Chapter 2 Injury Nomenclature

Soft Tissue Injuries  Most common form of orthopedic trauma  Injuries to: Muscles, Tendons, Skin, Joint Capsules, Ligaments, Bursae Muscles, Tendons, Skin, Joint Capsules, Ligaments, Bursae  Affect Performance by: Hindering joint motion Hindering joint motion Decreasing ability of muscle to produce force Decreasing ability of muscle to produce force Creating joint instability Creating joint instability Limiting amount of motion available to joint Limiting amount of motion available to joint

Musculotendinous Injuries  Affects muscle’s ability to contract fully, forcibly, or both  Mechanical insufficiency vs. pain  Partial tear in muscle or tendon Decreased force production secondary to pain elicited during contraction Decreased force production secondary to pain elicited during contraction  Complete tear Inability to produce any force Inability to produce any force

Strains  Tensile Forces  Dynamic Overload  Three-degree grading scale First-degree strains First-degree strains Second-degree strains Second-degree strains Third-degree strains Third-degree strains  Table 2-1, page 31

Tendinitis  Table 2-2, page 31  Tenosynovitis  Peritendinitis  Three-degree grading scale  Partial or complete tendon tearing  Calcific tendinitis  Table 2-3, page 32

Myositis Ossificans  Figure 2-2, page 32  Formation of bone within a muscle belly’s fascia  Due to traumatic injury  Very important to differentiate between muscle strain and contusions versus the formation of ossification  Table 2-4, page 33

Bursitis  Bursae – fluid-filled sacs that serve to buffer muscles, tendons, and ligaments from friction-causing structures and facilitate smooth motion  Table 2-5, page 34

Joint Structure Injuries  Injuries involve the capsular and ligamentous tissues  Directly affect the joint’s stability

Sprains  Occur when joint is forced beyond its normal limits resulting in stretching or tearing of ligaments, joint capsule, or both  Three-degree grading scale  Table 2-6, page 35

Joint Subluxation  Partial or complete disassociation of the joint’s articulating surfaces  Subsequent episodes  Apprehension Response  Table 2-7, page 35

Joint Dislocation  Obvious deformity, Figures 2-3 and 2-4, page 36  Risk of injury to bony, vascular, neurological, and other soft tissue structures  Dislocation of major joint = medical emergency  Table 2-8, page 36

Synovitis  Table 2-9, page 37

Articular Surface Injuries  Articular or hyaline cartilage may be injured acutely or damaged as a result of degenerative changes  Irreversible, leads to chronic pain and/or dysfunction

Osteochondral Defects  Fractures of a bone’s articular cartilage and progressive softening of the cartilage  Severity based on depth of defect and location  Table 2-10, page 38

Osteochondritis Dissecans  Dislodged fragments of bone within the joint space  Talus, femur, patella, capitellum, and humeral head most frequently affected  Pain, loss of ROM, decreased joint function, “locking”  Table 2-11, page 39

Arthritis  Osteoarthritis – degeneration of joint’s articular surface  Weight-bearing joints  Regeneration causes bony outgrowths  Figure 2-8, page 40  Rheumatoid Arthritis – systemic condition  Table 2-12, page 40

Bony Injuries  Tend to be traumatic  Proper initial management  Pediatric and adolescent population

Exostosis  Wolff’s Law  Growth of extraneous bone  Figure 2-9, page 41  Table 2-13, page 41

Apophysitis  “Growing pains”; inflammation of bone growth plate  Figure 2-10, page 42  Attachment sites for strong muscle groups  Rapid growth spurt, lack of flexibility

Fractures  Classified based on: Location of fracture, Box 2-1, page 43 Location of fracture, Box 2-1, page 43 Magnitude of fracture line, Box 2-2, page 43 Magnitude of fracture line, Box 2-2, page 43 Shape/direction of fracture, Box 2-3, page 44 Shape/direction of fracture, Box 2-3, page 44

Avulsion Fractures  Tearing of ligament or tendon from bony attachment  Small vs. large tendons  Figure 2-11, page 42

Stress Fractures  Chronic condition (repetitive stress), most common in lower extremity  Changes in training, equipment, surfaces  Table 2-14, page 45

Neurovascular Pathologies  Nerves, arteries, veins  Due to – joint dislocation, bony displacement, concussive forces  Injury can lead to loss of function  If untreated, vascular injury can lead to loss of body part

Peripheral Nerve Injury  Entrapment injuries are common at ankle, elbow, wrist, cervical spine  More distal = greater probability of regeneration  Swelling can cause paresthesia and muscular weakness  Stretch injuries Neurapraxia Neurapraxia Axonotmesis Axonotmesis Neurotmesis Neurotmesis

Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)  Exaggerated, generalized pain response after injury  Intense, prolonged pain that is out of proportion to severity of injury  Prognosis is variable  Symptomatic relief

Imaging Techniques  Table 2-15, page 47  Various figures, pages 47-50