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38 Cards in this Set

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Musculoskeletal System:

Lec.12 - Sprains and Strains
Musculoskeletal System:

Lec.12 - Sprains and Strains
Q12:

Difference between sprain and strain
sprain - tear of ligament, usually associated with the joint (result of sudden trauma that tears a ligament in the joint capsule)

Strain - Tear of muscle fibers (force in a muscle that's already contracting)
Q12:

What age group does Sprains occur in?
- Occur in all ages, but much more common in teens and young and middle aged adults
- In children the force required to sprain a muscle would likely break a bone
- Older adults - bone matrix is weakened and prone to Fx
Q12:

In what age group are Strains most common?
- Most common in middle aged and older adults do to decreased elasticity of collagen fibers in muscle and tendon
Q12:

How do you evaluate a sprain or strain?
- Hx (this is very important)
- Inspection
- Bony palpation
- Soft Tissue Palpation
- Range of Motion
- Neurologic examination
-Special tests
- Examination of related areas
Q12:

How may athletes present differently?
- may not present with complaint of pain, but one of decreased performance
Q12:

Different symptoms of sprain or strain?
Sprain:
-"heard a pop"
- Difficult weight bearing
- Pain, edema, Ecchymosis (24-48hrs)

Strain:
- "snap or tearing" sensation
- Pain or swelling may not be noted on the day of the injury.
Q12:

How do you differentiate strain from rupture?
- Are they able to move the joint?
- If they can't this indicates rupture
- a complete rupture may require surgical repair
Q12:

Classification of sprains:
Grade 0?
Plastic deformation of the tissue without tearing
Q12:

Grade 1 Sprain?
Partial tear but no instability, or opening of joint on stress maneuvers
Q12:

Grade 2 Sprain?
Partial tear with some instability indicated by partial opening of joint on stress maneuvers
Q12:

Grade 3 Sprain?
Complete tear with complete opening joint on stress
Q12:

What other things should be tested when someone has a sprain or strain?
-Sensation and function testing
- Deep tendon reflexes
Q12:

What orthopedic tests that evaluate structural integrity of the injured region?
-Apply’s Test
-Draw(er) Tests
-Hawkin’s Test
-Lachman’s Test
-McMurray’s Test
-Near’s Test
-Valgus stress test
-Varus Stress test
Q12:

What is are some sequela sometimes seen with sprains or strains?
- (sprain) Ligamentous laxity leading to joint instability and repeated injury
- (Strain) Prolonged muscle tightness, weakness, tenderness.
- somatic dysfunction
- Complex reginal pain syndrome
- Compartment syndrome
Q12:

Complex regional Pain syndrome?
- receptor dysfunction causing prolongation of normal postinjury process pain, autonomic dysfunction, trophic changes, functional impairment.
Q12:

Compartment Syndrome?
- ischemia of nerves and muscles within a fascial compartment due to increased pressure
- This is an emergency
Q12:

how do you treat an acute sprain?
-NSAIDs first few days
- RICE or PRICEM
(protest, rest, ice, compression, elevation, medicine / manipulation
- heat may be helpful later but not following an acute injury.
Q12:

Treatment for Grade 1 Sprains?
Symptomatic treatment
only. Immobilization
for comfort. OMT*. (OMT after free ROM)
Q12:

Treatment for grade 2 Sprains?
Immobilization to protect
injured part, but full
healing expected.
OMT*.
Q12:

Treatment for Grade 3 Sprains?
Immobilization or
possibly repair.
OMT**
Q12:

How do you determine when or when not to use OMT?
- Rule out Fx, and significant intra-articular injuries clinically and / or with imaging studies.
- techniques that put stress on the injury be warry of.
-
Q12:

what are the red flags for an orthopedic consult?
- Grade III sprains, may need to be surgically repaired
- Severe Grade II Sprains
- Complete ruptures
- pain out of proportion to injury
- repeat films if initially equiviccal
- suspected CRPS or compartment syndrome
Q12:

what makes plantar flexion / inversion injuries more likely?
- when you plantar flex the talus comes out from underneath the tibia, this makes it more prone to movement.
Q12:

What are the compenents ot the lateral collateral ligament of the ankle?
- Posterior talofibular ligament (complete rupture usually)
- calcaneofibular ligament* (usually 2 or 3 grade)
- anterior talofibular ligament* (usually grade 1 sprain)

*= most commonly injured with inversion sprains
Q12:

What is the most common ankle sprain
Anterior talofibular ligament (grade 1)
Q12:

What ligament is typically disrupted with a "high ankle sprain"?
Anterior tibiofibular ligament
Q12:

What are the clinical signs and symptoms of a grade 1 sprain?
Swelling. Should be able to ambulate, usually with slight limp.
Q12:

What are the clinical sings and symptoms of a grade 2 sprain?
Moderate to severe swelling. Antalgic gait. Some loss of motion &/or function.
Q12:

What are the clinical signs and symptoms of a grade 3 sprain?
Severe swelling and ecchymosis. Sig-nificant loss of motion, function, wt bearing
Q12:

What is the ottawa criteria?
- a criteria used to deterime when and when not to x-ray.
Zone A = Distal fibula
Zone B = medial maleolus
Zone C = heal
Zone D = middle of the foot
bone tendetness and innability to bear weight
Q12:

What is a Maisoneuve Fx?
- Fx of the distal fibula
Q12:

what is the normal distance of the syndesmosis (being evaluated for a high ankle sprain)?
-Should be 5mm or less
Q12:

When is the anterior draw test positive?
2nd and 3rd degree sprains?
Q12:

When is the talar tilt test positive?
3rd dagree sprains
Q12:

when you plantar flex when does the distal fibula go?
anterior laterally
Q12:

what are the 4 ways in which fascia disrupts?
-shearing force
- heat
-electricity
-pressure
Q12:

what to know?
- know how to grade
- know OMM can help