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Gen Ortho- Sprains+Strains

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taylormaloney's version from 2016-10-03 02:43

Section 1

Question Answer
Define StrainAn overstretch injury to a musculotendinous unit.(Muscle, tendon, attachment + junction)
What are the two categories of muscle contraction?Concentric + Eccentric.
What type of contraction produces a stronger contraction, making it more likely to cause injury?Eccentric contraction is stronger, and more likely to cause an injury.
Why is that type of contraction stronger?Because of how the actin and myosin bind.
What type of contraction recruits more muscle fibres?Concentric Contraction.
What characteristic of tendons contributes to decreased tissue health?Hypovascularity of the tendons.
In older adults, what frequently causes damage to the MT Junction/Tendon?Chronic overuse.
In children, when the epiphyseal plate is not ossified, what is stronger, the Tendons/muscles or the bone?The Tendons and Muscles.
Due to the lack of strength, what may happen?Tendon may avulse, or bone may fracture along epiphyseal line.
Tendons are prone to partial or complete rupture, where + why?Area of least blood supply, (middle of tendon, or at MT Junction) because they are only moderately vascularized.
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Section 2

Question Answer
What are the three classifications of strains?Gr 1, 2, 3.
What are the characteristics of a Gr 1 strain?Minor stretch/tear, minimal loss of strength, can continue activity.
What are the characteristics of a Gr 2 strain?Tearing of MT fibres (variable, several to majority), May be snapping sound/feeling.
What are the characteristics of a Gr 3 strain?Palpable/visible gap at injury site, muscle may be shortened/bunched up, cannot continue activity, May require surgical repair ( in acute stage ).
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Section 3

Question Answer
Symptoms of Acute Gr 1Minor discomfort, Tenderness, Little to no loss of function/ROM, Can continue activity.
Symptoms of Acute Gr 2Tearing of several/many fibres, snapping noise/feeling, moderate local edema/heat/bruising, possible gap, moderate tenderness, moderate pain with contraction/stretch, moderate loss of strength/ROM, Difficulty continuing activity.
Symptoms of Acute Gr 3Complete rupture of muscle/avulsion fracture at attachment, snapping noise/feeling, Severe local edema/heat/hematoma/bruising, palpable gap, spasmodic contractions, severe pain, immediate loss of strength/ROM, Cannot continue activity.
Symptoms common of Acute Gr 2 + Gr3Red/Black/Blue Bruising, hematoma present, reduced ROM, May be bandaged or use of sling/cane/crutches.
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Section 4

Question Answer
When to return to activity- Gr 1 StrainWith support after 2 days.
When to return to activity- Gr 2 StrainSeveral days-Several Weeks
When to return to activity- Gr 3 StrainImmobilization removed after 4-8 weeks, return to activity delayed until disuse atrophy has been overcome.
CIs/Precautions of StrainsAvoid removal of protective measures while acute, no distal circulation techs in acute/early SA. Gr 3 casted/no hot hydro/just proximal.
What are the Goals for Acute Strains?Reduce pain, reduce edema, reduce protective muscle spasm.
What are the Goals for Early SA Strains?Reduce pain, reduce edema, reduce spasm.
What are the Goals for a Late SA Strain?Reduce HT + TPs, Reduce Adhesions, Increase ROM.
What are the Goals for a Chronic Strain?Reduce HT + TPs, Reduce Adhesions, Increase ROM.
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Section 5

Question Answer
Define SprainAn overstretch injury to a ligament.
What are ligaments composed of?Flexible, non-contractile connective tissue.
What do ligaments do?Add stability to connective tissue joint capsules.
How are they named?Bones they are attached to and anatomical position.
Ligaments do what to the ROM of a joint?Limit and control the ROM, while allowing motion.
They are generally __________, at end range and ________, everywhere else.Taut at end range, slack everywhere else.
What causes a sprain?Trauma related to sudden twist or wrench of a joint beyond it's normal end range.
What are the contributing factors relating to sprains?Hypermobility, History of sprains, altered biomechanics, and connective tissue pathologies.
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Section 6

Question Answer
What are the levels of severity regarding sprains?Gr 1, Gr 2, Gr 3.
What are the characteristics of a Gr 1 sprain?Minor stretch/tear, no instability on passive relaxed testing, can continue activity.
What are the characteristics of a Gr 2 sprain?Tearings of ligamentous fibres ( several to majority), snapping sounds at time of injury while joint gives out, Joint is hypermobile but stable with passive relaxed testing. Discomfort on return to activity.
What are the characteristics of a Gr 3 sprain?Complete rupture/avulsion fracture at injury site, snapping sound while joint gives out, significant instability with no end point, Cannot continue activity, Painful in acute, possible pain-free hypermobility in chronic.
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Section 7

Question Answer
Define Joint effusionWhen injury is severe enough to inflame the synovium, increasing production of synovial fluid. Swelling of joint capsule.
Define HemarthrosisBleeding into the synovial space.
Scar tissue takes approximately how long to develop?6 weeks.
Scar tissue take approximately how long to fully mature and provide maximum strength to joint?6 months.
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Section 8

Question Answer
Return to activity for Gr 1 Sprain?4-5 days.
Return to activity for Gr 2 Sprain?7-14 days.
Return to activity for Gr 3 Sprain?Immobilization removed at 6-8 weeks, activity possibly up to 6 months.
CIs/PrecautionsAcute- no testing other than pain free AROM, avoid removing protective splinting, no distal techs in acute/early SA, Gr 3 avoid hot hydro, no joint play on unstable joint, no frictions of pt taking antiinflammatories.
Acute GoalsReduce pain, reduce edema, reduce protective mm spasm.
Early SA GoalsReduce pain, reduce edema, reduce muscle spasm, reduce TPs.
Late SA GoalsReduce HT + TPs, Reduce Adhesions, Increase ROM
Chronic GoalsReduce HT + TPs, Reduce Adhesions, Restore ROM.
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