Topic 9 - Repetitive Strain Injury

Question 1

These injuries are very common and can occur with all occupations and recreational activities. Any activity that can cause wear and tear on the body can lead to it.

Answer 1

Repetitive Strain injuries (RSIs)

Question 2

Injury results in the process of inflammation and repair. Some injuries are minor and never cause an acute response. This is known as ___________.

Answer 2

Microtrauma

Question 3

If the tissue that has already sustained microtrauma is continuously stressed, it won’t have the opportunity to heal and the inflammatory state can last much longer than the normal acute 4-6 day span. This is called _______ ____________.

Answer 3

Chronic Inflammation

Question 4

Chronic inflammation differs from acute inflammation in a number of ways including the ________ of the inflammatory process and the ________ process itself.

Answer 4

Duration
Cellular

Question 5

On a cellular level, tissues exposed to chronic inflammation possess an upregulation of ___________, as well as increased macrophages and lymphocytes. This results in increased ________ production with simultaneous destruction of mature tissue. This yields a predominance of new, ________ collagen, which weakens the tissue overall.

Answer 5

Fibroblasts
Collagen
Immature

Question 6

Some studies have discovered an increased amount of type __ / type __ collagen in tissue that has been exposed to chronic inflammation (relative to healthy tissue). This is hypothesized to be part of the cause of tissue dysfunction with chronic inflammation.

Answer 6

Type 3 / Type 5

Question 7

Many RSIs have a slow, _________ onset. Pain, inflammation and/or ________ come on slowly and often people don’t seek treatment right away.

Answer 7

Insidious
Weakness

Question 8

_____ inflammation can be described as:
- Fast onset
- Short duration (4-6 days)
- Cellular infiltrate = neutrophils
- Mild tissue injury/fibrosis (self-limited)
- Prominent local & systemic signs (e.g. SHARP)

Answer 8

Acute

Question 9

_______ inflammation can be described as:
- Slow onset
- Longterm duration
- Cellular infiltrate = macrophages, lymphocytes & monocytes
- Often severe tissue injury/fibrosis (progressive)
- Less prominent/subtle local & systemic signs

Answer 9

Chronic

Question 10

Causes of _______ inflammation include:
- Overuse, cumulative trauma & repetitive strain
- Trauma
- Scar tissue
- Contractures/poor mobility

Answer 10

Chronic

Question 11

Repetitive microtrauma or repeated strain overload over time results in structural _________ or fatigue breakdown of connective tissue and inflammation. Initially the trauma is ____________ and doesn’t produce an acute response, but eventually builds to a point of perceived pain and dysfunction.

Answer 11

Weakening
Subthreshold

Question 12

Trauma followed by superimposed repetitive trauma may be due to _________ return to function following an injury.

Answer 12

Premature

Question 13

An injury site is predisposed to future injury due to noncompliant, inextensible ____ tissue and adhesion to surrounding tissue. This causes malalignment to the stress imposed on the tissue as well as altered _____ transmission and ______ absorption.

Answer 13

Scar
Force
Energy

Question 14

Faulty/dysfunctional posture or prolonged immobility may lead to tissue ___________ that can become stressed with repeated vigorous activity.

Answer 14

Contracture

Question 15

_______ are vulnerable to repetitive strain. When muscles are unable to bear a given load due to a lack of adequate strength or endurance, the load is then passed onto this structure.

Answer 15

Tendons

Question 16

Tendons are not as ____________ as muscle and therefore have reduced perfusion and increased healing time.

Answer 16

Vascularized

Question 17

At one time, all tendon pain was considered to be ____________ in nature. However, the most current research is showing that in many cases tendon pain is not accompanied by these markers.

Answer 17

Inflammatory

Question 18

Studies examining individuals with _______ tendon pain have also showed the following symptoms:
- Excessive proliferation of disregulated collagen that is discoloured and easily disrupted
- Abundance of type 3 & 5 collagen
- Proliferation of micro blood vessels & nerves that are not contributing to the healing process

Answer 18

Chronic

Question 19

Likely, the process of ______ dysfunction starts with a prolonged inflammatory process that leads to tissue destruction, fibrosis and scarring with an overall weakened and dysfunctional ______ that is unable to bear load efficiently or effectively.

Answer 19

Tendon x2

Question 20

Contributing factors of ____________ include:
- Length/strength imbalances (e.g. unopposed agonist, weak antagonist, weak synergist)
- Postural dysfunction (e.g. lengthened/shortened position)
- Postural fault/sustained awkward postures
- Rapid/excessive repeated demand
- Muscle weakness
- Change in usual demands of an activity
- Returning to activity too soon after injury
- Environmental factors (e.g. excessive cold, ergonomic inefficiency)
- Age related factors (e.g. muscle strength, tissue fragility)
- Training errors (e.g. improper form, pushing through pain)
- Impingement type syndrome
- Carrying extra body weight

Answer 20

Tendinopathy

Question 21

Some tendons have _______ surrounding them (e.g. biceps long head tendon) that can become irritated and inflamed.

Answer 21

Sheaths

Question 22

General term referring to tendon pathology.

Answer 22

Tendinopathy

Question 23

Acute or chronic inflammation of a tendon.

Answer 23

Tendonitis

Question 24

Chronic degradation of a tendon without inflammation. Characterized by disrupted collagen fibres within the tendon, increased cellularity and neovascularization (not associated with increased healing).

Answer 24

Tendinosis

Question 25

Inflammation of a tendon sheath.

Answer 25

Tenosynovitis

Question 26

A tendon that is constantly undergoing microtrauma will suffer from small tears in its fibres. These are repaired with ____ ______ that builds up as more small tears occur.

Answer 26

Scar Tissue

Question 27

Over time the collagen fibres that make up the scar tissue may become stuck to surround tissue. This describes an ________.

Answer 27

Adhesion

Question 28

The repair and replacement of inflamed tissues by connective tissue.

Answer 28

Fibrosis