Musculoskeletal Acute & Chronic Injuries

1. MusculoskeletalAcute & ChronicInjuries http://www.dchospital.com/services/images/sports_medicine.jpg

2. 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 Lesson Goals;

3. 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 Structures

4. Tendinitis - 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! Tendinitis and Bursitis

5. Bursae in the Knee Joint

6. 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. Cartilage Damage

7. Sprains • 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

8. Grade 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

9. Grade 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

10. Grade 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

11. 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? Strains

12. Grade 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

13. Partial tear to muscle • Moderate pain during movement • ROM decreased more than Grade 1 strains • Moderate swelling, weakness & loss of function Grade 2 Strains

14. Muscle  Completely torn • Severe pain during movement • ROM may increase or decrease depending on swelling • Major swelling, weakness & major or complete loss of function Grade 3 Strains http://education.advancedorthopedic.net/Injuries-Conditions/Hamstring/Hamstring-Injuries/a~322/article.html

15. Separations • 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

16. Glenohumeral Dislocation: • head of the humerus is forced out of the glenoid fossa due to excessive force • Types of glenohumeral separations

18. 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 Chronic Injuries

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

20. 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

21. Non-Steroidal-Anti-Inflammatory-Drugs • To 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 NSAID’s Medication?

22. 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 Questions

23. 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 Review Questions