Lecture 10 - Sprains And Strains

Question 1

Grades of severity of tissue damage

Answer 1

• Grade 1: Mild tissue pain and swelling, 50% tissue disruption, significant LOF
• Grade 3: severe pain and swelling, 100% tissue disruption, complete LOF

Question 2

Repair vs regeneration

Answer 2

• Repair: replacement of damaged tissue with new tissues structuralky and functionally different
• Regeneration: replacement of damaged tissue with new tissue structurally and functionally identical

Question 3

3 phases of repair

Answer 3

1) acure inflammatory phase
2) Repair phase
3) Remodeling phase

Question 4

Phases of repair: 1) acute inflammatory phase

Answer 4

• first 3 days
• immediate non specific reaction to infection or injury
• AIMS: destroy damaged cells, inactivate foreign invaders, prepare for tissue repair
• damaged region is being prepared for repait

Question 5

Phases of repair: 2- repair (proliferation) phase

Answer 5

• 2 days - 6weeks post injury
• vascularisation of the damaged region
• synthesis and deposition of collagen fibres
• collagen laid down in a non-uniform manner
• damaged area is FILLED with new tissue

Question 6

Phases of repair 3) Remodelling phase

Answer 6

• 2 weeks - 12 months post injury
• overlap with phase 2
• collagen cross bonds and reorients in direction of stress
• tissue improves in quality and strength

Question 7

Wolf’s law

Answer 7

Tissue will respond to physical demands placed on them

• remodel or realign along lines of tensile force
• for optimal remodelling, tissues should be exposed to progressively increasing loads

Question 8

Treatment principles relative to stage of healing: Stage 1 - inflamatory phase

Answer 8

• reduce pain
• control inflammation
• prevent further cellular damage
• prevent onset of complications
• functional independence

Question 9

Treatmetn principles relative to stage of healing: stage 2: repair phase

Answer 9

• reduce pain
• restore ROM
• facilitate organised alignment of collagen
• prevent adhesion and scarring
• prevent further cellular damage
• prevent onset of complications
• maintain fitness

Question 10

Treatment principles relative to stage of healing: 3) remodelling phase

Answer 10

• strengthen new tissue
• restore ROM
• increased extensibility of new tissue
• specific training
• prevent recurrence

Question 11

Ligament injury

Answer 11

• when forces exceeds the ligaments ability to resist that load
• ligament stronger when load is applied slowly: rapid onset may cause the ligament to tear
• associated structures may be injured

Question 12

Diagnosis of ligament injury

Answer 12

• mechanism of injury
• pain localisation
• associated symptoms/sounds
• complaints about instability
• pain on palpation/stretching
• increased laxity in direction of ligament tension

Question 13

Classification of ligament injury

Answer 13

• Grade 1: partial tear: pain, no laxity
• Grade 2: PArtial tear: pain, some laxity
• Grade 3: complete tear: marked laxity and no disting end feel

Question 14

Ligament damage management

Answer 14

• grades 1,2: conservative
• Grade 3: conservative, surgical repair or reconstruction
• same principles for soft tissue injury management
• emphasis on re-injury prevention

Question 15

Lateral ankle sprain

Answer 15

• most common sporting injury
• 70% will reinjure or develop chronic ankle instability
• caused by forced inversion and plantarflexion force
• Most commonly affected: AFTL or CFL

Question 16

Special test for lateral ankle sprain

Answer 16

Anterior drawer test

Question 17

MAnagement of lateral ankle sprain

Answer 17

• RICE
• nobility
• bracing or taping
• joint mobilisations and manipulations
• proprioceptive, balance exercises
• strenghtening exercises

Question 18

Anterior cruciate ligament injury

Answer 18

• may have associated meniscal injury, articular cartilage damage or MCL
• RIsk factors: family Hx or previous injury, females, bone geometry…

Question 19

Theories for ACL injuries

Answer 19

• Ligament dominance theory: excessive knee valgus, hip adduction
• Trunk dominance theory: deficits in trunk control indirectly increases valgus forces at knee
• Quadriceps dominance theory: excessive quadriceps forces increase pull on ACL
• Leg dominance theory

Question 20

ACL Diagnosis

Answer 20

• pop/ snap sound
• Pain
• effusion
• instability
• clinical tests: Brush/swipe effusion test, anterior drawer test, Lachman’s test, pivot shift test

Question 21

Management of ACL tears

Answer 21

• ACL reconstruction is not the prerequisite for returning to sports
• conservative management for those copign well
• Surgery: Autograft (hamstring), Autograft (Patella tendon), LARS
• all the same after 2 years

Question 22

REhabilitation management of ACL tears

Answer 22

• weight bear as tolerated
• brace until quadriceps control returns
• gradual progression of exercises

Question 23

Muscle strain

Answer 23

• insertion sites
• tendon
• tendon sheaths
• MSK tendinous junction
• skeletal muscle

Question 24

HEaling of muscle injuries

- Inflammatory phase

Answer 24

• marked hematoma

- myofibrils contract

Question 25

HEaling of muscle injuries

- reparative phase

Answer 25

• regeneration of myofibers

- production of connective scar tissue

Question 26

HEaling of muscle injuries

- remodeing phase

Answer 26

• maturation of regenerated myofibers

- reorganisation od scar tissue

Question 27

Muscle strain

Answer 27

• indirect injury caused by overstretching or eccentric overload
• most common site is musculotendinous junction
• ## often occurs in 2 joint muscles

Question 28

Complication of muscle ruptures

Answer 28

• scar tissue formation -> affects elasticity of muscle
• traumatic myositis ossificans -> calcification and ossification of a hematoma, healing disrupted by repeated impact or contractin, results in areas of varying strength and elasticity in affected muscle

Question 29

Management of muscle injury consideration

Answer 29

• muscle strength
• muscle length
• stamina
• stability
• capacity for rapid contraction