Lecture 10 - Sprains And Strains Flashcards
Grades of severity of tissue damage
- Grade 1: Mild tissue pain and swelling, 50% tissue disruption, significant LOF
- Grade 3: severe pain and swelling, 100% tissue disruption, complete LOF
Repair vs regeneration
- Repair: replacement of damaged tissue with new tissues structuralky and functionally different
- Regeneration: replacement of damaged tissue with new tissue structurally and functionally identical
3 phases of repair
1) acure inflammatory phase
2) Repair phase
3) Remodeling phase
Phases of repair: 1) acute inflammatory phase
- first 3 days
- immediate non specific reaction to infection or injury
- AIMS: destroy damaged cells, inactivate foreign invaders, prepare for tissue repair
- damaged region is being prepared for repait
Phases of repair: 2- repair (proliferation) phase
- 2 days - 6weeks post injury
- vascularisation of the damaged region
- synthesis and deposition of collagen fibres
- collagen laid down in a non-uniform manner
- damaged area is FILLED with new tissue
Phases of repair 3) Remodelling phase
- 2 weeks - 12 months post injury
- overlap with phase 2
- collagen cross bonds and reorients in direction of stress
- tissue improves in quality and strength
Wolf’s law
Tissue will respond to physical demands placed on them
- remodel or realign along lines of tensile force
- for optimal remodelling, tissues should be exposed to progressively increasing loads
Treatment principles relative to stage of healing: Stage 1 - inflamatory phase
- reduce pain
- control inflammation
- prevent further cellular damage
- prevent onset of complications
- functional independence
Treatmetn principles relative to stage of healing: stage 2: repair phase
- reduce pain
- restore ROM
- facilitate organised alignment of collagen
- prevent adhesion and scarring
- prevent further cellular damage
- prevent onset of complications
- maintain fitness
Treatment principles relative to stage of healing: 3) remodelling phase
- strengthen new tissue
- restore ROM
- increased extensibility of new tissue
- specific training
- prevent recurrence
Ligament injury
- when forces exceeds the ligaments ability to resist that load
- ligament stronger when load is applied slowly: rapid onset may cause the ligament to tear
- associated structures may be injured
Diagnosis of ligament injury
- mechanism of injury
- pain localisation
- associated symptoms/sounds
- complaints about instability
- pain on palpation/stretching
- increased laxity in direction of ligament tension
Classification of ligament injury
- Grade 1: partial tear: pain, no laxity
- Grade 2: PArtial tear: pain, some laxity
- Grade 3: complete tear: marked laxity and no disting end feel
Ligament damage management
- grades 1,2: conservative
- Grade 3: conservative, surgical repair or reconstruction
- same principles for soft tissue injury management
- emphasis on re-injury prevention
Lateral ankle sprain
- most common sporting injury
- 70% will reinjure or develop chronic ankle instability
- caused by forced inversion and plantarflexion force
- Most commonly affected: AFTL or CFL
Special test for lateral ankle sprain
Anterior drawer test
MAnagement of lateral ankle sprain
- RICE
- nobility
- bracing or taping
- joint mobilisations and manipulations
- proprioceptive, balance exercises
- strenghtening exercises
Anterior cruciate ligament injury
- may have associated meniscal injury, articular cartilage damage or MCL
- RIsk factors: family Hx or previous injury, females, bone geometry…
Theories for ACL injuries
- Ligament dominance theory: excessive knee valgus, hip adduction
- Trunk dominance theory: deficits in trunk control indirectly increases valgus forces at knee
- Quadriceps dominance theory: excessive quadriceps forces increase pull on ACL
- Leg dominance theory
ACL Diagnosis
- pop/ snap sound
- Pain
- effusion
- instability
- clinical tests: Brush/swipe effusion test, anterior drawer test, Lachman’s test, pivot shift test
Management of ACL tears
- ACL reconstruction is not the prerequisite for returning to sports
- conservative management for those copign well
- Surgery: Autograft (hamstring), Autograft (Patella tendon), LARS
- all the same after 2 years
REhabilitation management of ACL tears
- weight bear as tolerated
- brace until quadriceps control returns
- gradual progression of exercises
Muscle strain
- insertion sites
- tendon
- tendon sheaths
- MSK tendinous junction
- skeletal muscle
HEaling of muscle injuries
- Inflammatory phase
- marked hematoma
- myofibrils contract
HEaling of muscle injuries
- reparative phase
- regeneration of myofibers
- production of connective scar tissue
HEaling of muscle injuries
- remodeing phase
- maturation of regenerated myofibers
- reorganisation od scar tissue
Muscle strain
- indirect injury caused by overstretching or eccentric overload
- most common site is musculotendinous junction
- ## often occurs in 2 joint muscles
Complication of muscle ruptures
- scar tissue formation -> affects elasticity of muscle
- traumatic myositis ossificans -> calcification and ossification of a hematoma, healing disrupted by repeated impact or contractin, results in areas of varying strength and elasticity in affected muscle
Management of muscle injury consideration
- muscle strength
- muscle length
- stamina
- stability
- capacity for rapid contraction
