation
↑ ground substance
Neovascularisation (↑ poor quality blood vessels)
common areas of tendinopathy
Rotator cuff Extensor Carpi Radialis Brevis (ERCB) ‘Tennis Elbow’ Patellar tendon (NMSK II) Achilles tendon (NMSK II) Adductor longus Biceps (upper and lower limb-NMSK II Tibialis posterior Gluteal (Med/Min) Muscles (NMSK II)
stages of tendinopathy
underloaded normal reactive tendinopathy tendon disrepair degenerative tear
cause and signs of underloaded tendinopathy
cause -Insufficient stress
sign - asymptomatic
cause and sign of normal tendinopathy
cause - Can cope with normal loading
sign -Asymptomatic
cause and sign tendinopathy
cause -
Applied load> physiological capability. Has potential to revert back to normal structure
applied - pain: constant or activity dependant. Positive signs on clinical examination
cause and signs of tendon disrepair
cause - Changes in quality of tendon
sign -Similar clinical signs +/- changes on US/MRI. Pain may be more persistent
cause and sign of degenerative tear
cause -Structural failure with partial or full thickness tears
signs -Significant impact on function and strength. Positive signs on examination including significant weakness
clinical presentation of tendinopathy
localised pain
sharp, dull, chronic ache
pain disappears with warm up, returns after exercise
local tenderness
tendinopathy contraction
Pain on contraction
May be weak due to pain or if degenerative tear
tendinopathy stretch
May or may not be painful
May limited flexibility due to pain
tendinopathy palpation
Tender /thickening over specific area of tendon
tenosynovitis
inflammation of synovial sheath surrounding a tendon
example of tenosynovitis
is De Quervain’s tenosynovitis at wrist
purpose of MRI/US for tendon injury
Can distinguish partial vs complete tear vs tendinopathy
bursitis
inflammation of bursa
bursa
small fluid filled sacs between bone and tendon
cause of bursitis
overuse
direct trauma
