contusions, hematomas, myositis ossificans & decubitus ulcers Flashcards
(34 cards)
1
Q
What are the classifications of contusions?
A
- mild
- moderate
- severe
2
Q
Describe a mild contusion
A
- minor crush injury with minimal bleeding
- minimal to no loss of strength
- minimal loss of ROM
- can continue with activity with mild discomfort
- 5-20% loss of ROM with minimal loss of strength
3
Q
Describe a moderate contusion
A
- moderate crush injury with bleeding and swelling
- difficulty continuing with activity due to pain and muscle weakness; disability the next day
- 20-50% loss of ROM and moderate loss of strength
4
Q
Describe a severe contusion
A
- severe crushing injury with rapid bleeding and swelling
- cannot continue with activity due to significant pain and muscle weakness
- more than 50% decrease in ROM and functional loss of strength
5
Q
Describe acute symptoms of contusions
A
- bruising is red, black and blue
- decreased ROM due to swelling and protective muscle spasms
- pain at rest
- inflammation (heat, redness, pain, swelling)
- tenderness at site of lesion
6
Q
Describe early sub-acute symptoms of a contusion
A
- bruising is black and blue
- pain, edema and inflammation are still present but reduced from the acute stage
- adhesions are developing around the injury
- protective muscle spasming decreases but tps occur in affected muscles and the synergist and antagonists
- ROM is still reduced/increased pain on mvmt
7
Q
Describe late cub-acute symptoms of contusions
A
- bruising is yellow, green and brown
- pain, edema and heat diminishes
- adhesions are developing around the injury
- protective muscle spasm is replaced by increased tone and tps in affected and compensatory muscles
- ROM and strength are reduced
- periperal nerves may be compressed by edema and swelling
8
Q
describe chronic symptoms of contusions
A
- bruising is gone
- adhesions are mature
- hypertonicity and tps are present in affected muscles and compensatory structures
- tissue may be cool due to ischemia
- moderate to severe - discomfort local to the lesion when muscles is stretched; full ROM and strength may still be reduced
- myositis ossificans can be produced within 3-6 weeks post injury
9
Q
CI’s for contusions
A
- in acute of moderate to severe contusion NO PROM OR RROM are done to prevent further tissue damage
- in acute of mild contusion - no onsite work
- acute and early subacute in moderate to severe - local and swedish massage is CI’d but proximal MLD is indicated
- avoid removing protective splinting of acute contusion
- first 10 days with moderate to severe - no heat or contrast bathing or vigorous treatments
- no circulatory techniques toward injury because of congestion of area
- no stretch or PROM beyond onset of discomfort
- frictions if client on anti-inflammatory or blood thinners
10
Q
Define Hematoma
A
- a localized collection of blood, usually clotted, in a tissue or organ.
- almost always present with a fracture
11
Q
What is a contusion?
A
- a crush injury to a muscle (without breaking the skin)
- damage to the mm fibers and bleeding into the subcutaneous tissue and skin
- can be local with minor discoloration to large and debilitating
- bruising can track along the fascial planes
- periosteum can be contused
- is caused when blood vessels are damaged or broken as the result of a blow to the skin
- a purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis
12
Q
What causes myositis ossificans?
A
- not applying cold therapy and compression immediately after the injury
- having intensive physiotherapy or massage too soon after the injury.
- returning too soon to training after exercise
13
Q
symptoms of myositis ossificans include:
A
-restricted ROM
-pain in muscle when you use it
-strength loss
-a hard lump in the mm/palpable mass within tissue
an x-ray can show bone growth
14
Q
precautions and management of myositis ossificans
A
- avoid use of deep pressure directly over severe bruises - this can aggravate the injury site and cause more production of bony material and a larger mass to form
- do not try to increase ROM of the surrounding joints while it is still in acute or subacute stage - this can be painful and may also aggravate the injury
- have patient rest the area as much as possible until maturation of the mass occurs
15
Q
observations for an acute contusion
A
- antalgic gait
- bandages/tensors to manage swelling
- antalgic posture
- edema at lesion site
- red, black or purple bruising
16
Q
observations for subacute contusions
A
- edema diminishes from the early to late subacute stage, both on site and distally
- bruising over the injury site changes from purple and black in early subacute stage to brown, yellow and green in late subacute
- contusions that occur in the distal thigh may drain down to the knee and produce local irritation
17
Q
observations for chronic contusions
A
- habituated antalgic gait and posture
- with a severe contusion, there may be an alteration in the contour of the muscle
18
Q
What will you palpate with an acute contusion?
A
- heat over the injured muscle and possibly in the surrounding tissue
- tenderness is present local to the lesion site and refers into the nearby tissue
- texture of the edema is firm
- protective mm spasm is present in the affected mm, the synergists, and the antagonists
19
Q
What will you palpate in a subacute contusion?
A
- temperature diminishes
- tenderness is present local to the injury
- texture of the edema is less firm
- adhesions are present as the healing progresses from early to late subacute
- trp may be present
20
Q
What will you palpate in a chronic contusion?
A
- injury site may be cool due to ischemia
- point tenderness at the lesion site
- adhesions and fascial restrictions are present local to the injury site
- hypertonicity and trps are present local to the injury and in compensating mm.
- IF myositis ossificans is present, there is local inflammation and the bony island is palpable as a hard, unyielding nodule
21
Q
What will the mvmt be like with an acute contusion?
A
- AFROM is reduced
- if moderate or severe suspected other testing is CI’d in acute phase
- PROM - painful, mm spasm end feel
- AROM - mild-minor to no loss of strength with some discomfort
22
Q
What will mvmt be like with a subacute contusion?
A
- AFROM & PROM - reduced
- RROM - pain at injury side
23
Q
What will mvmt be like with a chronic contusion?
A
- AROM - may be limited by any remaining pain at the end ranges of motion
- PROM - mildly painful, tissue stretch end feel on fully stretching the affected mmm
- RROM - may reveal decreased mm strength
24
Q
What special tests do you use with acute, subacute or chronic contusions?
A
- acute - girth measurement test
- subacute - AROM, PROM, isometric testing, quad contusion test
- chronic - length tests
25
What is a decubitus ulcer?
- aka. "pressure sores"
- skin lesions caused by an external pressure,shearing or friction force that is sufficient to locally impair circulation and lymphatic flow in susceptible individuals
- lesions may result in ulcerations
26
What does low pressure do to decubitus ulcers?
can cause tissue damage if it is applied over several hours
27
what does higher pressure do to decubitus ulcers?
can cause tissue damage in only a few minutes
28
Decubitus ulcers lead to...
- ischemia and irreversible tissue damage due to a deficiency of oxygen to the cells and retention of toxic metabolic waste.
- serious if left untreated, can lead to septicemia or even death
29
What can cause decubitus ulcers?
unrelieved pressure, friction, humidity, shearing forces, temperature, age, continence and medication to any part of the body, especially portions over bony or cartilaginous areas such as sacrum, elbows, knees, ankles, etc.
30
what are contributing factors to decubitus ulcers?
- sensory perception and motor losses, which are present with people who have neurological disorders, such as spinal cord injuries
- severely compromised tissue health
- incontinence - inadequate protein intake & vitamin deficiencies such as vit C or B12, iron and zinc
- medication - including tranquillizers, sedatives and opiates
31
Describe a stage 1 symptom picture for decubitus ulcers
- earliest stage of a pressure sore is evident with local erythema
- palpable warmth
- hardened swelling over the fragile but intact tissue
- redness in areas where pressure is applied will diminish upon release often w/in a few minutes
- reversible but require intervention
- visually similar to reactive hyperemia. can be distinguished in two ways: 1) reactive hyperemia resolves itself w/in 3/4 of the time pressure was applied, 2) reactive hyperemia blanches when pressure is applied, whereas a stage 1 pressure ulcer does not.
- the skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient
32
Describe a stage 2 decubitus ulcer symptom picture
- more tissue damage occurs, with the epidermis and often the dermis being affected
- classified as partial-thickness damage
- blister, abrasion or shallow ulcer may be present
- area is moist, pink and painful
33
Describe a stage 3 decubitus ulcer symptom picture
- full-thickness damage down to subcutaneous layers
- cavity is created
- may be exudate and a crust over the cavity
- crust is referred to as eschar, is thick and leathery necrotic tissue
- can be difficult to heal due to poor blood supply to this layer
34
Describe a stage 4 decubitus ulcer symptom picture
- most severe lesion includes not only full-thickness tissue damage but also necrosis to underlying muscle and bone
- deep cavity may be covered with a crust and lead to sepsis.
