TherEx: Chapter 10 - Soft Tissue Injury, Repair and Management

Strain

disruption of the musculotendinous unit

Sprain

disruption of the ligamentous unit

Dislocation

displacement resulting in loss of anatomical relationship

Subluxation

incomplete or partial dislocation

Muscle/Tendon Rupture

pain is present at time of injury

Partial Tear

pain is elicited when tissue is stressed

Complete Tear

NO pain with stretch or contraction

Tendinopathy

chronic tendon pathology

Tenosynovitis

inflammation of synovial membrane covering a tendon

Tendinitis

inflammation of tendon

Tendovaginitis

inflammation with thickening of tendon sheath

Tendinosis

degeneration of tendon due to repetitive microtrauma

Synovitis

inflammation of synovial membrane, excess of synovial fluid

Hemarthrosis

bleeding in a joint

Ganglion

ballooning of wall of joint capsule or tendon sheath

Bursitis

inflammation of bursa

Contusion

bruising from a direct blow, capillary rupture

Contracture

shortening of skin, fascia, muscle or joint capsule decreasing mobility of structure

Adhesion

abnormal adherence of collagen to surrounding structures

Reflex Muscle Guarding

muscle contraction in response to painful stimuli, functional slinting

Intrinsic Muscle Spasm

prolonged contraction in response to circulatory and metabolic changes (ie. pain results from altered environment despite reduction of primary cause

1st Degree

mild pain at time of injury, mild swelling, local tenderness, and pain when stressed

2nd Degree

moderate pain at time of injury, stress and palpation of area increase pain, some fibers torn (ligament)

3rd Degree

severe pain at time of injury, stress of tissues following injury is often painless, near complete tear, complete tear, or avulsion, possible instability

3 Stages of Tissue Healing

Inflammation, Proliferation, Maturation

Inflammation

vascular response, chemical mediators, initiation of healing process

Proliferation

collagen formation, granulation tissue

Maturation

remodeling of scar, collagen fiber alignment

Acute / Protection Phase

pt. ed, contraindications and reassurance; immobilize for protection; passive ROM; muscle sets; STM; maintain function of related areas of the body

Subacute / Controlled Motion Phase

pt. ed, follow guidelines, HEP; manage pain and inflammation; multi-angle submax isometrics; AROM; muscular endurance exercise; protected weight bearing exercises; initiate stretching; correct contributing factors

Chronic / Return to Function Phase

pt. ed, guidelines, HEP; develop balance of strength and mobility; introduce simulated work or sports activities

Chronic Inflammation

overuse repetitive strain; trauma followed by repetitive trauma; reinjury of an old scar; contractures or poor mobility