week 3 Sprain/Strain injuries Flashcards
(140 cards)
1
Q
What is a strain?
A
A strain is an overexertion involving overstretching or contusion.
2
Q
How does pain typically behave in a strain?
A
Pain is usually worse with initial activity and improves with rest
3
Q
What is a sprain?
A
A sprain is from prolonged periods of postural abuse or poor body mechanics during sudden motion.
4
Q
How does an acute sprain typically occur?
A
It usually happens due to sudden motion or improper body mechanics while performing an activity
5
Q
What are the key signs of a Grade 1 sprain/strain?
A
Mild swelling, point tenderness over the ligament, no bruising, and sharp pain at the time of injury.
6
Q
T/F: A Grade 1 sprain/strain shows no bruising and allows for continued activity.
A
True
7
Q
Can someone with a Grade 1 sprain/strain continue activity?
A
Yes, they are usually able to continue activity despite pain.
8
Q
T/F: A Grade 2 sprain/strain may show mild to moderate instability on stress tests
A
True
9
Q
How long is the functional recovery for a Grade 1 sprain/strain?
A
2-14 days (structural healing: 6-30 days).
10
Q
What differentiates a Grade 2 sprain/strain from Grade 1?
A
Grade 2 has mild to moderate swelling, partial tearing of tissues, and moderate instability on stress tests
11
Q
Can someone with a Grade 2 sprain/strain continue activity?
A
No, they are unable to continue activity
12
Q
How long is the functional recovery for a Grade 2 sprain/strain?
A
14 days to 2 months (structural healing: 1-3 months)
13
Q
What are the key features of a Grade 3 sprain/strain?
A
Severe bruising and swelling, immediate severe pain, disability, and complete tearing of multiple ligaments, muscles, and joint capsules
14
Q
Why must a fracture, instability, or dislocation be ruled out in a Grade 3 sprain/strain?
A
Because it involves complete ligament tears and marked instability, requiring careful assessment
15
Q
How long is the functional recovery for a Grade 3 sprain/strain?
A
1-3 months (structural healing: 6+ months).
16
Q
Where is the pain located in a cervical sprain/strain?
A
Local pain in the cervical region, depending on the muscles/ligaments involved.
17
Q
What symptoms may accompany cervical sprain/strain pain?
A
Headaches may accompany neck pain
18
Q
What are common causes (onset) of cervical sprain/strain?
A
Traumatic injury or repetitive stress.
19
Q
What movements provoke cervical sprain/strain pain?
A
Any movement that engages the affected muscles
20
Q
What helps relieve cervical sprain/strain pain (palliative)?
A
Rest and ice
21
Q
What is the typical pain quality in a cervical sprain/strain?
A
Constant dull pain that becomes sharp with movement
22
Q
Does pain from a cervical sprain/strain radiate or refer to other areas?
A
No radiation or referral is expected.
23
Q
How does pain severity vary in cervical sprain/strain?
A
It depends on the severity of the trauma.
24
Q
What is the timing of pain in a cervical sprain/strain?
A
Immediate pain at the time of injury, followed by a pain-free period, then stiffness, limited mobility, and muscle spasm.
25
What are the hallmark signs of a cervical sprain/strain?
1. Traumatic mechanism or repetitive stress history.
2. Pain increases with movement.
3. No neurological deficits.
4. Associated muscle spasm for protection.
26
What are common inspection findings in a cervical sprain/strain?
- Slow, guarded cervical movements.
- Possible distress.
- Local edema, redness, bruising.
- Rust’s Sign (if severe sprain) → Requires X-ray.
27
What would be expected upon palpation of a cervical sprain/strain?
Muscle spasm, heat, and edema.
28
How is ROM affected in cervical sprain/strain?
- Guarded movement in all ROM.
- Most painful and restricted when involved muscles are recruited.
- Passive ROM worsens sprains; active ROM worsens strains.
29
What orthopedic tests can be used for cervical sprain/strain?
- Max Cervical Compression Test – Negative but may show local neck pain on the convex side.
- O’Donoghue’s Test – Positive if local neck and muscle pain is present.
30
What are some red flags indicating a cervical sprain/strain may not be resolving properly?
- No improvement after 1 week
- Worsening symptoms after 1–2 weeks
- Signs of symptom magnification
- Non-compliance with recommendations
- Seeking rest instead of engaging in daily activities
- Seeking more medication or lack of drug effectiveness
31
What are the key treatments for acute cervical sprain/strain?
- Ice application
- gentle mobilization and manipulation
- Activity modification
- Analgesics
32
How is a sub-acute cervical sprain/strain managed?
- Moist hot packs
- Myofascial treatment and trigger point (TrP) therapy
- Isometric exercises
33
When might a cervical collar be appropriate for sprain/strain management?
In severe cases, for the first 2 weeks only.
34
What are some key activity modifications for managing cervical sprain/strain?
- Avoid lifting over 5 kg.
- Ensure adequate sleep.
- Review and manage activities of daily living (ADLs).
- Home exercise program.
- Review ergonomic factors and sleeping habits.
35
When should you refer a cervical sprain/strain patient?
If they do not respond to treatment or if psychosocial factors are suspected.
36
What are possible referral options for cervical s/s?
Physiotherapist, occupational therapist, GP, acupuncturist.
37
How is a Grade 1 cervical sprain/strain managed with chiropractic care?
No contraindication to adjusting—just patient tolerance.
38
How is a Grade 3 cervical sprain/strain managed?
Absolute contraindication to adjusting—rule out fracture.
38
How is a Grade 2 cervical sprain/strain managed?
Contraindication to manual adjusting—use light force techniques.
39
How quickly do muscle injuries typically heal?
Very rapidly, with high-frequency initial care.
40
Why do ligaments and disc fibrocartilage heal more slowly?
They are poorly vascularized, and full remodeling may not take place.
41
What is the typical recovery timeline for cervical sprain/strain?
- Most patients recover in 6–8 weeks.
- Whiplash recovery often takes 2–3 months, with chronicity risk after 2 years.
42
What are the key principles of the acute phase of muscle healing (1–5 days)?
- PRICE (Protection, Rest, Ice, Compression, Elevation).
- Avoid aggravating activities and pain control.
- Prevent re-injury and chronic condition development.
43
What happens during the post-acute phase (2 days–6 weeks) for cervical s/s?
- Pain-free ROM as soon as possible.
- Switch to heat therapy to improve blood flow.
- Regular stretching to reduce contracture.
44
What are the goals of the remodelling phase (1 week–12+ months) of cervical s/s?
- Functional recovery and proprioception improvement.
- Proper warm-up before activity.
- Strengthening and flexibility exercises
45
What are the key principles of the acute phase of ligament healing (1–5 days) of cervical s/s?
- PRICE and short-term immobilization.
- Avoid re-injury and chronic condition development.
46
What happens during the post-acute phase (2 days–6 weeks) of cervical s/s?
- Pain-free ROM as soon as possible.
- Switch to heat therapy to improve blood flow.
- Regular stretching to reduce contracture.
47
What are the goals of the remodelling phase (1 week–12+ months) of cervical s/s?
- Functional recovery and proprioception improvement.
- Gradual progression from isometric to eccentric exercises.
- Consider surgical consult for marked joint instability or failure of conservative care.
48
What is cervical whiplash?
An acceleration-deceleration mechanism of energy transfer to the neck, often due to rear-end or side-impact MVAs.
49
Why do symptoms often appear out of proportion to objective signs for whiplash?
Due to numerous psychological and behavioral changes related to chronic pain and poor response to treatment.
50
What causes the injury in whiplash?
Neck muscles are unable to compensate for the rapid head and torso movement caused by acceleration forces at impact.
51
What are the common pathological lesions associated with whiplash?
- Muscle strain
- Facet joint sprain or fracture
- ALL or PLL sprain/tear
- Intervertebral ligament tearing
- Disc herniation
- Retropharyngeal hematoma
- Concussion or MTBI
- Thoracic outlet syndrome (TOS)
- TMJ dysfunction
52
What are the neurological symptoms of whiplash?
- Dizziness
- Posture-related vertigo
- Tinnitus
- Blurred vision
52
What are the primary pain symptoms of whiplash?
- Head, neck, and upper thoracic pain
- Arm pain/weakness
- Lower back pain (resolves before neck pain)
53
How does location of pain typically present in whiplash?
- Local tenderness in the neck, head, or upper thoracic spine
- Achy discomfort in the posterior cervical region
54
What is the onset of whiplash symptoms?
Delayed onset—symptoms appear over the next few days after injury.
55
What movements provoke whiplash pain?
Head or cervical spine movement.
56
What palliates whiplash pain?
Rest and staying still.
57
What is the quality of whiplash pain?
Deep ache with burning, which may lead to stiffness.
58
How does whiplash pain radiate?
- Pain spreads from the posterior cervical spine
- May refer to the trapezius, shoulders, interscapular region, occiput, or down the arms (often ulnar distribution).
59
When does stiffness in whiplash typically occur?
Usually in the morning.
60
Why should an X-ray be done before physical examination for whiplash?
To rule out fractures or instability.
61
What should you look for in a whiplash patient?
- Rust’s sign (patient holds head to stabilize it)
- Guarding
- Altered posture
- Anxiety or distress
62
What are common palpatory findings in whiplash?
- Muscle spasm
- Edema
- Increased heat
- Point tenderness (especially SCM, scalene, and longus colli)
63
What might chiropractic scans show for whiplash?
Subluxation patterns
64
How is ROM affected in whiplash?
- Decreased in all directions due to pain and guarding.
- Patient may complain of stiffness
65
What orthopedic tests are positive in whiplash?
- O’Donoghue’s: Local neck and muscle pain.
- Maximum Cervical Compression: Local neck pain on convex side.
66
How does whiplash affect dermatomes, myotomes, and DTRs?
They are usually normal unless nerve root or CNS structures are affected.
67
Why should you assess the cerebellum in whiplash?
Because dizziness and vertigo may indicate cerebellar involvement.
68
What cranial nerve tests are important in whiplash?
- Check for concussion or brain hematoma
- Look for Horner’s Syndrome in severe cases
69
What is an absolute contraindication in whiplash?
Fracture—no chiropractic care until cleared.
70
When should you avoid HVLA adjustments in whiplash?
If the patient has an acute grade 2+ sprain/strain, avoid for at least 3 weeks.
71
Why is the Forward Motion Headpiece (Drop Table) contraindicated in acute whiplash with concussion signs?
It may worsen symptoms by increasing strain on an already injured neck.
72
How long does recovery from whiplash usually take?
- Most patients recover in 6-8 weeks.
- Recovery slows after 2-3 months.
- If not resolved in 2 years, it often becomes chronic.
73
What causes a burner/stinger injury?
Sudden pulling/stretching or compression of the cervical nerve roots or brachial plexus due to lateral flexion injuries.
74
What are the two mechanisms of injury for Burner/Stinger?
1. Lateral flexion AWAY from the involved side + shoulder depression on the involved side → Brachial plexopathy (more common).
2. Lateral flexion TOWARD the involved side → Nerve root compression.
75
Who is most commonly affected for Burner/Stinger?
- Older athletes
- Contact sports injuries
- 94% of cases have underlying disc disease or pathology
76
What is the typical pain location in a burner/stinger?
Shoulder and lateral arm pain + neurological symptoms.
77
How does the pain onset for Burner/Stinger?
Suddenly after trauma, often in collision/contact sports.
78
What movements provoke symptoms for Burner/Stinger?
Lateral flexion of the head and any stretching of the plexus
79
What relieves (palliates) the pain for Burner/Stinger?
No specific relieving factor because its goes away quickly
80
What is the quality of pain in a burner/stinger?
- Sharp, electric, burning pain
- Numbness/tingling
- Weakness in the arm
81
How does the pain radiate for Burner/Stinger?
Neurogenic pain into the arm on the affected side.
82
How severe are symptoms for Burner/Stinger?
Usually mild, but weakness may last days to weeks.
83
What is the timing of a burner/stinger?
Pain lasts seconds to minutes
Weakness may persist for days to weeks
84
Red Flags for Burner/Stinger
- Persistent symptoms
- Bilateral symptoms
- Painful or diminished cervical ROM
85
Hallmark Features of Burner/Stinger
- Sudden onset
- Lateral flexion mechanism
- Transient symptoms
- Burning or stinging down the arm (usually C5 or C6 dermatome)
86
What should you look for for Burner/Stinger?
- Clumsiness or weakness in one arm
- Postural guarding
87
What are common palpatory findings for Burner/Stinger?
- Local muscle spasm on the stretched side
- Heat, edema
88
What are the findings on scans for Burner/Stinger?
None needed
Usually normal as symptoms last seconds to minutes
89
How is ROM affected for Burner/Stinger?
- Reduced due to muscle spasm
- Lateral flexion most affected (due to mechanism of injury)
90
What cervical orthopedic tests should NOT be used as it recreate pain for Burner/Stinger?
- Jackson’s Compression (-ve)
- Shoulder Depression
91
What sensory changes are expected for Burner/Stinger?
- Possible sensory deficits in the affected dermatome
- May be delayed → re-examine 1 week post-injury
92
What muscle weakness is expected for Burner/Stinger?
Weakness in:
- Shoulder abduction
- External rotation
- Elbow flexion/extension
93
Are there any reflex changes for Burner/Stinger?
No abnormalities expected.
94
Are cranial nerves or cerebellum affected for Burner/Stinger?
No abnormalities expected
95
What should be avoided during treatment for Burner/Stinger?
- Do NOT reproduce the injury (e.g., avoid lateral flexion-type adjustments).
- Adjust based on patient tolerance.
96
What is recommended to prevent recurrence for Burner/Stinger?
Neck strengthening exercises.
97
When can an athlete return to sports for Burner/Stinger?
Only after:
- Complete resolution of motor deficits
- No pain with ROM
98
When should a referral for EMG be considered for Burner/Stinger?
If arm weakness persists for >21 days.
99
How common is a lumbar sprain/strain?
Very common! (~60% of back injuries).
100
What are the risk factors for lumbar sprain/strain?
- Prior lower back injury
- Repetitive lifting & twisting (especially over hours/days)
- Obesity
- Core muscle deconditioning
- Sudden unguarded movement (especially flexed & rotated lifting
101
Where is pain typically located for lumbar S/S?
Local lumbar spine pain (may be just lateral to the spine).
102
How does this injury develop for lumbar S/S?
- Acute: Trauma, whiplash-type movement, sudden unguarded motion
- Chronic: Repeated microtraumas, postural faults
103
What relieves symptoms for lumbar S/S?
Rest and ice
103
What makes symptoms worse for lumbar S/S?
- Movement (esp. flexion, rotation, sitting up straight)
- Arising from supine or seated position
104
What does the pain feel like for lumbar S/S?
- Constant dull ache, becomes sharp on movement
- Stiffness & decreased mobility
105
Does pain radiate or refer for lumbar S/S?
No radiation or referral
106
How severe is the pain for lumbar S/S?
Depends on injury mechanism
107
How does the pain progress for lumbar S/S?
1. Immediate pain at the time of injury
2. Pain-free interval
3. Subsequent stiffness, limited ROM, & muscle spasms
108
Hallmarks of Lumbar Sprain/Strain
- Mechanism of injury
- Pain worse with movement (especially involving injured structures)
- Pain at time of injury → temporary relief → returns with stiffness/limited ROM
- No radiation/referral
109
What should you look for lumbar S/S?
- Distress, slow guarded movements
- Loss of lumbar lordosis (due to muscle spasm)
110
What are common findings for lumbar S/S?
Muscle bunching & spasms (bilateral or unilateral)
Heat, edema, decreased joint play
111
What might be seen on muscle scans in lumbar S/S?
Increased muscle activity in lumbar spine
112
How is ROM affected in lumbar S/S?
Guarded, limited movement
Flexion, lateral flexion, & rotation most painful/limited
113
What orthopedic tests are used for lumbar sprain/strain?
- SLR: Negative (may have incidental pain)
- Standing Kemp’s: Positive for local pain (if injured tissues engaged)
- Seated Kemp’s: Negative (may show incidental lower back pain)
- SI Joint Tests: May be hard to perform due to pain
- Belt Test: Positive → Indicates lumbar spine injury
114
How are neurological tests affected for lumbar S/S?
1. Sensory: Normal
2. Myotomes: 5/5 (unless pain limits strength)
3. DTRs: Normal (2+)
4. Cerebellum & Cranial Nerves: Normal
115
When are X-rays warranted for lumbar S/S?
- Trauma mechanism of injury
- Significant loss of ROM
- Clusters of spinal/postural findings
116
advice for lumbar S/S
- Physiotherapy
- Ice/Heat
- Ultrasound
- NSAIDs, Muscle relaxants, Steroidal injections
- Bracing (only in early stages, removed ASAP)
117
Prognosis for lumbar S/S
Mild Strain =7-10 days
Moderate Strain = 2-4 weeks
Mild Sprain =1-4 weeks
Moderate Sprain = 1-12 months
Severe Strain/Sprain = May require surgery
118
Chiropractic Management for lumbar S/S
1. Adjust to patient tolerance
2. High-frequency care plan
3. Respect healing phases (Grade of sprain/strain)
4. Use manual techniques in non-injured areas
5. Encourage proper nutrition, hydration, & sleep
6. Recommend natural anti-inflammatory supplements
119
when does pain reduce for lumbar S/S
3-5 days
120
when does lumbar S/S generally recover
6-8 weeks
121
Who is predisposed?
- Pregnancy
- Athletes requiring unilateral loading or prolonged sitting (ballet, rowing, martial arts)
- Athletes with cumulative repetitive force injuries (weight-lifting, running, rowing, cross-country skiing)
- Degeneration
- Gait abnormalities
- Leg length inequality, scoliosis
122
Possible Mechanisms of Injury
- Sudden heavy lifting
- Prolonged lifting and bending
- Torsional strain
- Arising from a stooped position
- Fall onto the buttock
- Rear-end motor vehicle accident with ipsilateral foot on the brake
- Repetitive shear or torsional forces to the SIJ (e.g., figure skating, golf, bowling)
123
Location of SI S/S
Pain over one SI joint
124
Onset of SI S/S
- After straightening from a stooped position, often with lifting
- Trauma, fall, postpartum
125
Provocative Factors of S/S
- Transitional activities (e.g., getting up from seated, out of a car, or bed, ascending stairs)
- Direct compression or distraction
- Sitting or lying on the affected side
- Riding in a car
- Forward flexion in standing with knees fully extended
126
Palliative Factors of SI S/S
- Lying prone or supine (not on the affected side)
- Weight-bearing on opposite leg
127
Quality of Pain
- Sharp and stabbing
- May describe popping or clicking sound
128
Radiation/Referral
- Not always present
- Can radiate to the groin, gluteal region, or posterolateral thigh
129
Severity of SI S/S
Varies depending on injury
130
when if SI S/S worse
morning stiffness
131
what you would find when inspecting SI S/S
- Patient may be distressed due to pain
- Altered gait due to pain or tight hamstrings
- Minor’s Sign
132
SI S/S palpation findings
- Heat, edema, hypertonicity, and tenderness over SI joint
- Tight hip flexors, hamstrings, and quads
- Signs of subluxation
133
Range of Motion with SI S/S
- Reduced in any direction that stretches the involved SI joint
- Flexion, extension, lateral flexion away, and rotation away from painful side
134
SI S/S orthopaedic tests
- Nachlas, Belt, Goldthwait’s, Fabere’s → Positive for pain at SI joint
- Hibb’s → Positive for pelvic pain and possible hip pain
- Pace & Freiberg → Positive on side of piriformis involvement
135
chiro management for the acute phase of SI S/S
- Best managed with an SI support brace/belt
- Secured across the sacral base (posterior) and ASIS (anterior)
- Should be worn for walking and standing activities (and sedentary activities if needed)
- Wear for 3-6 weeks → excellent prognosis
- Avoid increased stretch to SI ligaments → NO - - HVLA adjustments into the joint while healing
- Check kinetic chain → Adjust hip if needed, refer out for hip ROM exercises
136
rehabilitation for SI S/S
Early Phase (Days 1-3)
- Restrict one-leg stance activities → rest the SI joint
- Ice and NSAIDs
- Gentle ROM within pain-free limits
Later Phase
- Once flexibility is restored, add muscle strength training
137
Prognosis & Healing Timeframes for SI S/S
- Mild STrain: 7-10 days
- Moderate STrain: 2-4 weeks
- Mild SPrain: 1-4 weeks
- Moderate SPrain: 1-12 months
