Lec.6 - Injury classification and stage of healing

Question 1

Musculoskeletal trauma - Macrotrauma

Answer 1

Large magnitude

Question 2

Musculoskeletal trauma - Microtrauma

Answer 2

Small magnitude

Question 3

Direction of force (5)

Answer 3

Tensile
Compression
Shear
Torsion
Bending (combination)

Question 4

Response to force - Elastic response

Answer 4

Tolerable load = load is removed and tissue goes back to original shape

Question 5

Response to force - Yield load

Answer 5

Max amount of load before deformation occurs

Question 6

Response to force - Failure

Answer 6

Does not return to normal shape

ex: fracture, strains, sprains

Question 7

Magnitude of stress - Stress

Answer 7

Force divided by the area over which the force acts

Question 8

Strength and stiffness of tissue - Acceptable strain tolerance

Answer 8

• Load before failing
• Deformation before failing
  Energy stored before failing

Question 9

Strength and stiffness of tissue - Stiffness of tissue

Answer 9

Steeper slope = greater stiffness

Greater stiffness = less deformation

Question 10

Fibrous joints (4)

Answer 10

• synarthrosis
• sutures
• syndesmoses
• gomphosis

Question 11

Synovial joints (6)

Answer 11

• plane
• hinge
• pivot
• condyloid
• saddle
• ball-and-socket

Question 12

Cartilaginous joints (2)

Answer 12

• synchondrosis & symphyses

Question 13

Main component of connective tissue

Answer 13

Collagen, elastin, reticulin and ground substance

Question 14

Role of connective tissue

Answer 14

Joins structures together

Question 15

Role of collagen

Answer 15

Gives strength to tissue

Most numerous protein in the body

Question 16

Role of elastin

Answer 16

Stretch property + ability to return to its original shape

Question 17

Role of ground substance

Answer 17

Protein chains that give substance to structure (cement like a foundation) + hold water

Question 18

Closed Soft tissue injuries

Answer 18

Muscle/tendon
- strains
- tendinopathy
- contusions
Joint injury 
- sprains 
- dislocations/subluxations
- articular cartilage damage
- bursitis

Question 19

Contusions

Answer 19

Direct compressive force created by external blow

Question 20

Complications of contusions (3)

Answer 20

Acute compartment syndrome, active bleeding, large hematomas

Question 21

Classification of contusions - First degree

Answer 21

Superficial tissues are crushed
Mild if any weakness
Mild loss of function
No restriction in ROM

Question 22

Classification of contusions - Second degree

Answer 22

Superficial and some deep tissues are crushed
Mild to moderate weakness
Moderate loss of function
Decreased in ROM

Question 23

Classification of contusions - Third degree

Answer 23

Deeper tissues are crushed
Moderate to severe weakness
Severe loss of function
Significantly decreased because of swelling

Question 24

Muscles strains

Answer 24

Caused by a stretch induced by a large contraction (eccentric)

Question 25

S/s of muscle strains

Answer 25

- Acute MOI - overstretch or overload - Pain located over injury site - Discolorations - Muscle weakness and ROM limitations

Question 26

Classification of strains - First degree

Answer 26

``` Few fibers of muscle are torn Mild weakness Mild muscle spasm Mild loss of function Mild swelling No palpable effect Mild pain on contraction Pain with stretching Decreased in ROM ```

Question 27

Classification of strains - Second degree

Answer 27

``` Nearly half of muscle fibers are torn Moderate to severe weakness Moderate to severe weakness Moderate to severe muscle spasm Moderate to severe loss of function Moderate to severe swelling No palpable effect Moderate to severe pain on contraction Pain with stretching Decreased in ROM ```

Question 28

Classification of strains - Third degree

Answer 28

``` All fibers are torn (rupture) Moderate to severe weakness Moderate to severe muscle spasm Severe loss of function Moderate to severe swelling Palpable effect None to mild pain on contraction No pain on stretching ROM may increase or decrease depending on swelling ```

Question 29

Ligament sprains

Answer 29

Acute traumatic injuries to ligaments (placed in extreme ROM in which ligament supports)

Question 30

S/S of ligament sprains

Answer 30

``` Discomfort over ligament Swelling Loss of function Increased laxity Pain with stretching Muscle weakness No contraction pain in theory (real life yes!) ```

Question 31

Classification of sprains - First degree

Answer 31

``` Few fibers of ligament are torn Less than 5mm distraction Mild weakness No muscle spasm Mild loss of function Mild swelling No pain on contraction Pain in stretching Decrease in ROM ```

Question 32

Classification of sprains - Second degree

Answer 32

``` Nearly half of fibers are torn 5-10 mm distraction Mild to moderate weakness None to minor muscle spasm Moderate to severe loss of function Moderate swelling No pain on contraction Pain with stretching Decrease ROM ```

Question 33

Classification of sprains - Third degree

Answer 33

``` All ligaments fibers are torn (rupture) More than 10 mm distraction Mild to moderate weakness None to minor muscle spasm Severe loss of function Moderate to severe swelling No pain on contraction No pain in stretching ROM may increase or decrease ```

Question 34

Dislocation/subluxation

Answer 34

Bones are forced beyond normal limits

Question 35

Bursitis

Answer 35

Irritation of the bursa

Question 36

S/S of bursitis

Answer 36

Localized swelling Point tender Warm to touch

Question 37

Tendinopathy (MOI)

Answer 37

Chronic onset - overuse or by repetitive overstretching or overload

Question 38

S/S of tendinopathy

Answer 38

``` Pain Swelling Crepitus Pain at extremes of motions Pain increases during stretching and RROM Strength decreases with pain ```

Question 39

Tenosynovitis

Answer 39

Inflammation of the synovial sheath surrounding a tendon (common in hands and feet)

Question 40

Acute tenosynovitis

Answer 40

Grating sound (crepitus) with movement, inflammation and swelling

Question 41

Chronic tenosynovitis

Answer 41

Nodule formation in the tendon sheath

Question 42

Long term tendinopathy can lead to_____

Answer 42

Accumulation of mineral deposits in the bone (myositis ossificans)

Question 43

Stages of overuse injuries (4)

Answer 43

Stage 1 = pain after activity only Stage 2 = pain during activity that does not restrict performance Stage 3 = pain during activity that restricts performance Stage 4 = Chronic, unremitting pain even at rest

Question 44

Causes of overuse injuries

Answer 44

Intrinsic factors | Extrinsic factors

Question 45

Overuse injuries - intrinsic factors (2)

Answer 45

Muscle imbalances | Malalignment of limbs

Question 46

Overuse injuries - extrinsic factors (4)

Answer 46

Training errors - too fast too soon Faulty technique Incorrect surfaces and equipment Poor environmental conditions

Question 47

Osteoarthritis

Answer 47

Degeneration of articular cartilage in a joint

Question 48

S/S and cause of osteoarthritis

Answer 48

Pain and limited movement | Cause : stresses obtained during PA, joint trauma, aging process

Question 49

Muscle cramps

Answer 49

Painful involuntary contractions of muscles Often exercise induced Exact cause unknown

Question 50

Muscle spasms

Answer 50

Involuntary contraction of short duration caused by a reflex action that can be biochemically derived or initiated by a mechanical blow to a nerve or muscle

Question 51

Injury types (2)

Answer 51

Primary injury | Secondary injury

Question 52

Cause of primary injury

Answer 52

Particular event | External causes vs internal causes

Question 53

Cause of secondary injury

Answer 53

Complications after the primary injury occurs | Hypoxia and ischemia

Question 54

3 separates phases of soft tissue healing

Answer 54

Inflammatory Proliferative Maturation

Question 55

Inflammatory phase

Answer 55

Day 0-6 Inflammatory response is GOOD (need to control it) SHARP

Question 56

S/S of inflammatory phase

Answer 56

``` Rubor (redness) Calor (local heat) Tumor (swelling) Dolor (pain) Function laesa (loss of function) ```

Question 57

Inflammatory phase part 1 - goal

Answer 57

Stop blood loss from the wound = local vasoconstriction

Question 58

Inflammatory phase part 1 - effect

Answer 58

``` Reduction of blood volume = increased blood viscosity Platelet reaction = clotting as cells form mechanical plug ```

Question 59

Inflammatory phase part 2 - goal

Answer 59

Vasodilatation due to histamine and bradykinin

Question 60

Inflammatory phase part 2 - effect

Answer 60

``` Phagocytosis Release of chemical mediators - increase blood vessel wall permeability - promotes vasodilatation - PAIN! ```

Question 61

Proliferative phase

Answer 61

``` Days 3-21 Repair and regeneration of the injured tissues Development of - new blood vessels - fibrous tissue formation - generation of new epithetical tissue - wound contractions ```

Question 62

Name of the process of new vessel formation

Answer 62

Angiogenesis

Question 63

Maturation phase

Answer 63

Up to 1 year Maturation of newly formed scar tissue Alignment of fibers along muscle fibers to regain mobility and strength

Question 64

Nerve injuries

Answer 64

Do not heal as fast as soft tissues or bones

Question 65

Nerves healing rate

Answer 65

less than 1 mm per day or 2.5mm per month

Question 66

Most common nerve injuries

Answer 66

Tensile and compression injuries