PHTY208 Lecture 4: 4 pathology of soft tissue
Pathology of soft tissue: muscle, ligament, tendon:
Muscle injuries:
-one of the most common injuries in sport
-10%-55% incidence
-types of acute injuries
-Contusion
-strain/tear
-Chronic/ overuse injuries
-Focal thickening/fibrosis
-compartment syndrome
-DOMS
-cramps?
Muscle contusion:
-muscle contusion usually occurs when a muscle is subject to a sudden, heavy compressive
force e.g. direct blow to the muscle
-overlying skin remains intact
-common in quadriceps; “corked thigh”
Hematoma:
-a large area of local haemorrhage (bleeding) is called a hematoma
-pain results from accumulating blood exerting pressure on nerve endings
-pain increases with movement or pressure to area
Hematoma:
Complication: myositis ossificans
-occurs when hematoma calcifies
-osteoblasts replace some of the fibroblasts in healing process
-observed on plain x-ray 3 weeks post injury
Increased risk:
-with increasing activity
-following a rebelled
-inappropriate treatment e.g. heat, massage
-in case of thigh:
-knee effusion present
-Prone knee flex < 45d
-Signs:
- increase in morning pain and pain with activity
-Nightpain
-palpable lump
-improvement cease with subsequent deterioration
Muscle strain/tear:
A muscle is strained or torn when some or all of the fibre fail to cope with the demands placed
upon them e.g. excessive tensile force.
Common in superficial, 2 joint muscles e.g. rectus femurs, hamstrings, gastrocnemius.
Often occurs during deceleration.
Clinical classification:
-Depends on severity of injury and nature of hematoma
-Intramuscular hematoma- extravasation of blood within intact muscle fascia results in increased
intramuscular pressure, subsequently compresses and limits size of hepatoma
-Intermuscular hematoma- develops if fascia surrounding muscle is torn and extravasated blood
has access to spread into interstitial and interfacial spaces
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Mild (1st degree):
-Minor swelling
-Minor discomfort
-No or minimal loss of strength
-No or minimal restriction of movement
-Represents tear of few fibres
Moderate (2nd degree):
-Significant swelling
-Significant discomfort
-Pain on contraction
-Loss of strength
-Restriction to movement
-Represents tear of significant number of muscle fibres
Severe (3rd degree):
-Complete tear of muscle
-Virtually complete loss of muscle function
Diagnosis of muscle injuries:
-Begins with careful patient history and clinical examination, imaging to assist!
Pathobiology of muscle injury:
-Skeletal muscle healing is a repair process (in contrast to bone which regenerates)
-Heals with a scar which replaces the original tissue
-3 phases of repair (irrespective of underlying cause I.e. contusion, strain etc)
-inflammation (destruction phase)
-proliferation (repair phase)
-Maturational (remodelling phase)
Healing of skeletal muscle:
Healing of skeletal muscle:
-Initial trauma
-Ruptured myofibrils contract
-Hematoma fills gap between myofibre stumps
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Document Summary
One of the most common injuries in sport. Muscle contusion usually occurs when a muscle is subject to a sudden, heavy compressive force e. g. direct blow to the muscle. A large area of local haemorrhage (bleeding) is called a hematoma. Pain results from accumulating blood exerting pressure on nerve endings. Pain increases with movement or pressure to area. Osteoblasts replace some of the broblasts in healing process. Observed on plain x-ray 3 weeks post injury. Increase in morning pain and pain with activity. A muscle is strained or torn when some or all of the bre fail to cope with the demands placed upon them e. g. excessive tensile force. Common in super cial, 2 joint muscles e. g. rectus femurs, hamstrings, gastrocnemius. Depends on severity of injury and nature of hematoma. Intramuscular hematoma- extravasation of blood within intact muscle fascia results in increased intramuscular pressure, subsequently compresses and limits size of hepatoma.
