Lecture 1: Introduction Flashcards
Tell me about the structure of ligaments and tendons and why its relevant to its dysfunction
Composed of dense, organised connective tissue (70% collagen). If you don’t get enough rest the healing can be disorganised.
-extreme tensile strength
What are the 3 phases of healing connective tissue?
what happens in them and what would this mean for how you would treat each stage?
question she likes to ask in exams
- Reaction phase (initial inflammatory response)–>
-vasodilation, oedema, pain fibres stim, chemotaxis for phagocytosis and initiation of cell division for healing.
Treatment: RICER - Regeneration phase (48hr-6weeks)
-Elimination of debris, revascularisation (more blood flow to area), fibroblast proliferation
Treatment: Rest/ protect - Remodelling phase (3wks-12m)
- contraction and maturation of collagen for increase in tensile strength
treatment: start moving around, basic mobilisation, manipulation and strengthening exercises. Want to increase ROM strength and proprioception
What is the classification of a Tissue injury?
Ligament trauma/injury
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1st Degree (mild)-classic sprain.
- minimal, no structural damage
- recovery usually 10days-2weeks
2nd degree (moderate)-
- moderate tearing
- some loss of structural integrity
- generally require 2-3 wks of activity modification and rehab up to 3 months for full recovery
3rd Degree (severe)
- complete tear
- up to 6 months for full recovery
Classification of Connective Tissue Injury
tendonitis: acute vs Chronic and is graded according to their functional impairment
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I – pain following activity
II – pain with activity
III – pain interferes with activity
IV – continuing pain even between activities
V - Pain interferes with activity and daily living
Requires prolonged rest from activity and may require surgical intervention
Tendon Rupture: partial vs. complete
Soft Tissue: Muscle Injury
Classification. 4 Types?
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- exercise induced muscle injury
- Muscle strain (1st, 2nd, 3rd and tear)
- Contusion (bruise)
- Avulsion (the action of pulling or tearing away.)
Muscle Injuries
Exercise-Induced Muscle Injury.
When are you likely to see it? why do they get pain?
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- Also referred to as post-exercise soreness
- Manifests 24-48 hours following unaccustomed or intense exercise
- Excessive eccentric loading magnifies the response
- Pain is related to damage of muscle cells and associated inflammation
- Can result in acute compartment syndrome, usually in the LL (discussed further in LL lectures)
Muscle Injuries: Muscle strain classifications? Presentation? prognosis? 14
Classification:
1st degree (mild)
2nd degree- partial tear (moderate)
3rd degree (complete tear (severe)
Presentation: Trauma, significant loss of ROM and function, tense and painful swelling
They have a better prognosis with mild-moderae strains and minimal bleeding
-poorer prognosis with re-tear, sever strain esp located in a compartment with excessive bleeding
If someone has grade 2 tear- you will apprach with light stretching and activity so that the repair is organised and hopefully can avoid scar tissue being layed down because this functions different to original tissue.
The degree of the muscle strain injury correlates with long-term disability as well as risk of complications such as?
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- Myositis ossificans
- prolific scarring
- slow resolution
- risk of re-injury
Contusion -common in what sports? classification? 2 types of contusion, what are they? 16
- common in contact sports
- mild contusion (more haemotoma than strain
- moderate to severe- hard to distinguish from a tear
- sever may bring signify scarring
Contusions are either
Intermuscular:
Along large intermuscular septa / fascial sheaths (eg. thigh)
Facilitates gravitational tracking of extravasated blood which minimises inflammatory response and potential scarring – early resolution!
Intramuscular:
2-3 times longer to heal than intermuscular
Heamorrhage more confined and palpable
Inflammation greater
Risk of Myosisits Ossificans, compartment syndrome and scarring greater
Bleeding significantly can cause replacement of scar tissue than muscle- want to do active stretching not massage ie compression
Muscle injury Avulsion What is it? 17 often in what locations?
An avulsion injury is one where a portion of cortical bone is separated from the rest of the bone by the attached tendon – therefore technically. avulsion is an injury caused directly by tendon pull, but is classified as a muscular injury due to the muscle contraction being the underlying cause of the injury. ASIS with Sartorius mm AIIS with Rectus Femoris Ischial tuberosity with Hamstring Olecranon process with Triceps Patella with Quadriceps tendon
What are the stages of Muscle healing?
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Initial inflammation which promotes phagocytosis
Early healing: initial focal deposits of collagen represent early scarring and contribute to tissue stiffness (replacement of contractile with non-contractile tissue)
- Early ROM exercises are essential here to lengthen the immature plastic scar, minimise adhesion formation and assist with collagen orientation
- Modalities such as heat and IFC may assist here
Established healing (days 6-14): early, gentle rehabilitation to re-establish strength and ROM, muscle regeneration is facilitated by activity Care must be taken here not to re-injure!
Bone
What are the common types of fracture we see?
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Common types of fracture:
Stable: broken ends of the bone are aligned (good prognosis for healing)
Simple (closed): no skin piercing; as opposed to –
Compound (open): skin is pierced either by bone or trauma to the region, bone may be visible
Concern for development of osteomyelitis
Transverse: Horizontal fracture line
Oblique: Oblique fracture line
Comminuted: 3 or more fragments; often referred to as “shattered” in lay terms
Classification of the Salter-Harris fractures
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a
What are the stages of fracture healing?
What are the factories that influence fracture healing?
Inflammation (<24 hours)
Soft callus formation (2 -3 weeks)
Hard callus formation (following soft callus – union, up to 3 or 4 months)
Formation of primary woven bone from initial fibrocartilagenous (soft callus) tissue
Remodelling
Can take months – years for complete remodelling
Factors:
- patient age
- circulation
- mechanical factors
Stress fractures:
Usually happen when?
Occurs mainly in who?
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Usually in response to repetitive stress, often due to accelerated, unaccustomed, intense activity with insufficient recovery period
Occurs in elderly, osteoporotic, but also healthy young athletes
Common regions include: femur, tibia, tarsals and metatarsals
Distinguish from pathological fracture – therefore if due to osteoporosis can be considered pathological. Other pathological causes include tumour or bone cyst.
