4. Swelling : Swelling occurs from the increased exudation. The amount of fluid depends on the severity of inflammatory reac- tion and tissue type affected.
5. Loss of function : Functions of the affected tissue will be reduced due to the pain and swelling.
TYPES OF MUSCULOSKELETAL INJURIES
● 3rd Degree: Complete rupture This is the most severe type of sprain. All ligament fibers are completely disrupted or the ligament detaches from the bone. The joint becomes unstable because ligament function is lost. The ligaments that are more prone for sprains are the medial col- lateral and anterior cruciate ligaments of the knee and the lat- eral collateral ligament of the ankle. A ligament sprain can be diagnosed with a stress test. When performing the stress test, the ligament should be passively stretched in the direction of original injury. Any pain during the procedure, any amount of instability, or protective muscle spasm, may denote a possible sprain. The end point of the movement may feel abnormal in a partial or complete rupture of a ligament. Strains Strains are the injuries of the muscles or tendons that occur due to overstretching. As in sprains, this also can be acute or chronic. Chronic strains develop inside a muscle over a period of time due to muscle spasm, fatigue, and/or ischemia. Acute strains occur as a result of single, violent force to a muscle. Identifying a muscle strain is essential. Pain over the affected area, bruising or a hematoma, swelling, loss of all or some function of the affected muscle, and muscle spasm are some of the signs and symptoms of a muscle strain, although these may vary according to the severity of the strain. Mueller-Wohlfahrt et al., have classified acute muscle injuries and disorders [4] as shown in Figure 1.
There are numerous types of musculoskeletal injuries. Sprains, strains, contusions/bruises, dislocations, and fractures are the most common. Sprains Sprains are injuries of the ligaments caused by overstretching or tearing. These injuries can be categorized as acute and chronic sprains. Instantaneous pain after the injury, tenderness over the injured area, localized swelling, and diminished or reduced move- ments in the affected joint are the prominent signs and symptoms of a ligament sprain [3] . Many with acute ligament sprains have felt or heard a popping/snapping sound at the onset of the injury. Sprains can be graded according to the severity of the damage. The categories are: ● 1st Degree: Mild stretching of the ligament This is the tearing of a few ligament fibers. As the ligament is still intact, the joint remains stable. ● 2nd Degree: Partial rupture of the ligament This is the tearing of a moderate number of ligament fibers, together with the stretching of the remaining ligament fibers. Functions of the ligament fibers are impaired as a result of this injury. Some degree of joint laxity can be noticed. If the sprain is associated with joint capsule, synovial effusion may present. These sprains are painful because of muscle spasms and swelling.
Figure 1: Classification of Acute Muscle Injuries and Disorders
Muscle Disorder/Injury
Type 1A: Fatigue-Induced Muscle Disorder Type 1B: Delayed-Onset Muscle Soreness Type 2A: Spine-Related Neuromuscular Muscle Disorder Type 2B: Muscle-Related Neuromuscular Muscle Disorder Type 3A: Minor Partial Muscle Tear Type 3B: Moderate Partial Muscle Tear
Type 1: Overexertion-Related Muscle Disorder
Functional
Type 2: Neuromuscular Muscle Disorder
Indirect
Type 3: Partial Muscle Tear
Structural
Type 4: Complete Muscle Tear/ Tendinous Avulsion
Laceration
Direct
Contusion
● Recurrence of pain during isometric contraction and stretching. ● Locally tender area over the strained muscle. ● In more severe cases, a palpable gap is felt in the muscle or in the musculotendinous junction. A rolled-up portion of muscle can be identified, indicating a complete rupture. Complications of muscle strain are fibrosis, cyst formation, calcifi- cation, and myositis ossificans in rare cases. Contusions (bruises) Contusions or bruises are caused by sudden, direct, or repeated blunt blows that crush the inner soft tissues without rupturing the skin. A contusion leaves a patchy skin discoloration. Starting with
Muscles that cross two joints are more susceptible to strains be- cause these muscles have different actions according to the rela- tive position of joints. Examples of such muscle groups are ham- string, quadriceps, and gastrocnemius. A muscle strain can occur in any part of the muscle including origin, insertion, or muscle belly. Muscle belly is more prone for injuries rather than any other section of the muscle. Manual muscle testing and special musculoskeletal tests may help detect the affected muscle or muscle group. On examination,
these features can be seen in a muscle strain: ● Loss of muscle strength and flexibility.
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