soft tissue injuries Flashcards
what does soft tissue refer to?
musculoskeletal tissue other than bone
soft tissue injuries include
muscle, blood vessels, ligaments, tendons, cartilage, skin, etc
tendons attach
muscle to bone
ligaments attach
bone to bone
another name for bruises
contusion
muscle injury caused by impact of blunt object of force
contusion
damage to contusions lie
closest to the bone
bleeding without breaking skin
contusion (bruise)
contusion symptoms
history of blunt trauma, weakness and/or pain to muscle group
tightness/swelling to muscle
inability to fully flex the joint (e.g. limited knee flexion for quadr injury)
palpable hematoma (solid swelling of clotted blood within the tissue) in muscle tissue
contusion muscle damage can be either
minor- involving only swelling on a cellular level
major- involving rupture of the capillaries and leading to heavy bleeding
Contusions: ROM of affected limb
mild - affected joint flexion ROM >90 degrees
moderate – 45-90 degrees
severe <45 degrees
Treatment of contusions
apply ice to the injured area immediately
after injury, and place the muscle on a light stretch (90˚) for 20 minutes
Repeat the “ice-on-stretch” 1–2 times every
2 hours for the first 48–72 hours
Compression wrap, rest extremity for 3 days
Begin muscle stretching 2-3 times per day, 3-7 days after injury, start light activity, increasing activity each day if no pain, ice area after activity
what are strains?
injury to muscle or tendon, or muscle- tendon unit
another name for strains
pulled muscle
strains are caused by
Caused by pulling or twisting injury, overuse/overstressed from heaving lifting or exertion, or by sudden stretch of a contracting muscle
strain symptoms
pain, muscle spasms, muscle weakness, stiffness, swelling & local tenderness
strain prevention
proper stretching, warm up (sports, physical work/activity), avoid over exertion
treatment of strain
RICE
Rest and protect the injured area. May also requiretemporary immobilization with splints, etc.
Ice injury for 20 minutes at a time, 3 to 8 times a day for first 3 days
Compression of injured area using elastic bandages
Elevate. Rest injured extremity above heart, to controlor reduce swelling
Preventing muscle strains
Strength Training
Weaker muscles more susceptible to muscle strain than stronger ones. Strength training may help make muscles more resistant to strains
Warm-Up
Warming up prior to a workout will prepare muscles for strenuous activity. Warming up may include a brisk walk, slow jogging, and/or light calisthenics
Stretch
Do slow, deliberate stretch for each muscle group to reduce muscle tension, improve range of motion, promote circulation, improve flexibility
sprains
joint ligament and capsule
sprains caused by
excessive move of the joint, resulting in torn or stretched ligaments
symtoms of sprains
pain, rapid swelling, tenderness,
discoloration, limited joint movement
Grade III sprains result in
joint instability
Treatment for sprains
Home treatment: RICE protocol
Medications Nonsteroidal anti-inflammatory drug (NSAID; i.e. aspirin and ibuprofen)
Ambulatory aids for lower extremity (crutches)
Immobilization: brace support, cast boots, air braces, short cast, etc.
Surgical repair may be necessary
Physical therapy if prescribed, may include
early ROM, strengthening, balance training (for ankle injuries), agility exercises, etc.
Preventing sprains
Maintain good muscle strength, balance, and flexibility
Warm up thoroughly before exercise and physical activity
Pay careful attention when walking, running, or working on uneven surface
Wear proper shoes made for your activity
Slow down or stop & rest when you feel pain or fatigue
elbow injuries
olecranon fracture & ORIF repair, susceptible to injury
treatment of elbow injuries is usually
splint or surgery
elbow fracture with ORIF protocol
Removable cast for 3-6 weeks, depending on fracture and repair
ROM starting in the 1st week
CPM (continuous passive motion unit)
Progressive strengthening program
Precautions: no lifting or carrying with involved arm or driving until healed (6 weeks)
Progressive lifting and carrying after 6 weeks
ORIF
Open reduction internal fixation (ORIF) is a surgery to fix severely broken bones. It’s only used for serious fractures that can’t be treated with a cast or splint
elbow lateral epicondylitis “tennis elbow”
Overuse or cumulative trauma, wear & tear, but can occur without injury
ages 30-50
elbow lateral epicondylitis “tennis elbow” affects what tendon?
extensor carpi radialis brevis tendon (inflammation and pain)
symptoms of elbow lateral epicondylitis “tennis elbow”
Pain to lat. epicondyle area when gripping, weak grip
Worse with hand and forearm activity, and gripping
treatment of tennis elbow
Non surgical treatment: rest, ice, NSAID, modalities, brace, exercises, steroid injections
wrist injuries: what’s interesting ab scaphoid bone?
retrograde blood supply
70-80% of blood supply comes from the dorsal carpal
branch of the radial artery
only 20-30% of the total supply come from the palmar and superficial palmar branches (radial artery), and does not reach the proximal pole
scaphoid fracture
Blood flow characteristics presents a problem with a scaphoid fracture
With a disruption of blood flow, healing can be slow, and/or may not heal at all
scaphoid bone is unique - it is a proximal row carpal bone that crosses into the distal row, serving as a type of link between the rows
important in maintaining normal biomechanics of the wrist
Extensor pollicis longus and brevis tendons border of snuff box!
signs of scaphoid fracture
Presents with deep, dull pain in the radial side of the wrist that usually worsens with gripping or squeezing
Swelling is typically present and bruising is often visible, but swelling is not always noted
Most suggestive sign is tenderness to palpation of the anatomical snuffbox
scaphoid fracture treatment
Non-surgical
Thumb-spica cast immobilization even with no x-ray evidence but with clinical signs
Surgery
open or closed reduction,
internal fixation
With or without surgery,
may be in a cast for months, depending on healing
potential complications of scaphoid fracture: non-union
abnormal motion and collapse of the bone fragments may lead to wrist mal-alignment
if bone fails to heal, surgery to apply a bone graft may be indicated
potential complications of scaphoid fracture: avascular necrosis
proximal 2/3 of the scaphoid is most vulnerable
most effectively treated with bone graft
potential complications of scaphoid fracture: arthritis
may be caused by nonunion and avascular necrosis of the scaphoid
resulting in aching in the wrist, decreased range of motion in the wrist, pain with lifting or gripping wrist fusion may be required
periunate dislocation
disruption of lunate and capitate
lunate dislocation
separation of lunate from capitate and radius
lunate or perilunate dislocation treatment
Closed reduction Preliminary to surgical treatment to: restore carpal alignment, improves the patient’s comfort and facilitates surgical repair
Open reduction, internal fixation (ORIF) with k- wires
most shoulder dislocations are
anterior shoulder dislocations (95%)
shoulder dislocations are usually the result of
a traumatic injury (forced out of the socket, as a result of a sudden injury or overuse) (displaced joint)
shoulder dislocations
May involve injury to nerve and blood vessels, medical examination includes ruling these out
May need an x-ray for diagnosis and to determine extent of injury
shoulder dislocations may have what tear and injury?
May have labrum tear, and associated rotator cuff injury
medical treatment for shoulder dislocation
shoulder joint reduction
Sling or shoulder immobilizer
shoulder dislocations are prone to
May be prone to recurrence or subluxation injury
shoulder anatomy joints
Glenohumeral joint (ball and socket joint) Acromioclavicular joint Scapulothoracic (ST) joint - not a true anatomic joint - has none of the usual joint characteristics (joint union by fibrous, cartilaginous, or synovial tissues)
Sternoclavicular joint is also involved in articulation
of the ST joint
what is the most moveable joints in body?
shoulder
greater range of motion (like in shoulder) causes
instablity
injuries that can happen to shoulder
complete dislocation & partial dislocation (subluxation)
when do dislocations reoccur?
Once the ligaments, tendons, and muscles around the shoulder become loose or torn from repeated injury
what is chronic shoulder instability?
the persistent inability of these tissues to keep the arm centered in the shoulder socket
what is also called shoulder “impingement syndrome?”
shoulder bursitis/rotator cuff tendonitis
shoulder bursitis/rotator cuff tendonitis happens when??
Occurs when the bursa and rotator cuff tendons are inflamed (inflammation usually involves both)
Often the result of injury that set off the inflammation
shoulder bursitis/rotator cuff tendonitis symptoms
shoulder pain with overhead activities, at the lateral/superior aspect, catching/grating when arm is raised or rotated
shoulder bursitis/rotator cuff tendonitis risk factors
prior shoulder injury, age (over 50), bone spurs from wear & tear
impingement syndrome treatment
Conservative treatment aims to reduce the swelling, relieve pain and rest the joint
impingement syndrome symptoms
may slowly recede over a period of weeks, however, it may take several months to fully recover
impingement syndrome treatment
NSAID treatment: over the counter
Avoid overhead activities that causes pain
Do exercises to maintain or increase shoulder ROM
Cortisone injections
Surgery (subacromial decompression, remove bone spurs, etc.)
rotator cuff tear is due to?
Result of injury, chronic tendinopathy, or a combination of both
If a tear is suspected, ultrasound or MRI is usually recommended to confirm the tear
what is recommened to confirm a rotator cuff tear?
ultrasound or MRI
small rotator cuff repairs are treated w
eat, ice, stretching, and strengthening exercises
Precautions (see next slide)
ROM exercises important to prevent impingement syndromes, frozen shoulder (adhesive capsulitis)
what is not recommended for rotator cuff repairs?
Arm sling is not recommended because this may lead to a frozen shoulder
Rules to decrease shoulder strain
Lift objects close to the body
Only lift light weights and limit lifting to below shoulder level
Do sidestroke or breaststroke when swimming
Throw balls underhand or sidearm
Avoid pushing exercises at the gym (eg, pushups, bench press, flys, shoulder press)
Avoid prolonged or repetitive overhead work
Maintain good posture with writing, assembly work, and other tasks by keeping the shoulder blades down and back
DeQuervain’s tenosynovitis
swelling of tendons on thumb side of wrist caused by repetitive motion
(extensor retinaculum ligament, extensor pollicis brevis, abductor pollicis longus)
duputrens disease is abnormal thickening of what?
of the fascia tissue in the palm, can extend to the fingers
duputrens disease is characterized by
firm pits, nodules, and cords that may pull the fingers into flexion at the MP joints (called Dupuytrens contracture),
not usually painful
duputrens disease involves both the
tendons and the skin
duputrens disease etiology
unknown, European men over 40
Depuytrens Contracture Treatment
Collagenase
- injected into the Dupuytren’s tissue, weakening it so that the finger can be manipulated manually to make it straighter
Needle aponeurotomy - a needle is placed through the skin and used to cut the Dupuytren’s tissue
Skin grafts are sometimes required to cover open areas in the fingers if the skin is deficient
Followed by splinting and hand therapy to maximize and maintain the improvement in finger position and function
Boutonniere deformity (injury) is caused by
foreful blow to bent finger (jammed)
what is ruptured in Boutonniere deformity ?
central slip that causes extrinsic extension of extensor digitorum communis (EDC) to be lost
Boutonniere deformity prevents extension at what joint?
PIP!
Boutonniere deformity: weakenening of the triangular ligament causes intrinsic hand muscles (lumbricals) to act as flexors at what joint?
PIP
Boutonniere deformity: lumbricals can extend what
extend the DIP, without an opposing or balancing force
Boutonniere deformity: what causes lumbricals to pull and become unopposed (PIP flexion and DIP extension)
palmar migration of collateral bands and lateral bands causes lumbricals pull to become unopposed, causing PIP flexion and DIP extension
Boutonniere deformity treatment
nonsurgical
Splinting PIP in extension,
Allowing MP and DIP flexion
Prescribed ROM exercises
Surgical options:
Tendon repair
Correct displaced bone fragment
Soft tissue reconstruction and rebalancing extensor hood
(not often successful, high risk of failure)
Joint fixation fusion (last option)
Skier’s (snow) or gamekeeper’s thumb is injury to what ligament
Injury to the ulnar collateral ligament of the thumb MP joint
UCL thumb MP joint injury DX and TX
History of injury, X-ray to determine if this represents strictly a ligament injury or if a piece of bone has pulled off with the ligament, as this difference guides treatment
Ice to reduce swelling
NSAID to reduce pain
Splint or cast for immobilization
Torn ulnar collateral ligament (UCL) or bone fragment avulsion may require surgical repair, followed by cast or splint immobilization for up to 6 weeks
bone fractures may be either
simple, aligned and stable OR unstable where bone shifts
communited fractures
(bone is shattered into many pieces) usually occur from a high energy force and are often unstable
open (compound) fracture
occurs when a bone fragment breaks through the ski.
There is some risk of infection with compound fractures
closed fracture also called
simple fracture
open fracture also called
compound fracture
transverse fracture
cut horizontal
greenstick fracture
common in children w bendable bones
purpose of splint or cast for fractures
can treat a fracture that has not been displaced, or to protect a fracture that has been set
closed reduction and internal fixation (CRIF) are for
Some displaced fractures may need to be set and then held in place with wires or pins (without incision)
internal fixation or open reduction internal fixation, ORIF are for
fractures may need surgery to set the bone (open reduction) and held together with pins, plates, or screws
fractures involve what surface?
Fractures involving joint surface (articular fractures) and usually need to be set more precisely to restore the joint surface as smooth as possible. If it cannot be repaired, then a bone graft may be necessary