Week 3 - Soft-tissue injuries & patient history taking Flashcards
Soft tissue injury signs + symptoms
- Amount of soft tissue fibres damaged
- Severity of pain, swelling, or bruising
- Severity of loss of ROM / ligament laxity
- Amount of LOF
Inflammatory phase:
0-72 hours
Initiates the proliferation of new tissue cells, which eventually remodel to restore normal tissue function.
- Swelling occurs (oedema)
Proliferation phase:
48 hrs - 6weeks
Remodelling phase:
3 weeks - 12 months
Bleeding 0-10 hours post injury:
- Due to damage of small blood vessels +capillaries in the soft tissue
- Can track distally due to gravity
- More vascular will bleed more
Main clinical features of the inflammatory phase:
- Pain, swelling, redness
- +/- increased local temp.
- LOF
The proliferation phase (what is happening):
- Collagen-forming phase (prod. of type III collagen fibres- form scar tissue)
- Formation of new blood vessels
- by 2-3 weeks most scar tissue is laid down.
Oedema:
Fluid retention causing affected tissue to become swollen
The remodelling phase (what is happening):
Collagen in scar tissue:
- Matures & becomes denser
- Becomes more organised along the lines of stress.
Contractile tissue 24 hr behaviour:
Usually benefits from rest, usually better in the mornings + worsen w/ activity throughout the day
Inflammatory behaviour 24 hr behaviour:
(i. e. OA/RA)
- May be worse in the morning, improve during the day then get worse in the evening.
Degenerating tendinopathies 24 hour behaviour:
Usually stiff in the morning & warm up with movement
- Worse the morning after activity
Serious pathology 24 hour behaviour:
Pain that wakes you up and keeps you up
Contractile tissue:
- Usually aggravated w/ activity that results in contraction fo that muscle.
- Improves w/ rest
Non-contractile tissue:
- Usually aggravated w/ activity that loads the joint/ligament
- Stress tests may be needed
- May stiffen w/ rest
Red flag examples:
- Age: <20 or >55
- Violent trauma
- Constant, progressive, non-mechanical pain
- Thoracic pain
- Previous history of cancer
- Systemic steroid use
- Drug abuse
- Unexplained weight loss
- Structural deformity
- Widespread neural symptoms
Yellow flag examples:
- Fear-avoidance behaviour
- Catastrophising
- Belief that pain is uncontrollable
- Excessive reliance on use of medication
- Workers compensation issues
- Depression/anxiety
- Lack of family support
- Employer is unsupportive
Sprain/subluxation/dislocation/tear
- Injury non-contractile structures
- Excessive force/load causes the structure to go beyond normal ROM / stretch
- Common in activities w/ sudden changes of direction
- Lateral ankle ligament sprain is most common
Signs + symptoms of non-contractile injury GRADE 1
- Mild over-stretching of non-contractile structure
- Mild pain + tenderness @ EOR
- Normal ROM, function, + feel
Signs + symptoms of non-contractile injury GRADE 2
- Moderate fibre disruption
- Moderate/severe pain, tenderness, bruising, + swelling
- Limited ROM (secondary to pain/swelling)
- Increased laxity on stress tests but definite end feel
Signs + symptoms of non-contractile injury GRADE 3
- Complete disruption of fibres
- No end feel, complete laxity
- Often severe pain, but can also be pain-free as sensory fibres are completely divided in injury
- Severe limitation in strength/ROM (second to bruising/swelling)
Strain/tear/rupture
- Injury to contractile tissue (muscle/tendon)
- Some/all tissue fibres fail to cope w/ demand
- Results from forceful contraction/over-stretching
- May require contraction/loading to reprod. symptoms
- 2-joint muscles susceptible to tears (HS/quad)
Signs + symptoms of a strain/tear/rupture GRADE 1:
- Small # of muscle fibres disrupted
- Localised pain of mod>high levels of contraction
- No loss of ROM/strength
Signs + symptoms of a strain/tear/rupture GRADE 2:
- Significant # of muscle fibres disrupted w/ associated pain/swelling
- Mod/severe pain reproduced on light/mod contraction
- Mod/severe pain reproduced on stretch of struc.
- Limitation to ROM, strength, + function
