Tissue Injuries

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Tissue Injuries

• Bone/Joint Injuries
• Fractures
• Dislocations
• Sprains
• Muscle/Tendon Injuries
• Contusions
• Strains
• Tendonitis
• Bursitis

• Nerve Injuries
• Spinal cord injuries
• Trauma injuries
• Compression injuries
• Traction injuries
• Open Wounds
• Abrasions
• Lacerations
• Avulsions
• Puncture Wounds
• Hematomas

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Bone Injuries

• Fracture break in bone
• Failure point amount of energy needed to cause a
  fracture

• Six types of fractures
• Simple Fracture
• Compound Fracture
• Greenstick Fracture
• Comminuted Fracture
• Stress Fracture
• Epiphyseal Plate Fracture

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Simple Fracture

• Occurs when forces on bone exceed the bones
  ability to withstand forces applied
• May be complete or incomplete

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Compound Fracture

• Complete break in bone where bone ends separate
  and break through the skin
• Greatly increased chance of wound bone infection

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Greenstick Fracture

• Incomplete break in shaft of the bone
• Occurs in children b/c bones are more pliable
• Usually occurs on outer bend

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Comminuted Fracture

• Break in bones in which the bones are shattered
  into many pieces

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Stress Fracture

• Small, incomplete break in bone due to
• Overuse
• Poor muscle balance
• Lack of flexibility
• Weakness in soft tissue
• Biomechanical problems
• Malnutrition
• Stresses on body are greater than the body can
  compensate

• Symptoms
• Pain
• Tenderness after activity
• No or little pain in AM, but pain returns after
  activity

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Epiphyseal Plate Fracture

• Break in bone at the growth plate
• Most in individuals, aged 10 16, due to sports
  participation
• X-ray wont show Fx of Epiphyseal b/c epiphyseal
  plate shows up clear

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Signs Symptoms

• Deformity
• Tenderness
• Guarding
• Swelling
• Bruising
• Crepitus
• False motion
• Exposed fragments
• Pain
• Locked joint

• Treatment
• External Fixation use of cast to keep bones
  aligned while natural healing occurs
• Internal Fixation surgery is required to align
  bones reduce fracture

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Treatment Repair

• Stage 1 Acute (4 days)
• Bleeding occurs in area
• Osteoclasts eat the debris or resorb it into
  the body
• Osteoblasts add new layers to outside of bone

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Treatment/Repair

• Stage 2 Repair (3-6 weeks)
• Bone Regeneration continues
• A bony splint forms (fibrous callous)
• Fibrous callous transformed into hard callus bone

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Treatment/Repair

• Stage 3 Remodeling
• Callus is reabsorbed replaced with fibrous cord
  of bone around fracture site
• May take years to complete

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Dislocations (Luxation)

• Occurs when a significant force displaces bone so
  that the two bone ends in a joint no longer line
  up
• A Subluxation occurs when the bone displaces,
  then returns to normal position

• Signs Symptoms
• Marked deformity
• Swelling
• Pain
• Tenderness on palpation
• Virtually complete loss of joint function
• Numbness or impaired circulation to the limb and
  digit

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Sprain

• Injury resulting from a fall, sudden twist, or
  blow to body that forces a joint out of its
  normal position
• Results in overstretching or tearing ligament

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Muscular Injuries

• Contusion
• Injury resulting from a direct blow or force that
  does not interrupt skin
• Symptoms
• Swelling
• Pain to touch
• Redness
• Ecchymosis (bruising)
• Treatment
• Anti-inflammatory drugs, ice, compression stretch
• Myositis Ossificans
• Calcification that forms within the muscle
• Results from improperly managed contusion

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Strains

• Injury to muscle caused by twisting or pulling of
  a muscle or tendon
• Acute Strain MOI
• Trauma or direct blow to body
• Improperly lifting heavy objects or overstressing
  muscles
• Chronic Strain MOI
• Overuseprolonged, repetitive movement of the
  muscles tendons

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Strains, cont.

• Signs Symptoms
• Localized swelling
• Cramping
• Inflammation
• Loss of function
• Pain
• General weakness
• Prevention
• Warm-up Stretch
• Proper mechanics

• Treatment
• Stage 1
• Goal reduce swelling pain
• PRICE 24 -48 hours NSAIDs
• Stage 2
• Goal Improve condition restore function
• Prevent stiffness, ? ROM, restore flexibility
  strength

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Tendonitis

• Inflammation of the tendon
• Occurs when tendons become irritated
• Most common cause is overuse
• ? level of demand too quickly

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Tendonitis, cont.

• Signs Symptoms
• Pain inflammation, worse with movement at
  night
• Treatment
• RICE
• NSAIDs
• Ultrasound therapy
• Physical Therapy

• Prevention
• Slowly ? intensity type of exercise
• Dont try to do more than ready for!
• Proper Warm-up Stretching

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Bursitis

• Inflammation of the bursa, a padded cavity around
  joint that ? friction b/t two surfaces
• Results from repetitive movement or
  prolonged/excessive pressure
• Treatment
• Rest, Ice, NSAIDs
• Drain bursa
• Prevention
• Strengthen muscles around joints
• Avoid repetitive stress
• Cushion joints

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Nerves

• Afferent (sensory) neuroncarry nerve signals
  toward CNS
• Efferent (motor) neuroncarry nerve impulses away
  from CNS
• Interneurons (association neuron) carry nerve
  impulses from sensory neurons to motor neurons

• Consists of 2 major types of nerve cells
  neuroglia neurons
• 3 types of neurons found in nervous sys.

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How Neurons Work
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Nerve Injuries

• Injury to nerve can stop signals to from brain
• Causes loss of function feeling
• May be due to
• Cut nerve
• Pressure on nerve
• Overstretched nerve

• If insulating myelin sheath is sewn together,
  fibers may grow back out restore function
• If insulation was not cut, new fibers may grow
  down the empty insulator until reaching a sensory
  receptor
• If nerve insulation have been cut nerve is
  not fixed, n. fibers will grow into a ball,
  forming a neuroma (painful)

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Nerve Injuries

• Stinger
• Injury to brachial plexus
• Due to overstretched nerve (neck goes one way,
  arm goes another_
• Due to compression (neck shoulder forced
  together)
• Symptoms arm pain, numbness, tingling,
  shoulder/neck pain
• Treatment PRICE
• Do not RTP until symptoms cleared!

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Soft Tissue Injuries

• Abrasions Scrapes
• Skin scraped against a rough surface
• Epidermis dermis worn away, exposing
  capillaries
• Treatment
• Clean wound
• Debridementuse brush/tweezers to remove debris
• Cover

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Laceration Puncture Wounds

• Laceration
• Flesh has been irregularly torn
• Tearing force
• Cleanse change dressing daily (may need
  sutured)
• Puncture Wound
• Direct penetration of tissues by a pointed object
• Cleanse change dressing daily
• If object remains in skindo not remove!

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Skin Wounds, cont.

• Skin Bruise
• Blow or compression crushes skin surface
  produces bleeding under skin
• Skin Avulsion
• Skin torn to extent that tissue is completely
  ripped from its source

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Skin Wounds, Cont.

• Friction Blister
• Continuous rubbing over surface of skin causes a
  collection of fluid below or within epidermal
  layer
• Incision
• Skin is sharply cut
• Hematoma
• Formation of blood fluid that pools within a
  tissue space
• Result of contusion

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Bodys Response to Injury

• Inflammation
• ? in blood supply due to blood vessel dilation
• ? capillary permeability permits molecules
  cells larger than usual to escape from
  capillaries
• WBC release chemical mediators that control the
  accumulation of other cells
• Phagocytes mop up inflammation

• Cell Regeneration
• Cells divide replace damaged cells
• If severe, scar tissue forms
• Cellular Differentiation
• Mature cells reenter the cell cycle to produce
  more cells of same function
• Cellular Transdifferentiation
• Cells dedifferentiate, divide, and differentiate
  into cells with different type function