Pathology of Injury Flashcards
All injury happens because of ______.
trauma
What is trauma also known as? What is it?
- MOI: mechanism of injury
- how did they get hurt
Define trauma. How does it help us?
- Defined as a physical injury that is produced by an external or internal force
- Gives you clues as to what might be hurt
What is a mechanical injury?
- Force is applied to the body (int/ext) and that results in a disturbance of either structure (ex. Broken bone, torn skin, torn ligament) or function (ex. Can’t bend elbow, can’t touch toes etc.)
What is mechanical failure?
- Point that injury happens, point where the body’s ability to withstand all forces is surpassed
- May take several times to reach threshold or just once
What are the 5 types of tissue loading?
- compression
- tension
- shearing
- bending
- torsion
Describe compression.
- tissues get “squished”/shortened
- ex. fracture
Describe tension.
- tissues get pulled apart
- ex. tears, strains
Describe shearing.
- friction
- forces aren’t balanced
- ex. road rash, blisters, disc injuries
Describe bending.
- bending where not meant to bend
- ex. strain, breaks, dislocate, tears
Describe torsion.
- twisting
- most disruptive
- body is not meant to twist in those ways
What is the difference between traumatic and overuse injuries?
- Traumatic: happens from 1 trauma or 1 MOI.
- Overuse: happens from lots of micro traumas, generally ends in the word “…itis” (inflammation)
What is the musculotendinous unit?
- Where the muscle becomes a tendon
- Point of change in a structure
- Point of weakness: place that trauma will hit first
Describe tendons.
- Tissue that attaches a muscle to a bone
- Most have tendons in each end
- Also a point of weakness
- Makes muscle smaller (concentrates down) so it has a small attachment space
Why is injury at the tendon rare? Where are we more likely to injure?
- Generally double the strength of the muscle
- More likely to have an injury at the musculotendinous unit or where tendon attaches to bone
Describe the aponeuroses.
- Thicker band of tissue (not a muscle) that joins 2 structures together, generally bones
- Helps disperse forces
Why is damage to the aponeuroses difficult to heal?
they do not have a very good blood supply
What are the 5 symptoms for every injury?
- inflammation
- redness
- bruising
- deformity
- heat
Strains can only happen in ____ and _____.
muscles and tendons
Describe a grade 1 strain.
- mild symptoms
- No deformity
- No loss of function
- May have pain, but this is dependent on each person
- Mild inflammation
- Redness
- Possibly mild bruising
- Mild heat
- Stretching of structure
Describe a grade 2 strain.
- moderate inflammation
- More redness and heat
- Some bruising
- Some deformity (can physically palpate it)
- Some tearing of structures
- Loss of some function
Describe a grade 3 strain
- severe inflammation
- Very red
- Very bruised
- Hot to the touch
- Significant deformity
- No function
- Nothing attached = doesn’t hurt anymore
- Feels like they “got shot, excruciating pain for 5 seconds, then no pain at all”
What causes muscle cramps?
- Happen because of an external or internal force
- Dehydration
- Heat
- Electrolyte imbalance
- Lack of oxygen
What kind of pain does muscle cramps give? What can we do for someone feeling this?
- Stabbing feeling, generally in 1 muscle group
- Massage, hydrate, get them air… nothing much else you can do for them
What is muscle guarding?
- What your body does before or after it gets injured to help stabilize the area
- “Stiff” feeling post injury ~36 hours
- All muscles around injury spasm to try and protect it
- Does not happen unless it is right around injury time
What are muscle spasms?
- Muscle guarding to a more extreme
- Muscle is protecting itself from you, nothing to do with cramps
- You did something muscle isn’t ready for
- Common in leg muscles
- Generally because load is too high
- No injury yet
What is muscle soreness?
- Post workout: DOMS (Delayed Onset Muscle Soreness)
- Workout = microtears, 5 symptoms, body is repairing itself = sore
- Lactic acid for ~12 hours, then DOMS
What can we do for muscle soreness?
Stretch, hydrate, nutrients
What are contusions?
bruises
Describe a grade 1 contusion.
- surface bruise
- no damage except blood vessel
Describe a grade 2 contusion.
- deeper
- painful to contract muscle
Describe a grade 3 contusion.
- damaged tissues
- lots of bleeding
- specifically in quad
What is atrophy?
- loss of muscle
- typically in a cast
What is contracture?
- shortening of a muscle
- left in a bad position
Name the 7 types of muscle injuries.
- muscle strains
- muscle cramps
- muscle guarding
- muscle soreness
- contusions
- atrophy and contracture
Name some characteristics of tendon injuries.
- Tend to be overuse injuries, tend to be more chronic
- Takes longer to heal
- 2 places of weakness
- No pain = want to return to activity
- Twice as strong, twice as long to heal
What is tendonitis?
- breakdown of tendon
- Tendon is getting inflammation
- Painful to use
- Continued use will lead to tendonosis (physical breakdown of tendon, irreparable)
What are the symptoms of tendonitis?
- pain with movement
- low grade inflammation
- warm to the touch
- crepitus (“grindy” sensation)
What is tendonosis?
- Can’t fix it, physically breaking down
- All we can do is try and slow it down
- More inflammation, more pain, more grinding
- May eventually rupture = surgical replacement
What is tenosynovitis?
- Sheath around tendon has injury, not to tendon
- Same symptoms as tendonitis but happens to sheath
What are myofascial trigger points?
- Muscle knot located very close to a nerve
- Activates nerve, travels
- Most headaches are caused by these
- Can massage
- Injury and trigger point are different
Name some characteristics of ligament injuries.
- Ligaments can break down
- Generally do not surgically repair ligaments, rest of the tissues need to make up for it
- Ligament injury = sprain
Describe the anatomy of ligaments.
- Ligaments stabilize joints, holds 2 bones together
- Ligaments have no elastic property, does not contract, only responsible for stability
Describe a grade 1 sprain.
- Mild inflammation
- Mild redness and heat
- No deformation
- Stretching
- Everything still attached
- Function (may have pain)
Describe a grade 2 sprain.
- Moderate inflammation
- Bruising
- some tearing
- Hot to the touch
- Some loss of function (limping, pain)
- Unstable
Describe a grade 3 sprain.
- Rupture
- Really painful then no pain
- Increased ROM @ joint
- Severe swelling
- Severe heat
- Severe bruising
- Bones can be dislocated or broken
What are dislocations?
- something is fully out of place, even for a second
- common in shoulders, hips, fingers, knees
What always accompanies dislocations?
ruptured ligaments, possible tears or strains of muscles, fractures
What are subluxations?
- Part way out of place
- Same as dislocation but less severe
- Commonly ribs, shoulder
What is the most common type of fracture?
long bone fractures
What is an avulsion fracture? Why is it different from every other fracture?
- when a ligament attached to the end of a bone pulls a chunk of bone off instead of spraining
- every other fracture occurs because of force on the bone.
What are stress fractures also known as?
march fractures
Where do stress fractures generally happen?
weight bearing bones (ex. Tibia, metatarsals of foot)
Why are stress fractures difficult to find?
Need 40% damage to find in x-ray, need a bone scan
What kind of injury are stress fractures?
overuse injury
What physically happens in stress fractures? What kind of symptoms do they have?
- Physical break in bone just at the edge
- Same symptoms as fractures
Why healing typically difficult in stress fractures?
people assume they’re fine so they continue activity
Describe epiphyseal injuries.
- Epiphyseal plate is at the ends of bone
- Bones grow from the end out
- Don’t solidify until 18-24 years old
- Fracture of these plates under 18-24 years old means it solidifies and does not grow
anymore - Generally 1 bone stunted and not the other
How do we avoid the damages from epiphyseal injuries?
need to continually re-break to allow growth
Describe nerve injuries.
- Nerves of body do not regenerate/grow
- At a certain point they are permanent
What kind of pain is associated with nerve injuries?
- Referred pain
- nerves will refer pain to other places, pain may be coming from somewhere else
What is the technical name for bruising?
Ecchymosis
