1. Pathophysiology of Injury to various Tissues Review of tissue Injuries

2. Pathophysiology Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from a disease or abnormal syndrome or condition that may not qualify to be called a disease.

3. Ligament Sprains A ligament is a tough,relatively inelastic band of tissue that connects bone to bone Function three fold To provide stability To provide control of position To provide proprioceptive input sense of its position

4. Ligament Sprains Healing process follows the same course of repair as other vascular tissues Sprained Extra-articular ligaments bleeding will occur in a subcutaneous space Sprained intra-articular ligaments bleeding will occur inside the joint capsule

5. Factors Affecting Ligament Healing Surgically repaired extra-articular ligaments have healed with decreased scar tissue and are generally stronger than non-repaired ligaments initially, this strength advantage may not however last as time passes Non-repaired ligaments heal with a fibrous scar effectively lengthening the ligament producing some degree of joint instability With intra-articular ligaments the presence of synovial fluid dilutes the hematoma and prevents formation of a clot and spontaneous healing

6. Factors Affecting Ligament Healing Actively exercised ligaments are stronger than immobilized ligaments Therefore it is important to minimize immobilization periods It is not likely that the inherent stability of the joint will be regained Therefore other surrounding structures must be strengthened

7. Fractures to Bone Extremely common in sports, classified as either OPEN or CLOSED Varieties of fractures Greenstick Transverse Oblique Spiral Comminuted Impacted Avulsive Stress

8. Bone Healing Healing of the bone is similar to soft tissue healing in that all phases of healing can be identified Bone regeneration capabilities are limited A callus is created between the two ends, its size is proportional to the damage and the amount of irritation to the fracture site during the healing process Once the cast is removed the bone must be subjected to normal stresses and strains so that tensile strength can be regained before the healing process is complete Wolfs law Bones and soft tissue will respond to the physical demands placed upon them, causing them to remodel/realign along lines of tensile strength

9. Bone Healing Time required for healing is variable 3- 10 weeks Depends on location, severity of fracture, age of patient Healing may continue for up to 2- 3 years

10. Cartilage Damage Arthrosis is primarily a degeneration process with destruction of the cartilage Chondromalacia- is the non-progressive transformation of cartilage with irregular surfaces and areas of softening

11. Cartilage Healing Cartilage has a relatively limited healing capacity Injuries fail to elicit clot formation or cellular response The defect fails to heal, however the damage to the area tends to remain the same

12. Muscle strains Muscle is Elastic Extensible Excitable Contractible Damage may occur in the muscle, at the musculo-tendinous junction or in the tendon Three grades

13. Muscle healing Injuries to muscle tissue involve similar processes of healing and repair Regardless of the severity of the strain, the time required for rehab is fairly lengthy. Rehab of muscle is often longer than ligament rehab Incapacitating muscle strains often occur in large force producing muscles ( quads, hamstrings) Hamstrings may require at least 6- 8 weeks and considerable amount of patience Attempts to return to soon frequently cause re-injury to the area and then the healing process must start again

14. Tendinitis Most common overuse problem is tendinitis Tendinitis is a catch all term used to describe many different pathological conditions of a tendon It essentially describes any inflammatory response with in the tendon

15. Para-tenonitis Inflamation of the outer layer of the tendon Usually occurs when the tendon rubs over a boney prominence

16. Tendinosis Describes a tendon that has significant degenerative changes with no signs of an inflammatory response

17. Tendinitis Chronic tendinitis Evidence of significant tendon degeneration, loss of normal collagen structure, no inflammatory cellular response. The point or cause where the acute inflammatory response terminates and the chronic degeneration begins is difficult to determine

18. Tendonitis During muscular activity, a tendon must move or slide on other structures If a particular movement is performed repeatedly the tendon becomes irritated and inflamed Inflammation is manifested by pain on movement, swelling, possibly some warmth, and usually crepitus Crepitus is a crackling sound and usually caused by adhesion of the para-tendon to the surrounding structures while is slides back and forth

19. Tendinitis Healing The key to treating tendinitis is rest Eliminate the repetitive motion The healing process should begin, however this rest period may be difficult in some activities NSAIDS, modalities alternative activities if possible