Ch. 10 Soft Tissue Injury, Repair and Management

Overstretching, overexertion or overuse of soft tissue; disruption of musculotendinous junction

Strain

Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle

Sprain

An incomplete or partial displacement of a part

Dislocation

A displacement of a part

Dislocation

Tendon injury affected by mechanical load

Tendinopathy

Inflammation of synovial membrane

Tenosynovitis

Inflammation of tendon (scarring or calcium deposits)

Tendinitis

Degeneration of the tendon caused by repetitive microtrauma

Tendinosis

Inflammation of synovial membrane (trauma or disease)

Synovitis

Bleeding into the joint

Hemarthrosis

Ballooning of the wall of a capsule or tendon sheath

Ganglion

Inflammation of bursa

Bursitis

Direct blow resulting in capillary rupture, bleeding, edema and inflammatory response

Contusion

What are the grades/severity of tissue injury?

Grade 1- First Degree
Grade 2- Second Degree
Grade 3- Third Degree

Which Grade of tissue injury causes:
Mild pain at time of injury
Mild swelling
Local tenderness
Pain with tissue stress

Grade 1- First Degree

Which Grade of tissue injury causes:
Moderate pain
Requires stopping activity
Stress and palpation greatly increases pain
When injury to ligaments some fibers torn

Grade 2- Second Degree

Which Grade of tissue injury causes:
Near complete tear
Severe pain
Stress to tissue is usually painless
Palpation may reveal defect
Torn ligaments results in instability of the joint

Grade 3- Third Degree

What is the best management for maximal protection (phase 1)?

Patient education
Protection of tissue
Prevention of adverse effects
Specific interventions and dosages
Interventions for associated areas

During the proliferation, repair and healing stage, what occurs?

Inflammation decreases
Repair of injured site begins

What are the 4 main management guidelines for moderate protection/controlled motion (phase 2)?

Patient education
Management of pain and inflammation
Initiation of active exercises and stretching
Correction of contributing factors

What encompasses the initiation and progression of stretching?

Warm the tissue
Muscle relaxation techniques
Joint mobilization/manipulation
Stretching techniques
Massage
Use of new range

What are management guidelines for minimum to no protection/return to sport (phase 3)?

Patient education
Considerations for progression of exercises
Progression of stretching
Progression of exercise of muscle performance
Return to high-demand activities

What is phase 5?

Develop exercise drills that stimulate the work or sport activities using a controlled environment with specific, progressive resistance and polymetric drills

True or False: During phase 5, as the patient demonstrates capabilities, we should increase the repetitions and speed of the movement

True

What are some causes of chronic inflammation?

Overuse, cumulative trauma, repetitive strain
Trauma
Reinjury of an old scar
Contractures or poor mobility

What are some contributing factors to chronic inflammation?

Imbalances between length and strength of muscles
Rapid or excessive repeated eccentric demand
Muscle fatigue
Bone malalignment or weak structural support
Change in usual intensity or demand

During the acute stage of chronic inflammation, what are the management guidelines?

Control inflammation to avoid continued tissue breakdown and scarring

During the subacute stage of chronic inflammation, what are the management guidelines?

Exercise program with controlled stresses until the tissue tolerates the load

What are the 3 main treatment approaches for chronic pain syndrome?

Medical, psychological and behavioral interventions

Why is patient education important for individuals with chronic pain syndrome?

Helps patient understand they are not causing continued tissue injury while being active, while experiencing positive outcomes that do not worsen their perceived pain

What is Peace & Love for soft tissue injury?

Protection
Elevation
Avoid anti-inflammatories
Compress
Educate

Load
Optimism
Vascularization
Exercise