Injury Nomenclature - Ortho 3.1

Signs

A finding that is observable or that can be measured

• Swelling, deform, discolor, crepitus, redness etc.

Symptom

A consequence of injury/illness that is not visually apparent to examiner

• Pain, nausea, fatigue, altered sensation

Physical Stress Theory

Tissue responds in a predictable manner to stresses placed upon them

• Atrophy, maintenance, hypertrophy, injury

1st Degree SPrain

• Ligament stretched w/ little or no tearing

• No abnormal motion, mild point tenderness, mild swelling

• Firm end-point evident

2nd degree SPrain

• Partial tearing of fibers

• Laxity, mushy until firm end point is reached

• Pain may limit accurate test of laxity

3rd degree SPrain

• Complete rupture

• Gross laxity, empty end point

• Immediate pain, swell, LOF

• Gradual ecchymosis

Joint Subluxation

Partial displacement of articular surfaces

• Spontaneous relocation

• Some tissue disrupt (unless hypermobile or repeat injury)

Joint Dislocation

Complete displacement of surfaces

• Obvious deformity

• Extensive tissue disruption

• Reduction required (eval PMS)

Muscle Strains

Tend to occur at musculotendinous junction or bone attachment site

• may have defect and ecchymosis

1st degree Strain

Micro-tears w/in muscle or tendon, no gross disruption

• Discomfort/pain with contraction, point tender, may/mat not swell

2nd degree Strain

Torn muscle fibers

• Pain, point tender, disability

• Some ecchymosis, swelling, decreased ROM + weakness

• May have palpable defect

3rd degree Strain

Complete rupture of some portion of muscle or tendon

• Audible pop, immediate pain and LOF

• Palpable defect, pain, swelling, ecchymosis

Myositis Ossificans/Heterotopic ossification

Muscle contusion w/ mineralization in muscle belly

• Palpable firmness, on radiographs

Tendinitis (or peri/paratendinitis)

Inflammatory response to acute tissue damage

• WBC infiltration

Tendinosis

Absence of inflammatory cells (repeat microtruama)

Angiofibroblastic Hyperplasia

• Abnormal vasculature between collagen

• Dense fibroblasts, disorganized collagen

Common tendinosis sites

• Common wrist extensor (Lat epi)

• Rotator cuff (supra)

• Patellar/Achilles/Post Tib tendon

• Plantar Fasc

Tenosynovitis

Inflammation of synovial sheath around tendon

• Common in hands/feet (small size)

• Adhesions, pain, crepitus

Bursitis

Inflammation of bursa (fluid filled sac)

• Bursa = friction reducer, normally not palpable

• From overuse, contusion, infection

Synovitis

Inflamm of synovial membrane

• Low-P watery effusion of joint capsule

Osteochondrosis Dissecans (OCD)

Fragments of articular cartilage (+bone) may detach within joint space

• Mechanical block

Osteoarthritis

Degeneration of articular surface, can lead to cartilage thinning and exposure of subchondral bone

Rheumatoid Arthritis

Congenital autoimmune disorder affecting articular cartilage

Apophysitis (Osteochondrosis)

Inflammatory condition involving growth plate (growing pains)

• Muscle exerts traction on growth plate

• Fragment, sclerosis

Epiphyseal (Growth plate injury)

Any disruption classified as a fracture

• 5 types

Nondisplaced Fx

Bone ends retain normal position

Displaced Fx

Bone ends are out of normal alignment

Complete Fx

Bone broken all the way through

Incomplete Fx

Bone is not broken all the way through

Linear Fx

Fx is parallel to long axis of the bone

Transverse

Fx is perpendicular to long axis of bone

Compound (open) Fx

Bone ends penetrate the skin

Simple (closed) Fx

Bone ends do not penetrate the skin

Comminuted Fx

Fx’s into 3 or more pieces

Compression Fx

Bone is crushed, typically from falls in vertebrae

Spiral Fx

S shaped around bone, Excess twisting

Epiphyseal Fx

Epiphysis separates from diaphysis along growth plate

Depressed Fx

Broken bone pressed inward, typically skull

Greenstick Fx

Incomplete bone break (like tree branch)

Entrapment (compression)

Constrictive soft tissues surround peripheral nerve

• Muscle tensionor formation of fibrous tissue

• Syms: Paresthesia or weakness

Neuropraxia

Axon, epineurium, myelin stretched

• Transient symp: burning, pain, numb, weak

Axonotmesis

Disruption in axon and myelin continuity, epineurium intact

• Longer symptoms, unpredictable regeneration

Neurotmesis

Complete disruption of a nerve

• Severe trauma, rare return to normal function

Neuralgia

Pain resulting from nerve compression

Neuroma

Fibrotic thickening of connective tissue surrounding peripheral nerve (compression)

Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)

An exaggerated pain response after an injury

• Prolonged pain disproportionate to injury severity

• Hypersensitive, vasomotor disturbances, delayed functional recovery