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Pathophysiology > Soft tissue injuries and fractures > Flashcards

Soft tissue injuries and fractures Flashcards

1
Q

Explain muscle pathophysiology including injuries

A
  • Muscles must be loaded 60% of maximal strength to increase in volume and strength
  • Inactivity reduces muscles

Injuries:
* Acute muscle rupture = damaged connective tissue causing inflammation (pain, bleeding, swelling)
* Delayed onset muscle soreness = overuse causing damage to cells

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2
Q

How does healing of muscles look like?

A
  • Injury = hemorrhage and inflammation
  • 1-2 days: breakdown of damaged tissue
  • 1-2 weeks: intact muscle fibers
  • 1-1.5 months: healed tissue
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3
Q

What are tendons and ligaments and explain their pathophysiology

A

Tendons = trensfers power
Ligaments = passive stability

  • Limited vascular supply and low metabolism making them dependant on loading and off-loading
  • Loading to rest - degenerates and thickens
  • inactivity - weakened
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4
Q

Which grades of injuries can occur in tendons/ligaments?

A
  1. Local tenderness, minimal swelling, normal ROM
  2. Tenderness, swelling, some functional deficits
  3. Popping sound when injured, acute pain, swelling, loss of function
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5
Q

Explain healing of tendon/ligaments

A
  • The process depend on location of injury
  • Hours-days: hemorrhage and inflammatory phase
  • Weeks: increased collagen
  • Weeks-years: alignment of fibers
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6
Q

What is the ACL and a rupture of it?

A
  • ACL = ligament connecting femur and tibia and is crucial for knee stability
  • Rupture = partial or complete tear och sprain of ligament
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7
Q

What causes rupture of ACL and what are the risks?

A
  • Often caused by sports involving sudden changes of direction and speed
  • Landing wrong after jump/fall
  • Direct trauma to knee
  • More common in women
  • Risk factors if you have faulty movements patternsnor poor fitting footwear
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8
Q

Explain symptoms and diagnostics of ACL rupture

A
  • Popping sound when injured
  • Pain and swelling
  • Instability of knee and loss of ROM
  • Diagnosed by imaging tests and Lachmans tests which asseses stability of ACL and abnormal motion of tibia in relation to femur
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9
Q

What are some consequences of ACL-rupture and how can we treat it?

A
  • Consequences: pain, muscle weakness, decreased ROM, increased risk of osteoarthritis
  • Treatment:
    1. Surgery for grade 3 (and 2 maybe) by substitute ACL with graft out of tendon
    2. Rehabilitation: physiotherapy, bracing to protect from secondary injury during rehabilitation
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10
Q

What is dysfunction of posterior tibialis?

A

Posterior tibialis tendon cannot offer support and stability of arch of the foot resulting in flat foot

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11
Q

What causes posterior tibialis dysfunction and what are the risk factors?

A
  • Torn in posterior tibialis tendon, ex. fall
  • Inflammation of tendon (tendonesis)
  • Degenerative processes
  • Functional processes - excessive plantar flexion, overuse
    Risk factors:
  • More common in women oldar than 40
  • Diabetes
  • Hypertension
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12
Q

What symptoms does posterior tibialis dysfunction give?

A
  • Flat foot
  • Weakness and pain of ankle and lower calf
  • Swollen and red ankle
  • Valgus position of the ankle
  • Pain during ohysical activity
  • Abduction of forefoot
  • Difficulties with single heel raise and standing on toes
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13
Q

How can we diagnose and treat posterior tibialis dysfunction? And explain general consequences

A
  • Diagnose by medical history, physical examination, and imaging tests
  • General complications include infection, neurologic injury, and pain
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14
Q

Explain how to treat dysfunction of posterior tibialis

A
  • Orthotic devices
  • Immobilisation to let tendon heal
  • Physiotherapy
  • Surgery
  • Without treatment the issue will progress until foot and ankle collapse
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15
Q

Explain what achilles tendon rupture is

A
  • Complete or partial rupture of Achilles tendon causing troubles walking, standing on toes, and running
  • Caused by sudden upward movement of foot like fall or step into a hole
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16
Q

Name some risk factors for achilles tendon rupture

A
  • More common in men at age 30-40
  • Steroids weaken tendon
  • Obsisity puts mor stress on tendon
17
Q

What are the symptoms of achilles tendon rupture?

A
  • Snapping sound when injured
  • Inability to plantar flex - troubles pushing off when walking
  • Cannot stand on toes
  • Inflammation near heel - pain, swelling, heat
18
Q

How can we diagnose achilles tendon rupture?

A

FLOS

  • Feel for tenderness and gap in tendon
  • Look for swelling and bruising
  • Observe movements (patient may still be able to stand on toes, plantar flex, and walk)
  • Simmonds calf squeez test: squeezing thick part of calf should cause plantar flexion, if not = rupture
19
Q

What are some consequences of achilles tendon rupture and how can we treat it?

A

Consequences:

  • Risk of re-rupture
  • Problems occuring up to a year after
  • Risks after surgery like infection, bleeding, nerve damage

Treatment:

  • Surgery - tendon stiched together
  • Rest tendon by using cruches
  • Immobilisation first weeks
  • Orthotics keeping foot plantar flexed to ease stress and enable heeling (AFO, boot with heel wedges)
  • Rehabilitation to return physical strength
    1. 4-6 month - daily activity
    2. 6 month - running
    3. 12 month - contact sports
  • Important with consistent strength training to decrease complications/consequences
20
Q

What is a fracture and whaich types are there?

A
  • A fructure is a break or crack in a bone
  • Closed = skin is intact, ex. oblique, transverse, impact (bone into each other)
  • Open = bone penetrates skin
21
Q

Explain different causes of fractures

A
  • Trauma: higher energy give more complex fracture
    1. High energy = Life threatening injuries, affect other interna organs increasing risk of complications, usually in younger population
    2. Low energy = Secondary to other condition, slipping or fall, more common in eldery population
22
Q

What are the symptoms of a fracture and how is it diagnosed?

A

Symptoms:

  • Inflammation symptoms - intense pain, swelling, bleeding causing bruising, tenderness
  • Deformity of limb
  • numbness/tingeling
  • Mobility problems

Diagnosed by imaging tests

23
Q

Explain the progression from fracture to healed bone

A
  1. Inflammatory phase - Hematoma formation:
  • Immediatly after fracture the bone ends becom necrotic and fracture site fills with blood
  • Hematoma forms to prevent more bleeding
  • Macrophages, osteblasts, and osteclasts enter the hematoma to remove damaged/necrotic tissue and starts healing process
  1. Repairative phase - cartilaginous callus:
  • Osteoid tissue develops and forms a soft cartilaginous callus which replaces hematoma
  • Can take up to 2-6 weeks after injury
  1. Repairative phase - bone callus:
  • Callus undergoes ossification forming hard bone callus (spongy)
  • Defomity and swelling can occur but it’s natural
  • Takes 6-12 weeks after injury
  1. Remodeling phase
  • Callus undergoes remodeling processes for several months to years
  • If no complications, new and normal bone is formed
  • Loading helps healing during this phase
24
Q

Which consequences can a fructure lead to?

A
  • Decrease in muscle mass due to longer time of immobility
  • Organ dysfunction of surrounding structures
  • Thrombosis
  • Compartment syndrome - too tight catering ex
  • Deformations - outgrowth of bone
  • Pseudoarthrosis (“fake joint” of long bone due to inability to heal bone properly)
  • Avescular necrosis - tissue death
  • Failure of osteosythesis
25
Q

Treatment for fractures are…?

A
  • Repositioning of broken bone to correct alignment: closed - just pull; open - surgery may be needed
  • Reconstructive surgery - screws, plates, wires
  • Fixation by casting or braces to heal right
  • Rehabilitation to follow-up, orthotics may be needed
  • Medication for pain
26
Q

What is compartment syndrome?

A
  • Swelling or bleeding of muscle leading to increased pressure on blood vessels, nerves, and muscles within compartment
  • Can cause permanent damage due to restricted blood flow (caused by pressure)
  • Can be treated by fasciotomy (cut open muscle)
  • Symptoms are intense pain, numbness/tingeling, swelling, burning feeling on skin, tightness of muscle

Pathophysiology (7 decks)

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