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INTRO TO ORTHO > quiz #1 - strains > Flashcards

quiz #1 - strains Flashcards

1
Q

what is a strain?

A

an overstretch to a musculotendinous unit

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2
Q

musculotendinous unit

A

the muscle, tendons, their osseous attachments & musculotendinous junction

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3
Q

weakest link in musculotendinous unit

A

=structure that is damaged
-tendons are moderately vascularized -> prone to partial / complete rupture at area of least blood supply
-usually in middle of tendon / musculotendinous junction

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4
Q

causes of strains

A

-sudden overstretch to mm
-extreme contracture of mm against heavy resistance

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5
Q

contributing factors to strains

A

-inadequate warm up before activity
-limited flexibility
-fatigue
-repetitive overuse
-over-stretching mm
-strength imbalance between mm & its antagonist
-history of previous strains

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6
Q

classifications of strains

A

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

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7
Q

GRADE 1 strain

A

-minor stretch & tear to musculotendinous unit
-minimal loss of strength
-can continue activity with mild discomfort

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8
Q

GRADE 2 strain

A

-tearing of musculotendinous fibres
-degree of tear quite variable from several fibres to the majority of the fibres
-may be snapping sensation/ sound at the time of injury
-palpable gap may appear at the injury site
-difficulty continuing the activity due to pain & mm weakness

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9
Q

GRADE 3 strain

A

-complete rupture of the musculotendinous unit / an avulsion fracture as body attachment of the tendon is torn off while unit remains intact
-snapping sensation/ sound at the time of rupture
-palpable & often visible gap appears at the injury site
-mm often shortens & bunches up
-cannot continue the activity due to significant pain and mm weakness

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10
Q

commonly strained muscles

A

Hamstrings - middle of mm belly / at the musculotendinous junction close to the ischial tuberosity
Quadriceps - especially rectus femoris
Gastrocnemius - usually at the musculotendinous junction / at attachment of Achilles tendon to the calcaneus
Adductors of the hip
Gracilis
Erector spinae
Rotator cuff - most frequently supraspinatus
Pectoralis major - at insertion of the humerus
Long head of biceps brachii
Muscles of the neck - during whiplash

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11
Q

symptom picture - ACUTE: GRADE 1

A

-minor discomfort local to the injury site on activity that contracts / stretches muscle
-local edema, heat, bruising minimal or not present
-tenderness at lesion site
-little / no loss of strength or ROM
-client can continue activity

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12
Q

symptom picture - ACUTE: GRADE 2

A

-tearing of several / many fibres of musculotendinous unit
-snapping noise or sensation at the time of injury
-moderate local edema, heat, hematoma & bruising
-gap may be palpated in tissue
-moderate tenderness at lesion site
-moderate pain with activities that contract or stretch musculotendinous unit
-moderate loss of strength & ROM
-difficulty continuing activity due to pain

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13
Q

symptom picture - ACUTE: GRADE 3

A

-complete rupture of muscle or avulsion fracture of tendinous attachment
-snapping noise or sensation at time of injury
-marked local edema, heat, hematoma & bruising
-severe pain at lesion site
-immediate loss of strength & ROM
-client cannot continue activity

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14
Q

GRADE 2 & 3: symptoms - acute

A

-bruising red, black & blue
-hematoma present at lesion site
-decreased ROM of joints crossed by affected muscle as protective mm spasm limits movement
-little, moderate or severe loss of function of affected limb
-mm may be bandaged to prevent further injury
-with Grade 3 strain of lower limb, ruptured muscle is usually surgically repaired

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15
Q

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

A

GRADE 1: little / no pain, reduced strength
GRADE 2: pain & reduced strength, bruising, alteration in contour of mm
GRADE 3: pain, reduced strength with AR testing, bruising, gap in tissue, mm may bunch up

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16
Q

grade 1, 2 & 3: symptoms - early subacute

A

-pain, edema & inflammation still present
-adhesions developing around injury site
-slow healing of tendons due to hypovascularity
-protective mm spasm diminishes
-TPs occur in affected mm, its synergists & its antagonists
-ROM reduced

17
Q

symptom picture - LATE SUBACUTE

A

-with Grade 2 / 3 strain, bruising yellow, green & brown, hematoma diminishes & gap still palpable in tissue
-pain, edema & inflammation diminishing
-protective mm spasm replaced by increased tone in affected mm, its synergists & its antagonists
-TPs occur in affected mm & compensatory mm
-adhesions maturing around injury
-ROM reduced

18
Q

symptom picture - CHRONIC

A

-bruising gone
-HT & TPs present in affected mm & any compensating structures
-adhesions matured around injury
-tissue may be cool due to ischemia
-discomfort local to lesion site only if mm is stretched
-with Grade 2 & 3 strains, full ROM of joint crossed by affected mm may be reduced
-if ruptured mm was not surgically repaired, there is reduced strength
-reduced strength of affected musculotendinous unit & possible disuse atrophy

19
Q

observations - ACUTE

A

-antalgic gait if strain is in lower limb
-affected mm may be supported by taping, elastic bandages, splints
-antalgic posture
-client may have pained facial expression
-edema present at the lesion site
-with a Grade 2/ 3 strain, hematoma present at lesion site
-some redness may be present local to injury
-red, black or purple bruising may be visible over injury site
-with Grade 2 strains, gap in the tissue or alteration in contour of mm may be noted
-with a Grade 3 strain, visible gap at lesion site & mm may bunch up

20
Q

observations - EARLY & LATE SUBACUTE

A

-antalgic gait if strain is in lower limb
-affected muscle may be supported by taping, elastic bandages or splints
-antalgic posture
-edema diminishes both on site & distally
-with Grade 2/ 3 strain, hematoma resolving at lesion site
-bruising over injury site changes from purple black in early subacute to brown, yellow & green in late subacute, then disappears
-with Grade 2 strains, alteration in contour of mm still apparent
-with Grade 3 strain, still a visible gap at lesion site & mm may remain bunched up if not surgically repaired

21
Q

observations - CHRONIC

A

-habituated antalgic gait & posture may be observed with strain in weight bearing limb
-with Grade 2/ 3 strain, affected mm may be supported during activities that stress tissue
-may be some residual chronic edema present local to injury site with repeated strains of same mm
-with Grade 2 strain, alteration in contour of mm is still present
-with Grade 3 strain, visible gap at lesion site remains & mm may be bunched up if not surgically repaired

22
Q

palpation - ACUTE

A

-heat present over injured mm & possibly surrounding tissue
-tenderness local to lesion site & refers into nearby tissue
-texture of edema is firm
-with Grade 2/ 3 strain, hematoma may be palpable
-palpable gap or alteration in mm contour is present with Grade 2 or 3 strain
-protective mm spasm is present in affected mm, synergists & antagonists

23
Q

palpation - EARLY & LATE SUBACUTE

A

-temp over injury site diminishes from early to late subacute stage
-tenderness present local to injury
-texture of edema is less firm
-adhesions present as healing progresses from early to late subacute stages, hematoma diminishes
-palpable gap or alteration in mm contour or fascial distortions may be present with grade 2 or 3 strain
-tone of affected mm, synergists & antagonists changes from spasm to tightness & HT
TPs are present in these muscles

24
Q

palpation - CHRONIC

A

-injury site may be cool due to ischemia
-point tenderness occurs local to lesion site
-adhesions present local to injury site
-palpable gap may be present with grade 2 or 3 strain
-HT & TPs may be present local to injured musculotendinous unit & in compensating muscles

25
Q

testing - ACUTE: AF ROM

A

Grade 1 strain-mild local pain when muscle is contracted or stretched & ROM is normal or near normal
Grade 2 strain-pain is moderate & only mid ranges of movement are possible
Grade 3-pain is severe & there is loss of function

26
Q

contraindications

A

-acute stage, testing of Grade 2 or 3 strain other than pain-free AF ROM is CI’d to prevent further tissue damage
-avoid removing protective mm splinting of acute strains
-distal circulation techniques CI’d in acute & early subacute stages to avoid increasing congestion through injury site
-with Grade 3 strains that are casted, hot hydro applications should not be applied to tissue immediately proximal to cast to prevent congestion
-frictions CI’d if client is taking anti-inflammatories or blood thinners

27
Q

treatment - ACUTE

A

-mm treated with RICE
-positioning depends on location of strained musculotendinous unit & client’s comfort
-hydro = cold
-reduce edema on injured area
-maintain local circulation proximal to injury
-reduce but do not remove protective mm spasm
-on site work is CI’d
-distal mm squeezing & stroking indicated
-maintain ROM with mid-range PR ROM on proximal joints

28
Q

treatment - EARLY SUBACUTE

A

-hydro = on site cold/warm contrast
-diaphragmatic breathing encouraged
-reduce edema proximal to injured limb
-maintain local circulation proximal to injury
-reduce spasm
-reduce TPs without disturbing injury site
-do not disturb a hematoma
-maintain ROM with mid-range PR ROM to onset of pain only on proximal & distal joints

29
Q

treatment - LATE SUBACUTE

A

-hydro = cold/hot contrast local to injury
-reduce remaining edema
-reduce HT & TPs in proximal limb
-reduce adhesions around & on-site to injury
-after adhesions have been frictioned, stretch & ice applied
-joint play to proximal & distal joints are performed
-increase ROM with mid to full range PR ROM to onset of pain
-increase local circulation

30
Q

treatment - CHRONIC

A

-hydro = proximal to strain & on the lesion itself, deep moist heat
-reduce chronic edema
-reduce HT & TPs
-reduce adhesions
-joint play to proximal & distal joints
-restore ROM with PR ROM on proximal, distal & affected joints
-increase local circulation proximal & distally to injury
-treat scar if mm was surgically repaired

31
Q

HOMECARE

A

-educate client on hydro appropriate for stage of healing
-self-massage to affected mm in late subacute & chronic stages
-maintain strength of mm with pain-free exercises
-stretch shortened muscles
-gradually increase strength in late subacute & chronic stages
-encourage activity that caused injury on a gradual basis to avoid re injury

INTRO TO ORTHO (5 decks)

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