what are the most common muscle injuries
sprains and contusions
what are some risk factors of muscle injury
-age-inadequate flexibility, strength or endurance-poor synergistic muscle contraction-insufficient warmup -inadequate rehab from previous injury
what is the difference between intramuscular and intermuscular hematomas
intramuscular: -associated with muscle strain or bruise-size is limited by muscle fascia-results in pain and loss of functionintermuscular:-associated with muscle fascial rupture-less severe pain
describe the test findings for muscle strain grades 1-3
1 = strong and painful2 = weak and painful3 = weak and painless
what muscles are most likely to be strained
-2 joint muscles-muscles that produce lots of force and torque
muscle treatment depends on what?
stage of healing
what subjective findings do we look for in muscle injuries
-specific MOI-heard/felt pop-prolonged immobilization
what test and measure will be most provocative for muscle injury
contractile testing
tendons are more elastic at _____ rates of tensile loading
elastic-stiffer with faster rates
what tendons are more prone to injury?
larger ones
what are the 3 regions of a tendon
-bone tendon junction (enthesis) -tendon midsubstance-musculotendinous junction
what is the most common location for tendon pathology
musculotendinous junction
tendon injury often involves _____ loading
repetitive
is inflammation a big factor for tendon pain?
no
define tendinosis
painful tendon due to degenerative changes with no signs of inflammation
define paritenonitis
inflammation of the outer layer of the tendon due to friction over bony prominenece
define tenosynovitis
inflammation within the tenosynovial sheath leading to reduced sliding of tendon-inflammatory by-products lead to potential adhesions between tendon and sheath
reactive Tendinopathy is the new ______
tendonitis
describe reactive tendinopathy
-noninflammatory proliferative response caused by acute tensile and/or compressive loads-reversible with appropriate load management
describe tendon dysrepair
-non-inflammatory-failed healing-greater matrix breakdown-potential for reversible changes
describe degenerative tendinopathy
-non-inflammatory-local pathologic changes within a normal tendon-little to no capacity to reverse changes
tendon injury is graded based off _____
symptom severity (Kennedy scale)
why do tendons have poor healing potential
-lower O2 consumption-blood vessels dont extend beyond proximal 1/3 of tendon
stage 1 of tendon treatment
isometrics (heavy loads)-mid range of 30-45 sec holds-results in analgesia for 45 mins
stage 2 of tendon treatment
heavy slow resistance-isotonic (eccentric included)-4 sets x 4-8 reps
stage 3 and 4 of tendon treatment
3: increase speed and energy storage exercise4: energy storage and sports specific
subjective findings to look for in tendon injury
-localized tendon pain-microtrauamatic overload-immobilization followed by quick return to sports
what test should be most provocative for tendon injuries
contractile testing-if not, the do progressive loading to increase likelihood of pain
is pain in tendon rehab ok?
yes (<4/10)
describe findings of ligament sprains (grades 1-3)
1: no laxity and painful2: laxity and pain3: laxity and painless
describe ligament healing for partial tears (grade 1-2)
goes through all phases of healing:hematoma --> inflammation --> proliferation --> remodeling and maturation
describe ligament treatment
depends on:-stage of healing-severity of tear-vascularity-immobilization-controlled motion and application of tension-cross friction massage
what dictates healing potential of partial ligament tears
vascularity
subjective findings to look for in ligament injury
-heard/felt pop-traumatic onset
what test is most provocative in ligament injury
ligamentous tress tests-AROM and PROM may be as well
is there inflammatory response to articular cartilage injury
no -avascular
what is the function of articular cartilage
distribute forces and allow almost friction free motion
describe healing of articular cartilage
depends upon depth of lesion:-superficial lesions have necrosis with no healing-deeper lesions access subchondral bone vascularity and have fibrocartilaginous healing
articular cartilage treatment options
-injections-arthroscopy-joint replacement-unloader braces-PT
subjective findings to look for in articular cartilage injury
-h/o prior trauma-joint pain-limited mobility-impaired function-worst in WB
what distinguishes bone from other connective tissue
mineral content
bone is strongest in ______ and weakest in ______
compression, tension
what injury occurs to bone in the plastic region
stress fx
primary vs secondary bone healing
primary:-periosteum intact and heals from insidesecondary:-periosteum broken and goes through process of forming soft-->hard callus
are we able to reproduce symptoms for stress fxs?
not usually
injury to dorsal root could cause _____
sensation issues
injury to ventral root could cause _____
weakness
injury to spinal nerve could cause _____
weakness and sensation issues
define neuropraxia
local conduction block due to segmental demyelination-excellent prognosis
define axonotmesis
wallerian degeneration distal to injury-axonal sprouting occurs-good prognosis
define neurotmesis
transection of nerve-very poor prognosis-neural tube compomised
describe nerve healing
very slow -1mm/day or 1 inch/month with good conditions
subjective findings to look for in nerve injury
-pain-n/t-weakness
what test is most provocative for nerve damage
neurodynamic tests
what is the neutral zone of a joint
where little or no internal resistance offered by the tissues to movment
how can the joints neutral zone increase
-injury or instability-joint degredation-muscle dysfunction
how can the joints neutral zone decrease
-osteophyte formation-surgical fusion-muscle spasm-muscle strenghtening-adaptive tissue shortening
what zone do we get our end feel from
elastic zone
define the elastic zone of a joint
goes through the physiological barrier and toward the anatomic barrier
define the plastic zone of a joint
where the tissue deforms and injury ensues
is hyper mobility pathological?
no