Orthopedic Tx 400 (Strains & Sprains -- 5 & 6) Flashcards
myositis ossificans risk factors
Not appropriately resting muscle after a bruise or muscle strain, thus causing repetitive injury to the injured muscle.
Not taking measures to reduce inflammation and swelling in the injured muscle, including not icing or applying compression.
who is myositis ossificans most common in?
Myositis ossificans is most common in young, active people and athletes of all levels. It is also more likely to occur in people who are paralyzed from the waist down (paraplegia), even if they haven’t had an injury that started the symptoms.
again, why?
While the exact cause of this reaction is unknown, athletes who subject the area to repetitive trauma before it is able to fully heal are more likely to have calcification and bony formation in the injured muscle.
Additionally, not taking measures to reduce inflammation in the muscle after the initial injury also leads to in an increased risk of developing myositis ossificans.
how long does it take to take place?
Calcification typically occurs 2-4 weeks after the initial muscle injury and the bone fully matures by 3-6 months.
myositis ossificans most common with
Trauma –> acute trauma
Far less likely with repetitive use –> E.g. strains
other risk factors (myositis ossificans)
Intensive stretching, therapy, or massage after an injury are thought to increase bleeding into the muscle and inhibit healing, thus leading to myositis ossificans.
Premature return to sport.
Re-injury to the same area as a previous injury.
Don’t friction ____?
calcified tissue in mm (via myositis ossificans)
note ROM testing — sprain vs strain
contractiel vs non-contratile tissue
strain most commonly occurs @
weakest area of musculotendinous unit
grade 1, mild, 1st degree STRAIN
Minor stretch and tear.
Minimal loss of strength.
Can continue with activity with mild discomfort.
0-20% tissue damage.
Grade 2, Moderate, or 2nd Degree STRAIN
Tearing occurs-varies from several fibers to many.
Snapping sensation or sound.
Palpable gap at injury site.
Difficulty continuing with activity due to pain and weakness.
20-70% tissue damage.
Grade 3, Severe, or 3rd Degree
Complete rupture or avulsion fracture.
Snapping sensation or sound.
Palpable & often visible gap
Cannot continue activity due to pain & weakness.
70 – 100% tissue damage.
MOI?
differentiate acute trauma vs RSI
onset?
stage of healing
can they continue with ADLs?
can speculate about grade
medication?
pain perception
no inflammatory response
—> I.e. watch out for pressure, or intense techniques like frictions and TrP ischemic compressions
what does strain look like in acute phase (esp grade 2-3)
Antalgic gait/posture. Support. Edema. Hematoma. Redness. Bruising is Red, black, purple.
what does strain look like in sub-acute phase?
Antalgic gait/posture & edema diminishes. May be supported. Bruising changes from purple & black in early to brown, yellow, & green in late.
whta does strain look like in chronic phase?
Habituated antalgic gait/posture. Grade 2-3 may have support with activity that stresses. May have residual edema. Fascial distortions may be noted. Scar will be present if surgically repaired.
what does acute strain feel like
Heat, tenderness, firm edema. Gap with grade 2 or 3. Protective mm spasms.
whta does sub acute strian feel like
Temp diminishes, tenderness present, edema less firm, gap, spasm in early change to HT in late. TP’s present.
what does chronic strain feel like?
Local ischemia, point tenderness, adhesions present and possible crepitus, gap with 2 or 3, HT, TP’s, disuse atrophy may be present.
some common acute vs sub-acute (RSI) pathologies for weightlifters
The pathology of shoulder pain with lifting also varies greatly.
Sub-acute injuries include rotator cuff tendinopathies, long head bicep tendinopathy, glenohumeral joint instability, and distal clavicle osteolysis.
Acute injuries include biceps and pectoralis tendon ruptures and shoulder dislocations.
movement testing & strains (acute)
AROM is decreased.
Other testing is contraindicated in acute if grade 2 or 3 suspected.
PROM grade 1 reduced. Painful mm spasm end feel. RROM minimal loss of strength with grade 1. Contract to Pain only.
movement testing & strains (sub-acute)
AROM decreased due to pain. PROM decreased, painful end feel. RROM contract to pain only. Grade 1: min. loss of strength. Grade 2: mod loss and pain. Grade 3: significant loss and pain.
movement testing & strains (chronic)
AROM may be limited. PROM mild pain with a tissue stretch end feel. RROM decreased strength.
CI’s – strain
In acute stage, only pain free AROM testing with grade 2 or 3 to prevent further injury.
Distal circulation techniques CI’d in acute and early sub-acute to avoid congestion.
No heat in acute/early subacute stages(?) grade 2/3 strain
Avoid MOI such as stretching the affected tissue in acute/early subacute gr2/3 strain
do not work on area in acute/early subacute stages
Avoid contracting or load the affected tissue in acute/early subacute stages gr2/3 strain
Tx – strains
Acute: RICE, reduce edema (nodal pumping, DB), Reduce mm spasm, no on-site tx’s.
Early sub-acute: Ice (or contrast ?). Reduce edema, spasm, & TP’s. On-site work only with grade 1.
Late sub-acute: Prevent excessive scar tissue formation (skin rolling, separations, MRF, frictions, rom, stretch all pain free) TPR. Reduce chronic edema if present. Cold/hot contrasts.
Chronic: Heat. Client presentation. Possible surgeries, complications, habitual gate/protective/ guarding ?
homecare – Strains
Hydrotherapy: Acute/Early Subacute(?) - cold , Late Subacute-heat/cold aka contrast.
chronic = heat
Remedial exercise is dependant on the stage of healing and severity of the strain. To avoid repeated strain or rupture, training programs for strength or fitness should be gradual. This applies to stretching also. It is important in the acute and sub-acute stages to work to the onset of pain only. In this way, contractile tissue can withstand incrementally heavier workloads or increasing stretches without injury.
