Week 9- Soft Tissue Injuries Flashcards
What are some examples of soft tissue injuries?
Bruises
Muscle strains and tears
Tendonitis, tendinopathy, tendon rupture
Ligament rupture or tear
Capsulitis
Bursitis
Sprains
What are some examples of tendon injuries?
Tennis elbow, golfer’s elbow, Achilles tendinopathy
Give an example of a muscle/musculotendinous tear
Shoulder rotator cuff tear
Give an example of a ligament injury
Ankle sprain
Give an example of bursitis
Subacromial bursitis
What are the common mechanisms of injury?
Trauma
Sports
Overuse
Abnormal use/repetitive use
Lack of conditioning, lifestyle
What factors make someone more likely to get tennis elbow (lateral epicondylitis)
Affects 1-3% adults annually
Most common in age range 35-50
Usually in dominant arm
Tennis players
Repetitive manual work
What things are done in the examination for tennis elbow?
Look, feel, move
Palpation of the lateral epicondyle- for tenderness and swelling
Examination of wrist extension- pain with resisted wrist extension with elbow in full extension
Mill’s test- reproducing tenderness over extensor compartment
Resisted supination- reproducing tenderness over extensor compartment
How is tennis elbow treated?
Change activity
Exercise the tendon as close to its limit as possible
Strengthening exercises
Analgesia- paracetamol or NSAIDs acutely
Ice after activity
What is the rotator cuff and what does it do?
Rotator cuff comprises four muscles designed to stabilise glenohumeral joint and assist in initiation of movement
What are the two groups rotator cuff tears can broadly be divided into?
Chronic degenerative tears
Acute traumatic tears
What things would you look for when suspecting rotator cuff tear?
Trauma– significant injury implying acute tear
Age
Comorbidities– diabetes
History of subacromial impingement
Cardinal feature is weakness
Secondarily pain
Exclude fracture and neurological cause (cervical spine, plexus)
What is done during a clinical examination for a rotator cuff tear?
Supraspinatus– resisted abuction with thumbs down to defunction deltoid
Infraspinatus and teres minor– resisted external rotation
Subscapularis– resisted internal rotation
What investigations are done for a rotator cuff injury?
X-ray– shoulder trauma series to exclude fracture or dislocation
Ultrasound scan/MRI– confirms cuff tear and dimensions
What is done to manage acute tears of rotator cuff (identified within 6 weeks)?
Surgical repair for younger patients (<50)
Older patients- ice, NSAIDs, exercises, possible corticosteroid injection
What is done to manage chronic tears of the rotator cuff?
Ice, NSAIDs, exercises, corticosteroid injection
Describe the Achilles tendon and what it does?
Strongest tendon in the human body
Connects plantaris, gastrocnemius and soleus to the calcaneum
Comprised of type I collagen
Tendon covered by connective tissue rich in elastin
What are some common movements that cause rupture of the Achilles tendon?
Sudden unexpected dorsiflexion
Strong push off (plantar-flexion) with simultaneous knee extension and calf contraction
How does pain with rupture of Achilles tendon present?
Sudden pain often with an audible “pop”
What are the risk factors for Achilles tendon rupture?
Male, middle age
Sports activity
Chronic inflammatory disease- rheumatoid arthritis
Chronic renal failure
Certain drugs- corticosteroids, fluoroquinolone antibiotics
What is used to diagnose rupture of Achilles tendon?
Pain and bruising around heel
Thompson test
Ultrasound used to confirm
What is used in the management of an Achilles tendon rupture?
Rest/immobilisation
Use crutches
Air-cast/moonboot slight plantar flexion
Ice
Analgesia
Refer to orthopaedic surgery
What is an ankle sprain?
‘Lateral ligament complex’
Deltoid ligament
Syndesmosis ligaments
Injury such as stretch or tear of these ligaments is an ‘ankle sprain’
How is an ankle sprain diagnosed?
Ankle X-ray
Pain in malleolar area AND any of the following-
Unable to weight bear
Bony tenderness at posterior edge or tip of lateral malleous
Bony tenderness at posterior edge or tip of medial malleous
What is used in the management of an ankle sprain?
Analgesia
Rest including a controlled ankle motion walking boot
Ice
Compression
Elevation
What exercises are done in the management of an ankle sprain?
Early ankle motion in a controlled brace after 48 hours, against resistance within 4-5 days- therabands
Ankle strengthening
Improve proprioception- wobble board, BOSU ball
What is a key aspect of treating soft tissue injuries?
Physiotherapist
