Topic 6 - MSK Injuries Flashcards
When a client has experienced a trauma, it is important that therapists consider the ________ of the injury, identify all musculoskeletal __________ that are involved and identify the _____ of inflammation/recovery of the involved tissues.
Severity
Structures
Stage
It is important that therapists take a complete _______ including systemic conditions, medications, ADLs and anything else that may impede the _______ process.
History
Healing
Therapists must perform both an orthopaedic and palpation __________, so they can identify all the impairments and functional limitations present.
Assessment
A crushing injury from a direct blow that results in a capillary rupture, bleeding, edema and an inflammatory response.
Contusion (aka. Bruise)
Trauma to a muscle and/or its tendon from overstretching or violent contraction. There is some degree of disruption to the musculotendinous unit.
Strain
Overstretching, partial tearing or complete tearing of a ligament/joint capsule due to trauma. There is some degree of disruption to the soft tissue.
Sprain
How are strains and sprains graded based on severity?
1) Mild (1st degree)
2) Moderate (2nd degree)
3) Severe (3rd degree)
Repeated submaximal overload and/or frictional wear to a muscle/tendon resulting in inflammation and pain.
Repetitive Strain injury (RSI) (aka. Overuse Syndrome, Cumulative Trauma)
An injury to a joint in which the articulating surfaces are no longer in contact.
Dislocation
A fracture that occurs as the result of the pulling of soft tissue attached to the bone from a trauma.
Avulsion
An incomplete disruption of boney continuity that often involves soft tissue injury.
Subluxation
Bleeding into a joint, usually due to a severe trauma.
Hemarthrosis
Swelling in the joint. Abnormal fluid accumulation can result from inflammation, infection or trauma and may be exudate, transudate, blood and/or fat.
Joint Effusion
Ballooning of the wall of a joint capsule or tendon sheath.
Ganglion
Inflammation of a bursa.
Bursitis
Loss of normal function of a tissue or region. May be caused by adaptive shortening of the soft tissues (e.g. contractures), adhesions, muscle weakness or any condition resulting in abnormal tissue mobility.
Dysfunction
Mechanical loss of normal joint play in synovial joints commonly cause loss of function and pain.
Joint Dysfunction
Abnormal adherence of collagen fibres to surrounding structures during immobilization, after trauma or as a complication of surgery, which restricts normal elasticity and gliding of the structures involved.
Adhesion
Adaptive shortening of skin, fascia, muscle or a joint capsule that prevents normal mobility or flexibility of that structure.
Contracture
Involuntary contraction of a muscle (motor unit) that can be intrinsic or protective (reflex muscle guarding).
Spasm
A decrease in the strength of muscle contraction that can result from stretch/tight weakness, direct insult to the muscle, inactivity and/or impairments of the nervous system.
Muscle Weakness
A condition in which a muscle is elongated beyond physiological neutral but not beyond the normal ROM. Prolonged muscle elongation causes muscle spindle inhibition and the creation of additional sarcomeres. It also changes the length-tension curve.
Stretch Weakness
The most severe form of muscle tightness that is often overlooked clinically. Overused muscle shortens over time, changing its length-tension curve and becoming more readily activated and weaker after time.
Tightness Weakness
With _________ weakness, there is an increase in the non-contractile tissue and a decrease in elasticity, leading to hypertrophy. Overuse leads to ischemia and degeneration of muscle fibres, which further weakens the muscle.
Tightness Weakness
Increased interstitial pressure in a closed, non-expanding myofascial compartment that compromises the function of the blood vessels, muscles and nerves.
Myofascial Compartment Syndrome
_____ compartment syndrome causes include (but are not limited to) fractures and crush injuries. Results in ischemia and eventual necrosis of muscles and/or nerves.
Acute
T/F - Acute compartment syndrome is considered a medical emergency.
True
_______ compartment syndrome can occur in distance runners or those involved in major change in activity levels. Leads to ischemia, pain and rarely neurological signs, but it is possible they are present.
Chronic (aka. Exertional)
Symptoms of _______ compartment syndrome are less severe and tend to improve with rest, but may proceed to _____ compartment syndrome if the exercise continues.
Chronic
Acute
What are the 3 stages of inflammation and repair?
1) Acute Stage (Inflammatory Reaction)
2) Subacute Stage (Repair & Healing)
3) Chronic Stage (Maturation & Remodelling)
Signs of inflammation (e.g. swelling, redness, heat, pain at rest, loss of function) are present in this stage. Movement is painful and the patient usually guards against motion before completion of range (pain before tissue resistance).
Acute Stage (Inflammatory Reaction)
Pain and impaired movement in the _____ stage are from the altered chemical state that irritates the nerve endings, increased tissue tension due to edema/joint effusion and muscle guarding (spasm). This is the body’s way of ____________ the painful area.
Acute
Immobilizing
The acute stage (inflammatory reaction) usually lasts __ to __ days, unless the injury is aggravated.
4-6 days
Signs of inflammation progressively decrease and eventually disappear. Revascularization is occurring and fibroblasts produce collagen which mends the tissue, however it is still fragile and easily damaged.
Subacute Stage (Repair & Healing)
Immature connective tissue is thin and unorganized in the ________ stage and proper growth/alignment can be stimulated by appropriate tensile loading. Collagen fibres will align according to the ________ placed upon them.
Subacute
Stresses
In the ________ stage, new tissue may adhere to surrounding structures, which can:
- Restrict ROM
- Become a source of pain
- Impair circulation to the tissue
Subacute
T/F - At the end of the chronic stage, a stable scar is formed.
False - At the end of the SUBACUTE stage, a stable scar is formed.
With ROM testing in the ________ stage, pain may be experienced synchronous with tissue resistance towards the end of available range. Pain only occurs when the newly developing tissue is stressed and muscles may test ____ and function is limited as a result of the weakened tissue.
Subacute
Weak
The subacute stage (repair & healing) usually lasts ___ to ___ days (14-21 days after the onset of injury). It may last up to __ weeks in some tissues with limited circulation (e.g. ligaments, tendons).
10-17 days
6 weeks
No signs of inflammation are present in this stage and the molecular structure of collagen changes by becoming thicker and stronger.
Chronic Stage (Maturation & Remodelling)
In the _______ stage, immature collagen can be remodelled with gentle persistent treatment ( __ to ___ weeks) and after 14 weeks, scar tissue is unresponsive to remodelling stresses.
Chronic
8-10 weeks
Old scars do not respond well to __________ and require adaptive lengthening of surrounding tissues.
Stretching
In the _______ stage, ther may be muscle weakness limiting normal function as well as contractures/adhesions that limit range. Connective tissue continues to strengthen and remodel.
Chronic
With ROM testing in the _______ stage, stretch pain may be felt when testing tight structures at the end of their available range. Function may be limited by weakness, poor endurance or poor neuromuscular control.
Chronic
The chronic stage (maturation & remodelling) may last __ months to __ year depending on the tissue involved and the amount of damage.
6 months-1 year
What are the 3 levels of severity of tissue injury?
1) Grade 1 (First Degree)
2) Grade 2 (Second Degree)
3) Grade 3 (Third Degree)
Grade __ severity of tissue injury involves:
- Mild pain at time of injury or within 24 hours
- Mild swelling, local tenderness & pain when tissue is stressed
Grade 1 (First Degree)
Grade __ severity of tissue injury involves:
- Moderate pain that requires stopping the activity
- Stress & palpation of tissue greatly increase pain
- With injury to ligaments, some of the fibres are torn = increased joint mobility
Grade 2 (Second Degree)
Grade __ severity of tissue injury involves:
- Near-complete or complete tear/avulsion of tissue (e.g. tendon, ligament) with severe pain
- Stress to tissue is usually painless
- Palpation may reveal the defect
- Torn ligament results in instability of joint
Grade 3 (Third Degree)
T/F - Skin is intact with contusions common sites are soft tissue structures that are exposed to contact, as well as bony prominences.
True
What are the 3 classifications of contusion injuries?
1) Mild
2) Moderate
3) Severe
With a ____ contusion injury:
- 2/3 ROM available
- Minimal bleeding
- Minimal to no loss of function
Mild
With a ________ contusion injury:
- 1/3-2/3 ROM available
- Some bleeding
- Difficulty with function
Moderate
With a ______ contusion injury:
- < 1/3 ROM available
- Significant bleeding
- Very little to no function
Severe
A swelling comprised of a mass of blood that is confined to an organ, space or tissue and caused by a break in a blood vessel. Usually a normal occurence with contusions. If palpable, it will feel like a hard lump at the lesion site and should resolve as injury heals.
Hematoma
With significant ________, there is a risk of severe bleeding or re-bleeding. This is a feature of more severe contusions and we must use care during treatment.
Hematoma
Bleeding is between the muscles. Blood disperses early and recovery is faster with less scar tissue.
Intermuscular Hematoma
Bleeding occurs within the muscle (contained by fascia/surrounding tissue) and there is a longer recovery with more scar tissue formation. There is also a higher risk of developing myositis ossificans or compartment syndromes.
Intramuscular Hematoma
Formation of osseous tissue within muscle (e.g. quadriceps, brachialis). Incidence increases with severity and/or repetitive contusions, along with poor treatment.
Myositis Ossificans
We should be suspicious of _________ __________ (red flag), when there is an increase in pain, return of inflammation and increasing hardness of the hematoma.
Myositis Ossificans
