introduction to soft tissue injuries Flashcards
what are examples of radiology images that can be used to see soft tissue injuries?
X ray, ultrasound, MRI, CT scan
what processes does the inflammatory phase of healing involve after an acute/ traumatic injury?
vasodilatation, exudate of tissue fluids, oedema, stimulation of pain fibres
what does the proliferative phase of injury healing involve?
elimination of debris, revascularisation, fibroblast proliferation
what processes does the remodelling phase of soft tissue injury involve?
maturation of collagen fibres, contraction of wound .. can continue up to 6 months
what are the main aims of treatment during the inflammatory phase of injury?
to minimise pain and loss of function
minimise traumatic exudate
promote rapid acceleration to subsequent phases
what are examples of general factors that can delay healing?
Age
protein deficiency
vitamin deficiency
medication - eg NSAID’s
chronic disease
what are examples of local factors which can delay healing?
type and size of injury
poor blood supply to the area
infection
continued inflammation
excessive movement too early
what does the elastic limit represent on the stress strain curve?
it represents the maximum stress that is possible for the tissue in order for it to return to its original shape once the load is removed
why do bones, ligaments, tendons and cartilages all have different shapes to their stress stain curves?
because they are made from different materials - ie some might be more rigid or more elastic than others
what is the stress strain curve?
how the structure of the tissue changes in response to increasing stresses
what does the acronym POLICE stand for in acute injury management?
P= Protect
OL= Optimal Loading
I= Ice
C= Compression
E=Elevate
what structures do ligaments attach?
they attach bone to bone
what is the function of a ligament?
they provide passive stability to a joint - can allow movement to take place in certain planes but not others
what are ligaments made of?
70-80% collagen
3-5% elastic fibres
how would ligament injuries usually occur?
usually a force overload
can be due to trauma or a direct blow
what is a grade 1 ligament sprain?
microscopic or minimal tearing of a few fibres
is there loss of structural integrity with a grade 1 ligament sprain?
there is little or no loss of structural integrity
what are the signs/symptoms of a grade 1 ligament sprain?
little or no swelling
localised tenderness
minimal bruising
what is a grade II or moderate ligament tear?
moderate tearing of the ligaments collagenous fibres with some loss of structural integrity
what are the physical signs / symptoms of a grade II moderate ligament sprain?
structural weakness
some loss of ROM
more bruising and swelling
what does rehab for a grade II ligament injury normally involve?
modified rear and rehab, combined with careful introduction of increasing stress
may take 2-3 months before return to full physical activity
rehab must focus on proprioception
& balance to prevent reoccurrence
what is a grade III severe ligament tear?
a complete tear of ligament with loss of structural integrity
what are the signs of a grade III ligament tear?
altered end feel, abnormal motion
significant bleeding and bruising
may require surgical repair
describe the structure of the joint capsule
there are 2 layers
there is an outer fibrous later that is strong and flexible but inelastic which is supported by ligaments
then there is an inner synovial layer - where the synovial membrane is located
what are the 3 main types of joint injuries?
- Dislocation
- subluxation
- Capsular tear
Define dislocation
the separation of 2 bones where they meet at a joint
Define subluxation
an incomplete or partial dislocation of a joint
what is an example of a joint that are more vulnerable to injuries than others?
the shoulder
what is a muscle strain / tear?
when some or all of the muscle fibres fail to cope with the demands placed upon them
what is a contusion/ haematoma involving muscle?
bleeding into a muscle due to a direct blow eg kick, contact from sport
what is a grade 1 muscle tear?
small number of muscle fibres torn, localised pain, no major loss of strength
what is a grade II muscle tear?
the tearing of a significant number of muscle fibres with associated pain and swelling
note the pain is reproduced by muscle contraction
is strength and movement reduced with a grade II muscle tear?
yes strength is reduced and movement is limited by pain
what is a grade III muscle tear?
a complete tear of muscle, often at a musculotendinous junction.. the function is severely impaired
what is a musclotendinous junction?
the junction in which force is transmitted between a muscle and tendon
what are some examples of predisposing factors in the development of muscle strains?
- inadequate warm up
- insufficient ROM
-fatigue or overuse of muscle
-muscle imbalance
-faulty technique - work, lifting, sport
-previous injury
what are contusions caused by?
a direct blow causing trauma and tearing of muscle fibre - can be intramuscular or intermuscular
what is a tendon?
a strong rope like structure that attaches muscle to bone (note contains type 1 collagen and no elastic fibres)
its role is to transmit load
what are tendons surrounded by?
all tendons are surrounded by fibroelastic paratenon to facilitate gliding and some tendons are surrounded by a synovial sheath
what are 2 examples of tendon injury?
1- rupture/ tear- can be partial or complete
2- tendinopathy
where does a tendon rupture?
occurs at the point of least blood supply eg in the achilles
describe the assessment (what’s noted after contraction, stretch and palpation) of a partial tear of a tendon
contraction - painful and weak
stretch- painful
palpation- tender to touch
describe the assessment (what’s noted after contraction, stretch and palpation) of a complete tear of a tendon?
contraction - no contraction, no pain
stretch- potential increase in ROM
palpation - a gap may be noticed
what is tendinopathy?
an overuse condition/ injury in which the tendon is repeatedly strained and micro tears form
what is neovascularisation?
the growth of new poor quality blood vessels
what are the main aims of tendinopathy rehab treatment /progression?
- to reduce pain
- to improve strength
- too build functional strength - ie more functional tasks
- to increase power by introducing plyometrics
- to develop stretch- shortening cycle SSC
what is the stretch shortening cycle?
the process by which muscles undergo massive stretch and then rapid contraction
what are examples of tendons in the body that are commonly affected by tendinopathy?
- rotator cuff
-patellar tendon
-Achilles tendon - gluteal (medius and minimus) muscles
- adductor longs muscle (muscle of the medial thigh)
Describe the assessment (ie upon contraction, stretch and palpation) of tendinopathy
- CONTRACTION - pain on contraction, also may be weak due to pain of if degenerative tear
- STRETCH- often painful and may be limited flexibility due to pain
- PALPATION - tender and thickening over specific area of the tendon
what is tenosynovitis?
some tendons are surrounded by synovial sheaths to reduce friction
tenosynovitis is inflammation of the synovial sheath surrounding the tendon
what is an example of tenosynovitis?
De Quervain’s tenosynovitis in the wrist
what is the plantar fascia?
a thick connective tissue that functions to support and protect the underlying vital structures of the foot
what is a bursa?
they are small fluid filled sacs between bone and tendon
their role is to reduce friction
what are DOMS?
delayed onset muscle soreness
-sore,aching, painful feeling in muscles after exercise
