injury and healing p2 - soft tissues

Question 1

what are soft tissues?

Answer 1

ligaments, tendons + muscle

Question 2

what are soft tissue made up of?

Answer 2

type 1 collagen

Question 3

what are ligaments

Answer 3

soft tissue which connect bone to bone

Question 4

what is the function of ligaments

Answer 4

• restricts joint motion
• hence provides stability
• has proprioception

Question 5

what do tendons do

Answer 5

connect muscle to bone

Question 6

what is the function of tendons

Answer 6

it transmits force

Question 7

what is the typical cause of ligament and tendon injuries?

Answer 7

usually sport related

Question 8

what are the causes of soft tissue injuries?

Answer 8

1. pivoting forces (e.g rolling/twisting joints)
2. eccentric contraction (force placed on muscle too high, causing muscle to snap)
3. trauma (e.g car accident)
4. laceration (cuts)
5. avulsion injury

Question 9

what is an avulsion injury?

Answer 9

occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.

Question 10

how is the severity of a soft tissue injury determined?

Answer 10

using the grading system

Question 11

what are the different categories of severity of soft tissue injuries?

Answer 11

1. grade 1
2. grade 2
3. grade 3

Question 12

what happens in a grade 1 tear?

Answer 12

slight incomplete tear, no notable joint instability

Question 13

what grade tear is this?

Answer 13

grade 1

Question 14

what happens in a grade 2 tear?

Answer 14

• moderate/severe
• incomplete tear
• some joint instability

Question 15

what grade tear is this?

Answer 15

grade 2

Question 16

what happens in a grade 3 tear?

Answer 16

• complete tearing of 1 or more ligaments
• obvious instability
• surgery may be requried

Question 17

what grade tear is this

Answer 17

grade 3

Question 18

what are the 4 stages of healing soft tissue injuries?

Answer 18

1. bleeding
2. inflammation
3. proliferation
4. re-modelling

Question 19

how do soft tissues heal differently to bones?

Answer 19

• they heal much slower
• maximum strength of recovery >6 months
• tissue may never fully recover full tensile strength

Question 20

what anatomical features does the knee consist of

Answer 20

1. bones
2. muscles
3. ligaments
4. cartilage

Question 21

what is this?

Answer 21

anterior cruciate ligament - ACL

Question 22

what is the role of the ACL in the knee?

Answer 22

gives rotational stability

Question 23

what are some symptoms of an ACL tear?

Answer 23

• knee feel unstable during sports
• painful
• swelling

Question 24

what 3 tests can you do on physical examination to determine whether patient has an ACL tear?

Answer 24

1. lachmann’s test
2. anterior drawer test
3. pivot shift test

Question 25

what is a very broad + generic way of managing an ACl tear?

Answer 25

using PRICE protocol Protect Rest Ice Compress Elevate

Question 26

what are the 2 options of managing ACL tear?

Answer 26

1. non-operative 2. operative

Question 27

If you have a ruptured ACL, will it heal to the way it was before?

Answer 27

* no, heals awfully (as avascular tissue) * means you will permanently have an unstable knee

Question 28

if ACL ruptures heal so badly, why do many people not get operative treatments?

Answer 28

As ACL is only really needed for rotational stability, meaning ppl without ACL would be fine with day 2 day activities, would only struggle with pivoting sports e.g football/skiing

Question 29

what is the management process if patient opts for non-operative approach of ACL rupture?

Answer 29

- put in brace - Use phsyiotherpay/rehab to strengthen muscles to compensate for loss of ACL

Question 30

If a patient opts for operative approach for ACL rupture, what are the 2 ways it can be treated?

Answer 30

1. repaired 2. replaced (more common)

Question 31

what 3 things do you need to consider when determining a management strategy for a patient with ACL tear?

Answer 31

1. functional demands 2. patient factors 3. compliance

Question 32

what are the risk factors for ruptured achilles?

Answer 32

1. 30-50s M 2. anabolic steriod users 3. ppl taking fluroquinolone 4. weekend warrior - only participate in activity in free time

Question 33

which antibiotic put you at risk of future soft-tissue injuries?

Answer 33

fluoroquinolone

Question 34

what are some findings on physical examination of patient with ruptured achilles?

Answer 34

1. difficulty walking/limp 2. unable to stand on tip toes 3. swelling/thickening of ankle 4. feet will sit up when you lying down

Question 34

what are some findings on physical examination of patient with ruptured achilles?

Answer 34

1. difficulty walking/limp 2. unable to stand on tip toes 3. swelling/thickening of ankle 4. feet will sit up when you lying down

Question 34

what are some findings on physical examination of patient with ruptured achilles?

Answer 34

1. difficulty walking/limp 2. unable to stand on tip toes 3. swelling/thickening of ankle 4. feet will sit up when you lying down

Question 35

what kind of test can you do on patients to see if they have ruptured their achilles?

Answer 35

simmonds calf squeeze test | essentially squeeze calf and foot goes down if achilles is present

Question 36

do you repair or replace tendon injuries in surgery?

Answer 36

repair it, cant really replace it

Question 37

what are some general complications of performing surgery on achilles tendon?

Answer 37

1. DVT 2. infection 3. prolonged immobility