Week 10 Flashcards
What are the tissue types?
- Soft tissue
- Hard tissue
- Special tissues and organs
difference between sprain and strain?
sprain a ligament
strain a muscle
what is the stress strain curve?
stress - the amount of load placed on a tissue
Strain - the relative change in length associated with the stress applied
(the amount of stress it can absorb before it gets damaged)
what are the grades of soft tissue injury?
Grade 1 - mild injury involving tearing of only a few fibres
Grade 2 - moderate injury involving a considerable portion of fibres
Grade 3 - complete tear or rupture
how does a grade 1 injury present for a muscle?
focal pain, no loss in strength
how does a grade 1 injury present for a ligament?
pain on applied stress/load
normal end feel
how does a grade 2 injury present for a muscle?
pain, swelling, loss of strength
pain reproduced on mm contraction and stretch
how does a grade 2 injury present for a ligament?
pain on applied stress
increased joint laxity, end feel still present
how does a grade 3 injury present for a muscle?
Often musculotendinious junction
- very painful
- loss of function
- visual and palpable deformit
how does a grade3 injury present for a ligament?
complete tear
gross join laxity, empty or no end feel
pain significant or absent
What are the 3 stages of soft tissue repair?
- acute inflammatory
- initial injury -> 2-3days
- Repair (reconstructive/proliferative)
- 2-3 days -> 2-6 weeks
- Remodelling (maturation)
- 3 weeks ->6-12 months
what are the advantage of immobilisation?
- provides protection for injured area
- allows undisturbed inflammatory phase to occur
- mobilise too intensely too early = more type 3 collagen = weaker tissue
- avoids re-injury when tissue not fully recovered
what are the disadvnatged of immobilisation
- shortening of ligaments (contractures)
- decreased length of muscle tissue
- decreased bone desnity
what are the basic principles of injury management?
- minimise extent of intial damage
- reduce associated pain/inflammation
- promote healing of damaged tissue
- maintain/restore flexibility, strength, proprioception
- functional rehabilitation
- assess and correct predisposing factors
What is the initial treatment for soft tissue injury?
Aimed at controlling the local inflammation
RICER? R- rest I - Ice C - Compression E - Elevation R - ? Refer (rehab)
Avoid massage and alcohol in first 48 hours
What influences the prognosis of injury?
- extent of injury
- individual healing capacity
- patients age/general health
- previous function
- goals
- commitment/motivation
what is the most common sporting injury
lateral ankle ligament sprain
What history do you take for ankle injury?
- establish mechanism
- was there another player/force involved
- sounds (pop/crack)
- ability to weightbear
- degree of pain, dysfunction, instability
- initial management
- investigations
How do you assess an acute ankle in a physical examination?
- Gait
- AROM DF, PF, Inversion, Eversion
- PROM = AROM
- Palpation
What are the ottowa ankle rules?
Inidcates when an xray is required
Is there pain in the malleolar zone and any of :
- Bone tenderness posterior edge of the distal 6cm tibia
OR
- bone tenderness at the posterior edge of the distal 6cm of fib
OR
- inability to weighbear for 4 steps both immediately and at time of examination
when dont ottowa rules apply?
- pregnancy
- intoxicated, uncooperative, altered LOC
- other distracting injuries
- Diminished sensation in legs
- Gross swelling preventing palpation
- Age less than 18
How do you managemnt a lateral ankle ligament sprain?
- reduction of pain and swelling - RICER
- use ottawa rules
- Gait aids as needed
- Early controlled mobilisation
- Restoration of range of movement
- strength
- proprioception
what do you look at in the clinical presentation of a significant knee injury?
- machanism of injury
- severity of pain and disability at time of injury
- presence and timing of swelling
- degree of disability on presentation to you
how does swelling help show you severity of knee injury?
Immediate swelling (0-2 hours) = usually a bleed - Haemarthrosis
Delayed swelling (6-24 hours) = Effusion
What sounds and sensations may indicate what unjury in a knee injury?
- snap or pop = ACL
- moved or popped = ACL or patella dislocation
- Clicking or locking = meniscal
what are the ottowa knee rules?
x ray is indicated when one of the following is present:
- age over 55 or under 18
- tenderness to fib head
- tenderness over patella
- inability to flex knee 90 degrees
- inability to weight bear for 4 steps
What arethe high index of suspicion rules for ottowa knee rules?
- high speed injuries
- children or adolescents
- clinical suspicion of loose bodies
what is the mechanism of injury for ACL rptures?
- sudden change of direction
- landing knee in hyperextension
- landing and twisting
what history will you see with an ACL?
- landing from jump/deceleration/pivoting etc
- sharp pain
- often audible pop or crack
- instability
- locking
- immediate onset of swelling (haemarthorosis)
what mechanism can cause a medial collateral ligament rupture?
Valgus force to partially flexed knee from the lateral side
what are the signs of meniscus injury?
- gradual or delayed swelling
- intermittent locking
- restriction in range of motion
- pain on weight bearing
What do you see with patella disolcation?
- acute mechanism (twisting and landing)
- pops out
- immediate pain and swelling
- usually reduces spontaneously with knee extension
whats the difference between a shoulder dislocation and sublaxation?
Dislocation = complete absence of continuity between the humeral head and the glenoid
Subluxation = partial discontinuity
what do you have to be careful of with shoulder dislocations?
nerves running around humoral head
