Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury...

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Chapter 14 Injuries to the Tissues

Transcript of Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury...

Page 1: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Chapter 14

Injuries to the Tissues

Page 2: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Objectives

• Introduce the terminology associated with injury classification

• Introduce biomechanical forces that cause injuries

• Explain biomechanical concepts for various tissues

Page 3: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Injury classification

• Intrinsic– Infection (viral, bacterial)

• Extrinsic– Tissue stressed to the point of mechanical

failure due to excessive force

Page 4: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Extrinsic injury classification

• Primary Injury– Direct immediate consequence of

excessive force (trauma)

• Secondary Injury– Delayed injury some time after initial

trauma– An accommodation to the primary injury

Page 5: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Extrinsic injury classification

• Acute Injury– Mechanical failure of soft tissue due to

excessive force occurring in a single bout– Sudden onset of short duration

Page 6: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Extrinsic injury classification

• Chronic Injury– Mechanical failure of soft tissue due to

repeated micro-trauma occurring over an extended period of time

– Gradual onset and are of prolonged duration

Page 7: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Injury classification

• Microtrauma– Occurs with repeated submaximal forces

over time, and the tissues are unable to adapt

• Macrotrauma– Occurs when a single force exceeds the

tissue’s failure point

Page 8: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Open vs. closed

• Open– Exposed – Breaks the surface of the skin

• Closed– Unexposed – Any injury that does not involve disruption

of the skin surface

Page 9: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical stresses

• Load/Stress– External/internal force acting on the tissue– Force = Mass x Acceleration (F=ma)

• Deformation/Strain– Extent of deformation under loading

Page 10: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

load/deformation

• Mechanical force causes deformation

• Degree of deformation depends on:– Tissue composition– Speed of applied load– Frequency of loading– Direction of loading

Deformation

Load

Page 11: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Yield point

• Load is greater than mechanical capabilities of the tissue

• Elastic limit of the tissue has been reached

• Mechanical failure occurs

Deformation

Load YieldPoint

UltimateFailurePoint

ElasticRegion

PlasticRegion

Page 12: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tissue stresses

• Five primary mechanical forces that cause injury– Tension– Compression– Bending– Shear– Torsion

Page 13: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tissue stresses

• Can occur alone or in combination

• Type of force = Mechanism of Injury (MOI)

Page 14: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

tension

• Creates a pulling action trying to elongate the structure– Longitudinal “tearing” stress– Overstretched tissue (i.e. valgus force)

Page 15: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Valgus force

Page 16: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

compression

• Creates a pushing action tending to shorten the structure– Stress is applied at each end (i.e. FOOSH)

Page 17: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

FOOSH

Page 18: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

bending

• Loading about an axis – Combination of tension and compression

Page 19: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Shear force

• Force that acts perpendicular to the surface of a structure

Page 20: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Shear force

Page 21: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

torsion

• Load applied causing structure to twist about an axis

Page 22: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

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Page 23: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Combined loading

• Tissue is seldom loaded in one mode only

• Subjected to multiple indeterminate loads

• Geometric structure is irregular

Page 24: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

forces

Page 25: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

SUPERFICIAL INJURIES

Page 26: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Integumentary System

• Skin and structures derived from it– Hair, nails, sweat

and oil glands

Page 27: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Functions

– Regulate body temperature– Protects body– Receives stimuli

• Temp, pressure, pain

– Eliminates waste • Sweat

Page 28: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Three Layers

• Epidermis:– Most Superficial

Page 29: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Three Layers• Dermis:

– Tough Fibrous Connective Tissue– Partly vascularized

Page 30: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Three Layers

• Subcutaneous (Hypodermis):– Superficial Fascia– Mostly Fat

(Insulate &Absorb Shock)

– Anchors Skin toUnderlyingStructures

Page 31: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Three Layers

Page 32: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Injurious Mechanical Forces

• Friction• Scraping• Compression• Tearing• Cutting• Penetrating

Page 33: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Open Vs. Closed

• Open– Exposed – Breaks the surface of the skin

• Closed– Unexposed – Any injury that does not involve disruption

of the skin surface

Page 34: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Abrasions

• Scraping away of the superficial tissue– Sliding or skidding across a surface

• Superficial in depth, large in area• Bleeding is minimal, risk of infection is

great

Page 35: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 36: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Laceration

• Irregular cut caused by tearing forces– Jagged wound edges– Can be minor or very deep

Page 37: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 38: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Puncture

• Penetration of the skin by an object– Most susceptible to infection– why?– Impaling = object is embedded & partially

sticks out

Page 39: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 40: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Incision

• A clean, straight, knife-like cut– Commonly caused by a surgeon

Page 41: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 42: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Avulsion

• Tearing away of tissue, commonly paired with a laceration.– Flap avulsion – tissue is still connected

Page 43: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 44: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Calluses

• Skin thickening due to increased friction or intermittent pressure

Page 45: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 46: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Blister

• Excessive friction combined with shear forces causing fluid build-up under the skin

Page 47: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

General Principles Of Wound Care

Page 48: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Chain of infectionRESERVOIR HOST

• Infected individual

PORTAL OF EXIT• Nose, mouth, eyes,

urinary/reproductive system, open wounds

ROUTE OF TRANSMISSION

• Direct or indirect contact

PORTAL OF ENTRY• Nose, mouth, eyes,

urinary/reproductive system, open wounds

SUSCEPTIBLE HOST• Very young and elderly are most

susceptible

pathogen

Page 49: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Universal Precautions

• Those in direct contact must use protective equipment– Non-latex gloves, gowns, aprons, masks & face

shield, eye protection, CPR barriers– Emergency kits should include gloves, CPR

barrier, alcohol prep pads at minimum

Page 50: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Universal Precautions

• Doubling gloves is suggested with severe bleeding

Page 51: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Universal precautions

• Use Personal Precautions– Extreme care must be used with glove

removal– Glove Removal

Page 52: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Universal precautions

• Use Personal Precautions– Wash hand & skin surfaces

• Proper Hand Washing

Page 53: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Supplies to have on hand

• Non-latex gloves• Sterile 4”x4” gauze

pads/sponges• Sterile saline solution• Non-adherent pads• Antiseptic/antibiotic

ointment• Non-adherent

cohesive tape

• Optional: soap, water, hand sanitizer, hydrogen peroxide, cinder suds, nitrotan

Page 54: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

bleeding

• 3 types of external bleeding– Venous – dark red blood, slowly flowing– Capillary – bright red, seeping/oozing– Arterial – bright red, spurts or streams

Page 55: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Controlling bleeding

• For all types of bleeding direct pressure must be applied to the area– Blood takes 4-6 minutes to clot

Page 56: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Controlling bleeding

• Use a sterile gauze pad/compress to collect the blood– If saturated, add additional gauze as

needed• Never remove and replace, always add!

Page 57: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Controlling bleeding

• Arterial bleeding is a medical emergency– Direct pressure must

be applied until EMS arrives

• Elevation can help slow blood loss– Body part placed

above level of the heart

– Exceptions: fractures & spinal injuries

Page 58: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Controlling bleeding

• Indirect pressure can slow blood loss– Pressure points proximal to the injury

Page 59: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Controlling bleeding

• An ice pack causes vasoconstriction (narrowing of blood vessels), slowing bleeding

Page 60: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Wound cleansing

• Debridement - removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

Page 61: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Wound cleansing

• Cleansing and debriding a wound prevents infections and increases healing time.

Page 62: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

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OA 10.23

• List in order the four methods for controlling bleeding.

Page 63: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Wound cleansing

1. Remove any dirty bandages, clothing, etc. from the wound

2. Apply a solution to irrigate the wound1. Saline, sterile water, etc.

3. Clean the wound with circular motion starting at the center and working outwards

4. Irrigate the wound once more to remove all dirt & debris

5. Dry the area with sterile gauze

6. Cover the wound with a sterile dressing

Page 64: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Wound cleansing

• Wound Cleansing

Page 65: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Applying bandages & dressings

• Dressing = contact with the wound• Bandage = holds dressing in place

Page 66: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Applying bandages & dressings

• Bandages and dressings decrease the risk of infection if properly applied and maintained– Must cover the wound entirely and stay in

place– Allow for normal movement and activity– Absorb blood and drainage– Protect from further injury

Page 67: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bandage & dressing types

• Dressings:– Non-adherent pads– Vasiline gauze– Telfa pads– Adaptic pads– Xeroform gauze

Page 68: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bandage & dressing types

• Bandages– Sterile gauze– ABD dressings– Rolled gauze– Oval eye pads– Adhesive bandages

Page 69: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Applying dressings

1. Select the proper dressing

2. Ensure the wound is cleansed

3. Apply antibiotic ointment to the dressing

4. Place dressing directly over the wound

Page 70: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Applying bandages

1. Select appropriate bandage1. Allows movement

2. Remains sturdy

2. Remove jewelry, clothing, etc. near bandage site1. Circulation can be impaired with swelling

3. Leave fingers & toes exposed1. To check circulation

Page 71: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Applying bandages

4. Cover the dressing entirely

5. Apply bandage snugly, but not too tightly1. Apply in the position they will remain in

6. Secure loose ends with tape, or tuck them in

Page 72: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 73: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Wound care management

• Patient instructions– Keep wound clean and dry– Change dressings daily– Remove and replace if wet– Watch circulation of the limb; seek medical

help if circulation is impaired– Watch for signs of infection

Page 74: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Signs of infection

• Redness• Swelling• Increased pain• Red streak up the arm or leg• Foul-smelling odor• Elevation in temperature

over the wound or surrounding tissue

Page 75: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

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OA 10.24

• List the 6 signs of infection

Page 76: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tissue stresses

• Five primary mechanical forces that cause injury– Tension– Compression– Bending– Shear– Torsion

Page 77: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tissue stresses

• Can occur alone or in combination

• Type of force = Mechanism of Injury (MOI)

Page 78: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 79: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Five Major Functions Of The Skeleton

• Protection of vital soft tissues• Support human posture• Movement by serving as points of

attachment for muscles• Storage for minerals• Hemopoiesis – the process of blood

formation that occurs in the red bone marrow

Page 80: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical properties of bone

• Wolff’s Law: bone will adapt to the loads under which it is placed.

Page 81: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical properties of bone

• Direction of Loading– Strongest in compression– Weak in tension– Weakest in shear

Compression > Tension > Shear

Page 82: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical properties of bone

• Bone size– ↑ size of bone (mass) = ↑ bone strength– Greater area to distribute mechanical

stresses

Page 83: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical properties of bone

• Bone shape– Sudden shape changes are areas where

mechanical stresses are most concentrated• Weak points/Stress risers

Page 84: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone growth

• Epiphyseal growth plate– Cartilaginous disk near

the end of each long bone

– Dependent on plate– Injury can prematurely

close the plate causing loss of length

Page 85: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanisms of bone injuries

• Pure tensile forces

• Compression forces

• Bending

Page 86: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Three-point bending

• ↑ distance from center = ↑ bending moment

Tensile Force

Compressive Force

Page 87: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 88: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

88

SKELETAL INJURIES

Page 89: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone injuries

• Periostitis– Inflammation of the periosteum, usually

from contusion

• Bone contusion– Bruising of the bone tissue– Very painful– Slow to heal – typically 6-8 weeks

Page 91: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

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OA 10.28

• Describe the properties of bone that make it strongest, weakest, and most prone to injury.

Page 92: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone injuries

• Fracture– Any disruption in the continuity of the bone

or periosteum

Page 93: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone injuries

• Description of Fracture– Site– Extent – partial, complete, hairline– Configuration - type– Relationship of fragments – displaced,

non-displaced– Relationship to external environment –

closed, compound

Page 94: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Incomplete Fracture

Page 95: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Undisplaced Fracture

Page 96: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Displaced Fracture

Page 97: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Open (Compound) Fracture

Page 98: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone trauma classificationType EtiologyTransverse Direct BlowSpiral Rotation on planted footOblique One end fixed, other sudden

torsionComminuted Blow or fall in awkward positionDepressed Flat bones, direct blow

Page 99: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bone trauma classificationType EtiologyGreenstick Incomplete Fx, skeletally

immature (convex)Longitudinal Splits along length, jumping

from heightSerrated Direct blow, jagged edgesContrecoup Side opposite to point of impactImpacted Compressive force on long axis

of bone

Page 100: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Transverse Fracture

Page 101: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Spiral Fracture

Page 102: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Oblique Fracture

Page 103: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Comminuted Fracture

Page 104: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Depression Fracture

Page 105: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Greenstick Fracture

Page 106: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Longitudinal fracture

Page 107: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Serrated fracture

Page 108: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Impacted Fracture

Page 109: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Other fractures

• Some fractures have names based on founder, mechanism, common type– Bennett’s fracture– Maisonneuve fracture– Boxer’s fracture– Bankart fracture– Pott’s fracture– Many, many more

Page 110: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bennett’s fracture

Page 111: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Maisonneuve fracture

Page 112: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Boxer’s fracture

Page 113: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bankart fracture

Page 114: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Pott’s fracture

Page 115: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Stress Fractures

• Also called march, fatigue, & spontaneous fractures

• Weight bearing bones become weaker before they become stronger

Page 116: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Stress Fractures

• Typical causes in sports:– Coming back too soon after injury or illness– Changing events without proper training– Starting initial training too quickly– Changing habits or the environment

Page 117: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Stress Fracture

Page 118: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Avulsion Fracture

Page 119: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Avulsion Fracture

Page 120: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Joints (Articulations)

• All joints are comprised of capsular tissue surrounding the joint itself– Strong, fibrous tissue

• Synovial joints– Capsular tissue– Articular cartilage at ends of bones– Synovial membrane & fluid– Muscles affecting the joint

Page 121: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joints

• Synovial Membrane & Fluid– Membrane made of connective tissue for

articular capsule– Fluid is secreted & absorbed in membrane;

acts as lubricant

Page 122: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joints

• Articular Cartilage– Connective tissue providing support– Hyaline (nasal septum), fibrous (vertebral

disks & menisci), & elastic (ear)– Aids in motion control, stability, and load

transmission for joints

Page 123: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.
Page 124: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Functional Synovial Joint Characteristics

• Synovial Joint Stabilization– Provided by skeleton, ligaments, joint

capsules and muscles– Reflex contraction of muscles to prevent

overstretch

Page 125: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Functional Synovial Joint Characteristics

• Articular Capsule & Ligaments– Elastic fibers as opposed to contractile– Fast protective response time– Ligaments are strongest in center of

ligament

Page 126: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Trauma

• Constant compression or tension can lead to ligament or capsular deterioration

• Intermittent compression or stress can increase strength

Page 127: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Trauma

• Tension, torsion, or twisting forces that exceed yield point will lead to injury

• Articular cartilage failing to properly transmit load may lead to failure

Page 128: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Acute Joint Injuries– Joint Sprains

• Stretch or tear of stabilizing connective tissue

• Severity Grading

Page 129: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Acute Joint Injuries– Acute synovitis

• Injury to synovial membrane of joint

• Result of contusion or sprain

Page 130: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Acute Joint Injuries– Subluxations &

dislocations• Disruption of the joint

capsule & membraneor joint surfaces

Page 131: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Chronic Joint Injuries– Osteochondrosis

• Degenerative changes in ossification centers of epiphyses of bones

• Joint (OCD) or tuberosity (apophysitis)

Page 132: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Chronic Joint Injuries– Osteoarthritis

• Wearing down of cartilage• Most often in weight-bearing

joints

Page 133: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Chronic Joint Injuries– Bursitis

• Caused by overuse or external compression/trauma

Page 134: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Synovial Joint Injury Classification

• Chronic Joint Injuries– Capsulitis & synovitis

• Degenerative tissue changes

Page 135: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Bursitis

• Fluid filled sac in places where friction occurs– Between bony

prominences and tendons

Page 136: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tendons and Ligaments

• Functions– Tendons

• Execute joint motion by transmitting mechanical forces from muscles to bones

– Ligaments• Join bones and provide stability to joints

• Inert Structures– Non-contractile structures (passive tissues)– Unable to actively generate forces

Page 137: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical Properties of Tendon

• Composed of mostly collagen fibers– High resistance to tensile forces

• Location– Strongest in mid-point– Weakest at myo-tendinous and osteo-

tendinous junctions• Due to changes in tissue composition

Page 138: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tendon Injuries

• Tendinitis – inflammation of the tendon– Chronic injury due to repetitive motion or

overuse– Appears as dull, aching pain

before/during/after exercise– Occurs with crepitus

Page 139: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tendon Injuries

• Tenosynovitis – inflammation of the synovial sheath– More severe form of “-itis” injury

Page 140: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tendon Injuries

• Strain / Rupture – overload of the tendinous junction

• Contusion

Page 141: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Tendon Injury

• Attaches muscle to bone

• Usually double the strength of the muscle it serves

• Acute strain• Tendonitis

Page 142: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanisms of Tendon Injuries

• High magnitude, single load, tensile forces– Acute strain or rupture

• Low magnitude, repetitive load, tensile forces– Tendinitis or tenosynovitis

Dynamite vs. Axe

Page 143: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical Properties of Ligaments

• Greater proportion of elastic collagen fibers than in tendon– Less resistant to

tensile forces– Greater deformation

occurs prior to mechanical failure

Page 144: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanical Properties of Ligaments

• Frequency of Loading– Repeated loading Mechanical Weakening

instability

• Direction of Loading– Resists tensile forces

Page 145: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanisms of Ligament Injuries

• High magnitude, single load, tensile forces– Acute sprain or rupture

• Low magnitude, repetitive load, tensile forces– Constant tensile forces lead to ligamentous

deterioration– Chronic instability

Page 146: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanisms of Ligament Injuries

Page 147: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Grades of Ligamentous Injury

Degree Etiology End Feel Instability

First Mild overstretching, no tissue disruption

Firm None

Second Partial disruption or macrotearing of the ligament

Definite (soft) Slight to Moderate

Third Complete disruption None Severe

Page 148: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Skeletal Muscle

• Composed of contractile cells• Function

– Generates force to drive motion– Dynamic stability of joints

Page 149: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Skeletal Muscle

• Tensile Forces– Produces active and passive tensile forces– Active tension contraction– Passive tension stretched past resting

length

Page 150: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Skeletal Muscle Injuries

• Strains• Contusions• Muscle

lacerations• Myositis

• Atrophy• Contracture• DOMS• Spasm

Page 151: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Muscle Injury

• Acute– Contusions

• Sudden traumatic blow with compressive force

• Superficial or deep tissue affected

• Rated by the ability of muscle to produce ROM

Page 152: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Muscle Injury

• Acute– Strains

• Stretch or tear in muscle• Abnormal muscle contraction

– Mineral imbalance or dehydration

– Fatigue– Strength imbalance

Page 153: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Muscle Injury

• Acute– Muscle spasms (cramps)

• Clonic - intermittent• Tonic – constant• Contracture• May lead to strains• DOMS

Page 154: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Muscle Injury

• Chronic– Myositis

• Inflammation of muscle

– Fasciitis• Inflammation of fascia

within the muscle

– Myositis ossificans• Repeat trauma• Calcium deposits within

the muscle• Can resorb in 9-12

months

Page 155: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Mechanisms of Muscle Injuries

• High magnitude, single load, tensile forces– Acute strains or ruptures

• Low magnitude, repetitive load, tensile forces– Degenerative effect

Dynamite vs. Axe

Page 156: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Grades of Muscle Injuries

Degree Etiology Signs/Symptoms

First Overstretching or microtearing of muscle or tendon

Mild loss of strength, swelling, ecchymosis, point tenderness

SecondFurther stretching and partial tearing of muscle or tendon fibers

Symptoms are more severe, greater function loss

Third Complete ruptureSevere symptoms, loss of muscle function, possible palpable defect

Page 157: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Nerve Injuries

• Compression or tensioning of neural structure– Secondary to direct blow– Acute swelling in enclosed space– Pathology which compromises space for

nerve

Page 158: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Nerve Injuries

• Anesthesia – absent sensation• Paresthesia – diminished sensation• Hyperesthesia – over-sensation

Page 159: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

Neuropraxia

• “Burners” or “stingers”• Transient and reversible loss in nerve

function • Secondary to trauma or irritation• Mechanical deformation of the nerve• Disruption of nerve fibers & signals• Short-lived sensory and motor deficits

(seconds-two weeks)

Page 160: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

A shortstop is hit in the shin by a batted ball that took a bad hop

• What kind of force is involved?• What type of injury is likely to have

occurred?

Page 161: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

A football player sustains repeated blows to his left quadriceps muscle

• What type of injury could be sustained from repeated compressive forces to the muscle?

Page 162: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

A basketball player steps on another player’s foot and sustains a lateral ankle injury

• What forces are applied?• What type of injury has occurred?

Page 163: Chapter 14 Injuries to the Tissues. Objectives Introduce the terminology associated with injury classification Introduce biomechanical forces that cause.

An alpine skier catches his right ski tip and severely twists the lower leg

• What type of serious injury could be created by this mechanism?