Cruciate & Miniscal injury

Cruciate & meniscal injury

It is important as RMT to be able to differentiate between cruciate or meniscal injuries and collateral Lig injuries

Massage has a direct effect on collateral ligaments b/o its anatomical location (palpable)

Assessment

Acute w/swelling
AROM-limited, PROM-mxl guarding

mxl strength testing: mxl crossing the knee should be Painless and indicated normal strength
If there is pain, accompanying mxl might be injured
Presence of swelling

Early/Late subacute and Chronic
AROM-limited, PROM-limited where jt locking is present, unable to fully extend the knee
Mxl strength: Quadriceps may be reduced with disuse atrophy

Special test: Lachman's test, Ant./Post. drawer test, Valgus/Varus test
Miniscal injury:McMurray's test, Bragard's sign, Apley's compression test, Helfet's test

Massage of cruciate injury

Acute/Subacute
RICE
Elevate the limb
Primary focus of tx is the compensating structures (High tone, TrP)
ACL injury: Initial focus of AROM is on hamstrings
Lymph drainage tech proximal to the knee could be used to reduce swelling
Isometric full knee extension against the gravity
Distally, mxl squeezing and careful jt play for the ankle and foot are indicated

　Chronic
After 4-6 weeks focus on both affected and unaffected knee and lower back
Fascial tech, skin rolling, cross fibre friction can be used
Heat hydrotherapy

Massage of Meniscal injuries

Acute/Subacute
RICE
Patellofemoral Jt mobs, Gentle PROM into pain free extension
In the late subacute, cross fibre friction to the lision are indicated

Chronic
Lower back, Gluteals, and legs being treated for hypertonicity, fascial retractions and TrP
Caution: Joint play for the tibiofemoral joint can be introduced in the 3rd week if hypo mobility is present

Self Care

Acute/Subacute

Straight leg raise, hip adduction, gastrocnemius setting in week 1

Chronic

If there is tear or partial menisctomy has full ROM, Isometric exercise are progressed to isotonic exercise for quadriceps & hamstrings & gastrocnemius

Resistance exercise are added over 3-week period

Healing time
Grade 3 sprain takes up to 4 months to recover
Minor meniscal tear takes 3-4 weeks

Comments

Tendinitis

Tendinitis Inflammation of a tendon or tendons NOTE : What is the difference between "Tendinitis" and "Tendinosis"? The main difference between tendinosis and tendinitis is time. Tendinosis is a chronic (persistent or recurring) condition caused by repetitive trauma or an injury that hasn't healed. By contrast, tendinitis is an acute (sudden, short-term) condition in which inflammation is caused by a direct injury to a tendon (from Google search) Another Link regarding this difference HERE Okay, From here below, informations are taken from Rattray textbook! Tendon : Made of regularly arranged, dense collagen fibrils. It appear in 2 shapes: Cord-like structures and broad, sheet-like structures called aponeuroses Limited blood supply compared to Mxl and that makes it slow down of healing process Cause Chronic overload of the tendon leading to micro tearing and inflammatory response in the tendon Cont

Strain VS Sprain

Strain vs Sprain STRAINS s"T"rain = "T"endon Overstretch injury to musculotendinous unit (tendon) Concentric : Mxl contraction as the origin and insertion of the mxl comes closer together, Mxl fibres shorten Eccentric :Origin and insertion move farther apart, the mxl fibres lengthen Eccentric contraction can produce. greater force within the mxl than concentric contraction, predisposing the mxl to injury at this time Hypovascular nature of tendons contributes to decreased tissue health, allowing the tendon itself to rupture Fun fact! The younger people where the epiphyseal plate in the bone has not yet ossified, the mxl and tendons are stronger than the bone! Because tendons are moderately vascularized, they are prone to partial or complete rupture at the area of least blood supply either in the middle of the tendon or at the musculotendinous junction. What is the cause of STRAINS? Sudden overstitching of the mxl Extreme contraction o

Fractures

Break in the continuity of a bone Type of fracture Transverse, oblique, spiral, comminuted, avulsion, osteochondral Common fx names Stage of healing 1. Hematoma within 72H of initial trauma 2.Inflammatory rxn, proliferation of osteoblasts at the periosteum 3.Soft callus or splint is formed from mass of proliferating osteoblast, repair is still incomplete 4.Consolidation occurs as the immature woven bome is changed into mature lamellar bone This is a complete repair 5.Remodeling of the irregular outer surface and reshaping of the marrow space inside the bone take place through alternating osteoclastic and osteoblastic activity Complications of Fx Compartment syndrome This can occur in the forearm and lower legs following fx Nerve compressions This may be indicated by paresthesia in the tissues under the cast Untreated vascular damage It may be indicated by an increase in observable distal red, black or blue bruising Refer to MD!! Bone

Massage therapy (Rattray)

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