lecture 6: injury classification Flashcards
explain macrotrauma and give exmples
large maginited
ex: sprains, strains, contusions
explain microtrauma and examples
small magnitutde
ex: stress fractures, overuse injuries
what are the forms of muscuoloskeletal trauma
physical, chemical, thermal, metabolic and biological
what are the 5 directions of force
Tensile Compression Shear Torsion Bending (combination)
what are the2 types of dirextion of force that are longitudinal
and give example
tensile and compression
muscle elong.
true or false: direction of focre only applied ot bone
false, bone,l igs, capsules and msucles
be able to explain the different forces
.
what are the 3 responses to force
1) elstic response
2) yield load
3) failiurre
explain elastic repsonse
period of time where normal structire function
Load is removed and tissue goes back to original shape
explain yield load
max amount of load before deformation occurs
explain failure
Does not return to normal shape
Fractures, strains, sprains
in what region do injuries happen
failure/plastic region
turue or false : the deformation in the elastic region is tolerable
true
whats the general response to force
elongation (strecth/deformation) >miccrotauma > failure/macro
what is stress
Force divided by the area over which the force acts
true or false and explain: Force over a large area versus over a small concentrated area can have very different results
ex: Increased SA= decraed foce
what is the accpetable strain tolerance
Load before failing
Deformation before failing
Energy stored before failing
in terms of stiffness of tissue, a steeper slope mean
greatter stifness
if a tissue has a greater stiffness, it has more or less deformation
less
know the straing and stress grpah
.
deformation that is accetepable occurs in what region
elastaic
what affects the load distrubion ,force absorption and stabilityo of a joint
joint types
what are the fibrous joints
Fibrous joints: synarthrosis, sutures, syndesmoses and gomphosis joints
what are the cartilaginous joints
Cartilaginous joints: synchondrosis & symphyses
what are the sunovial joints
Synovial joints: plane, hinge, pivot, condyloid, saddle & ball-and-socket.
Synovial joints incl. what structures
articular cartilage, synovial cavity, articular capsule, synovial fluid and ligaments.
what tis the function of connective tissue
joins strtuctures toghther
connecttve tissue can be …
dense or loss
and regular vs irrengular
what are the 3 main componenets of connectiev tissue
collagen, elasttin, reticulum
=and ground substance
whatt is the function of collagen
give stregnth to tissue
what is the most numerous protein in the body
collagen
whatt makes up 95% of bones sexttracellular matrix
collagen
what did collagen develep from
fibroblasts
collagen forms what and why is that imporant
crosslinks and it increases soliditty
what is elastic
has a stretch property,
ability to retturn to origional shape
where is elastin scarce
tendon and ligaments
why can tendons and ligamentts only be strecthed limited amounts
because scarce amount of elastin
what is ground substance
Protein chains that give substance to structure
Provide cement like foundation (provide strength for collagen)
Hold water
what is the cause of injuries in terms of proteins
collagen and elastin becaome distubed
what is the cause of injury
event altering the tissue structure
what does injury affect
the ability of tissues to carry out normal function/ load
why do we care about cause of injury
1) helps with injury prevention again
2) helps with injury rehab
= allows to assess in a more specific mannerr
what are the closed soft tissue injuries of muscle/
strains
tendinopathy
contusions
what are the closed soft tissue injuries of joints
Sprains
Dislocations/subluxations
Articular cartilage damage
Bursitis
what is the main 2 symptoms of closed soft tissue injuries
sweeling and discolouratiton
true or fasle: in a closed soft tissue injury there is leakage
false, swelling is all contained
what is tthe cause of contusion
Direct compressive force created by external blow
or falling
what is an ecchymosis
Ecchymosis- tissue discoloration if hemorrhage is superficial
what is hematoma
Hematoma- swelling of clotted blood
what are some expamples of complicates of contunsions
Complications of contusions can be acute compartment syndrome, active bleeding and large hematomas
wgat is acute compartmentt syndrome
if fluid gets in comparment and sweels it can compress on nerves, veins ettc and cause problems
explain first degree cnotusions
superficial strecutures crushed
mild weaknes and loss of function
no restriction in ROM
explain second deree contusions
superficial and some deep are crushed
mild weakness and mod loss of function
decreased ROM
explain third degree contusions
deeoer tissues are crushed (fasicia can be raptured and swollen tissues protrude)
mod to severe weakness nd loss of function
ROM is significantly decreased because of swelling
what are muscle strains
Injuries to the muscle that cause varying degrees of tears to a muscle
ttrue or false: grading if very different for diff structures that are injuried
trtue
what is the typical cause of muscle strain
Typically caused by a stretch induced by a large contraction
Eccentric contractions**
ex: decceleration
what are some signs and symptoms of muscle strain
Acute MOI- overstretch or overload
Pain located over injury site (commonly musculotendinous junction)
Discolorations (severe cases)
Muscle weakness and/or ROM limitations
explain first degree strain
few fibers are ttorn and there is mild weakness, loss of function, swelling =no pap. defect =mild contrtction pain =pain with strtecth decrased ROM
exlain 2nd degree strain of muscle
nearly half fibers are torn and there is mod to sevsere weakness, loss of function, swelling =no pap. defect =mod-severe contrtction pain =pain with strtecth decrased ROM
explain 3rd degree strains of muscle
all muscle fibers torn (ruptture) and there is mod to sevsere weakness, loss of function, swelling =yes pap. defect =none to mild contract. pain =no pain with sttretcth decrased/increase ROM
true or false: in a muscle strain 3rd degree there is pain with strtecthing
false, no ligaments left to stretcth
what is the cause of ligament sprains
Acute traumatic injuries to ligaments
Placed in extreme ROM in which ligament supports
(extreme force on log at ROM or combined force directions)
signs and symptoms of ligament sprains
Discomfort over ligament (point tenderness)
Swelling
Loss of function
Increased laxity (no passive stability)
Pain with stretching
Muscle weakness (usually pain/apprehension)
No contraction pain*** theory no, real life yes!
explain why in lgament sprains there should technically be no contraction pain
because no affecting muscles just ligamnets (so only passive should hurt)
treu or false: ligamentts will tear before joint stability is compormised
true
does pain dictate grade
no
explain first degree sprain
check slides
what is discolation and what are tthe 2 types
Bones are forced beyond normal limits
Partial or incomplete dislocation is called a subluxation
true or false: subluxation is a complete dislocation
falsse, that is subluxation
what is discolation/sub usually assocaitted with
Associated with damage to surrounding ligaments and capsules, as well as possible muscle-tendon units
what is bursitis
irritation to bursa
true or false and explain: bursitis can be both acutte and chronic
true
it can be from single traumatic compression or repeated compressions
what ar the signs and symptoms of bursitis
Localized swelling (obvious in olecranon, prepatellar) Point tender Warm to touch
which type of bursitis causes warm to tocu h
acutet
chronic is not warm
what is tendinopathy
common term for tendon pattholgy
what is tendinitis
Tendons lack good blood supply, many have lack of direct inflammatory response (tendinitis)
what causes tendinosis
degenative changes in the tendon
how can you confirm either tendinitus/tendinosis
both need to be confirmed witth histopatthological examinaiton
how can you go from tendinitus to tendinosus
through degenerative changes
aftter time and consttant imflamtion
what are the signs and symtpoms of tendiopathy
Chronic onset- MOI overuse or by repetitive overstretching or overload
Pain, swelling
Crepitus
Pain at extremes of motions (passive and active)
Pain increases during stretching and RROM
Strength decreases with pain
whatt is tenosynovitis and where is it common
Inflammation of the synovial sheath surrounding a tendon
Common in hands and feet
explain acute tenosynovitis
Acute- grating sound (crepitus) with movement, inflammation and swelling
explain chronic ttenosynovitus
Chronic- nodule formation in the tendon sheath
what can long term tendinopathy lead to
Long term tendinopathy can lead to accumulation of mineral deposits in the bone (myositis ossificans)
what are the 4 sttages of overuse injuries
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
at what stage do athletets usually come see hte doctor
stage 3
whatt are the two factors of overuse injuries
intrinsic and extrinsic
explain the intrinsic factors causing overuse injures
Malalignment of limbs Muscle imbalances (weaknesses, tightness)
explain the extrinsic factors causing overuse injures
Training errors- to fast to soon
Faulty technique
Incorrect surfaces and equipment
Poor environmental conditions
what is osteoarthritis
Degeneration of articular cartilage in a joint
whatt is osteoarthritis caused by
Caused by a combination of factors
Stresses obtained during physical activity, joint trauma, aging process
what are teh signs and symtoms in osteoarthrisu
pain
limited movement
where is osteoartthritis common
knees
wha tis msucle cramps
Painful involuntary contractions of muscles
what are the 2 types of muscle cramps and explain
Clonic- alternating contraction and relaxation
Tonic- continued contraction
which type of muscle cramp is pumping
clonic
which type of muscle type is contatnt
totnic
true or fa;se Muscle cramps are usually exercis induced
yes
whatt are the exact causes of muscle crramps
Exact causes unknown
Biochemical imbalances
Neuromuscular fatigue
what are the 2 injury types
primary and secondary
explain primary injuries
Caused by a particular event
External causes vs internal causes
explain secondary injury
Caused by complications after the primary injury occurs
Hypoxia and ischemia
(accumulation of calcium)
whatt are the 3 phases of soft tissue healing
inflamatory
proliferation
matturation
in general, how long is the soft tissue healing
3 days -1 year
how long is the inflam period
0-6 days
when is inflammatory greates f
firstt 24-72 hours
is inflammatory response good or bad
good for healing but needs to be controlled (use compression, evelattion, movementt)
what is common to see in inflammatory phase
Rubor (redness), calor (local heat), tumor (swelling), dolor (pain) and function laesa (loss of function)
SHARP
what is the first goal in inflammatory phase
stop blood loss to the wound
explain part 1 of stopping blood in inflmattory phase
Local vasoconstriction (few seconds-10 minutes) Large vessels constrict from signals from neurotransmitters
reduction of blood volume = increased blood viscosity/ resistance to the flow (further reducing loss of blood at site)
=first clot
Platelet reaction then promotes clotting as cells combine together with fibrin to form a mechanical plug
=second clott
what comes firstt vasoconsttriction or dilation
vasodilation
what is vasodilation due to
histamine and bradykinin (neurotransmitters)
why are proteins activiated in inflmatory phase
to promote a variety of activities essential for healing
ex: phagocytosis
explain phagocytosis
Phagocytosis- attraction of macrophages and neutrophils
what does the release of chemical mediators cause
Increase blood vessel wall permeability
Promotes vasodilation
Pain!
explain vascular events
Vascular- first a quite vasoconstriction followed by a vasodilation. Increase pressure in the capillaries causes fluid to move into the tissue and produce swelling, pain and impaired function
explain cellular events
Cellular- mast cells released which mobilize leukocytes (neutrophils and monocytes). Neutrophils first line of defense, can cause damage to healthy tissue
what is the duratiton of the proliferative pahse
fays 3-21
what is the prolif. phase
repair and regen of the injured tissue
during the proliferattive phase, what is tthere tthe develipment of
new blood vessels
fibrous tissue formation
generation of new epithetical tissue
wound contractions/scarring
in prolif phase, what do fibroblats synthesize
new type III collagen fibesr
true or false: in thte prolif phase we get new vessel formation
ttrue
angiogenesis
how long can thte maturation phase be
up to 1 year
what is scar tissue
Scar tissue is fibrous, inelastic and nonvascular- less strong and less functional than original tissue
new scar tissue has more or less flexibility
less and decreased size of involved tissues
what is execssive scar tissue called
keloid tissue
during the maturattion phase, what does type 3 collagem become
type 1= it is stronger
whatt happens to the fibers in the matturation phase
alighment of fibers along muscle fibers to regain mobility and strength
how long can tensile strtength take to increase
up ot 2 uyears postt injurt
Bad rehabilitation that doesn’t reorient collagen fibers could lead to what
permanent decrease of 30% compared to pre-injury strength.
true or false: ,muscle fibres can reproduce
false, do no t
=thats why we need to prvent necrosis
what do ligaments and tendons need to have for a chance of healing
they need to be in very close proximity. If a ligament is isolated (ex: ACL), it has a poor chance of healing conservatively.
what does tissue immbolization cause
leads to atrophy, loss of strength and decreased healing of the tissues. ↑Immobilization time = ↑atrophy
explain immolixation vs atrphy
if you are immbolized longer than you will increase atrphy which delays rehab
try to stay moving asap after injury when possibble
(frcature must be immoblized longer)
which heals the slowest, soft tissue, bone or nerve injuries
nerve injries
what is the healing rate of nerve injuries
rate <1mm per day or 2.5mm per month
most common nerve injuries are what tyoe of injuries
tension and compression injuries
or severed
