Topic 4 - Pathology of Soft Tissue

Question 1

Features of a muscle contusion

Answer 1

Hematoma from sudden heavy compressive force

Question 2

Risk factors for myositis ossificans

Answer 2

High injury severity.
Following a rebleed.
Inappropriate Rx (heat, massage ect).
Thigh: effusion present, prone knee flexion <45

Question 3

Clinical signs myositis ossificans

Answer 3

Increased morning pain, pain with activity.
Night pain.
Palpable lump.
Improvement cease, then deteriorates.

Question 4

The difference between a strain and a sprain

Answer 4

Strain - muscular

Sprain - ligament

Question 5

Which muscles have a higher injury risk?

Answer 5

Two joint muscles

eg. Rectus Femoris, Gastrocnemius, Hamstrings

Question 6

Mild/1st degree muscle strain - Clinical presentation

Answer 6

Minor swelling/discomfort.
No/minimal loss of strength.
No/minimal movement restriction.
Few fibers torn.

Question 7

Moderate/2nd degree muscle strain - Clinical presentation

Answer 7

Significant swelling/discomfort. 
Pain on contraction. 
Loss of strength. 
Restriction of movement. 
Significant (more than half) fibers torn.

Question 8

Severe/3rd degree muscle strain - Clinical presentation

Answer 8

Complete tear of muscle.

Virtually complete loss of muscle function

Question 9

Stage 1 of skeletal muscle healing

Answer 9

Inflammation.
Rupture and necrosis of myofibers.
Formation of haematoma.
Inflammatory cell reaction.

Question 10

Stage 2 of skeletal muscle healing

Answer 10

Proliferation.
Phagocytosis of necrotised tissue.
Regeneration of myofibers and production of connective scar tissue.
Revascularisation by in-growth of capillaries.

Question 11

Stage 3 of skeletal muscle healing

Answer 11

Maturation.
Maturation of regenerated myofibers.
Retraction and reorganisation of scar tissue,
Recovery of functional capacity of muscle.

Question 12

Compartment Syndrome - Clinical Signs

Answer 12

Pain during activity, ceases with rest.

Question 13

Compartment Syndrome - Pathology

Answer 13

Overuse/Exercise raises intracompartmental pressure.
Local tissue swells
Compartment tightens
Blood supply is decreased
Leads to further tissue swelling, repeats

Question 14

Define DOMS

Answer 14

Muscle soreness that develops 24-48 hours after unaccustomed physical activity.

Question 15

DOMS Etiology theories

Answer 15

Lactic acid, muscle spasm, torn tissue, Connective tissue, Enzyme efflux, Tissue fluid.

Question 16

Define Tendinopathy

Answer 16

General descriptor for tendon pathology

Question 17

Tendinosis pathology

Answer 17

Collagen degeneration - disarray and separation.
Increased cells and vascular space.
Neovascularization (blood vessels where there shouldn’t be).
Increased mucoid ground substance
ABSENT inflammatory cells

Question 18

Tendinosis Signs

Answer 18

Pain some time after exercise (next day.
Painful at rest, “warms up” with use, worsens in cool down.
Local tenderness and thickening.
possible swelling/crepitus

Question 19

Define Tendinitis

Answer 19

Inflammation of the tendon itself.

Rarely proven, often used incorrectly instead of tendonosis

Question 20

Paratendonitis pathology

Answer 20

Inflammation of the outer layer (paratenon).
Occurs where tendon rubs over bony prominence.
Infiltration of inflammatory cells.
Acute odema and hyperaemia.

Question 21

Paratendonitis signs

Answer 21

Crepitis

Difficult to differentiate from tendinosis

Question 22

Grade 1 ligament sprain

Answer 22

Stretched fibers but normal ROM on stressing ligament

Question 23

Grade 2 ligament sprain

Answer 23

Considerable proportion of fibers torn.

Stressing of ligament reveals increased laxity, but definite end point.

Question 24

Grade 3 ligament sprain

Answer 24

Complete tear of ligament.
Excessive joint laxity with NO end point.
(be wary as may be no pain)