quiz #1 - sprains Flashcards
(36 cards)
what is a sprain?
overstretch injury to a ligament
ligaments
-flexible, noncontractile CT
-add stability to CT joint capsule: bands around synovial joints, blend into periosteum & joint bones together
-named according to bones they attach to & their anatomical position
-taut at end ROM opposite to which it prevents
causes of sprains
-trauma related sudden twist/ wrench of joint beyond normal ROM
FACTORS:
*congenital ligamentous laxity (hypermobility)
*history of previous sprains
*altered biomechanics that place stress on ligament & joint
*CT pathologies (RA)
classifications of sprains
GRADE 1: mild / 1st degree
GRADE 2: moderate / 2nd degree
GRADE 4: severe / 3rd degree
classifications of sprains - GRADE 1
*minor stretch & tear
*no instability on PR testing
*person can continue activity with some discomfort
classifications of sprains - GRADE 2
*tearing of ligament fibers
*degree of tear is variable from several fibers to majority of fibers
*snapping sound at time of injury
*joint = hypermobile yet stable on PR testing
*person has difficulty continuing activity
classifications of sprains - GRADE 3
*complete rupture of ligament / avulsion fracture as bony attachment of ligament is torn off while ligament remains intact
*snapping sound & joint gives away
*significant instability & no end point on PR testing
*person cannot continue activity
joint effusion
-when injury is severe enough to inflame synovium, increasing production of syonvial fluid causing joint capsule to swell
-synovial fluid, intracapsular
-hemarthrosis / bleeding into synovial spaces may happen
-edema in extracapsular interstitial spaces as result of inflammatory process & composed of inflammatory exudate
ligaments
-moderatley vascularized, heal slowly
-adhesions from between sprained ligament & nearby structures, painfully limiting ROM controlled by ligament
-grade 3 sprains: ligaments may be surgically repaired
ligaments - scar tissue
-scar tissue takes up to 6 weeks to develop
-6 months for scar tissue to completely mature & provide max strength at affected joint
common ankle sprains
ANTERIOR TALOFIBULAR: most frequently sprained lateral ankle ligament
CALCANEOFIBULAR: 2nd most sprained lateral ligament
CALCANEOCUBOID: less frequently injured
DELTOID: eversion
most common mechanism of injury - ankle ligaments
INVERSION sprain - damaging ligaments on lateral side
common knee sprains (collateral)
MCL: most frequently injured, foot fixed to ground & knee is struck medially
LCL: laterally directed
*collateral ligaments = extracapsular, massage can directly treat
common knee sprains (cruciate)
ACL: tibia forced anteriorly, when weight bearing
PCL: tibia pushed posteriorly
*cruciates = deep within joint, not accessible with massage - often surgically repaired
common wrist sprains
PALMAR RADIOCARPAL: forced hyperextension, quite strong & unlikely to be sprained - damage to flexor mm, tendons, bones
DORSAL RADIOCARPAL: forced hyperflexion, injury to extensor tendons & wrist bones - weaker than palmar
common shoulder sprains
ACROMIOCLAVICULAR:
-grade 1 AC: tearing of joint capsule
-grade 2 AC: tear of joint capsule & AC ligament
-grade 3 AC: tear of joint capsule, AC ligament, conoid & trapezoid, fracture may be present
*mechanism of injury = falling onto shoulder
GRADE 1 - symptom picture: ACUTE
-minor stretch to ligament
-pain = mild & local
-minimal local edema, heat & bruising
-joint is stable
-can continue activity
GRADE 2 - symptom picture: ACUTE
-tearing of some/ many fibers
-snapping noise, joint gives away
-pain = moderate at rest & with activities
-moderate local edema, heat & bruising
-joint instability is slight
-difficulty continuing activity
GRADE 3 - symptom picture: ACUTE
-complete rupture / avulsion fracture
-snapping noise
-pain = intense / mild at rest
-marked local edema, heat & bruising
-hematoma present, joint effusion may occur
-joint unstable
-cannot continue activity
in all grades of sprain
-bruising: red, black, blue
-decreased ROM local to joint (protective mm spasm, edema, & pain limit movement)
-little, moderate, or severe loss of function
-strain / contusion of mm crossing joint, vascular damage, nerve complications possible
GRADE 1, 2, & 3 - symptom picture: EARLY SUBACUTE
1: stable
2: hypermobile but stable
3: hypermobile & unstable with ligamentous stress testing
GRADE 1, 2, & 3 - symptom picture: EARLY SUBACUTE - symptoms
-bruising = black & blue
-pain, edema, inflammation still present but reduced
-adhesions develop
-healing = slow (ligaments hypovascular)
-protective mm spasm diminish
-ROM reduced
-loss of proprioception at joint
-joint my be taped, splinted, immobilized
GRADE 1, 2, & 3 - symptom picture: LATE SUBACUTE - symptoms
-bruising = yellow, green, brown
-pain, edema, inflammation diminishing
-protective mm spasm replaced by increased tone of mm crossing joint
-affected joint may be supported
-ROM reduced
-loss of proprioception at joint
GRADE 1, 2, & 3 - symptom picture: CHRONIC - symptoms
-pain = local only if ligament is stressed
-bruising gone
-adhesions have matured
-HT & TP’s present in mm crossing joint & compensating structures
-full ROM restricted
-may be pocket of chronic edema
-tissue may be cool due to ischemia
-loss of proprioception
-joint unstable (grade 3) unless surgically repaired
-mm weakness / disuse atrophy
-may need taping & bandages for activity
