Injury Classification Unit

MGonzalez

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INJURY CLASSIFICATIONS Notes

  • Identification of the types of Injuries
  • Direct Injury (Primary Injury)
  • Indirect Injury (Secondary Injury)
  • Mechanism of Injury (MOI)
  • Acute Injury: instant injury
  • Chronic Injury: develops over time getting progressively worse
  • Skin Injuries
  • Blister: collection of fluid caught under epidermis
  • Abrasion: scraping of the skin
  • Laceration: cut with jagged edges
  • Incision: cut with clean edges
  • Avulsion: a tearing away of the skin usually leaving a flap
  • Puncture: object penetrates the skin
    • Embedded object: object still in body
  • Contusion (bruise): compression or direct blow to skin
  • Muscle Injuries
  • Acute Muscle Injuries
  • Contusion (bruise): compression of skin and tissue causing blood vessels to break
    • Hemorrhage: bleeding
    • Hematoma: collection of blood caught in tissue
  • Muscle Contusions
  • 1st Degree: normal range of motion (ROM)
  • 2nd Degree: limited ROM
  • 3rd Degree: restricted ROM
  • Muscle Strains
  • MOI:
    • Abnormal muscle contraction
    • Violent muscle contraction
    • Excessive stretch
    • Antagonist muscles not working in coordination with agonists
    • Mineral loss in muscle
    • Excessive fatigue acids
    • Strength imbalance between agonists/antagonists
  • Muscle Strains: Degrees of Severity
  • 1st Degree: Minimal Tear
    • Localized pain
    • Minor loss of strength and ROM
    • Ususally plays through pain
  • 2nd Degree: Moderate Tear
    • Varied degree of damage
    • Pain moderate to severe
    • Decreased strength and ROM
    • Possible swelling and ecchymosis
    • Out of activity from 2 days to 4 weeks depending on severity
    • 3rd Degree: Complete Tear
      • Pain then no pain
      • Palpable defect (visible?)
      • Obvious decrease of loss of strength/ROM
      • Possible surgical repair; out of activity 8 weeks or more
      • Muscle strain healing
  • Hematoma forms at injury site
  • Collagen fibers form the scar tissue
  • The healing process (scar maturation) can take up to a year
  • Scar tissue does not have the elasticity that normal muscle fibers have and its edges are prone to injury; can lead to chronic strains
  • Muscle Cramps/Spasms
  • MOI: Involuntary muscle contraction due to
    • Mineral imbalance (dehydration)
    • Muscle fatigue
    • Injury (body attempting to prevent further injury)
    • Treatment:
    • Increase water intake
    • Ice
    • Stretch
    • massage
  • Acute Onset Muscle Soreness
  • Lactic acid buildup in muscles causes soreness
  • Found in anaerobic activities
  • Resolves quickly
  • Delayed Onset Muscle Soreness (DOMS)
  • Soreness develops post-activity due to small microtears and microtrauma to tissues. This causes inflammation which presses on nerve endings sending the pain messages to the brain.
  • Pain decreases as inflammation decreases
  • Prevent DOMS by gradual warmup/cooldown and gradual increase in exercise intensity
  • Care:
    • Ice
    • stretch
  • Chronic Muscle Injuries
  • Causes:
    • Overuse
    • Lack of strength
    • Muscle strength imbalance
    • Poor sport technique
    • Genetics
    • Return too soon after injury
    • Numerous microtraumas
    • Types of chronic injuries: -itis
  • Myositis/fasciitis
  • Tendinitis
  • Bursitis
  • Ectopic calcification (myositis ossificans)
  • Prepatellar Bursitis
  • Chronic injuries continued…
  • Atrophy
  • Contractures- due to immobilization, muscle length shortens causing decrease in ROM
  • Soft Tissue Healing
  • Stage 1: Acute Inflammatory
    • Increase in blood flow bringing phagocytes, leukocytes and platelets. <2 days
  • Stage 2: Repair
    • Fibroblasts start scar formation. 6 weeks to 3 months
  • Stage 3: Remodeling
    • Building tissue strength. <1 year or longer
  • Joint Injuries
  • Sprains
  • A stretch or tear of a ligament
  • Sprain classifications:
  • 1st degree Minimal tear:
    • Some pain
    • Little or no loss of function
    • No abnormal ROM (solid endpoint)
  • 2nd degree Moderate tear:
    • Wide range of pain
    • Some decreased ROM
    • Wide range of swelling
    • Some instability (change in endpoint)
  • 3rd degree Complete Tear
    • Pain then no pain
    • Swelling
    • Instability (no endpoint)
    • Great loss of function (ROM)
    • Check for possible avulsion fracture
    • Can be associated with a subluxation/dislocation
  • Synovitis:
  • Irritation of the joint capsule causing increase in synovial fluid production
    • Swelling
    • Decreased ROM and possible pain
  • Non-unions
  • Dislocations-total disruption of bones at the joint.
    • Loss of function
    • Obvious deformity
    • Swelling
    • Pain/muscle spasm
  • Non-unions
  • Subluxations-partial dislocation (2 bones slip out of place then go back or bone slightly moves out of position)
  • Subluxations/Dislocations can lead to damage to the following structures:
  • Muscles
  • Ligaments
  • Joint capsule
  • Bone
  • Cartilage
  • Nerves
  • Blood vessels
  • Subluxation/Dislocations:
  • Once you suffer one subluxation/dislocation, you are more likely to suffer more
  • Lead to joint instability
  • Lead to arthritic changes
  • Bone Injuries
  • Forces that act on bones:
  • Tension
  • Bending
  • Twisting/torsion
  • Shearing
  • Compression
  • Fractures
  • Closed (simple) fracture-does not stick through skin
  • Fractures
  • Open (compound)- bone ends stick through skin
  • Compound tib/fib fracture
  • Other types of fractures…
  • Comminuted-multiple pieces
  • Depressed-direct blow
  • Other types of fractures…
  • Greenstick- found in children; incomplete break
  • Impacted- fall from a height; bone rams into other piece
  • Other types of fractures…
  • Longitudinal- split down the length of the bone
  • Spiral/Oblique- twist to one bone end while other end is fixed
  • Other types of fractures…
  • Serrated- sharp edges from direct blow
  • Transverse- cross-cut
  • Other types of fractures…
  • Contrecoup- fracture occurs opposite site of contact
  • Avulsion- ligament or tendon pulls off a piece of bone (disguised as a 3rd degree sprain)
  • Other types of fractures…
  • Blow out fracture- blow to eye that fractures the eye orbit
  • Other types of fractures…
  • Stress Fractures: chronic fracture caused by repetitive stress at a particular site
    • Predisposers:
      • Malnutrition/eating disorders
      • Amenorrhea
      • Heavy repetitive activity
      • Poor technique
    • Difficult to diagnose: do not show up on x-rays until some healing has occurred (callus formation)
  • Apophyseal Injuries
  • Apophysis- site where muscle(s) attach to bones
  • Apophysitis- inflammation of the muscle attachment due to constant stress
  • Osteoporosis
  • Weakening of bones leading to increased chance of fractures
    • Malnutrition/eating disorder
    • Amenorrhea/menopause
    • Old age
  • Fracture Healing
  • Stage 1: Acute
    • Osteoclasts eat the bad tissue, osteoblasts begin laying down new tissue. <4 days
  • Stage 2: Repair
    • Cells continue rebuilding; callus forms to hold bone together. 3 weeks to 3 months
  • Stage 3: Remodeling
    • Callus is absorbed and replaced with fibrous cord of bone. Can take several years
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Injury Classification Unit