Sprains Strains

Question 1

Neuro soft tissue

Answer 1

nerve roots, trunks, peripheral nerves

Question 2

contractile soft tissue

Answer 2

muscles, tendons

Question 3

Inert soft tissue

Answer 3

(ligaments, capsules, fascia)

Bone
Bursa
Joint capsule
Synovium
Meniscus

Question 4

Nerve Injury Can Be Caused By

Answer 4

• Compression
• Stretch or traction
• Friction
• Cooling or freezing
• Thermal/electrical

Question 5

Lower Motor Neuron Lesions Presentation

Answer 5

• Flaccidity
• Hyporeflexia or areflexia
• Hypotonicity
• Fasciculations
• Muscle weakness/atrophy (specific to nerve)
• Positive pathological reflex (1 side)

Question 6

UMN Lesion Presentation

Answer 6

• Spasticity
• Hyperreflexia
• Hypertonicity
• Muscle weakness
• Extensor plantar response (bilateral)
• Absent or reduced superficial reflex

Question 7

• West Point Ankle Sprain Grading System
  
  • Grade I

Answer 7

• Location of Tenderness
  ATF Ligament
• Edema and Ecchymosis
  Slight and Local
• Weight-Bearing Ability
  Full or partial
• Ligament Damage
  Stretched
• Instability
  None

Question 8

• West Point Ankle Sprain Grading System
  
  • Grade II

Answer 8

• Location of Tenderness
  ATF and CF Ligament
• Edema and Ecchymosis
  Moderate and Local
• Weight-Bearing Ability
  Difficulty without crutches
• Ligament Damage
  Partial tear
• Instability
  None or slight

Question 9

• West Point Ankle Sprain Grading System
  
  • Grade III

Answer 9

• Location of Tenderness
  ATF, CF, and PTF Ligaments
• Edema and Ecchymosis
  Significant and diffuse
• Weight-Bearing Ability
  impossible (too painful)
• Ligament Damage
  Complete tear
• Instability
  definite

Question 10

• Soft Tissue Lesions: Stages of Inflammation and Repair
  
  • Acute Stage - Reaction and Inflammation

Answer 10

4-6 days

Question 11

Soft Tissue Lesions: Stages of Inflammation and Repair
Subacute Stage - Proliferation, Repair, and Healing

Answer 11

• Usually lasts 10 to 17 days (14 to 21 days after onset of injury)
• May last up to 6 weeks or longer in tissues with limited circulation, such as tendons

Question 12

Soft Tissue Lesions: Stages of Inflammation and Repair
Chronic Stage - Maturation and Remodeling

Answer 12

May last 6 weeks to one year depending on the tissue involved and amount of tissue damage

Question 13

• Soft Tissue Lesions: Response to Therapist Exam
  
  • “Irritability” of tissue:

Answer 13

reflects stages of inflammation and repair

Question 14

• Acute Stage - Phase I (Maximum Protection)
  
  • Tissue Response: Inflammation

Answer 14

• Cellular
• Vascular
• Chemical
• During the second to fourth days after tissue injury, the inflammation begins to decrease, the clot starts resolving, and repair of the injured site begins.
• Myofibroblastic activity begins about day 5, causing scar shrinkage (contraction).

Question 15

Subacute Stage— Phase II (Moderate Protection/Controlled Motion)
- Tissue response: Proliferation, repair, and healing

Answer 15

• 10 to 17 days (14–21 days after onset of injury), but may last up to 6 weeks
  • Noxious stimuli are removed, and capillary beds begin to grow into the area
  • Synthesis and deposition of collagen
    • Fibroblastic activity, collagen formation, and granulation tissue development increase
    • The fibroblasts produce new collagen, and this immature collagen replaces the exudate that originally formed the clot

Question 16

Depending on the size of injury, wound closure usually takes

Answer 16

5 to 8 days in muscle and skin and 3 to 6 weeks in tendons and ligaments.

Question 17

Subacute Stage— Phase II (Moderate Protection/Controlled Motion)
During this stage of healing, the immature connective tissue that is produced is

Answer 17

thin and unorganized. It is extremely fragile and easily injured if overstressed.

Question 18

• Chronic Stage— Phase III- Minimum to no protection/return to function
  
  • Tissue response: Maturation and remodeling

Answer 18

Scar retraction from activity of the myofibroblasts is usually complete by day 21 and the scar stops increasing in size

Question 19

From day 21 to day 60, there is a predominance of

Answer 19

fibroblasts that are easily remodeled. Want to avoid adhesions/contractures!

Question 20

The maturation and remodeling of the scar tissue occur as collagen fibers become

Answer 20

thicker and reorient in response to stresses placed on the connective tissue.

Question 21

Remodeling time is influenced by factors that affect the density and activity level of the

Answer 21

fibroblasts, including the amount of time immobilized, stress placed on the tissue, location of the lesion, and vascular supply.

Question 22

• Cumulative Trauma: Chronic Recurring Pain
  
  • Tissue response from repetitive stress: chronic inflammation
    Causes of chronic inflammation:

Answer 22

• Overuse, cumulative trauma, repetitive strain
• Reinjury of an “old scar”
• Contractures or poor mobility

Question 23

MSK Pain

Answer 23

Sharp, superficial

■Associated with movement

■Aggravated by mechanical stress

■Associated with trauma or overuse

■Generally lessens at night

Question 24

Systemic Pain

Answer 24

■Deep, aching throb

■Reduced by pressure

■Constant waves of pain & spasm

■Not affected by movement

■Associated with jaundice, migratory arthralgias, skin rash, fatigue, weight loss, low- grade fever, weakness, signs of infection

■Progressive symptoms\

■Disturbs sleep

Question 25

Pain with activity that decreases with rest usually indicates

Answer 25

mechanical pain from something being pinched, stretched, or contracted (tightened).

Question 26

Pain and stiffness in the morning, which improves with activity, usually indicates

Answer 26

chronic inflammation & edema that decrease with activity.

Question 27

Pain that is not affected by rest or activity usually indicates

Answer 27

bone pain, organic/systemic disorders, or other severe pathology.

Question 28

Pain and aching that increase as the day progresses usually indicate

Answer 28

congestion (swelling) in the joint from the joint being overstressed.

Question 29

Patterns of Inert Tissue Lesion

Answer 29

- Look for capsular patterns - Pain and limited ROM in all directions - Pain and excessive or limited ROM

Question 30

Causes of Active Movement Abnormalities

Answer 30

Pain Muscle weakness Muscle paralysis Muscle spasm Tight or shortened structures Altered length-tension relationships Neuromuscular factors Joint-muscle interaction

Question 31

Abnormal End Feels

Answer 31

- Muscle spasm - Spasticity - Capsular - Bone to bone - Empty - Springy block

Question 32

Non Capsular Patterns

Answer 32

- Movement in one direction limited (e.g., impingement) - Internal derangement (e.g., meniscus) - Extra-articular lesion (e.g., adhesions)

Question 33

A noncapsularpattern of restricted hip motion may be a sign of

Answer 33

pathology other than a joint problem associated with osteoarthritis

Question 34

Empty end feel can be an indicator of

Answer 34

potentially serious disease such as infection or neoplasm. Empty end feel is described as limiting pain before the end range of motion is reached but with no resistance perceived by the examiner.

Question 35

Vascular disorders such as Arterial Insufficiency-

Answer 35

pain is often throbbing in nature and exacerbated by activity. Look for Risk factors!

Question 36

Cancer can cause

Answer 36

METS to the Hip- such as Prostate, Testicular, Breast and Ovarian cancer