Orthopedic Tx 400 (Contusions, Hematomas, Myositis Ossificans, Decubitus Ulcers) Flashcards
contusion
A crush injury to a muscle. The periosteum can also be involved. Note: That the skin overlying the injury is intact.
contusion, d/t
Due to the damage to the mm fibers there will be bleeding aka hematoma into the subcutaneous tissue.
That will present as bruising aka ecchymosis that might range from a local and minor to a large areas of skin “discoloration”.
note that bruising can appear at…
Note: The bruising may track along fascial planes, appearing at a distance from the injury site.
contusion MOI
MOI: Direct blow to the mm. Contact Sports, MVA, Fall
other soft tissue injuries that can occur alongside contusion
Other soft tissue injuries can occur in combination with a contusion, such as…
sprains, strains, dislocations, even internal organ involvement.
Classifications/Severity/Grades
mild, moderate, eevere
Mild contusio
Minor crush with minimal bleeding.
Minimal to no loss of strength.
Minimal loss in ROM.
5-20% loss.
Can continue with activity.
Moderate
Moderate crush with bleeding and swelling.
Moderate loss of strength.
Difficulty continuing with activity.
Disability the next day.
20-50% loss in ROM.
Severe
Severe crushing with bleeding and swelling.
Difficulty continuing with activity due to pain and weakness, disability the next day.
More than 50% loss in ROM
Contusions – the first 24 hour
The first 24 hours after injury are the most crucial. The primary goal is to control bleeding.
Stretching, exercise, heat, alcohol, and vigorous massage
—-> should be AVOIDED as they can increase bleeding.
Most frequent locations (cntusions):
Quadriceps, dorsum of the foot, periosteum of the anterior tibia, sacrum, iliac crest, greater trochanter, acromion, olecranon, dorsum of the hand, gluteal, deltoid, biceps, and triceps.
So, almost everywhere.
Healing Stages/Symptoms/Presentation
..
Acute
Bruising is Red, Black, and Purple.
<ROM due to swelling & protective mm spasms.
Pain at rest?
Inflammation.
Early Sub-acute
Bruising is Black and Blue.
PAIN, edema, inflammation present but reduced.
Adhesions may developing.
<mm spasms, TP’s are present.
ROM still reduced, >PAIN with movement.
Late Sub-acute
Bruising is Yellow, Green, and Brown.
Diminished PAIN, edema, and heat.
Adhesions are maturing.
Spasms replaced by > tone and TrP’s.
ROM and strength are still reduced.
Peripheral nn may be compressed from edema.
note colour
warm –> cool –> to more close to skin tone (but still darker?)
chronic
Bruising is absent.
Adhesions are mature.
HT and TrP’s present.
Tissue may be cool resulting from ischemia
.
PAIN with stretch, ROM and strength may be reduced.
Myositis Ossificans can occur within 3-6 weeks after injury.
CI’s (contusion tx)
No PROM or RROM with acute mod and sev. to prevent tissue damage.
No onsite work in acute mild.
No Swedish acute & early sub, (porx MLD ok (??))
Do not remove protective splinting in acute.
No heat, contrast, or vigorous Tx in the first 10days with mod to sev.
Do not direct circulation toward injury.
No stretch or PROM past comfort level.
No FRICTIONS if Pt is taking blood thinners or anti-inflammatory meds.
HEMATOMA
..
what is hematoma
A localized collection of blood, usually clotted, in a tissue or organ.
An area of local hemorrhage following trauma.
hematoma swelling and pain
Swelling and pain are present.
Swelling is more rapid than that of edema.
hematoma – fascial compartment
Can remain in fascial compartment.
hematoma, increase pain w/
> P with movement or pressure.
where can hematoma occur?
Can occur almost anywhere in the body.
unless infection develops, blood is…
Blood is absorbed, unless infection develops.
EXAMPLES OF HEMATOMAS
Contusions and black eyes are examples.
which injury are hematomas almost always present with?
What is the danger of hematomas in the skull?
They are almost always present with a fracture. Can be serious inside the scull, where pressure on the brain can cause long term damage.
myositis ossificans
Calcification and ossification within a damaged mm.
Ectopic bone formation in an abnormal site, usually the belly of a mm.
May be present in connective tissue without being apparent, until ossification of the mass occurs. (2-4 weeks post injury).
Usually the result of MM and periosteal injury.
—> E.g. CONTUSION
how long after injury can myositis ossificans occur?
Grows 2-4 weeks post injury, matures 3-6 months post injury.
myositis ossificans – contributing factors
Lack of cold H2O (ICE) immediately after injury.
Intense physiotherapy/rehab or massage too early.
Returning to training too soon.
myositis ossificans SSx
Restricted ROM.
PAIN with mm use.
Loss of strength.
Palpable mass.
Visible with X-Ray.
myositis ossificans – precautions & management
Avoid deep pressure over severe bruises or try to increase ROM too early, it can increase the risk.
Rest the area until maturation. There may be reabsorption of the bony mass if handled conservatively.
HOPMNRS for contusions
..
History
MOI?
When?
Continue with activity?
Any treatment at the time?
Meds?
Observation (acute)
Acute
Antalgic gait, bandages, edema, discoloration,
antalgic etmyology
From anti- + Ancient Greek ἄλγος (álgos, “pain”)
An antalgic gait is a gait that develops as a way to avoid pain while walking. It is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It is a good indication of weight-bearing pain.
observation (subacute)
<Edema,
discoloration changes,
antalgic/habituated/protective gait.
observation (chronic)
Habituated gait, possible contour change.
PALPATION
Acute
Heat, tenderness, firm edema, protective MM spams.
Subacute
<Temp, local tenderness, edema <firm, adhesions are present, TrP’s.
Chronic
Cool/ischemic, point tenderness, adhesions and fascial restrictions local, HT and TrP’s, Myositis ossificans will appear w/ local inflammation.
MOVEMENT
Acute
AROM only!, No other testing in acute stage of Mod-Severe contusion
PAIN w/ PROM, MM Spasm end feel, RROM minor to severe PAIN
*
Subacute
<AROM, <PROM, RROM local PAIN.
–
Chronic
AROM P may be present and at end range, PROM mild P and with stretch, RROM possible <strength.
SPECIAL TEST
Acute
Girth measurement
Subacute AROM, PROM, Isometric testing, Quad. Contusion test. Chronic AROM, PROM, Isometric testing, Length tests; Thomas, Ely’s etc…
CONTRAINDICATION
Acute
P free AROM(only) testing,
no on-site work,
no distal circulatory work,
do not put stretch on affected tissue in mod to severe cases;
no heat on edema
TREATMENT GOALS
Acute
<Inflammation, <P, Tx compensatory, <edema, <protective spasm; maintain pain free ROM, MLD, GTO prox, TPR, Vibrations,
Early Subacute – same/similar as acute
Late Subacute
<Adhesions, >ROM, >Circulation, Distal work ok. Skin rolling, Frictions, Stretch, Joint play etc.
Chronic
As per client presentation/complaint
HOMECARE (contusion)
Hydro Cold, Late subacute- contrasts
Maintain ROM Pain free AROM
Strength isometric, then isotonic, Pain free
Stretch Pain free
homecare —> return to activity
Return to activity that caused the injury once ROM is almost recovered and with minimal P. Elastic bandage or support may be needed during some activities.