Injury Pathology Nomenclature ATHT 305 Chapter 4.

Injury Pathology Nomenclature

ATHT 305 Chapter 4

Tissue Response to Stress

• Stress is needed for maintenance of soft tissue and bone

• When the amount of stress falls below what is needed for maintenance, the tissues __________

• Progressively increased stress that allows for accommodation is ____________

• If the body cannot adapt, then ____________ occurs

Stress-Strain Curve

MOI

• Macrotrauma vs Microtrauma– What is the difference?

• Tensile Force– Exerts longitudinal stress

on structure• Muscle tissue, ligaments,

fascia• Muscles that cross 2 joints

are more apt to be injured

• ___________ Forces– Stress applies at each end

• Shear Force– Forces occur

____________ across long axis

– May cause fracture or dislocation

• Torsion Force– Twisting, occurs more

when shoes fix the foot to the ground

• Direct Blow– Results in contusions,

fractures, possible disclocation

Soft Tissue Pathology

• Damage to muscles, tendons, skin, joint capsule, ligaments, nerve, bursae

• Hinder motion at one or more joints• Decrease ability to produce force• Create joint ___________• Make volitional control difficult or

impossible• Mechanically limit amount of motion

available

Musculotendinous Injury

• ____________– Caused by excessive tension in fibers

• Muscle stretched beyond normal ROM• Dynamic overload- muscle generates more force

than fibers can withstand

– Commonly occur as the result of muscle contracting __________ and an antagonistic force attempts to elongate the muscle

Strain Severity

• First degree– Stretching of fibers

and/or damage to myofibrils

– Increase pain with contraction, especially vs resistance

– Site of injury TTP– Swelling may be

present

• Second-Degree– Actual tearing of some

of the muscle fibers– Inflammatory response

more pronounced than 1st degree

– Same findings with 1st degree, but more severe

– Ecchymosis may be present

• Third-degree– Complete rupture of

muscle and blood vessels– Total loss of function– Palpable defect– Tissue becomes ischemic,

causing more damage and edema

– Pain, swelling, and ecchymosis

• Tend to occur junction bt muscle belly and tendon

Tendinopathy

• Describes any tendon pathology• _____________ inflammation of structures

incased in the tendons outer layer, most commonly at bony attachment– Due to relative lack of blood supply, tendons lack a

direct inflammatory response and degenerative changes, or ___________, tends to result

• _______________ inflammation of synovial shealth surrounding tendon

Tendinopathy

• Degrees– 1st- pain and slight

dysfunction during activity

– 2nd- decreased function and pain during and after activity

– 3rd- constant pain that prohibits activity

• Long term tendinopathy– can result in partial or

full tear of tendon• Tendon tears more

common after corticosteroid or those who abuse anabolic steroids because these chemicals weaken the tissue

– Calcium buildup

Contusions

• Result from a direct blow

• ___________ bleeding and breakdown of hemoglobin provide coloring

• Can be bone

• Need to rule out fracture or nerve damage

• Treatment- ice, __________, padding to protect from further injury

Heterotopic Ossification

• Formation of bone in __________ fascia or other soft tissue

• Heterotopic means “in the wrong place”

• Occur due to deep or multiple contusions, possibly muscle strain

• Most common in rectus femoris, hip adductor group, biceps brachii

• Will show up on x-ray 3 weeks post injury

Bursitis

• Triggering event is irritation of the bursal sac secondary to a disease state, increased stress, friction, or single traumatic force that activated inflammatory process

• Can be local or systemic infection

Joint Pathologies• _____________

– Occur when joint forced beyond normal anatomical limits

• Ligaments thickened areas of a joint capsule-those within or part of joint capsule produce more swelling

• Degrees of Sprains– 1st ligament is stretched with

little or no tearing of fibers, no abnormal motion, normal firm end-point felt. Local pain, mild point tender, slight swelling

– 2nd partial tearing, joint laxity when ligament stressed, moderate pain and swelling, loss of joints function

– 3rd ligament completely torn, gross joint laxity, possible instability, empty or absent end point. Swelling marked, pain may be limited 2ndary to tearing of nerves. Complete loss of function

Dislocation vs Subluxation

• __________ -disassociation of joints articulating surfaces caused by forces that rupture many of the joint soft tissue restraints– When do we refer for

dislocated joints?

• ___________- partial or complete disassociated of joint’s articulating surfaces that spontaneously return to normal alignment – 1st time should be

referred– Each Sublux = more

and bigger to come

Dislocation and subluxations

• What damage done?– __________________________________

______________

• “Joint feels like it is going out, then popping back in”

Joint Pathologies Cont.

• Synovitis– Inflammation of ____________ secondary to

presence of existing inflammation in or around joint that spreads to synovial membrane

• May complain of “bogginess” in joint

• Cellulitis– Bacterial infection of skins connective tissue– Edema, redness, tightening of skin. If spread-

fever, chills, fatigue, malaise– Immediate referral, withheld from activity

Articular Surface Pathologies

• Damage to articular cartilage

• Osteochondral defects- from trauma or gradual softening of underlying bone– Osteochondral ________-Bony fragment in

joint space or free floating in joint due to ischemia, trauma, degenerative changes

– C/C- “locking”, inc pain, inability to function

Arthritis & Lyme Disease

• Osteoarthritis- articular surface degenerates and regenerative process causes bony outgrowths on the smooth surface

• Rheumatoid Arthritis- systemic autoimmune disease

• Lyme Disease- from tick bite- joints form unexplained pain and inflammation (knee most common)

Bony Pathology

• Fractures in pediatric population– Open epiphyseal plates are weak point in

skeletal system

• Exostosis – Growth of extraneous ____ due to stress reaction

from injury or irregular forces placed on bone – ________ Law- bone remodels itself in response to

forces placed on it, allows bone to adapt and become stronger

• Apophysitis– “growing pains”. Involves growth plate. When larger,

stronger muscles attach close to the growth plate, tightness or repetitive forces applied can result in inflammation and eventual separation of this area from the rest of the bone

– History of recent rapid growth

Fractures

• Classifcation based on location of fx, magnitude of fx, and shape & direction

• Fx that do not heal within 9 months of the expected time = __________ fracture

• Fx that healed in functionally unacceptable position = _________ fracture

• Avulsion fx- tearing away of ligament or tendon’s bony attachment. Can occur when muscle forcefully contracted and attachment site pulled away from the rest of the bone

• Stress fx- occur when bone subjected to abnormally high, repeated submax stresses and is linked to change in activity. Can result from weak bones subjected to normal force– ___________ activity outweighs _________ activity– Amenorrheic women

Peripheral Nerve Injury

• Entrapment• ____________ stretch injury. S/S are transient-

burning pain, temporary weak, numb, pain• Complex Regional Pain Syndrome- exagerated

generalized pain response after injury– Complaints include: P! disproportional to injury,

superficial hypersensitivity, muscle spasm, skeletal changes

Homework

• Draw, label, and describe in your own words the following fractures– Diaphyseal– Epiphyseal– Articular– Incomplete– Undisplaced– Displaced– Open

• Depressed• Transverse• Comminuted• Compacted• Spiral• Longitudinal• Greenstick