lecture 6: injury classification Flashcards
1
Q
explain macrotrauma and give exmples
A
large maginited
ex: sprains, strains, contusions
2
Q
explain microtrauma and examples
A
small magnitutde
ex: stress fractures, overuse injuries
3
Q
what are the forms of muscuoloskeletal trauma
A
physical, chemical, thermal, metabolic and biological
4
Q
what are the 5 directions of force
A
Tensile Compression Shear Torsion Bending (combination)
5
Q
what are the2 types of dirextion of force that are longitudinal
and give example
A
tensile and compression
muscle elong.
6
Q
true or false: direction of focre only applied ot bone
A
false, bone,l igs, capsules and msucles
7
Q
be able to explain the different forces
A
.
8
Q
what are the 3 responses to force
A
1) elstic response
2) yield load
3) failiurre
9
Q
explain elastic repsonse
A
period of time where normal structire function
Load is removed and tissue goes back to original shape
10
Q
explain yield load
A
max amount of load before deformation occurs
11
Q
explain failure
A
Does not return to normal shape
Fractures, strains, sprains
12
Q
in what region do injuries happen
A
failure/plastic region
13
Q
turue or false : the deformation in the elastic region is tolerable
A
true
14
Q
whats the general response to force
A
elongation (strecth/deformation) >miccrotauma > failure/macro
15
Q
what is stress
A
Force divided by the area over which the force acts
16
Q
true or false and explain: Force over a large area versus over a small concentrated area can have very different results
A
ex: Increased SA= decraed foce
17
Q
what is the accpetable strain tolerance
A
Load before failing
Deformation before failing
Energy stored before failing
18
Q
in terms of stiffness of tissue, a steeper slope mean
A
greatter stifness
19
Q
if a tissue has a greater stiffness, it has more or less deformation
A
less
20
Q
know the straing and stress grpah
A
.
21
Q
deformation that is accetepable occurs in what region
A
elastaic
22
Q
what affects the load distrubion ,force absorption and stabilityo of a joint
A
joint types
23
Q
what are the fibrous joints
A
Fibrous joints: synarthrosis, sutures, syndesmoses and gomphosis joints
24
Q
what are the cartilaginous joints
A
Cartilaginous joints: synchondrosis & symphyses
25
what are the sunovial joints
Synovial joints: plane, hinge, pivot, condyloid, saddle & ball-and-socket.
26
Synovial joints incl. what structures
articular cartilage, synovial cavity, articular capsule, synovial fluid and ligaments.
27
what tis the function of connective tissue
joins strtuctures toghther
28
connecttve tissue can be ...
dense or loss
| and regular vs irrengular
29
what are the 3 main componenets of connectiev tissue
collagen, elasttin, reticulum
| =and ground substance
30
whatt is the function of collagen
give stregnth to tissue
31
what is the most numerous protein in the body
collagen
32
whatt makes up 95% of bones sexttracellular matrix
collagen
33
what did collagen develep from
fibroblasts
34
collagen forms what and why is that imporant
crosslinks and it increases soliditty
35
what is elastic
has a stretch property,
| ability to retturn to origional shape
36
where is elastin scarce
tendon and ligaments
37
why can tendons and ligamentts only be strecthed limited amounts
because scarce amount of elastin
38
what is ground substance
Protein chains that give substance to structure
Provide cement like foundation (provide strength for collagen)
Hold water
39
what is the cause of injuries in terms of proteins
collagen and elastin becaome distubed
40
what is the cause of injury
event altering the tissue structure
41
what does injury affect
the ability of tissues to carry out normal function/ load
42
why do we care about cause of injury
1) helps with injury prevention again
2) helps with injury rehab
= allows to assess in a more specific mannerr
43
what are the closed soft tissue injuries of muscle/
strains
tendinopathy
contusions
44
what are the closed soft tissue injuries of joints
Sprains
Dislocations/subluxations
Articular cartilage damage
Bursitis
45
what is the main 2 symptoms of closed soft tissue injuries
sweeling and discolouratiton
46
true or fasle: in a closed soft tissue injury there is leakage
false, swelling is all contained
47
what is tthe cause of contusion
Direct compressive force created by external blow
| or falling
48
what is an ecchymosis
Ecchymosis- tissue discoloration if hemorrhage is superficial
49
what is hematoma
Hematoma- swelling of clotted blood
50
what are some expamples of complicates of contunsions
Complications of contusions can be acute compartment syndrome, active bleeding and large hematomas
51
wgat is acute compartmentt syndrome
if fluid gets in comparment and sweels it can compress on nerves, veins ettc and cause problems
52
explain first degree cnotusions
superficial strecutures crushed
mild weaknes and loss of function
no restriction in ROM
53
explain second deree contusions
superficial and some deep are crushed
mild weakness and mod loss of function
decreased ROM
54
explain third degree contusions
deeoer tissues are crushed (fasicia can be raptured and swollen tissues protrude)
mod to severe weakness nd loss of function
ROM is significantly decreased because of swelling
55
what are muscle strains
Injuries to the muscle that cause varying degrees of tears to a muscle
56
ttrue or false: grading if very different for diff structures that are injuried
trtue
57
what is the typical cause of muscle strain
Typically caused by a stretch induced by a large contraction
Eccentric contractions**
ex: decceleration
58
what are some signs and symptoms of muscle strain
Acute MOI- overstretch or overload
Pain located over injury site (commonly musculotendinous junction)
Discolorations (severe cases)
Muscle weakness and/or ROM limitations
59
explain first degree strain
```
few fibers are ttorn and there is mild weakness, loss of function, swelling
=no pap. defect
=mild contrtction pain
=pain with strtecth
decrased ROM
```
60
exlain 2nd degree strain of muscle
```
nearly half fibers are torn and there is mod to sevsere weakness, loss of function, swelling
=no pap. defect
=mod-severe contrtction pain
=pain with strtecth
decrased ROM
```
61
explain 3rd degree strains of muscle
```
all muscle fibers torn (ruptture) and there is mod to sevsere weakness, loss of function, swelling
=yes pap. defect
=none to mild contract. pain
=no pain with sttretcth
decrased/increase ROM
```
62
true or false: in a muscle strain 3rd degree there is pain with strtecthing
false, no ligaments left to stretcth
63
what is the cause of ligament sprains
Acute traumatic injuries to ligaments
Placed in extreme ROM in which ligament supports
(extreme force on log at ROM or combined force directions)
64
signs and symptoms of ligament sprains
Discomfort over ligament (point tenderness)
Swelling
Loss of function
Increased laxity (no passive stability)
Pain with stretching
Muscle weakness (usually pain/apprehension)
No contraction pain*** theory no, real life yes!
65
explain why in lgament sprains there should technically be no contraction pain
because no affecting muscles just ligamnets (so only passive should hurt)
66
treu or false: ligamentts will tear before joint stability is compormised
true
67
does pain dictate grade
no
68
explain first degree sprain
check slides
69
what is discolation and what are tthe 2 types
Bones are forced beyond normal limits
| Partial or incomplete dislocation is called a subluxation
70
true or false: subluxation is a complete dislocation
falsse, that is subluxation
71
what is discolation/sub usually assocaitted with
Associated with damage to surrounding ligaments and capsules, as well as possible muscle-tendon units
72
what is bursitis
irritation to bursa
73
true or false and explain: bursitis can be both acutte and chronic
true
| it can be from single traumatic compression or repeated compressions
74
what ar the signs and symptoms of bursitis
```
Localized swelling (obvious in olecranon, prepatellar)
Point tender
Warm to touch
```
75
which type of bursitis causes warm to tocu h
acutet
| chronic is not warm
76
what is tendinopathy
common term for tendon pattholgy
77
what is tendinitis
Tendons lack good blood supply, many have lack of direct inflammatory response (tendinitis)
78
what causes tendinosis
degenative changes in the tendon
79
how can you confirm either tendinitus/tendinosis
both need to be confirmed witth histopatthological examinaiton
80
how can you go from tendinitus to tendinosus
through degenerative changes
| aftter time and consttant imflamtion
81
what are the signs and symtpoms of tendiopathy
Chronic onset- MOI overuse or by repetitive overstretching or overload
Pain, swelling
Crepitus
Pain at extremes of motions (passive and active)
Pain increases during stretching and RROM
Strength decreases with pain
82
whatt is tenosynovitis and where is it common
Inflammation of the synovial sheath surrounding a tendon
Common in hands and feet
83
explain acute tenosynovitis
Acute- grating sound (crepitus) with movement, inflammation and swelling
84
explain chronic ttenosynovitus
Chronic- nodule formation in the tendon sheath
85
what can long term tendinopathy lead to
Long term tendinopathy can lead to accumulation of mineral deposits in the bone (myositis ossificans)
86
what are the 4 sttages of overuse injuries
Stage 1: pain after activity only
Stage 2: pain during activity that does not restrict performance
Stage 3: pain during activity that restricts performance
Stage 4: chronic, unremitting pain even at rest
87
at what stage do athletets usually come see hte doctor
stage 3
88
whatt are the two factors of overuse injuries
intrinsic and extrinsic
89
explain the intrinsic factors causing overuse injures
```
Malalignment of limbs
Muscle imbalances (weaknesses, tightness)
```
90
explain the extrinsic factors causing overuse injures
Training errors- to fast to soon
Faulty technique
Incorrect surfaces and equipment
Poor environmental conditions
91
what is osteoarthritis
Degeneration of articular cartilage in a joint
92
whatt is osteoarthritis caused by
Caused by a combination of factors
| Stresses obtained during physical activity, joint trauma, aging process
93
what are teh signs and symtoms in osteoarthrisu
pain
| limited movement
94
where is osteoartthritis common
knees
95
wha tis msucle cramps
Painful involuntary contractions of muscles
96
what are the 2 types of muscle cramps and explain
Clonic- alternating contraction and relaxation
| Tonic- continued contraction
97
which type of muscle cramp is pumping
clonic
98
which type of muscle type is contatnt
totnic
99
true or fa;se Muscle cramps are usually exercis induced
yes
100
whatt are the exact causes of muscle crramps
Exact causes unknown
Biochemical imbalances
Neuromuscular fatigue
101
what are the 2 injury types
primary and secondary
102
explain primary injuries
Caused by a particular event
| External causes vs internal causes
103
explain secondary injury
Caused by complications after the primary injury occurs
Hypoxia and ischemia
(accumulation of calcium)
104
whatt are the 3 phases of soft tissue healing
inflamatory
proliferation
matturation
105
in general, how long is the soft tissue healing
3 days -1 year
106
how long is the inflam period
0-6 days
107
when is inflammatory greates f
firstt 24-72 hours
108
is inflammatory response good or bad
good for healing but needs to be controlled (use compression, evelattion, movementt)
109
what is common to see in inflammatory phase
Rubor (redness), calor (local heat), tumor (swelling), dolor (pain) and function laesa (loss of function)
SHARP
110
what is the first goal in inflammatory phase
stop blood loss to the wound
111
explain part 1 of stopping blood in inflmattory phase
```
Local vasoconstriction (few seconds-10 minutes)
Large vessels constrict from signals from neurotransmitters
```
reduction of blood volume = increased blood viscosity/ resistance to the flow (further reducing loss of blood at site)
=first clot
Platelet reaction then promotes clotting as cells combine together with fibrin to form a mechanical plug
=second clott
112
what comes firstt vasoconsttriction or dilation
vasodilation
113
what is vasodilation due to
histamine and bradykinin (neurotransmitters)
114
why are proteins activiated in inflmatory phase
to promote a variety of activities essential for healing
| ex: phagocytosis
115
explain phagocytosis
Phagocytosis- attraction of macrophages and neutrophils
116
what does the release of chemical mediators cause
Increase blood vessel wall permeability
Promotes vasodilation
Pain!
117
explain vascular events
Vascular- first a quite vasoconstriction followed by a vasodilation. Increase pressure in the capillaries causes fluid to move into the tissue and produce swelling, pain and impaired function
118
explain cellular events
Cellular- mast cells released which mobilize leukocytes (neutrophils and monocytes). Neutrophils first line of defense, can cause damage to healthy tissue
119
what is the duratiton of the proliferative pahse
fays 3-21
120
what is the prolif. phase
repair and regen of the injured tissue
121
during the proliferattive phase, what is tthere tthe develipment of
new blood vessels
fibrous tissue formation
generation of new epithetical tissue
wound contractions/scarring
122
in prolif phase, what do fibroblats synthesize
new type III collagen fibesr
123
true or false: in thte prolif phase we get new vessel formation
ttrue
| angiogenesis
124
how long can thte maturation phase be
up to 1 year
125
what is scar tissue
Scar tissue is fibrous, inelastic and nonvascular- less strong and less functional than original tissue
126
new scar tissue has more or less flexibility
less and decreased size of involved tissues
127
what is execssive scar tissue called
keloid tissue
128
during the maturattion phase, what does type 3 collagem become
type 1= it is stronger
129
whatt happens to the fibers in the matturation phase
alighment of fibers along muscle fibers to regain mobility and strength
130
how long can tensile strtength take to increase
up ot 2 uyears postt injurt
131
Bad rehabilitation that doesn’t reorient collagen fibers could lead to what
permanent decrease of 30% compared to pre-injury strength.
132
true or false: ,muscle fibres can reproduce
false, do no t
| =thats why we need to prvent necrosis
133
what do ligaments and tendons need to have for a chance of healing
they need to be in very close proximity. If a ligament is isolated (ex: ACL), it has a poor chance of healing conservatively.
134
what does tissue immbolization cause
leads to atrophy, loss of strength and decreased healing of the tissues. ↑Immobilization time = ↑atrophy
135
explain immolixation vs atrphy
if you are immbolized longer than you will increase atrphy which delays rehab
try to stay moving asap after injury when possibble
(frcature must be immoblized longer)
136
which heals the slowest, soft tissue, bone or nerve injuries
nerve injries
137
what is the healing rate of nerve injuries
rate <1mm per day or 2.5mm per month
138
most common nerve injuries are what tyoe of injuries
tension and compression injuries
| or severed
