EXSS 366- IC2

what is toe?

the regular state of soft tissue

what is linear?

a slight stretch of soft tissue

what is failure?

when an injury occurs to soft tissue[

what happens during the inflammatory phase of skin wound repair?

• wound filled with blood and cellular debris

• epithelia cells migrate across defect

• increased permeability allows leakage of fluid

  • beginning of transformation of fibroblasts

what is the migratory phase of skin wound repair?

• debris removed by leukocytes

• epithelial cells proliferate

• fibroblasts migrate along fibrin strands and capillaries begin to bud

• granulation tissue is seen

• epithelium thickens beneath scab

• collagen is laid down irregulary

• capillaries increase

• debris is nearly absent

what happens during the maturation phase of skin wound repair?

• scab slough as epithelium resumes normal stratification

• collagen increases bulk and organizes

• vascular network reappears

• fibroblast begin to disappear

what is a grade 1 ligament injury?

stretching/minor tear, mild pain, little swelling, joint stiffness

what is a grade 2 ligament injury?

tearing and separation of fibers, moderate instability, moderate to severe pain, little selling, joint stiffness

what is a grade 3 ligament injury?

total rupture, gross instability, severe pain, profuse swelling, may require reconstruction

what happens in the first 72 hours of ligament healing?

bleeding and inflammation

what is extra-articular in ligament?

subcutaneous space

what is intra-articular in ligament?

joint capsule

what happens in 6 weeks of ligament healing?

• vascular proliferation

• collagen synthesis

what happens within 12 months of ligament healing?

scar maturation (12 months)

what factors affect ligament healing?

• intra-articular ligament damage

• immobilization

• surgically repaired extra-articular ligaments

• non-surgically repaired ligaments

what dilutes hematoma and disrupts healing?

synovial fluid presence

what kind of ligaments are stronger?

exercised ligaments are stronger than immobilized

what can happen to a ligament if there is too much exercise too soon?

excessive scar tissue can form

what is typically seen with surgically repaired extra-articular ligaments?

heal with less scarring and are stronger than un-repaired ligaments

how do non-surgically repaired ligaments heal?

via fibrous scarring

what does fibrous scarring lead to?

ligament lengthening and instability

describe muscle

• elastic

• extensible

• excitable

• contractile

what is strain?

injury to muscle fibers, musculotendonus junction, tendon, or attachment site

what is a grade 1 muscle strain?

muscle/tendon fibers have microtears

what is a grade 2 muscle strain?

muscle/tendon fiber have been torn, palpable depression, swelling, capillary bleeding

what is a grade 3 muscle strain?

complete rupture of muscle/tendon, initial intense pain subsides due to severed nerve

what is the inflammation process with muscle strains?

process is the same; some immobilization; motion control can be recommended

what is crucial to muscl strains?

repair and remodeling phase

why is the repair and remodeling phase crucial?

collagen must be laid down to adequately distribute forces

what does collagen undergo?

maturation

what is important for collagen maturation?

active contractions being critical to apply tensile stress

how long can muscle strains take to heal?

6-8 weeks

what is the typical management for a muscle strain?

typical tendon healing may require 4-5 weeks before strong contractions can be imparted on tendon

what must be taken into account for muscle strain management?

• type of injury

• inflammatory

• degenerative

greenstick

transverse/nondisplace

linear

oblique/nondisplaces

spiral

comminuted

what are stress fractures?

• weight bearing sites

• repetitive stresses

what are the weakest areas of bones?

• changes in thickness

• changes in shape

• changes in direction

what happens in week 1 of bone healing?

hematoma or inflammation

what happens in weeks 2-3 of bone healing?

soft callus

what happens in weeks 4-16 of bone healing?

hard callus

what happens in weeks 17+ of bone healing?

remodeling

what is Wolff’s Law in relation to bone healing?

bone will adapt to mechanical stresses and strains by changing size

what are common issues with bone healing?

• osteoclastic and osteoblastic activity/balance

• internal and external callus

• must resist compressive, torsion, and tensile forces

• immobilization for a certain amount of time yet movement is needed to strengthen

what are common nervous tissue injuries?

• contusions

• inflammation

• crush

• severing

  • stretching

what do injuries to the nervous system typically have?

consequences on other body systems

what is a concussion?

a brain injury and is defined as a complex pathophysiologial process affecting the brain, induced by biomechanical forces

what do concussions result in?

results in the rapid onset short-lived impairment of neurologic function; some cases, symptoms, and signs may evolve over a number of minutes to hours

what do concussion actue clinical symptoms reflect?

a functional disturbance rather than a structural injury and as such, no abnormaility is seen on neuroimaging studies

what might a concussion involve?

a loss of consciousness

what is the recommendation of a good plan for concussions?

• suspect concussion

• remove from play

• evaluate symptoms balance, cognition

• inform parents/legal custodians

• academic recommendations

• daily eval until sympton-free

• gradually increase cognitive exertion

• gradually increase physical exertion

• return to play with written clearence