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Chapter 5 - Mechanisms of Injury. Physical process responsible for a given action, reaction or result. Why is it necessary to determine the mechanism of injuries?. Important for the diagnosis, rehabilitation and prevention of injuries. Depends persons perspective

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chapter 5 mechanisms of injury

Chapter 5 - Mechanisms of Injury

Physical process responsible for a given action, reaction or result

why is it necessary to determine the mechanism of injuries

Why is it necessary to determine the mechanism of injuries?

Important for the diagnosis, rehabilitation and prevention of injuries

injury mechanism
Depends persons perspective

Mechanism often acts in combination

Establish cause and effect relationship

Sport medicine classification

Contact or impact

dynamic overload

overuse

structural vulnerability

inflexibility

muscle inbalance

rapid growth

Injury Mechanism
mechanical loading
Mechanical Loading
  • Loads greater than physiological lead to injuries
  • Chronic injuries
    • cumulative trauma
    • repetitive stress
  • Acute injuries
principles of injuries
Principles of Injuries
  • Catch-all terms
    • shinsplints
    • tennis elbow
    • jumper’s knee
  • Level of dysfunction
    • catastrophic injuries
  • Progression
    • untreated or lack to time to heal lead to more severe injuries
assessment of severity
Clinical classifications

help assign common characteristics to injuries

Severity linked to amount of tissue damage

Mild & moderate: partial disruption, tissue is able to accept loads

Ligaments

grade 1 mild

negligible structural

minimal time loss

grade 2 moderate

partial rupture

swelling tenderness

up to 6 wk time

grade 3 severe

complete, gross swelling, 8 wk min

Assessment of Severity
injury principles
Injury Principles
  • Micro vs macrotrauma
  • Primary: direct consequence of trauma
  • Secondary
    • injury surface after original trauma
    • accommodation to primary injury (adaptation of loads)
  • Tissue structure
contributing factors
Age

acute injuries: young

chronic: older

Gender

Genetics

Fitness level

Nutrition

Psychological

Human interaction

Fatigue

physical & mental

Environment

Equipment

protective

contributes to injuries

Previous injury

Disease

Drugs

Rehabilitation

Anthropometrics

Skill level

Experience

Pain

Contributing factors
tissue injury
Tissue Injury
  • Inflammation: pathological process
    • vascular response
    • increase capillary permeability (swelling)
  • Pain: swelling related pressure on nerve endings (more in confined spaces)
tissue injury1
Vasodilatory phase

flow of fluid/plasma proteins into tissue

Plasma proteins

fibrinogen

Functions

dilutes & inactivates toxins

nutrients to inflammatory cells

antibodies, proteins

Control of inflammation

Chemicals mediators

histamine, serotonin, bradykin, prostagladins, plasmin etc.

Other Cells

Phagocytes (fungal and bacterial infection)

Lymphocytes (antigens)

Tissue Injury
why inflammation

Why inflammation?

Body’s first line of defense against injuries

slide12
Bone
  • Any conditions that affects osteocyte performance
  • Osteonecrosis: cessation of blood flow
    • vessel disruption
    • occlussion
    • injury or pressure to arterial walls
  •  matrix, bone strength
  •  likelihood of fracture
slide13
Bone
  • Osteoporosis
  • Major public health issue
  • Affect mostly trabercular bone
  • Bone of axial skeleton
  • Multifactor
  • Clinical conditions
slide14
Bone
  • Fracture (break): applied loads exceeds bone’s ability
  • Resistance
    • material properties
    • geometry
    • anisotropic effects
    • porosity
  • Type of loading
    • acute vs chronic
fractures
Fractures
  • Indirect or direct
  • Risk and type of bone
  • Diagnosis
    • site
    • extent of injury
    • configuration
    • fragments (displaced)
    • environmental (open closed)
    • complications
    • etiological
fractures1
Fractures
  • Healing phases:
    • inflammation
    • union of bony ends (3wk)
    • callus remodeling (6 wks)
articular cartilage
Articular Cartilage
  • Excessive loading
    • loss of cartilage matrix
    • chondral fractures
    • osteochondral fracture
  • Inability to repair
articular cartilage1
Articular Cartilage
  • AO
    • non inflammatory
    • weight bearing joints
    • deterioration of AC
    • osteophytes formation
    • cartilage fibrillation
  • Artificial Joints
    • cemented or non
fibrocartilage
Fibrocartilage
  • Distributes forces at joints
  • Shock absorber
  • Improve joint fit
  • menisci
  • intervertebral disks
tendon
Tendon
  • Force transfer
  • Injuries
    • direct (cuts)
    • indirect (excessive loads applied to unit)
  • Musculotendinous injuries: Strain
    • Mild, moderate, severe
    • severe: precede by microdamage
tendon1
Repetitive overloading: inflammatory response or tendinitis

Also could affect tendon sheath, peritenon etc.

Healing

Inflammation

Synthesis of collagen and GAG (matrix)

Cyclic loading (2-3 wk)

Progressive stress

Peritenonitis

Tendinosis (intratendinous degeneration dut ot atrophy)

Tendinitis (Symptomatic degeneration vascular disruption and inflammation

Tendon
ligaments
Ligaments
  • Ligament injuries
    • sprain
    • partial tears
    • complete tears
  • Healing
    • bleeding & inflammation (fibrin, fibroblas scar cells)
    • proliferation of building material (scar tissue)
    • matrix remodeling
      • smaller fibers
      • lack organization
muscle
Muscle
  • Injuries
    • Acute muscular strain
      • overstreching or overloading
      • force, rate, application
      • moderate:partial tear
      • severe: complete tear, hemorrage, swelling
    • contusions
      • intramuscular bleeding
      • myositis ossificans
    • exercise induced injury
      • DOMS 24-72 hr after exercise
      • eccentric
slide24
Skin
  • Abrasions
  • Contusions
  • Penetrating wounds
    • obscure deeper damage
  • Lacerations
  • Infection
  • Excessive bleeding
nervous tissue
Not musculoskeletal

Greatest potential for dysfunction

Injuries

chemical

thermal

ischemic

mechanical

entrapment

trauma: compressive or tensile

Temporary or complete axonal discontinuity

Motor impairment can lead to secondary injuries

Nervous tissue
nervous tissue2
Nervous Tissue
  • Compartment or entrapments of nerves or vessels
    • Increase pressure transmitted
    • Enclosed spacing
  • Symptons
    • numbness, tingling & pain
    • decreased vessel perfusion
  • Inflammation: positive feedback loop
joint injuries
Joint Injuries
  • Excessive loading
  • Dislocation (luxation)
  • Partial dislocation (subluxation)
  • Synovitis
  • Arthritis
    • OA
    • RA
    • Gouty
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