Orthopedic Pathology 1 Flashcards
Sprain
What: Overstretch injury to a ligament
Why: Trauma related sudden twist or wench of the joint beyond normal ROM
How they look: joint effusion (too much External intercellular fluid), hemarthrosis (bleeding into joints)
* Scar tissue in ligaments takes 6 weeks to develop and 6 months to mature and provide maximum strength to joint
S&S: pain, swelling, bruising, a “pop” when the injury occurs
Orthopedic Pathology
The Study of injuries to or conditions involving the musculoskeletal system
Grade I Sprain (mild)
overstretching or mild tearing of ligaments with no joint instability
minimal pain and no or slight swelling or bruising
Grade II Sprain (Moderate)
20-70% tearing of a ligament
Bruising, moderate pain and swelling. May have trouble bearing weight on the affected joint
Grade III (Severe)
- 70%+ or complete tear or rupture of a ligament
- Severe pain, swelling, etc
- Unable to put any weight on the affected joint
- Sometimes no pain with grade III, could be repaired better than overstretched, repeated grade II sprains
- X-ray to role out fractured bone (avulsion)
- Often requires immobilization and or surgery
Common location of sprain
Ankle
Anterior talofibular, calcaneofibular, calcaneocuboid (Inversion sprain) Deltoid ligament (Eversion sprain and they are strong that they could avulse the medial malleoli of tibia)
Common Location of Sprain
Knee
MCL, LCL, PCL, ACL
Valgus force affects Medial meniscus, ACL, and MCL (Unhappy triad of knee)
Common location of sprains
Wrist
Palmar radiocarpal Dorsal radiocarpal Ulnar collateral Radial collateral Intercarpal ligament MOI-Forced hyperextention
Common location of sprains
Shoulder
Acromioclavicular ligament (carrying heavy backpack)
Conoid ligament
Trapezoid ligament
Strains
A twisting or pulling injury to musculotendinous unit
Can be classified as acute or chronic
Acute: Caused by a sudden overstretching of the muscle or an extreme contraction of the muscle against heavy resistance
Chronic: strains are usually the result of overuse
Common location
Hamstrings, quads, gastrocs, adductors, gracilis, rotator cuff, supraspinatus, pec major, biceps, lavator scapula, longus colli, scalenes, posterior cervicals, infrahyoid, suprahyoid
Grade I sprain (mild)
- Only some muscles fibers have been damaged
- Mild pain, swelling, localized tenderness and pain
- usually heals in 2-3 weeks
Grade II Strain
Moderate pain that requires stopping activity, stress and palpation of the tissue greatly increases pain
usually heals in 3-6 weeks
Grade III severe strain
Complete rupture of the muscle
severe pain and disability
typically involves surgical repair of the muscle
Healing period can be up to 3 months
Contusion
- A crush injury to a muscle, with resultant bleeding into the subcutaneous tissue and skin. There is bruising (ecchymosis) ranging from a local, minor discoloration to a large debilitating area. Can appear at a distant site tracking the fascial planes.
- Any muscles/bones, most commonly quadricepts, dorsum of foot, anterior tibia, sacrum, iliac crest
- 1st 24 hours critical, control bleeding and avoid alcohol, stretching, heat, massage as push blood towards center everything else pushing away - spreads infection.
Mild Contusion
Minor crush with minimal bleeding
Minimal or no loss of strength
Minimal loss of ROM
Can continue ADL’s with mild discomfort
moderate contusion
moderate crushing of muscle with bleeding and swelling
Difficulty continuing ADLs
Severe contusion
severe crushing of tissue,
with rapid bleeding and swelling
Significant pain and muscle weakness
unable to continue ADL’s
Hematoma
Swelling due to blood
A local hemorrhage following a trauma
More rapid swelling than edema
Swelling and pain as it compresses nearby nerve fibers
pain increases with movement or if pressure applied to site
Myositis ossificans
Occasional complication following a hematoma, contusion or fracture
Blood calcifies into bone
Fibroblasts replaced with osteoblasts
Takes approx 6 weeks to develop
some of the bone is slowly reabsorbed
May have attachment to an existing bone
Strength of muscle decrease
surgical excision if the calcification is not attached to bone and is only found in the muscle
not always done because any increase n trauma from surgery can cause more bone formation
Intrinsic muscle spasm
The prolonged contraction of a muscle in response to the local circulatory and metabolic changes that occur where a muscle is in a continued state of contraction
Muscle spasm causes
pain (guarding/splinting), circulatory stasis, chilling of muscle, impaired nutrition, infections, thrombi or emboli, metabolic disorders, blood vessel disorders, intermittent claudication, degenerative joint changes, medication
Reflex muscle guarding
muscle spasm in response to pain, also can result from referred pain. It disappears when pain disappears
Protective muscle spasm (splinting)
Reflexive reaction against injury
Myopathy
Myo=muscle Pathy=disease disease leading to muscular weakness inflammatory myopaties (myositis), dystrophies, etc
Myalagia
My=Muscle
Alagia=pain
Myotonia
Slow relaxation of muscles after contraction or electrical stimulation due to neurological pathologies
Disused Atrophy
decrease in size of body organ tissue or part because muscles not being used
Denervation atrophy
atrophy caused by damaged nerve supply
Myositis
Inflammation of the muscle, usually due to infection but can be due to autoimmune disorders
