Lecture 10 - Sprains And Strains Flashcards Preview

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Flashcards in Lecture 10 - Sprains And Strains Deck (29):
1

Grades of severity of tissue damage

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

2

Repair vs regeneration

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

3

3 phases of repair

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

4

Phases of repair: 1) acute inflammatory phase

- 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

5

Phases of repair: 2- repair (proliferation) phase

- 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

6

Phases of repair 3) Remodelling phase

- 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

7

Wolf's law

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

8

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

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

9

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

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

10

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

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

11

Ligament injury

- 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

12

Diagnosis of ligament injury

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

13

Classification of ligament injury

- 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

14

Ligament damage management

- grades 1,2: conservative
- Grade 3: conservative, surgical repair or reconstruction

- same principles for soft tissue injury management
- emphasis on re-injury prevention

15

Lateral ankle sprain

- 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

16

Special test for lateral ankle sprain

Anterior drawer test

17

MAnagement of lateral ankle sprain

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

18

Anterior cruciate ligament injury

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

19

Theories for ACL injuries

- 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

20

ACL Diagnosis

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

21

Management of ACL tears

- 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

22

REhabilitation management of ACL tears

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

23

Muscle strain

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

24

HEaling of muscle injuries
- Inflammatory phase

- marked hematoma
- myofibrils contract

25

HEaling of muscle injuries
- reparative phase

- regeneration of myofibers
- production of connective scar tissue

26

HEaling of muscle injuries
- remodeing phase

- maturation of regenerated myofibers
- reorganisation od scar tissue

27

Muscle strain

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

28

Complication of muscle ruptures

- 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

29

Management of muscle injury consideration

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