Week 3 (Soft Tissue Injury) Flashcards
Grade 1 soft tissue injury (mild)
- Few soft tissue fibres damaged
- Minor pain, swelling or bruising
- Minimal loss of ROM (muscle) or laxity (ligament)
- Minimal loss of function
Grade 2 soft tissue injury (moderate)
- Moderate amount of soft tissue fibres damaged
- Moderate pain, swelling or bruising
- Moderate loss of ROM (muscle) or laxity (ligament)
- Moderate loss of function
Grade 3 soft tissue injury (severe)
- Inability to contract a muscle
- Period of immobilisation
- Viability of tissue healing
- Extensive amount of soft tissue fibres damaged
- Substantial pain, swelling or bruising
- Severe loss of ROM (muscle) or laxity (ligament)
Bleeding associated with injury
- Due to damage of small blood vessels and capillaries in soft tissues
- Can track distally due to gravity
- More vascular tissue will bleed more
Inflammatory phase
- Main CF: pain, swelling, redness, +/- increased local temp and loss of function
- Accumulation of exudate and oedema causing swelling
- Peripheral muscle fibre contraction
- Cell damage and protein breakdown
- Phagocytosis to decrease debris and oedema
Inflammatory process initiates proliferation of new tissue cells (i.e. next phase) which eventually remodel to restore normal tissue function
Proliferation phase
- Collagen-forming phase
- Structures are rebuilt and regeneration occurs
- Ongoing phagocytosis
- Formation of new blood cells
- Proliferation of fibroblasts
- Production of type 3 collagen fibres - form scar tissue with disordered alignment
- By 2-3 weeks most of the scar tissue is laid down
Absorption of inflammatory exudate - reduces swelling and pain
Remodelling phase
- Long-term process
- At 1 year, injured tissue regained 80% of its original strength
- Collagen in scar tissue become mature and denser and organised along lines of stress
24 hour behaviour of conditions?
Better in morning, worse in afternoon or with activity
- Contractile tissue usually benefits from rest so better in morning and worsens with activity throughout the day
Worse in morning, better with movement/throughout day
- Inflammatory and other pathologies may be worse in morning, improve during day and worse in evening
- Degenerating tendinopathies are usually stiff in morning and warm-up with movement
Aggravating and easing factors of contractile and non-contractile tissue
Contractile tissue
Usually aggravated with activity that result in contraction of that muscle
- Improves with rest
- Amount of activity provides insight into severity of tear/strain/rupture
Non-contractile tissue
Usually aggravated with activity that loads the joint of ligament
- Stress tests may be needed
- May stiffen with rest
Irritability questions
How intense is the pain? How easy is it aggravated? How long does the pain take to settle?
Red flags
- Age of onset <20 or >55 years
- Violent trauma e.g. fall from a height, car accident, etc.
- Constant, progressive, non-mechanical pain
- Thoracic pain
- Previous history of cancer
- Systemic steroid use
- Drug abuse
- Systemically unwell
- Unexplained weight loss
- Structural deformity
- Widespread neural symptoms
Yellow flags
- Fear avoidance behaviour e.g. fear of movement because of pain
- Catastrophising
- Belief that pain is uncontrollable
- Excessive reliance on use of medication
- Worker compensation issues
- Depression and anxiety
- Lack of family support
- Employer is unsupportive
Sprain/subluxation/dislocation/tear
Injury to non-contractile structures (ligament or joint)
- Excessive force/load causes structures to go beyond normal ROM or stretch
- Common in activities which require sudden change of direction or uneven surfaces
Strain/tear/rupture
Injury to contractile tissues (muscle or tendon)
- Contractile tissue fibres fail to cope with demands placed upon them
- Results from forceful contraction
- May require contraction or loading to reproduce symptoms
Contusion
Often results from a direct blow from contact with a player, equipment or object
