Transcript Chapter 2

Chapter 2
Injury Nomenclature
Soft Tissue Injuries
 Most
common form of orthopedic trauma
 Injuries to:

Muscles, Tendons, Skin, Joint Capsules,
Ligaments, Bursae
 Affect
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Performance by:
Hindering joint motion
Decreasing ability of muscle to produce force
Creating joint instability
Limiting amount of motion available to joint
Musculotendinous Injuries
 Affects
muscle’s ability to contract fully,
forcibly, or both
 Mechanical insufficiency vs. pain
 Partial tear in muscle or tendon

Decreased force production secondary to pain
elicited during contraction
 Complete

tear
Inability to produce any force
Strains
 Tensile
Forces
 Dynamic Overload
 Three-degree grading scale
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First-degree strains
Second-degree strains
Third-degree strains
 Table
2-1, page 31
Tendinitis
 Table
2-2, page 31
 Tenosynovitis
 Peritendinitis
 Three-degree grading scale
 Partial or complete tendon tearing
 Calcific tendinitis
 Table 2-3, page 32
Myositis Ossificans
 Figure
2-2, page 32
 Formation of bone within a muscle belly’s
fascia
 Due to traumatic injury
 Very important to differentiate between
muscle strain and contusions versus the
formation of ossification
 Table 2-4, page 33
Bursitis
– fluid-filled sacs that serve to
buffer muscles, tendons, and ligaments
from friction-causing structures and
facilitate smooth motion
 Table 2-5, page 34
 Bursae
Joint Structure Injuries
 Injuries
involve the capsular and
ligamentous tissues
 Directly affect the joint’s stability
Sprains
 Occur
when joint is forced beyond its
normal limits resulting in stretching or
tearing of ligaments, joint capsule, or both
 Three-degree grading scale
 Table 2-6, page 35
Joint Subluxation
 Partial
or complete disassociation of the
joint’s articulating surfaces
 Subsequent episodes
 Apprehension Response
 Table 2-7, page 35
Joint Dislocation
 Obvious
deformity, Figures 2-3 and 2-4,
page 36
 Risk of injury to bony, vascular,
neurological, and other soft tissue
structures
 Dislocation of major joint = medical
emergency
 Table 2-8, page 36
Synovitis
 Table
2-9, page 37
Articular Surface Injuries
 Articular
or hyaline cartilage may be
injured acutely or damaged as a result of
degenerative changes
 Irreversible, leads to chronic pain and/or
dysfunction
Osteochondral Defects
 Fractures
of a bone’s articular cartilage
and progressive softening of the cartilage
 Severity based on depth of defect and
location
 Table 2-10, page 38
Osteochondritis Dissecans
 Dislodged
fragments of bone within the
joint space
 Talus, femur, patella, capitellum, and
humeral head most frequently affected
 Pain, loss of ROM, decreased joint
function, “locking”
 Table 2-11, page 39
Arthritis
– degeneration of joint’s
articular surface
 Weight-bearing joints
 Regeneration causes bony outgrowths
 Figure 2-8, page 40
 Rheumatoid Arthritis – systemic condition
 Table 2-12, page 40
 Osteoarthritis
Bony Injuries
 Tend
to be traumatic
 Proper initial management
 Pediatric and adolescent population
Exostosis
 Wolff’s
Law
 Growth of extraneous bone
 Figure 2-9, page 41
 Table 2-13, page 41
Apophysitis
 “Growing
pains”; inflammation of bone
growth plate
 Figure 2-10, page 42
 Attachment sites for strong muscle groups
 Rapid growth spurt, lack of flexibility
Fractures
 Classified
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based on:
Location of fracture, Box 2-1, page 43
Magnitude of fracture line, Box 2-2, page 43
Shape/direction of fracture, Box 2-3, page 44
Avulsion Fractures
 Tearing
of ligament or tendon from bony
attachment
 Small vs. large tendons
 Figure 2-11, page 42
Stress Fractures
 Chronic
condition (repetitive stress), most
common in lower extremity
 Changes in training, equipment, surfaces
 Table 2-14, page 45
Neurovascular Pathologies
 Nerves,
arteries, veins
 Due to – joint dislocation, bony
displacement, concussive forces
 Injury can lead to loss of function
 If untreated, vascular injury can lead to
loss of body part
Peripheral Nerve Injury
 Entrapment
injuries are common at ankle,
elbow, wrist, cervical spine
 More distal = greater probability of
regeneration
 Swelling can cause paresthesia and
muscular weakness
 Stretch injuries
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Neurapraxia
Axonotmesis
Neurotmesis
Complex Regional Pain Syndrome
(Reflex Sympathetic Dystrophy)
 Exaggerated,
generalized pain response
after injury
 Intense, prolonged pain that is out of
proportion to severity of injury
 Prognosis is variable
 Symptomatic relief
Imaging Techniques
 Table
2-15, page 47
 Various figures, pages 47-50