Acute and Overuse Injuries

Question 1

Cartilage Function

Answer 1

Shock absorber, joint lubrication

Question 2

Cartilage types

Answer 2

Hyaline e.g. joint surface
Fibrocartilage e.g. meniscus, vertebral disc
Elastic e.g. outer ear

Question 3

Joint function

Answer 3

Stability on bony configuration and soft tissues

Question 4

Bursa

Answer 4

Facilitates the movement of the tendon over the bony surface

Question 5

Bone fracture

Answer 5

Acute
Transverse, oblique, comminuted, spiral, avulsion
Open or closed
Displaced or non-displaced

Sx - pain, tenderness, bruising, swelling, deformity, ROM

Question 6

Periosteal injury

Answer 6

Acute
Bleeding in periosteum due to direct blow
e.g. tibia from stick/ kick

Question 7

Wolff law

Answer 7

Bone remodels in response to the direct force/stress applied to it, using osteoclasts and osteoblasts

Question 8

Bone strain

Answer 8

Overuse
Non-tender
Mildly increased uptake on bone scan
XR/CT Normal

Question 9

Stress Reaction

Answer 9

Overuse
Tender
Mildly increased uptake on bone scan
XR/CT Normal

Question 10

Stress Fracture

Answer 10

Overuse
Microfracture due to repetitive loading that over time exceeds bone's ability to repair
Due to impact forces or muscle pull
Tender
Increased uptake on bone scan
XR/CT Abnormal

Question 11

Osteochondral injury

Answer 11

Acute
Damage to articular cartilage +/- subchondral bone
Poor healing capacity due to inadequate blood supply
May predispose to ealy OA
E.G. metatarsal dome with inversion injury

Question 12

Meniscal Tear

Answer 12

Acute (fibrocartilage)

Question 13

Intervertebral disc prolapse

Answer 13

Acute (elastic cartilage)

Question 14

Patellofemoral Syndrome

Answer 14

Overuse - Microscopic inflammation of cartilage

inflammation leads to softening => fibrillation => fissuring =>gross disruption

Question 15

Osteochondritis Dissecans

Answer 15

Separation of bone and cartilage from normal surrounding structures

e.g. medial femoral condyle - Axial CT of the knee demonstrates a completely detaches

Question 16

Joint Dislocation

Answer 16

Acute

Complete disassociation of the joint surfaces

Question 17

Joint Subluxation

Answer 17

Acute

Partial disassociation of the articulating surfaces

Question 18

Sinus Tarsi Syndrome

Answer 18

Overuse injury causing chronic inflammation
following inversion injury
lateral ankle pain

Question 19

Osteoarthritis

Answer 19

Overuse
Fraying of cartilage +/- loose fragments, bony cysts, subchondral bone sclerosis, osteophtes, thickening of synovium

RF - age, FHx. congenital/ developmental joint alterations, alterations of supporting structures, injury, obesity, occupational overuse

Question 20

Ligament Sprain

Answer 20

Acute
GRADE 1
- Stretching of fibres, minimal tearing
- No laxity, normal end feel
- Mild/mod pain

GRADE 2

• Partial tear
• Laxity, normal end feel
• Mod/sev pain

GRADE 3

• Complete tear
• Laxity, no end feel
• May be pain free

Question 21

MCL Knee inflammation - Breaststroke swimmers

Answer 21

Overuse

repetitive valgus loads across the knee

Question 22

MCL Elbow Inflammation

Answer 22

Overuse

Repetitive throwing with valgus loading

Question 23

Plantar Fasciitis

Answer 23

Overuse syndromes of the foot

Question 24

Muscle Strain

Answer 24

Acute
GRADE 1
- Small no. of muscle fibres torn, fascia intact, minimal bleeding
- Mild pain, FROM, full strength

GRADE 2

• Significant no. of muscle fibres torn, increased bleeding
• Increased pain, swelling, decreased ROM and strength, palpable haematoma

GRADE 3

• Complete tear (usually at musculotendinous junction)
• Bleeding & swelling +++, no active contraction

Question 25

Cramps

Answer 25

Acute painful involuntary contraction sudden and temporarily debilitating

Question 26

Contusion

Answer 26

Acute Direct blow to muscle cause bleeding with haematoma formation can lead to MYOSITIS OSSIFICANS - bone tisse formation inside the muscle or other soft tissue e.g. dead leg in footballers

Question 27

Focal Fibrosis of muscle

Answer 27

Overuse repetitive microtrauma cause inflammation and adhesions

Question 28

Chronic compartment syndrome

Answer 28

Overuse Exercise causes increased intra-compartmental pressure; tight fascia does not allow for expansion and impairs blood supply => pain

Question 29

Delayed Onset Muscle Soreness (DOMS)

Answer 29

Overuse 24-48hrs post exercise, esp eccentric Secondary to inflammatory cell/metabolite build up e.g. downhill running

Question 30

Myofascial Pain

Answer 30

Overuse due to injuries, stress, inflammation and poor posture Trigger points hardening of muscle upon palpation of trigger points subjective weakness referred pain from trigger point shared Sx with fibromyalgia (but fibromyalgia = widespread, systemic, associated with fatigue)

Question 31

Tendon Tear

Answer 31

Acute Usually at site of least blood supply (e.g. 3cm above achilles tendon insertion) or musculotendinous junction complete or partial

Question 32

Tendinosis

Answer 32

Overuse Collagen degeneration neovascularisation causes pain

Question 33

Tendinitis

Answer 33

Overuse inflammation e.g. inflammatory arthritides

Question 34

Paratenonitis

Answer 34

Overuse Inflammation of paratenon/ tendon sheath e.g. deQuervain's tenosynovitis (APL and EPB) in rowers

Question 35

Traumatic Bursitis

Answer 35

Acute | direct knock causes bleeding in bursa

Question 36

Bursitis

Answer 36

Overuse | e.g. greater trochanteric bursa (gluteus medius attachment)

Question 37

Neuropraxia

Answer 37

Acute due to direct blow pain, tingling, numbness +/- weakness - along distribution e.g. common peroneal nerve at the neck of fibula

Question 38

Nerve Entrapment

Answer 38

Acute or Chronic | e.g. prolapsed IV disc and nerve root compression

Question 39

Adverse Neural tension

Answer 39

Chronic irritation of nerve due to local inflammation pain on stretching nerve e.g. RSI (carpal tunnel)

Question 40

Abrasion/Laceration

Answer 40

Acute common complications - bleeding, infection

Question 41

Blisters/Callus

Answer 41

Chronic | common