MusculoskeletalMusculoskeletalAcute & ChronicAcute & Chronic

InjuriesInjurieshttp://www.dchospital.com/services/images/sports_medicine.jpg

Lesson Goals;Lesson Goals;

Explore joint structures that are prone to injury

Classify injuries into main categories

Discuss and understand the difference between Acute and Chronic injuries

Discuss causality of injuries

Explore immediate treatment options

StructuresStructures

Tendon cords of dense fibrous tissue attaching a muscle to a bone

- built to withstand tension

- very elastic ability to lengthen under tension- i.e: stretching/flexibility

Ligament a cord of fibrous tissue that connects bones forming a joint.

- movement reinforcement & joint stability

- slightly elastic little to no ability to lengthen under tension - i.e: implications?

Bursa fluid filled sac like structure in joints that help decrease friction between surfaces during movement of that joint

Tendinitis and BursitisTendinitis and BursitisTendinitis - Inflammation of a tendon caused by

prolonged or improper execution of movement. Bursitis – Inflammation of the Bursa or complete

bursting.

When one or all of these are injured the term impingement syndrome is often used.

More on impingement tomorrow!

Bursae in the Knee JointBursae in the Knee Joint

Cartilage DamageCartilage Damage

Normally occurs to hyaline cartilage which is located at the ends of bones and free moving joints. Often damage or tearing occurs due to vigorous lateral movements.

SprainsSprains- Sprains involve the ligaments or tendons

reinforcing a joint

- Damage caused by excessive stretching or too much force

- May cause partial or complete tear from the bone

- Heal very slowly due to structure properties & poor blood supply

Grade 1 SprainsGrade 1 Sprains- Ligament or Tendon

slightly torn or overstretched

- Minor pain during movement

- ROM decreased

- Minor swelling, weakness and loss of function

- Recovery? – minutes to days

Grade 2 SprainsGrade 2 Sprains- Ligament or Tendon moderately

stretched or torn

- Moderate pain during movement

- ROM decreased more than Grade 1 Sprains

- Moderate swelling, weakness and loss of function

- Recovery? days to weeks, surgery might be an option

Grade 3 SprainsGrade 3 Sprains- Ligament or Tendon completely

torn away from bone

- Usually there is no pain shortly after the initial acute trauma; why?

- ROM may increase or decrease depending on swelling

- Major swelling, weakness and loss of function

- Recovery? weeks to months, surgery required

StrainsStrains

- Strains involve the muscle fibers or entire muscle

- Damage caused by excessive stretching or too much force.

- May cause partial tearing of the muscle fibers or complete tear of the muscle.

- Heal well....why?

Grade 1 StrainsGrade 1 Strains- Muscle Fibers Few overstretched

or torn

- Minor pain during movement

- ROM decreased

- Minor swelling and weakness

- Minimal or no loss of function

- Are all grade 1 muscle strains bad?

http://health.allrefer.com/health/strains-first-aid-muscle-strain.html

Grade 2 StrainsGrade 2 Strains

- Partial tear to muscle

- Moderate pain during movement

- ROM decreased more than Grade 1 strains

- Moderate swelling, weakness & loss of function

Grade 3 StrainsGrade 3 Strains

- Muscle Completely torn

- Severe pain during movement- ROM may increase or decrease

depending on swelling

- Major swelling, weakness & major or complete loss of function

http://education.advancedorthopedic.net/Injuries-Conditions/Hamstring/Hamstring-Injuries/a~322/article.html

SeparationsSeparations- Most commonly occur in ball &

socket joints - ~ROM vs Stability~

- Shoulder & Hip multi-axial joints

AC Acromioclavicular separation:- Damage to ligaments surrounding AC

joint causes the clavicle to separate or dislocate.

- More on separations tomorrow!

http://www.eorthopod.com/public/patient_education/6525/acromioclavicular_joint_separation.html

Glenohumeral Dislocation: - head of the humerus is forced out of the glenoid fossa due to

excessive force

- Types of glenohumeral separations

Chronic InjuriesChronic Injuries

- Overuse of a part of the body during repeated movement over a period of time.

- Example: patellar tendonitis (jumper’s knee)

Causes:- Improper execution of movement (accounts for 98% of injuries)- Poor posture & flexibility- Muscle balance & imbalance discrepancies- Failure to recognize and treat acute injury- Returning to activity too soon post injury- Poor nutritional habits- Poor lifestyle habits ie: substance abuse, steroids, lack of sleep- Poor Mental & Emotional Health

Treatment – R.I.C.E. Or P.I.E.R.Treatment – R.I.C.E. Or P.I.E.R.

PRESURE OR COMPRESSION:- Helps reduce bleeding, which limits swelling and scaring- Reduces and controls ROM to further protect the injured area

Not Too Tight!- Loss of Sensation?- Discoloured fingers and or toes?- More Pain?

ICE: (helps to control swelling & pain but doesn't stop it completely)

- first 72 hours is crucial!- 1st 2 hours post injury 20 min on & 20 min off- 20 min on every 2 hours also at night- Place some form of medium between skin & ice to avoid ice burn- Wet ice is better…why?

ELEVATION:- Reduce swelling, inflammation & improve return blood flow- Raise and support the injured body part at or above the level

of the heart

REST: (Critical!)- Too much stress, tension or weight on an injured limb can

cause more damage to the already injured area, resulting in more scar tissue and complications later on (examples?)

- Grade 1-2 injuries, few days to a week of immobilization, may need the use of assistive equipment (crutches)

- Grade 3, more than a week of immobilization and use of assistive equipment

NSAID’s Medication?NSAID’s Medication?

Non-Steroidal-Anti-Inflammatory-DrugsTo use or to not use?

Benefits ◦reduce inflammation and pain

Drawbacks◦may interrupt the body’s natural healing

mechanism which is driven by the inflammatory response

Review QuestionsReview Questions

1) What joint structures are most prone to physical injury?

2) What structures are involved in Sprains?

3) what structures are involved in Strains?

4) Grade 3 sprains are often associated with no pain after the initial trauma. Why?

Review QuestionsReview Questions

5) This injury is often the result of a weight training workout

6) the suffix “itis” is associated with what physical symptoms?

7) These injuries occur due to repeated improper execution of a movement or skill

8) What is the main difference between acute and chronic injuries?

9) A sudden pop and bulging of a muscle can indicate this grade of injury?

10) Describe the proper RICE process for the first 72 hours after an injury