Sprains, Contusions and Tendonitis

Question 1

________ is an overstretch injury to a ligament.

Answer 1

Sprain

Question 2

What are some causes of a sprain?

Answer 2

• trauma-related twist/wrench of the jt beyond normal ROM
• Contributing factors: congenital ligamentous laxity, history of previous sprains to the jt, altered biomechanics, connective tissue pathologies, pregnancy - relaxin - ligaments in pelvis

Question 3

What are the three grades of Severity for a Sprain?

Answer 3

Grade 1: minor stretch or tear to the ligament, no instability on PROM, can continue activity with discomfort
Grade 2: tearing of several to majority of ligamentous fibbers, snapping sound at time of injury and jt gives way, joint is hypermobile yet stable in PROM, difficulty continuing activity due to pain
Grade 3: either complete rupture of ligament or avulsion fracture, snapping sound and jt gives way, significant instability, and no end point on PROM, can’t continue activity due to pain and instability

Question 4

Health Hx Questions Relevant to Sprain:

Answer 4

Has the sprain be diagnosed?
Was surgery required?
Mechanism of injury?
What was done at the time of injury?
Could they continue activity? 
Did they hear any audible sounds?s

Question 5

What are some treatment goals for an Acute Sprain?

Answer 5

• Decrease inflammation/pain/edema/SNS firing [via LD, swedish massage, elevation, cryotherapy]
• tx compensations, maintain circulation proximal to injury, [via, swedish massage, MFR, NMT]
• reduce but do not remove protective mm spasm [via indirect techniques, swedish massage]
• maintain ROM [via PROM]

Question 6

What are some treatment goals for Subacute Sprain?

Answer 6

• decrease inflammation/pain/edema/SNS [via LD, swedish massage, elevation, cryotherapy]
• maintain circulation prox. to injury (early subacute) and local (late subacute) [via MFR, Swedish massage]
• reduce spasm, Tp’s and HT (NOT protecting guarding) [via indirect techniques, tp release, swedish massage, xff]
• maintain ROM, then gradually increase (in late subacute) [via PROM, AROM, Stretch]
• reduce adhesions [via indirect techniques, MFR, swedish massage]

Question 7

What are some tx goals for Chronic Sprain?

Answer 7

• decrease SNS, HT, TP’s and adhesion’s [via swedish massage, TP release, MFR, frictions followed by ice and stretch]
• tx compensations [via MFR, Swedish Massage, NMT]
• decrease chronic edema [via LD, elevate, MFR]
• increase ROM [via PROM, Stretch]
• increase local circulation [via swedish massage]

Question 8

What are some CI’s for Sprains?

Answer 8

• in acute stage, testing other than pain free AROM
• avoid elmininating protective mm spasm in acute
• no distal circ. techniques in acute and early subacute
• if grade 3 sprain is casted, avoid hot hydrotherapy immediately proximal to cast
• if grade 3 surgically repaired, caution re: full ROM - no pop
• no frictions - re: anti-inflammatories and blood thinners

Question 9

__________ us a crush injury to a muscle resulting in capillary rupture, bleeding, and edema.

Answer 9

Contusions

Question 10

_________ is a large area of lock hemorrhage following a trauma

Answer 10

hematoma

Question 11

What are some causes of Contusions?

Answer 11

Trauma due to direct blow (i.e. contact sports), a fall, MVA

Can get other injuries along with Contusions: strains, sprains, dislocations and fracture

Question 12

What is the Classification of Severity of Contusions?

Answer 12

Mild - minor crush injury with minimal bleeding; minimal or no strength or motion loss (5-20% loss of ROM); able to continue activity with mild discomfort.
Moderate - moderate crush with bleeding and swelling; (20-50% loss of ROM); difficulty continuing activity due to pain and muscle weakness
Severe - severe crush with rapid bleeding and swelling; (50%-100% loss of ROM); not able to continue activity due to pain and mm weakness

Question 13

What is considered a MEDICAL EMERGENCY with contusions?

Answer 13

Rapid bleeding/swelling to an area and weak

Question 14

Factors that may increase bleeding in contusions are:

Answer 14

stretching, exercising, heat, alcohol intake and vigorous massage

Question 15

What are some case interview questions specific to contusions?

Answer 15

• What medications are you on? (blood thinners)
• Have you had any previous contusions?
• What was done immediately after the injury?
• Were you able to continue activity after the injury?
• How fast did the swelling occur after the injury?