BASICS OF TISSUE INJURY Unit 10 https://www.youtube.com/watch?v=m8s1VILkTN8

Injury Mechanisms PRIMARY or ACUTE Injury is one that results directly from the stress imposed on the body.

SECONDARY or CHRONIC Injury that arises from another injury and/or over use of a body part.

Forces applied to the body: Torsional - An action or state of being twisted. Shear - Tearing across the parallel fibers.

Forces applied to the body: Tension - Pull or stretching tissue. Compression - Crushes tissue.

Components of Injury A. Ligaments B. Muscle – Tendons C. Nerves D. Skin / Cartilage E. Bones

Often called wounds & are commonplace in athletes. Soft Tissue Injury Often called wounds & are commonplace in athletes. Injured tissue may bleed Injured tissue may become inflamed Injured tissue may produce extra fluid

1. Sprains and Strains Wounds that bleed internally and may cause fluid buildup. Sprains-injury to ligaments Strains-injury to muscle or tendon

A. Ligaments An injury to the Capsule and/or the Ligament is referred to as a SPRAIN.

1. FIRST DEGREE SPRAIN: 0-20% of the Ligament Damaged. Pain - Mild Swelling - Zero to Mild (Golf Ball) Point Tender – Depends on Athlete Functionability - Normal

20-70% of the Ligament Damaged Pain - Moderate Swelling – Moderate 2. SECOND DEGREE SPRAIN: 20-70% of the Ligament Damaged Pain - Moderate Swelling – Moderate (Grapefruit) Point Tender - Moderate Functionability - Limited (Limp)

3. THIRD DEGREE SPRAIN 70-100% of the Ligament Damaged Pain - Varied Swelling - Varied Point Tender- Varied Functionability - Limited to None

An injury to a Muscle and/or Tendon is referred to as a STRAIN. B. Muscle/Tendons An injury to a Muscle and/or Tendon is referred to as a STRAIN.

0-20% of the Muscle/Tendon Damaged Pain - Mild Swelling - Mild 1. FIRST DEGREE STRAIN 0-20% of the Muscle/Tendon Damaged Pain - Mild Swelling - Mild Point Tender - Mild Funcationability-normal

20-70% of the Muscle and/or Tendon damaged. Pain - Moderate 2. SECOND DEGREE STRAIN: 20-70% of the Muscle and/or Tendon damaged. Pain - Moderate Swelling - Moderate Point Tender - Moderate Functionability-limited; limp

70-100% of the Muscle and/or Tendon damaged. Pain - Varied 3. THIRD DEGREE STRAIN: 70-100% of the Muscle and/or Tendon damaged. Pain - Varied Swelling - Varied Point Tender - Varied Functionability - Moderate to None

C. Nerve Injury Nerves are soft tissue and can be injured Injury can: Result in a loss of sensation Result in a loss of movement Result in extreme pain Healing takes a long time, and if the damage is severe, it may never heal.

D. Skin

Incision An open wound made by a cutting object such as a scalpel. It is rarely seen in athletics.

Abrasion Results from scraping off a layer of skin, may or may not bleed, depending on depth. ~ Base runner may acquire an abrasion when sliding into base.

Contusion Closed wound, commonly called a bruise. Bleeds under the skin, causes swelling & discoloration. Athletes receive a contusion from running into something. Ex: when an athlete’s eye runs into another person’s elbow!

Laceration A jagged, irregular open wound created by a non cutting object such as a steel pole or wall. ~ Ex: a football player that runs into the goal posts may receive a laceration.

Avulsion A partial tearing away of a body part. An avulsion of a finger may occur if one catches a ring on the basketball hoop when dunking a basketball.

Amputation An open wound in which a part is completely cut away from the body. Cutting off a finger with an ice skate is an example of an amputation.

Puncture Occurs when a pointed object enters the body. Puncture wounds do not bleed much, so they are more likely to become infected than freely bleeding wounds. ~ Ex: stepping on a nail

Contrecoup Occurs on the opposite side of the initial injury. This usually occurs in the brain when the head hits against an unyielding object or surface. The impact to the back of the head, for example, forces the brain against the anterior part of the skull resulting in a contrecoup injury.

II. Stages of Soft Tissue Healing When soft tissue is injured, it progresses through three stages of healing: Stage I: Acute Inflammatory Stage II: Repair Stage III: Remodeling

Stage I: Acute Inflammatory 1. Increased blood flow brings cells & chemicals to begin healing process ~ Phagocytes-engulf and eat up injured cells ~ Leukocytes-infection-fighting white blood cells ~ Platelets-carry blood clotting materials

Stage I: Acute Inflammatory 2. Acute stage lasts for about 3-4 days after initial injury.

Stage II: Repair 1. Once filled with blood, cells, and chemicals the rebuilding can begin. 2. Fibroblasts-fiber-building cells that begin building fibers across the injured area. a. begin to build a scar which can take from six weeks to three months.

Stage III: Remodeling 1. Building tissue strength in tendons, ligaments and muscles to withstand stress applied during activity. 2. Remodeling may take a year or more.

Healing time depends on 1. Degree of the injury III. Healing Time Healing time depends on 1. Degree of the injury 2. Location of and blood supply to the injury 3. The age of the athlete

Factors that slow healing; 1. Poor blood supply 2. Poor nutrition 3. Illnesses like diabetes

4. Certain medications (corticosteroids-chemicals made in ther body to reduce inflammation-synthetic corticosteroids can reduce inflammation, but increase healing time) 5. infections

C. Complications to healing ~ Scar tissue-excessive scar tissue can slow healing time. ~ Scar tissue that forms in the joints may have to be removed to restore proper movement.

~ Large wounds with edges far apart take longer to heal. ~ Returning to activity too soon can cause more cellular injury and longer healing time.

IV. Bone Injury and Healing Functions through different shapes bones: Support, Protect, Provide Movement, Reservoir for Red Blood Cells, and Calcium.

The area where bone growth occurs from each end is referred to as the Epiphyseal Growth Plate.

SIGNS AND SYMPTOMS OF BONE INJURY: Pain Swelling Point Tender Loss of Function Deformity - Possible

A. Dislocation When bones come together at a joint they are said to articulate. A dislocation occurs when a significant force displaces bones so that the two bone ends in the same joint no longer line up

Dislocations can also cause avulsion fractures, strains, sprains, disruption of nerve conduction. Painful! ATC does not put a dislocation back in place!!!

TWO TYPES Luxation: the disunion of two bone ends at a joint which doesn’t return to normal position.

Subluxation: the disunion of two bone ends at a joint which returns to normal position.

B. Fractures There are 13 different types of acute fractures; a crack or break in a bone.

Failure points vary with the athlete, age and bone structure. Fractures Failure point-the amount of force required to cause a broken bone (a fracture) Failure points vary with the athlete, age and bone structure.

With any fracture injury, the athlete will require a cast or splint for 6-8 weeks, although some can resume participation.

Fractures are named according to type of impact, and how failure of the bone occurred. All fractures mean the bone has been compromised or weakened.

Simple (closed) fracture bone does not penetrate the skin Compound (open) fracture bone penetrates through the skin.

1. Avulsion Occurs when a ligament or tendon pulls so hard at its bony attachment that a portion of the bone is torn away. Common with sprains, strains, and dislocations.

Microscopic: cannot be seen on x-ray. 2. Stress AKA fatigue fracture - occurs in a bone subjected to repetitive stress. The athlete will complain of a persistent sore spot over the bone. Microscopic: cannot be seen on x-ray.

Looks like a candy cane stripe on x-ray. 3. Spiral a torsional force (twisting) along the length of the bone causes a spiral fracture. Looks like a candy cane stripe on x-ray.

runs the length of the bone; usually caused by an impact. 4. Longitudinal runs the length of the bone; usually caused by an impact.

Often occur in the spine 5. Compression opposing forces are applied to the bone from both ends at the same time. Often occur in the spine

fracture that runs in a diagonal line across the bone. 6. Oblique fracture that runs in a diagonal line across the bone. Longer healing time because it is hard to keep bones aligned-even in a cast.

the bone is crushed into smaller pieces 7. Comminuted the bone is crushed into smaller pieces

bone is bent and fractures only part way through. 8. Greenstick bone is bent and fractures only part way through. Children and adolescents have soft bones, like cartilage.

travels across a bone, and is perpendicular to that bone. 9. Transverse travels across a bone, and is perpendicular to that bone. Occurs from impact that is perpendicular to the bone.

an indentation in the skull cause by direct impact 10. Depressed an indentation in the skull cause by direct impact

11. Blowout small bones under the eye are crushed and embedded into the muscles of the eye when the eye is pushed hard backwards and down into the eye socket. AKA = Orbital FX

12. Pathological caused by a disease process a bone tumor can weaken the bone and make it more susceptible to fracture. Improper nutrition and eating disorders are common causes of pathological fractures.

13. Epiphyseal occurs in children and young adults in the area of the bone where bone growth occurs. Adults do not get epiphyseal fractures because the growth plate is closed. Not visible on x-ray because epiphysis is clear on film.

C. Bone Fracture Healing Like soft tissue, bone fractures go through three stages of healing: Stage I: Acute Inflammatory Stage II: Repair Stage III: Remodeling

Stage I: Acute Inflammatory (4 days) When bone breaks, it bleeds Osteoclasts (bone-absorbing cells) begin to “eat” debris and reabsorb it into the body Osteoblasts (bone-building cells) begin to add new layers to the outside of the bony tissue

Callus transforms to bone (bony callus) Stage II: Repair A bony splint, called a fibrous callus forms; it extends internally and externally to hold bone ends together. Callus transforms to bone (bony callus)

This process begins at about week three and continues for about three months. Most casts are left for only three weeks. This provides enough strength to return to activity, but healing continues.

Stage III: Remodeling Several years to complete Callus is reabsorbed and replaced with fibrous bone around fracture site. If bones are not healing, electrical stimulation can be used.

A non-union fracture means the bones never healed A non-union fracture means the bones never healed. If non-union occurs in a weight-bearing bone, like the leg, the athlete may not be able to walk.

Number your paper 1-15 Quiz

What injury is shown in each of the following illustrations?

1.

2.

3.

4.

5.

6.

E E E E 7. Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we

8.

E E E E 9. Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we

10.

11.

12.

13.

14.

15.

Answers

1. Epiphyseal fx

2. Abrasion

3. Incision

Contrecoup 4.

5. Comminuted fx

6. Puncture

E Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we E 7. E E Oblique fx Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we

8. Avulsion

Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we 9. E E Transverse fx Jilub;ienfq;oin.ieqrnf;oieknfifno;iwfn;oifh;owiefh’we

10. Amputation

11. Contusion

12. Greenstick fx

13. Spiral fx

14. Laceration

15. Compression fx