quiz #1 - sprains

Question 1

what is a sprain?

Answer 1

overstretch injury to a ligament

Question 2

ligaments

Answer 2

-flexible, noncontractile CT
-add stability to CT joint capsule: bands around synovial joints, blend into periosteum & joint bones together
-named according to bones they attach to & their anatomical position
-taut at end ROM opposite to which it prevents

Question 3

causes of sprains

Answer 3

-trauma related sudden twist/ wrench of joint beyond normal ROM
FACTORS:
*congenital ligamentous laxity (hypermobility)
*history of previous sprains
*altered biomechanics that place stress on ligament & joint
*CT pathologies (RA)

Question 4

classifications of sprains

Answer 4

GRADE 1: mild / 1st degree
GRADE 2: moderate / 2nd degree
GRADE 4: severe / 3rd degree

Question 5

classifications of sprains - GRADE 1

Answer 5

*minor stretch & tear
*no instability on PR testing
*person can continue activity with some discomfort

Question 6

classifications of sprains - GRADE 2

Answer 6

*tearing of ligament fibers
*degree of tear is variable from several fibers to majority of fibers
*snapping sound at time of injury
*joint = hypermobile yet stable on PR testing
*person has difficulty continuing activity

Question 7

classifications of sprains - GRADE 3

Answer 7

*complete rupture of ligament / avulsion fracture as bony attachment of ligament is torn off while ligament remains intact
*snapping sound & joint gives away
*significant instability & no end point on PR testing
*person cannot continue activity

Question 8

joint effusion

Answer 8

-when injury is severe enough to inflame synovium, increasing production of syonvial fluid causing joint capsule to swell
-synovial fluid, intracapsular
-hemarthrosis / bleeding into synovial spaces may happen
-edema in extracapsular interstitial spaces as result of inflammatory process & composed of inflammatory exudate

Question 9

ligaments

Answer 9

-moderatley vascularized, heal slowly
-adhesions from between sprained ligament & nearby structures, painfully limiting ROM controlled by ligament
-grade 3 sprains: ligaments may be surgically repaired

Question 10

ligaments - scar tissue

Answer 10

-scar tissue takes up to 6 weeks to develop
-6 months for scar tissue to completely mature & provide max strength at affected joint

Question 11

common ankle sprains

Answer 11

ANTERIOR TALOFIBULAR: most frequently sprained lateral ankle ligament
CALCANEOFIBULAR: 2nd most sprained lateral ligament
CALCANEOCUBOID: less frequently injured
DELTOID: eversion

Question 12

most common mechanism of injury - ankle ligaments

Answer 12

INVERSION sprain - damaging ligaments on lateral side

Question 13

common knee sprains (collateral)

Answer 13

MCL: most frequently injured, foot fixed to ground & knee is struck medially
LCL: laterally directed
*collateral ligaments = extracapsular, massage can directly treat

Question 14

common knee sprains (cruciate)

Answer 14

ACL: tibia forced anteriorly, when weight bearing
PCL: tibia pushed posteriorly
*cruciates = deep within joint, not accessible with massage - often surgically repaired

Question 15

common wrist sprains

Answer 15

PALMAR RADIOCARPAL: forced hyperextension, quite strong & unlikely to be sprained - damage to flexor mm, tendons, bones
DORSAL RADIOCARPAL: forced hyperflexion, injury to extensor tendons & wrist bones - weaker than palmar

Question 16

common shoulder sprains

Answer 16

ACROMIOCLAVICULAR:
-grade 1 AC: tearing of joint capsule
-grade 2 AC: tear of joint capsule & AC ligament
-grade 3 AC: tear of joint capsule, AC ligament, conoid & trapezoid, fracture may be present
*mechanism of injury = falling onto shoulder

Question 17

GRADE 1 - symptom picture: ACUTE

Answer 17

-minor stretch to ligament
-pain = mild & local
-minimal local edema, heat & bruising
-joint is stable
-can continue activity

Question 18

GRADE 2 - symptom picture: ACUTE

Answer 18

-tearing of some/ many fibers
-snapping noise, joint gives away
-pain = moderate at rest & with activities
-moderate local edema, heat & bruising
-joint instability is slight
-difficulty continuing activity

Question 19

GRADE 3 - symptom picture: ACUTE

Answer 19

-complete rupture / avulsion fracture
-snapping noise
-pain = intense / mild at rest
-marked local edema, heat & bruising
-hematoma present, joint effusion may occur
-joint unstable
-cannot continue activity

Question 20

in all grades of sprain

Answer 20

-bruising: red, black, blue
-decreased ROM local to joint (protective mm spasm, edema, & pain limit movement)
-little, moderate, or severe loss of function
-strain / contusion of mm crossing joint, vascular damage, nerve complications possible

Question 21

GRADE 1, 2, & 3 - symptom picture: EARLY SUBACUTE

Answer 21

1: stable
2: hypermobile but stable
3: hypermobile & unstable with ligamentous stress testing

Question 22

GRADE 1, 2, & 3 - symptom picture: EARLY SUBACUTE - symptoms

Answer 22

-bruising = black & blue
-pain, edema, inflammation still present but reduced
-adhesions develop
-healing = slow (ligaments hypovascular)
-protective mm spasm diminish
-ROM reduced
-loss of proprioception at joint
-joint my be taped, splinted, immobilized

Question 23

GRADE 1, 2, & 3 - symptom picture: LATE SUBACUTE - symptoms

Answer 23

-bruising = yellow, green, brown
-pain, edema, inflammation diminishing
-protective mm spasm replaced by increased tone of mm crossing joint
-affected joint may be supported
-ROM reduced
-loss of proprioception at joint

Question 24

GRADE 1, 2, & 3 - symptom picture: CHRONIC - symptoms

Answer 24

-pain = local only if ligament is stressed
-bruising gone
-adhesions have matured
-HT & TP’s present in mm crossing joint & compensating structures
-full ROM restricted
-may be pocket of chronic edema
-tissue may be cool due to ischemia
-loss of proprioception
-joint unstable (grade 3) unless surgically repaired
-mm weakness / disuse atrophy
-may need taping & bandages for activity

Question 25

observations - ACUTE

Answer 25

-antalgic gait & posture
-may be supported by taping, bandages, splint
-pained facial expression
-edema present
-redness
-red, black, purple bruising
-hematoma: grade 2/ 3

Question 26

observations - EARLY & LATE SUBACUTE

Answer 26

-antalgic gate & posture
-supports may be present
-edema diminishes
-yellow & green bruising
-if surgically reduced, scars are present

Question 27

observations - CHRONIC

Answer 27

-habituated antalgic gait & posture
-supports may be used for activity
-some residual chronic edema
-if surgically reduced, scars are present

Question 28

palpation - ACUTE

Answer 28

-heat
-tenderness
-texture of edema is firm
-protective mm spasm

Question 29

palpation - EARLY & LATE SUBACUTE

Answer 29

-temperature diminishes
-tenderness
-texture of edema is less firm
-adhesions present
-tone of mm = tight (early) & HT (late)

Question 30

palpation - CHRONIC

Answer 30

-cool due to ischemia
-point tenderness
-edema is boggy, jelly-like
-adhesions, crepitus
-HT & TP’s local to joint & compensating mm
-disuse atrophy may be present

Question 31

contraindications

Answer 31

-acute: testing other than pain free AF ROM
-avoid removing protective mm splinting
-distal circulations
-grade 3: casted, avoid hot hydro proximal
-grade 3: surgical repair, do not restore full ROM
-frictions: anti-inflammatories / blood thinners

Question 32

treatment: ACUTE

Answer 32

-RICE
-hydro = cold
-reduce edema
-maintain local circ proximal ONLY
-reduce but do not remove protective mm spasm
-maintain ROM
-treat secondary conditions

Question 33

treatment: EARLY SUBACUTE

Answer 33

-limb elevated
-hydro = cold/ warm
-reduce edema proximal
-reduce TP
-maintain ROM
-distal: light stroking & mm squeezing

Question 34

treatment: LATE SUBACUTE

Answer 34

-limb elevated
-hydro = cold/ hot
-reduce edema
-reduce HT & TPs in proximal limb
-reduce adhesions
-joint play after frictions
-increase ROM gradually
-increase local circulation

Question 35

treatment: CHRONIC

Answer 35

-position: client comfort
-hydro = deep moist heat
-reduce chronic edema
-reduce HT & TPs proximal
-reduce adhesions
-restore ROM
-increase circulation

Question 36

treatment if limb is immoblized

Answer 36

-joint likely unstable in direction sprain occurred
-little to prevent hypermobility
-mobilization techniques = CI’d
-remedial exercises to strengthen mm