Orthopedic Tx 400 (Contusions, Hematomas, Myositis Ossificans, Decubitus Ulcers)

Question 1

contusion

Answer 1

A crush injury to a muscle. The periosteum can also be involved. Note: That the skin overlying the injury is intact.

Question 2

contusion, d/t

Answer 2

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”.

Question 3

note that bruising can appear at…

Answer 3

Note: The bruising may track along fascial planes, appearing at a distance from the injury site.

Question 4

contusion MOI

Answer 4

MOI: Direct blow to the mm. Contact Sports, MVA, Fall

Question 5

other soft tissue injuries that can occur alongside contusion

Answer 5

Other soft tissue injuries can occur in combination with a contusion, such as…

sprains, strains, dislocations, even internal organ involvement.

Question 6

Classifications/Severity/Grades

Answer 6

mild, moderate, eevere

Question 7

Mild contusio

Answer 7

Minor crush with minimal bleeding.
Minimal to no loss of strength.
Minimal loss in ROM.

5-20% loss.
Can continue with activity.

Question 8

Moderate

Answer 8

Moderate crush with bleeding and swelling.
Moderate loss of strength.

Difficulty continuing with activity.
Disability the next day.
20-50% loss in ROM.

Question 9

Severe

Answer 9

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

Question 10

Contusions – the first 24 hour

Answer 10

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.

Question 11

Most frequent locations (cntusions):

Answer 11

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.

Question 12

Healing Stages/Symptoms/Presentation

Answer 12

..

Question 13

Acute

Answer 13

Bruising is Red, Black, and Purple.

<ROM due to swelling & protective mm spasms.

Pain at rest?

Inflammation.

Question 14

Early Sub-acute

Answer 14

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.

Question 15

Late Sub-acute

Answer 15

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.

Question 16

note colour

Answer 16

warm –> cool –> to more close to skin tone (but still darker?)

Question 17

chronic

Answer 17

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.

Question 18

CI’s (contusion tx)

Answer 18

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.

Question 19

HEMATOMA

Answer 19

..

Question 20

what is hematoma

Answer 20

A localized collection of blood, usually clotted, in a tissue or organ.

An area of local hemorrhage following trauma.

Question 21

hematoma swelling and pain

Answer 21

Swelling and pain are present.

Swelling is more rapid than that of edema.

Question 22

hematoma – fascial compartment

Answer 22

Can remain in fascial compartment.

Question 23

hematoma, increase pain w/

Answer 23

> P with movement or pressure.

Question 24

where can hematoma occur?

Answer 24

Can occur almost anywhere in the body.

Question 25

unless infection develops, blood is…

Answer 25

Blood is absorbed, unless infection develops.

Question 26

EXAMPLES OF HEMATOMAS

Answer 26

Contusions and black eyes are examples.

Question 27

which injury are hematomas almost always present with?

What is the danger of hematomas in the skull?

Answer 27

They are almost always present with a fracture. Can be serious inside the scull, where pressure on the brain can cause long term damage.

Question 28

myositis ossificans

Answer 28

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

Question 29

how long after injury can myositis ossificans occur?

Answer 29

Grows 2-4 weeks post injury, matures 3-6 months post injury.

Question 30

myositis ossificans – contributing factors

Answer 30

Lack of cold H2O (ICE) immediately after injury.

Intense physiotherapy/rehab or massage too early.

Returning to training too soon.

Question 31

myositis ossificans SSx

Answer 31

Restricted ROM.

PAIN with mm use.

Loss of strength.

Palpable mass.

Visible with X-Ray.

Question 32

myositis ossificans – precautions & management

Answer 32

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.

Question 33

HOPMNRS for contusions

Answer 33

..

Question 34

History

Answer 34

MOI?
When?
Continue with activity?
Any treatment at the time?
Meds?

Question 35

Observation (acute)

Answer 35

Acute
Antalgic gait, bandages, edema, discoloration,

Question 36

antalgic etmyology

Answer 36

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.

Question 37

observation (subacute)

Answer 37

<Edema,

discoloration changes,

antalgic/habituated/protective gait.

Question 38

observation (chronic)

Answer 38

Habituated gait, possible contour change.

Question 39

PALPATION

Answer 39

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.

Question 40

MOVEMENT

Answer 40

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.

Question 41

SPECIAL TEST

Answer 41

Acute
Girth measurement

 Subacute
        AROM, PROM, Isometric testing, Quad. Contusion test.

 Chronic
       AROM, PROM, Isometric testing, Length tests; Thomas, Ely’s etc…

Question 42

CONTRAINDICATION

Answer 42

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

Question 43

TREATMENT GOALS

Answer 43

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

Question 44

HOMECARE (contusion)

Answer 44

Hydro Cold, Late subacute- contrasts

Maintain ROM Pain free AROM

Strength isometric, then isotonic, Pain free

Stretch Pain free

Question 45

homecare —> return to activity

Answer 45

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.