Presentation is loading. Please wait.

Presentation is loading. Please wait.

Mechanical Injury Trauma is defined as physical injury or wound, produced by internal or external force Mechanical injury results from force or mechanical.

Similar presentations


Presentation on theme: "Mechanical Injury Trauma is defined as physical injury or wound, produced by internal or external force Mechanical injury results from force or mechanical."— Presentation transcript:

1 Chapter 9: Mechanisms and Characteristics of Musculoskeletal and Nerve Trauma

2 Mechanical Injury Trauma is defined as physical injury or wound, produced by internal or external force Mechanical injury results from force or mechanical energy that changes state of rest or uniform motion of matter

3 Tissue Properties ______ __________
An external force acting on the body causing internal reactions within the tissues __________ Ability of a tissue to resist a load Greater stiffness = greater magnitude load can resist Internal resistance to a load Internal change in tissue (i.e. length) resulting in deformation

4 Figure 9-1

5 Body tissues are ____________ and contain both viscous (fluid like) and elastic (stretchy) properties Yield point Point at which elasticity is almost exceeded is the yield point If deformation persists, following release of load permanent or plastic changes result When yield point is far exceeded mechanical failure occurs resulting in __________

6 Tissue Loading ________ ____________
Force that pulls and stretches tissue ____________ Force that results in tissue crush – two forces applied towards one another Force that moves across the parallel organization of tissue Figure 9-2

7 ________ Two force pairs act at opposite ends of a structure (4 points) Three forces cause bending (2 points) Already bowed structures encounter axial loading Loads caused by ________ in opposite directions from opposite ends Shear stress encountered will be perpendicular and parallel to the loads Figure 9-2

8 Traumatic vs. Overuse Injuries
Nature of physical activity dictates that over time injury will occur Debate over acute vs. chronic injuries When injury is ________ – something has initiated the injury process Injury becomes ________ when it doesn’t properly heal Could define relative to mechanism Traumatic (i.e. a direct blow) vs. Overuse (i.e. repetitive dynamic use over time)

9 Musculotendinous Unit Injuries
High incidence in ________ Anatomical Characteristics Composed of contractile cells that produce movement Possess following characteristics Irritability Contractility Conductivity Elasticity

10 Three types of muscle Cardiac Smooth __________(skeletal)
Skeletal Muscle Three types of muscle Cardiac Smooth __________(skeletal) Figure 9-3

11 Muscle Strains Stretch, tear or rip to muscle or adjacent tissue
Cause is often obscure Abnormal muscle contraction is the result of 1)failure in reciprocal coordination of ________ and __________, 2) electrolyte imbalance due to profuse sweating or 3) strength imbalance May range from minute separation of connective tissue to complete tendinous avulsion or muscle rupture

12 Muscle Strain Grades __________ - some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, movement painful but full range present __________- number of fibers have been torn and active contraction is painful, usually a depression or divot is palpable, some swelling and discoloration result __________- Complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage Pathologically, strain is very similar to contusion or sprain with capillary or blood vessel hemorrhage

13 Muscle Cramps Muscle Guarding
Painful involuntary skeletal __________ contraction Occurs in well-developed individuals when muscle is in shortened position Experienced at night or at rest Muscle Guarding Following injury, muscles within an effected area contract to splint the area in an effort to minimize pain through limitation of motion ____________ muscle contraction in response to pain following injury Not spasm which would indicate increased tone due to upper motor neuron lesion in the brain

14 Muscle Spasms A reflex reaction caused by trauma Two types
________ - alternating involuntary muscular contractions and relaxations in quick succession ________ - rigid contraction that lasts a period of time May lead to muscle or tendon injuries

15 Muscle Soreness ____________ in strenuous exercise resulting in muscular pain Generally occurs following participation in activity that individual is unaccustomed Two types of soreness ________-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exercise __________-onset muscle soreness (DOMS) - pain that occurs ___-___hours following activity that gradually subsides (pain free 3-4 days later) Potentially caused by slight microtrauma to muscle or connective tissue structures Prevent soreness through gradual build-up of intensity

16 Tendon Injuries Wavy parallel collagenous fibers organized in bundles - upon loading Can produce and maintain 8, ,000 lbs/in2 Collagen straightens during loading but will return to shape after loading Breaking point occurs at 6-8% of increased length Tears generally occur in ________ and not ________

17 Repetitive stress on tendon will result in ____________ and ____________, causing fibroblasts influx and increased collagen production ________ microtrauma may evolve into ________ muscle strain due to reabsorption of collagen fibers Results in weakening tendons Collagen reabsorption occurs in early period of sports conditioning and immobilization making tissue susceptibility to injury – requires __________ loading and __________

18 Tendinitis __________ onset, with diffuse tenderness due to __________microtrauma and degenerative changes Obvious signs of swelling and pain Key to treatment is ______ May require substitution of activity in order to maintain fitness without stressing injured structure Without proper healing condition may begin to degenerate and be referred to as __________ Less inflammation, more visibly swollen with stiffness and restricted motion Treatment involves __________ and strengthening Figure 9-5

19 Tenosynovitis Inflammation of synovial sheath
In ______ case - rapid onset, crepitus, and diffuse swelling Chronic cases result in ____________ of tendon with pain and crepitus Often occurs in long flexor tendon of the digits and the biceps tendon Due to nature of injury anti-inflammatory agents may be helpful

20 Myofascial Trigger Points
Discrete, hypersensitive nodule within tight band of muscle or fascia Classified as latent or active Develop as the result of mechanical stress Either acute trauma or ____________ May lead to development of stress on muscle fiber = formation of trigger points

21 Active trigger point Causes ______ at ______
Applying pressure = pain = ______ sign Tender to palpation with referred pain Tender point vs. trigger point Found most commonly in muscles involved in postural support

22 Contusions Result of sudden blow to body
Can be both ______ and __________ Hematoma results from blood and lymph flow into surrounding tissue Localization of extravasated blood into clot, encapsulated by connective tissue Speed of healing dependent on the extent of damage Chronically inflamed and contused tissue may result in generation of calcium deposits (myositis ossificans) Prevention through protection of contused area with __________

23

24 Atrophy and Contracture
Atrophy is wasting away of muscle due to immobilization, inactivity, or loss of nerve functioning Contracture is an abnormal __________ of muscle where there is a great deal of resistance to passive stretch Generally the result of a __________ injury which impacts the ________, resulting in accumulation of scar tissue

25 Synovial Joints Injuries
Each joint has both ________ or ____________ cartilage and a fibrous connective tissue capsule Additional synovial joint characteristics Capsule and ligaments for ________ Capsule is lined with synovial membrane Hyaline cartilage Joint cavity with synovial ________ Blood and nerve supply with muscles crossing joint Menisci (fibrocartilage)

26 Figure 9-8

27 Ligament Sprains Result of traumatic joint twist that causes stretching or tearing of connective tissue Graded based on the severity of injury __________- some pain, minimal loss of function, no abnormal motion, and mild point tenderness __________- pain, moderate loss of function, swelling, and instability with tearing and separation of ligament fibers __________- extremely painful, inevitable loss of function, severe instability and swelling, and may also represent subluxation

28 Can result in joint effusion and swelling, local temperature increase, pain and point tenderness, ecchymosis (change in skin color) and possibly an avulsion fracture Greatest difficulty with grade 1 & 2 sprains is restoring stability due to stretched tissue and inelastic scar tissue which forms To regain joint stability strengthening of muscles around the joint is critical

29 Dislocations and Subluxations
Result in separation of bony articulating surfaces Subluxation Partial dislocations causing ____________ separation of two bones Bones come back together in alignment Dislocations HIGH level of incidence in ________ and __________ Occurs when at least one bone in a joint is forced out of alignment and must be ________ or __________ reduced Gross deformity is typically apparent with bilateral comparison revealing asymmetry

30 Dislocation (cont.) Figure 9-9
Stabilizing structures of the joint are disrupted Joint often becomes susceptible to subsequent dislocations __-_____ is the only absolute diagnostic technique (able to see bone fragments from possible avulsion fractures, disruption of growth plates or connective tissue) Dislocations (particularly first time) should always be considered and treated as a fracture until ruled out “Once a dislocation, always a dislocation” Figure 9-9

31 Osteoarthritis Figure 9-10
__________ away of hyaline cartilage as a result of normal use Changes in joint mechanics lead to joint degeneration Commonly affects weight bearing joints but can also impact shoulders and cervical spine Symptoms include ______ (as the result of friction), __________, prominent morning pain, localized tenderness, creaking, grating Either generalized joint pain or localized to one side of the joint Figure 9-10

32 Bursitis Bursa are fluid filled sacs that develop in areas of friction
Sudden irritation can cause acute bursitis, while overuse and constant external compression can cause chronic bursitis Signs and symptoms include ________, ______ and some loss of function Repeated trauma can lead to calcification and degeneration of internal bursa linings Figure 9-11

33 Bone Injuries Anatomical Characteristics
Dense connective tissue matrix Outer compact tissue Inner porous cancellous bone including Haversian canals Figure 9-12

34 Bone Functions Types of Bone ______ support Organ protection
Movement (through joints and levers) ________ storage Formation of blood cells (hematopoiesis) Types of Bone Classified according to shape ______ bones - skull, ribs, scapulae ________ bones - vertebrae and skull ______ bones- wrist and ankle ______ bones (humerus, ulna, tibia, radius, fibula, femur) - bones most commonly injured

35 Gross Structures __________ -shaft - hollow and cylindrical
- covered by compact bone - medullary cavity contains yellow marrow and lined by endosteum __________ - composed of cancellous bone and has hyaline cartilage covering - provides areas for muscle attachment __________- dense, white fibrous covering which penetrates bone via Sharpey’ fibers - contains blood vessels and osteoblasts

36 Bone Growth Ossification occurs from synthesis of bones organic matrix (work of osteoblasts and osteoclasts) Involves growth of diaphysis and the epiphyseal growth plates (towards one another) As cartilage matures, immature ____________ replace to ultimately form ________ bone Deforming forces, premature injury and growth plate dislocation can ________ growth patterns and/or result in __________ of bone At full size, bone maintains state of balance between osteoblastic and -clastic activity

37 Changes in activity and hormonal levels can alter balance
Bone loss begins to exceed external bone growth overtime As thickness decreases, bones are less resistant to forces --____________

38 Bone Fractures Classified as either closed or open
________ fractures are those where there is little movement or displacement ________ fractures involve displacement of the fractured ends and breaking through the surrounding tissue Serious condition if not managed properly Signs & symptoms Deformity, ________, point tenderness, ________, pain on active and passive movements Possible crepitus __-____ will be necessary for definitive diagnosis

39 Mechanism of Injury Types of fractures
Fracture may be direct (at point of force application) or indirect Sudden violent and forceful muscle contraction Types of fractures _________ Comminuted Transverse Spiral Depressed Figure 9-13

40 Less common types of fractures
________ Separation of bone fragment from cortex via pull of ligament or tendon ________ fracture Serrated fracture Contrecoup fracture

41 Stress fractures No specific cause but with a number of possible causes Overload due to muscle contraction, altered stress distribution due to muscle fatigue, changes in surface, rhythmic repetitive stress vibrations Early detection is difficult- bone scan is useful, __-___ is effective after _________ weeks

42 Typical causes include
Coming back to competition too soon after injury Changing events without proper conditioning Starting initial training too quickly Changing training habits (surfaces, shoes….etc) Variety of postural and foot conditions Signs and symptoms Focal tenderness and pain, (early stages) Pain with activity, (later stages) with pain becoming constant and more intense, particularly at night, (exhibit a positive percussion tap test) Common sites involve ______, ________, metatarsal shaft, __________, femur, pars interarticularis, ribs, and humerus Management varies between individuals, injury site and extent of injury

43 Epiphyseal Conditions
Three types can be sustained by adolescents (injury to growth plate, articular epiphysis, and apophyseal injuries) Occur most often in children ages years old Classified by Salter-Harris into five types (see illustration on next slide) Apophyseal Injuries Young physically active individuals are susceptible Apophyses are traction epiphyses in contrast to pressure epiphyses. Serve as sites of origin and insertion for muscles Common avulsion conditions include Sever’s disease and __________-__________disease

44 Figure 9-15

45 Osteochondrosis Also known as osteochondritis dissecans and apophysitis (if located at a tubercle/tuberosity) Causes not well understood Degenerative changes to epiphyses of bone during rapid child growth

46 Nerve Trauma Abnormal nerve responses can be attributed to injury or athletic participation The most frequent injury is neuropraxia produced by direct trauma Lacerations of nerves as well as compression of nerves as a result of fractures and dislocations can impact nerve function

47 Nerve Injuries __________ and ________ are primary mechanisms
May be acute or chronic Physical trauma causes pain and can result in a host of sensory responses (_______, burn, ______, muscle weakness, ________ ______) Long term problems can go from minor nerve problems to ________

48 Microtrauma and Overuse Syndrome
Injuries as a result of abnormal and repetitive stress and microtraumas fall into a class with certain identifiable syndromes Frequently result in limitation or curtailment of sports involvement Often seen in ________, ________, and ________ activities Some of these injuries while small can be debilitating Repetitive overuse and stress injuries include ________ tendinitis, shin splints, ______ fx, Osgood-Schlatter's disease, ________ and ________ knee, patellar chondromalacia and apophyseal avulsion


Download ppt "Mechanical Injury Trauma is defined as physical injury or wound, produced by internal or external force Mechanical injury results from force or mechanical."

Similar presentations


Ads by Google