Advanced Injury Management Lecture 1 PDF

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Summary

This lecture covers the basics in different body tissues, injuries and movements. It serves as review from intro to injury management....

Description

Week 1 • Review!! • Movement Assessment • Tissue can be classified into contractile or inert/non-contractile • Contractile- muscle and tendon • Non-contractile- bone, ligament, joint capsules, fascia, bursa & nerves • Types of movements assessed • Active, passive and resisted • Must compare bilaterally • You must compare to un-ijured side first to get an idea of the patient’s normal ranges • Active Range of Motion • The first technique used to assess functional movement of a joint • Joint motion performed voluntarily by the individual through muscular contraction • Indicates willingness and ability to move body part • Looking to evaluate quality of movement, range of movement, motion in other planes, movement at varying speeds • Asking what pain feels like, when the pain occurs, how bad the pain is during ROM • •

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Active Range of Motion Pain with active movement may indicate an injury in contractile tissues (in the muscle contracting) • Ex. Knee pain: pointing to thigh, must consider muscle injury Pain in a joint may be from a contractile or non-contractile tissue injury • Ex pointing at knee joint- it is painful due to swelling, or stretching of the capsule Measurement of all motions, except rotation, starts with the body in anatomic position Passive Range of Motion Pain with passive movements indicates a lesion in non-contractile tissue, or may cause pain in a muscle that is placed on stretch • Muscle on stretch will hurt Taking injured body part is moved through ROM w no assistance from injured individual • ex. Peroneal strain w Inversion injury– resisted eversion would cause most pain The patient must be completely relaxed for a valid test • Need to reduce the influence of contractile tissue

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End of the range, gentle overpressure to determine end feel

Passive Range of Motion Note the “End Feel” of the joint • Normal – Soft-tissue approximation, Capsular, Boney, Muscular • Abnormal – Empty, Spasm (Guarding), Loose, Springy block Observe limitation of movement and presence of pain Notes differences in ROM between AROM and PROM

Resisted Range of Motion The tissue (muscle) is held in mid-range and an isometric contraction is performed • Contraction is held for 5 seconds • Measure strength • 0 – No contraction evident – usually indicates nerve injury • 1-2 – Minimal contraction (cannot lift limb against gravity) • 3 – Can hold limb against gravity (cannot resist added pressure) • 4 – Moderate strength • 5 – Full strength • Note pain level (if any)associated with the contraction • Signs and Symptoms of Sprains Sprains Injury to a ligament resulting from overstress of the collagen/elastin fibers or to their attachment to bone • History of acute onset • Mechanism of Injury (MOI) • Overstretch or overload of a ligament • Pain localized over injury site • Make sure that the swelling goes down to test for injury so we know if there is an injury or if there is just pain from swelling • Detectable joint instability (if 2nd or 3rd degree) • When tested before effusion starts • •

• Classification of Sprains • Signs and Symptoms of Strains Strains Injury to musculotendinous unit • Hx of acute onset • MOI – • Overstretch or overload of a muscle or tendon • Pain localized over injury site (likely midbelly, or MT junction) • May see bruising or blood pooling distal to injury site

Muscle weakness (if 2nd or 3rd degree) Classification of Muscle Strains

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First Degree

Second Degree

Number of Fibres Torn

Microscopic stretching Few fibres torn

Significant number of fibres torn

Sound

None

Snap or pop may be heard

Pain

Transitory pain Local point tenderness Next day pain at end ROM

A lot of pain May be local or diffuse

Swelling

Little to none

Moderate to severe May not be noticeable if intramuscul ar

Discolouratio n

Minimal

May be severe 1-3 days if inter3+ days if intra

May be same day

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AROM

Slight decreased ROM

Moderate Rom limitation

Severe ROM limitation

PROM

Slight decreased ROM

Moderate Rom limitation

Severe ROM limitation

RROM

Slight reduction

Moderate strength loss with pain

Unable to produce a contraction

Function

Slight loss, if any

Loss of function (PWB/NWB)

Unwilling to use Complete loss of function

Signs and Symptoms of Contusions Contusions Crushing of soft tissue resulting in hematoma formation • Hx of acute onset • MOI • Compressive force • Pain localized over injury site • Discolouration may be present if injury is superficial • ROM limited due to swelling and bleeding • Ex. Felt pop in quad with no direct contact= strain •

Inflammation of a tendon • Hx of chronic onset • MOI Third • Overuse, repetitive Degree stress Complete • Pain often exists through tearing of fibres length of tendon • Swelling may be mild to Audible major snap or pop • Thickening of the tendon may be present Severe pain • Crepitus may be present Occasionall y no pain is • Pain at extremes of motion present with PROM and AROM • Pain increases during stretching and RROM • Other Types of injuries Severe May be • Dislocation haematoma • Bursitis May have palpable • Fractures defect open, closed, stess Dramatic • Laceration

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Ex. Direct hit to quad more likely contusion

Classification of Contusions • Signs and Symptoms of Tendinitis Tendinitis

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Emergency Review Primary survey • Life threatening issues A B C’s, spine, AVPU, shock, rapid body survey Secondary survey • Interview – Sample, opqrt • Baseline vitals • Body Scan • Head Injury, Fracture, MSK EAP • Charge, control, call Hierarchy of Conditions consciousness

• Level of ABC’s Spinal cord injury, concussion Abdominal Injuries Shock Heat/Cold Conditions Fracture Joint Injuries Soft Tissue Injuries • On-Field Management Basic history Observe the injury site Fracture testing Functional Testing (Active/Passive/Resisted) • Perform as many as needed to insure safe removal from field • Do not have to perform all functionals on field Special tests Palpation

This process should be efficient and ensure safe removal from the field – a full diagnosis is not expected • Sideline Assessment HOPS Assessment H-history: mechanism opqrst, prev injuries Observation • Full Palpation • Palapte structure and area over it Special tests • Repeat special tests, and do more if needed • Musculoskeletal Injuries Injury • External forces directed on the body or internal forces created within the body Trauma • A physical injury or wound that is produced by external or internal force Forces • Tension – pulling or stretching of a tissue • Compression – crushing of tissue • Shear – across the length of the tissue • Torsion – twisting around the longitudinal axis of a structure • Bending

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Factors Affecting Likelihood of Injury Size/Magnitude of force Direction in which force is applied Area over which force is applied Magnitude of stress produced by the force Amount of torque generated by the force Material properties of the tissue affected • Categorize Force Relative to Direction Axial • Force that acts on the long axis of a structure Compression • Axial load that produces a crushing or squeezing type force Tension • Axial force in opposite direction; pulling or stretching the tissues Shear • Force parallel to a plane passing through the object • Tends to cause sliding or displacement • Element of Time Acute Injury • Results from a single traumatic force • Macrotrauma (large magnitude) is the causative force •

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Characterized by a definitive moment of onset

Chronic Injury • The result of repeated or chronic loading forces producing injury over time • Microtraumas (small magnitude) are the causative force • Characterized by becoming more problematic over time

Tissue types Tendon – Stronger than muscle it serves • Parallel arrangement of collagen – resists unidirectional tension loads • Muscle – viscoelastic • Types of contractions • Most common site for tears • Ligament – collagen bundles are arranged parallel AND interwoven • Resists tensile loads and smaller loads in other directions • More elastic than tendons • Well innervated, but poor blood supply • Aponeurosis • Capsule – membrane that encloses a joint – mostly collagen • Lined with synovial membrane • Bursae • Types of Injuries Strain – Separation or tearing of muscle fibres • Occurs if a muscle is overstretched or forced to contract against too much resistance (eccentric load) Sprain – Injury to a ligament resulting from overstress of the fibres Dislocation – At least one bone in a joint is force completely out of its normal alignment Subluxation – A bone comes partially out of its norm articulation but reduces itself on its own Contusion – Crushing of soft tissue leading to bruise formation Fracture – Disruption of bony tissue Stress Fracture – Results from repeated, lowmagnitude forces • •

• Types of Injuries (Continued) “itis” - Suffix denoting inflammation • When you see a condition ending with “itis”, it means that it is an inflammation of that tissue Tendinitis – Inflammation of a tendon

Tenosynovitis – Inflammation of the synovial sheath around a tendon Capsulitis – A chronic inflammatory condition in a joint capsule Periostitis – Inflammation of the surface of a bone

Bursitis – Inflammation of a bursa due to trauma or excessive friction Tendinosis – Tendon degeneration after the inflammatory process has finished...