CLASSIFICATION AND CLASSIFICATION AND MECHANISMS OF INJURIESMECHANISMS OF INJURIES

OBJECTIVESOBJECTIVES

MECHANISMS OF INJURYTISSUE-BASED CLASSIFICATIONGENERAL PATHOLOGY OF THE

REPAIR PROCESSBASIC BIOMECHANICS OF TISSUE

INJURY

OBJECTIVESOBJECTIVES

LIGAMENTS AND TENDONSBONEFIBROCARTILAGE MENISCI OF THE

KNEEMUSCLE

MECHANISMS OF INJURYMECHANISMS OF INJURY

PRIMARY INJURY:1) DIRECT OR EXTRINSIC INJURY2) INDIRECT OR INTRINSIC INJURY3) OVERUSE INJURY:A) ACUTE REPETITIVE FRICTIONB) CHRONIC REPETITIVE

MICROFATIGUE

MECHANISMS OF INJURYMECHANISMS OF INJURY

SECONDARY INJURY:1) SHORT TERM – PRIMARY INJURY

MISMANAGED2) LONG TERM – DEGENERATIVE

PROBLEMS ( ACL )

TISSUE-BASED TISSUE-BASED CLASSIFICATION CLASSIFICATION

SOFT TISSUE INJURIES:1) SKIN AND DEEP FASCIA2) MUSCLE-TENDON UNIT AND

TENDOPERIOSTEAL ATTACHMENTS3) MUSCLE COMPARTMENTS4) JOINTS AND THEIR ASSOCIATED

STRUCTURES5) INTEVERTEBRAL DISC

TISSUE BASED TISSUE BASED CLASSIFICATIONCLASSIFICATION

HARD TISSUE INJURIES:1) BONE FRACTURES,

OSTEOCHONDRAL FRACTURES AND AVULSIONS

2) PERIOSTITIS 3) STRESS FRACTURES4) HYALINE ARTICULAR AND

EPIPHYSEAL CARTILAGE INJURIES

TISSUE BASED TISSUE BASED CLASSIFICATIONSCLASSIFICATIONS

SPECIAL TISSUE OR ORGAN INJURIES:

1) BRAIN AND PERIPHERAL NERVES2) EYE, NOSE, SINUSES, LARYNX,

TEETH3) THORACIC, ABDOMINAL AND

PELVIC ORGANS

GENERAL PATHOLOGY OF GENERAL PATHOLOGY OF THE REPAIR PROCESSTHE REPAIR PROCESS

THREE PHASES: ( ALVAREZ ET AL 1987 ) 1) THE ACUTE INFLAMMATORY RESPONSE

( APPROX.0-72H AFTER INJURY ) 2) THE MATRIX AND CELLULAR

PROLIFERATION PHASE (72H-6/52 ) 3) REMODELING AND MATURATION OF

HEALING ( 6/52 – 7/12 )

BASIC BIOMECHANICS OF BASIC BIOMECHANICS OF TISSUE INJURYTISSUE INJURY

MUSCLE-TENDON-BONE INJURY:1) “ TWO-JOINT MUSCLES” – RECTUS

FEMORIS AND HAMSTRINGS2) ECCENTRIC AND LESS

CONCENTRIC LOADING – JUMPERS KNEE

BASIC BIOMECHANICS OF BASIC BIOMECHANICS OF TISSUE INJURYTISSUE INJURY

MUSCLE-TENDON JUNCTION:- THE TERMINAL MUSCLE

SARCOMERE INFOLDINGTENDON INJURY:SPONTANEOUS TENDON RUPTURE:

LIGAMENTS AND TENDONSLIGAMENTS AND TENDONS

1) STRUCTURE AND BIOMECHANICS OF LIGAMENTS AND TENDONS

2) CORRELATION OF COLLAGEN FIBRIL SIZE WITH MECHANICAL PROPERTIES OF TISSUE

3) THE EFFECTS OF IMMOBILIZATION OF LIGAMENTS

BONEBONE

1) ACUTE FRACTURES2) AVULSION FRACTURES3) STRESS FRACTURES: THRESHOLD

LEVEL VS CYCLIC LOADINGMEASURE OF PLASMA

HYDROXYPROLINE (BONE RESORPTION )

FIBROCARTILAGE MENISCIFIBROCARTILAGE MENISCI

LOCATION OF THE TEAR DICTATES THE RESPONSE TO THE INJURY

MUSCLEMUSCLE

TWO COMPETING PROCESSES DURING MUSCLE HEALING:

1) REGENERATION OF THE DISRUPTED MUSCLE FIBRES

2) THE PRODUCTION OF CONNECTIVE TISSUE COLLAGEN

MUSCLEMUSCLE

- IMMOBILIZATION ( LESS POSSIBLE ) WILL REDUCE CONNECTIVE TISSUE AND ASSIST PENETRATION OF REGENERATED FIBRES

- STRETCHED MUSCLES WILL INCREASE NUMBER OF TERMINAL SARCOMERES, REDUCE INTRAMUSCULAR CONNECTIVE TISSUE