● 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. ● 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 collateral and anterior cruciate ligaments of the knee and the lateral 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.
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
Muscles that cross two joints are more susceptible to strains because these muscles have different actions according to the relative position of joints. Examples of such muscle groups are hamstring, 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. ● 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, calcification, 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 a pink or red color, a bruise or contusion eventually changes to blue and green. As it heals, it returns to the normal skin color. A contusion can be subcutaneous, intramuscular, or periosteal [5] . Dislocations and subluxations A dislocation is the displacement of a bone in a particular joint, which results in loss of anatomical relationship and proper alignment [6] . A partial or incomplete dislocation of the bony partners in a particular joint is a subluxation. These dislocations and subluxations lead to soft tissue damage, pain, inflammation, and muscle spasm. Realigning a dislocated or subluxed joint should be done under supervision of a physician or a qualified A fracture is the disturbance of the integrity and continuity of a bone [6] . It can be either a complete fracture or an incomplete (hairline) fracture. Sudden direct or indirect force, repetitive stresses, and bone pathologies may cause fractures. A fracture is characterized by severe pain, marked swelling within a few hours from the onset, deformed body part, and loss of function of the affected limb. therapist. Fractures
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