1. Injury Pathology Nomenclature ATHT 305 Chapter 4

2. Tissue Response to Stress Stress is needed for maintenance of soft tissue and bone When the amount of stress falls below what is needed for maintenance, the tissues __________ Progressively increased stress that allows for accommodation is ____________ If the body cannot adapt, then ____________ occurs

3. Stress-Strain Curve

4. MOI Macrotrauma vs Microtrauma –What is the difference? Tensile Force –Exerts longitudinal stress on structure Muscle tissue, ligaments, fascia Muscles that cross 2 joints are more apt to be injured ___________ Forces –Stress applies at each end Shear Force –Forces occur ____________ across long axis –May cause fracture or dislocation Torsion Force –Twisting, occurs more when shoes fix the foot to the ground Direct Blow –Results in contusions, fractures, possible disclocation

6. Soft Tissue Pathology Damage to muscles, tendons, skin, joint capsule, ligaments, nerve, bursae Hinder motion at one or more joints Decrease ability to produce force Create joint ___________ Make volitional control difficult or impossible Mechanically limit amount of motion available

7. Musculotendinous Injury ____________ –Caused by excessive tension in fibers Muscle stretched beyond normal ROM Dynamic overload- muscle generates more force than fibers can withstand –Commonly occur as the result of muscle contracting __________ and an antagonistic force attempts to elongate the muscle

8. Strain Severity First degree –Stretching of fibers and/or damage to myofibrils –Increase pain with contraction, especially vs resistance –Site of injury TTP –Swelling may be present Second-Degree –Actual tearing of some of the muscle fibers –Inflammatory response more pronounced than 1 st degree –Same findings with 1 st degree, but more severe –Ecchymosis may be present

9. Third-degree –Complete rupture of muscle and blood vessels –Total loss of function –Palpable defect –Tissue becomes ischemic, causing more damage and edema –Pain, swelling, and ecchymosis Tend to occur junction bt muscle belly and tendon

10. Tendinopathy Describes any tendon pathology _____________ inflammation of structures incased in the tendons outer layer, most commonly at bony attachment –Due to relative lack of blood supply, tendons lack a direct inflammatory response and degenerative changes, or ___________, tends to result _______________ inflammation of synovial shealth surrounding tendon

11. Tendinopathy Degrees –1 st - pain and slight dysfunction during activity –2 nd - decreased function and pain during and after activity –3 rd - constant pain that prohibits activity Long term tendinopathy –can result in partial or full tear of tendon Tendon tears more common after corticosteroid or those who abuse anabolic steroids because these chemicals weaken the tissue –Calcium buildup

12. Contusions Result from a direct blow ___________ bleeding and breakdown of hemoglobin provide coloring Can be bone Need to rule out fracture or nerve damage Treatment- ice, __________, padding to protect from further injury

13. Heterotopic Ossification Formation of bone in __________ fascia or other soft tissue Heterotopic means “in the wrong place” Occur due to deep or multiple contusions, possibly muscle strain Most common in rectus femoris, hip adductor group, biceps brachii Will show up on x-ray 3 weeks post injury

14. Bursitis Triggering event is irritation of the bursal sac secondary to a disease state, increased stress, friction, or single traumatic force that activated inflammatory process Can be local or systemic infection

15. Joint Pathologies _____________ –Occur when joint forced beyond normal anatomical limits Ligaments thickened areas of a joint capsule-those within or part of joint capsule produce more swelling Degrees of Sprains –1 st ligament is stretched with little or no tearing of fibers, no abnormal motion, normal firm end-point felt. Local pain, mild point tender, slight swelling –2 nd partial tearing, joint laxity when ligament stressed, moderate pain and swelling, loss of joints function –3 rd ligament completely torn, gross joint laxity, possible instability, empty or absent end point. Swelling marked, pain may be limited 2ndary to tearing of nerves. Complete loss of function

16. Dislocation vs Subluxation __________ - disassociation of joints articulating surfaces caused by forces that rupture many of the joint soft tissue restraints –When do we refer for dislocated joints? ___________- partial or complete disassociated of joint’s articulating surfaces that spontaneously return to normal alignment –1 st time should be referred –Each Sublux = more and bigger to come

17. Dislocation and subluxations What damage done? –__________________________________ ______________ “Joint feels like it is going out, then popping back in”

18. Joint Pathologies Cont. Synovitis –Inflammation of ____________ secondary to presence of existing inflammation in or around joint that spreads to synovial membrane May complain of “bogginess” in joint Cellulitis –Bacterial infection of skins connective tissue –Edema, redness, tightening of skin. If spread- fever, chills, fatigue, malaise –Immediate referral, withheld from activity

19. Articular Surface Pathologies Damage to articular cartilage Osteochondral defects- from trauma or gradual softening of underlying bone –Osteochondral ________-Bony fragment in joint space or free floating in joint due to ischemia, trauma, degenerative changes –C/C- “locking”, inc pain, inability to function

21. Arthritis & Lyme Disease Osteoarthritis- articular surface degenerates and regenerative process causes bony outgrowths on the smooth surface Rheumatoid Arthritis- systemic autoimmune disease Lyme Disease- from tick bite- joints form unexplained pain and inflammation (knee most common)

22. Bony Pathology Fractures in pediatric population –Open epiphyseal plates are weak point in skeletal system

23. Exostosis –Growth of extraneous ____ due to stress reaction from injury or irregular forces placed on bone –________ Law- bone remodels itself in response to forces placed on it, allows bone to adapt and become stronger Apophysitis –“growing pains”. Involves growth plate. When larger, stronger muscles attach close to the growth plate, tightness or repetitive forces applied can result in inflammation and eventual separation of this area from the rest of the bone –History of recent rapid growth

24. Fractures Classifcation based on location of fx, magnitude of fx, and shape & direction Fx that do not heal within 9 months of the expected time = __________ fracture Fx that healed in functionally unacceptable position = _________ fracture

25. Avulsion fx- tearing away of ligament or tendon’s bony attachment. Can occur when muscle forcefully contracted and attachment site pulled away from the rest of the bone Stress fx- occur when bone subjected to abnormally high, repeated submax stresses and is linked to change in activity. Can result from weak bones subjected to normal force –___________ activity outweighs _________ activity –Amenorrheic women

26. Peripheral Nerve Injury Entrapment ____________ stretch injury. S/S are transient- burning pain, temporary weak, numb, pain Complex Regional Pain Syndrome- exagerated generalized pain response after injury –Complaints include: P! disproportional to injury, superficial hypersensitivity, muscle spasm, skeletal changes

27. Homework Draw, label, and describe in your own words the following fractures –Diaphyseal –Epiphyseal –Articular –Incomplete –Undisplaced –Displaced –Open Depressed Transverse Comminuted Compacted Spiral Longitudinal Greenstick