Soft tissue injuries and fractures Flashcards
Explain muscle pathophysiology including injuries
- 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
How does healing of muscles look like?
- Injury = hemorrhage and inflammation
- 1-2 days: breakdown of damaged tissue
- 1-2 weeks: intact muscle fibers
- 1-1.5 months: healed tissue
What are tendons and ligaments and explain their pathophysiology
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
Which grades of injuries can occur in tendons/ligaments?
- Local tenderness, minimal swelling, normal ROM
- Tenderness, swelling, some functional deficits
- Popping sound when injured, acute pain, swelling, loss of function
Explain healing of tendon/ligaments
- The process depend on location of injury
- Hours-days: hemorrhage and inflammatory phase
- Weeks: increased collagen
- Weeks-years: alignment of fibers
What is the ACL and a rupture of it?
- ACL = ligament connecting femur and tibia and is crucial for knee stability
- Rupture = partial or complete tear och sprain of ligament
What causes rupture of ACL and what are the risks?
- 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
Explain symptoms and diagnostics of ACL rupture
- 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
What are some consequences of ACL-rupture and how can we treat it?
- 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
What is dysfunction of posterior tibialis?
Posterior tibialis tendon cannot offer support and stability of arch of the foot resulting in flat foot
What causes posterior tibialis dysfunction and what are the risk factors?
- 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
What symptoms does posterior tibialis dysfunction give?
- 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
How can we diagnose and treat posterior tibialis dysfunction? And explain general consequences
- Diagnose by medical history, physical examination, and imaging tests
- General complications include infection, neurologic injury, and pain
Explain how to treat dysfunction of posterior tibialis
- Orthotic devices
- Immobilisation to let tendon heal
- Physiotherapy
- Surgery
- Without treatment the issue will progress until foot and ankle collapse
Explain what achilles tendon rupture is
- 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
Name some risk factors for achilles tendon rupture
- More common in men at age 30-40
- Steroids weaken tendon
- Obsisity puts mor stress on tendon
What are the symptoms of achilles tendon rupture?
- Snapping sound when injured
- Inability to plantar flex - troubles pushing off when walking
- Cannot stand on toes
- Inflammation near heel - pain, swelling, heat
How can we diagnose achilles tendon rupture?
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
What are some consequences of achilles tendon rupture and how can we treat it?
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
What is a fracture and whaich types are there?
- 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
Explain different causes of fractures
- 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
What are the symptoms of a fracture and how is it diagnosed?
Symptoms:
- Inflammation symptoms - intense pain, swelling, bleeding causing bruising, tenderness
- Deformity of limb
- numbness/tingeling
- Mobility problems
Diagnosed by imaging tests
Explain the progression from fracture to healed bone
- 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
- 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
- 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
- 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
Which consequences can a fructure lead to?
- 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
