Sprains and Strains Flashcards
In general, what are the 2 ways you can get a ligament sprain? aka….which motions?
exceed normal range of motion of a joint (hyperestension, inversion/eversion)
Force joitn in a non-anatomical position (rotational deformity, valgus/varus of knee)
What types of injuries willc uase a muscle or tendon strain?
exposive concentric contraction
excessive eccentric contraction
What is the biomechanical model of legament/tendon acute and overuse injuries?
an occur injury occurs when a ligament or tendon is subjected to tensile load that exceeds its tensile strenght
overuse injury occurs when the ligament or tendon is subjected to repetitive tensile stress at a frequency/duration that exceeds its capcity for recovery or repair
What will cause decreased tensile strength in a ligament or tendon? How about decreased ability to heal?
prior injury
disuse atrophy
degenerative disease - aging
connective tissue diseases
some medications
diabetes
smoking
What is the difference between joint laxity and joint instability?
They’re basically the same thing, but instability has negative symptoms
What is the difference between a static joint stabilizer and a dynamic joint stabilizer?
static stabilizers may allow movement of the joint, but do not cause movement of the joint (like the ankle’s ATF)
dynamic stabilizers cause movement of the joint (like the peroneus muscles of the ankle)
In looking for sprains we do the anterior drawer and feel for an endpoint. WHat are some situatinos where might not be able to do this test?
muscle ton is too high
muscle guarding - can’t relax due to pain
joint effusion or soft tissue swelling - too wollen for joint to even bend
mechanical block - fracture
ligamentous endpoint
What is the grading system for strains and sprains?
gade 1 - microtears (stretch)
grade 2 - macrotears (partial tear)
grade 3 - complete tear
What is the initial treatment acronym for sprains/strains?
PRICEMM
protection, (active) rest, intermittent ice (and head), compression, elevation, anti-inflammatory medications and modalities
Why do you want the rest to be active rest?
Use stimulates the healing of tissue
it allows maintenance of general conditioning and prevents loss of strength in the supporting structures
maintains joint ROM
addresses proprioception retraining (balance)
Why is bracing so helpful for active rest?
it makes sure activity is performed in a biomechanically normal position and protects it from abnormal motion
WHat should be the requirements for returning to full activity?
absence of pain
strength over 80% of normal
ROM normal
Balance normal
How dow bracing help - 2 ways?
supports the joint and enhances proprioception
Which bone can be avulsed in hamstring tears?
the ischial tuberosity
What will you see on a hamstring injury exam?
eccymosis of posterior thigh, sometimes going down to the ankle
palpable deformity sometimes
pain with passive stretch
painful contraction
Where does the gastrocneius usually tear?
Mid muscle
What will you see on a gastroc tear exam?
bruising of the calf down to the ankle
tender to palpation
palpable defect sometimes
painful limp
WEAK plantar flexion (but they’ll still have it - differentiates it from an achilles tendon rupture. also, they will continue to be extremely painful, unlike an achilles tear which only hurts immediatley during injury)
Which ligament is most often sprained in ankle injuries? WHat other structure is usually involved with htis?
the anterior talofibular ligament
the peroneus tendone will almost always be involved
WHat happens in a high ankle sprain?
THe ankle is hyperdorsiflexted and rotates, causing the talus to spread the tibia and fibula apart to tear the syndesmosis between them
How will an ankle sprain present/exam?
swelling, ecchymosis
pain with weight bearing
tender at the injured ligament and/or tendon
anterior drawer may have some laxity
everting the foot against resistance will cause pain up the peroneus
What are the two most ocmmon mechanisms for an ACL tear?
twisting motion or hyperestension injury
How will an ACL tear present/exam?
immmediate swelling (hemarthrosis)
feeling of instability with all weight bearing
laxity on anterior drawer and Lachman’s
Do you do surgery on an ACL right away?
No - usually weight 3-6 weeks for swelling to go down
What knee motion will cause an MCL sprain?
valgus
