Compression Tension Shear

Transcription

1 Bertram Zarins, MD Physics 3 Forces Compression Tension Shear Current Clinical Issues in Primary Care Bone resists all 3 forces Muscles, tendons, & ligaments resist tension Epi- Meta- Dia- Apo- Physis Definitions Contusion compression injury Strain tension injury to muscle or tendon Sprain tension injury to ligament Bruise Injury caused by compressive force (a direct blow) Contusion

2 Quadriceps contusion To estimate severity of quad contusion, measure degrees of knee flexion hours after injury Charley horse Mild: >90 degrees Moderate: degrees Severe: <45 degrees Initial Treatment Return to Sports? Ice Compression (full knee flexion) When knee has fll full range of motion Full strength and flexibility Return to Sports too soon? Myositis Ossificans Results in re-injury More lost time Risk of myositis ossificans (20% in severe quad contusions)

3 Myositis Ossificans Appendicular skeleton Usually diaphysis Trauma 75% Calcification > 3-6 wks Intact cortex on x-ray Intact cortex on x-ray Mature bone periperally vs Osteosarcoma Axial skeleton Metaphysis No trauma Mature bone in center, immature peripheral Strain muscle or tendon Caused by violent muscle contraction or excessive stretch (tension) Spectrum Microscopic tear to complete rupture or avulsion Muscle Contraction Concentric Eccentric Isometric Muscle shortens as it contracts Muscle lengthens as it contracts Muscle remains same length as it contracts Muscle strains Usually in high speed muscles Cross two joints Hamstrings Predisposing Factors: Weakness Fatigue Prior injury Insufficient warm-up Muscle Strains

4 Treatment of Muscle Injuries Compression Ice Adequate time to heal Stretching Strengthening Medial Head of Gastrocnemius Tennis leg Prevention of Muscle Injuries Strengthening Flexibility Warm-up Avoid fatigue Recognize Repair Tendon Injuries Achilles Tendon Rupture Palpate tendon defect Squeeze calf no passive plantar flexion of foot Biceps Tendon Rupture Proximal popeye muscle Cosmetic R/O rotator cuff tear Distal (elbow) Surgical repair

5 Adult Acquired Flatfoot Sprains Tibialis posterior tendon rupture Attrition, degeneration Excess tension (stretch) to ligament Joint instability? Neurovascular Peroneal Tendon Subluxation Grading Severity Clinical Vs. Anatomical Diagnosis First degree fibers intact Second degree partially torn Third degree completely torn Rest Ice Compression Elevation Initial Treatment Medial epicondylitis Golfer s elbow Lateral epicondylitis Tennis elbow Overuse Syndromes

6 Patellar Tendonitis Achilles Tendonitis Jumper s knee Tender inferior pole patella Osgood Schlatter s Disease Chronic Muscle Strain Overuse injury tibial tuberosity apophysis Proximal tibia growth plate epiphysis and apophysis are continuous Re-injury of healing acute injury Stress injury (overuse) Chronic Injury Living tissue response to stress Fatigue failure Stress failure Overuse syndrome FORCE Magnitude Time Other BREAKDOWN ADAPTATION

7 Treatments Cryotherapy 1 st 48 hours 20 minutes on/ 20 minutes off Excess cold Frostbite Reactive hyperemia when discontinue Knee - risk of peroneal nerve palsy Clin J Sport Med 7/97 Not for acute injuries OK to loosen tissues before activities Use before P.T. Warm up body to increase core temp Apply heat 20 min Heat treatment From Wikipedia Inflammation (Latin, inflammare, to set on fire) is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. Inflammation Good or bad? NSAIDs Cortisone injection drugs with analgesic, antipyretic (feverreducing) and, in higher doses, with antiinflammatory effects (reducing inflammation). Not indicated in high doses in acute injuries Impairs proliferative phase of healing (days 0-4) Delays soft issue healing Impairs muscle regeneration Shuts down chondrocyte metabolism for 24 hrs Pi Pain relief lif Duration variable Side effects of multiple injections Soluble (Dexamethasone) Depot (Kenalog)

8 Glucosamine and Chondroitin Sulfate A food (not a drug) not controlled by FDA NIH funded study proved not effective Multicenter t Placebo - controlled Double blind New Engl J Med 354 (8): Meta-analysis showed no benefit Annals of Internal Medicine 146: , 2007 Prevention and Conditioning Adaptation vs. Breakdown Stress, if it doesn t kill you, makes you strong Stretching Exercises Specificity of Exercises To be done in the cooling-down phase Summary