SOFT TISSUE INJURY, REPAIR,

AND MANAGEMENT
 Subluxation
Partial or incomplete dislocation that often
involves secondary trauma to surrounding
tissues

Foramen of Weitbrecht
i.e shoulder subluxation
 Dislocation
Displacement of a part specifically
disarrangement of the normal relation of the
bones entering into the formation of the joint
 Shoulder Dislocation
Pathomechanism Distinctive Feature Mx and Prognosis
1. Hyperabduction with -20-25 y/o -immobilization
tearing of inferior capsule -Held in abduction (Ant)
2. Direct blow from behind -Held in add & IR
3. Forced ER with arm -pain
abducted -loss of roundedness
4. Fall on flexed, IR arm Incarm(?) length
 Muscle/Tendon Rupture
Partial Rupture: (+) pain
Complete Rupture: (-) pain
 Biceps Rupture
Pathomechanism Distinctive Feature
-Avulsed at the insertion -painful snap over elbow
-strong elbow flexionn -biceps weakness
(+) popeye sign
Mx and Prognosis
-surgery
-5 weeks immobilization

-After the injury there is

usually localised pain at
the front of the elbow, with
bruising and swelling. The
biceps muscle may retract
up the upper arm crating a
prominent bump, known
as the 'Popeye' sign.
 Tenosynovitis
Inflammation of synovial membrane covering
tendon
 Tendinitis
Inflammation of the tendon with scarring and
calcium deposition
May cause impingement syndrome
Dx: medical hx
 Rotator Cuff Tendinitis
Aka impingement syndrome/ painful arc sd
S/Sx: nocturnal pain
Nagging aching pain at lat humerus
Inc pain with resisted abduction
(+) impingement sign
Mx:
Rest
Avoid lifting and throwing movts
Pain relieving drugs and modalities
Shoulder exercises
surgery
Vicious Cycle
 Grades of Muscle Tear

Grade 1 Simpe pulled muscle

Grade 2 Greater structural disruption but intact muscle
Grade 3 Completely Torn
 Blazina Staging of Tendinitis

Grade 0 No Pain
Grade 1 Pain with Sports Activity
Grade 2 Pain in the beginning of activity but disappears after warming up
Grade 3 Pain during and after the activity
Grade 4 Constant pain
 Severity if Tissue Injury
Grade 1 Mild pain at the time of injury or within 24 hours
Grade 2 Moderate pain that requires stopping of activity
Grade 3 Complete avulsion of the tissue with severe pain
Common Orthopedic and Surgical Procedures
and Guidelines for Postoperative Care

Arthroscopy
Synovectomy
Osteotomy
Arthrodesis
Arthroplasty
 Arthroscopy
Direct visualization of a joint using an
endoscope
Rehabilitation proceeds more quickly
Knee Arthroscopy
 Synovectomy
Removal of synovium in px with chronic swelling
Post operative mx
Immobilization
Elevation
Exercise
Muscle setting exercises --- a method of maintaining muscle strength and tone
by alternately contracting and relaxing a skeletal muscle or group of skeletal muscles without
moving the associated body part. Such activity is useful in preventing atrophy of the muscles,
especially in patients with conditions involving the joints.
CPM (continuous passive motion)
Resistive exercises (6-12 wks)
FWB (full wt bearing) and lifting activities restricted (6-8
wks)
Synovectomy
 Osteotomy
Surgical cutting and realignment of bone
Post op mx
Immobilization (8-12 wks)
Exercise
Cast: AROM/resistive exercises
Osteotomy
 Arthrodesis
Fusion of bony surface of a joint with internal
fixation
Common in wrist, ankle and thumb
Post operative mx
Immobilization (8-12 weeks)
Exercise below and above the joint
Wt bearing restricted on xray shows evidence of
bony healing
Arthrodesis
 Arthroplasty-
is an orthopedic surgery where the articular surface of a musculoskeletal joint
is replaced, remodeled, or realigned by osteotomy or some other procedure.
It is an elective procedure that is done to relieve pain and restore function to
the joint after damage by arthritis or some other type of trauma.
Any reconstructive joint
procedure with or without
implant designed to relieve 3-5 days post op
pain and improve fxn
Good Candidates
Sitting tolerance
(-)infection healthy Gait training
elderly individuals
Post op of arthroplasty Transfer activities
2-4 days AAROM-AROM Hip
Abduction splint
Muscle testing
flexion and
AAROM of Hip flexion 45 Extension
and hip extension
Ankle Pumping exercises
Hip Abduction
Active resistive exercises Exercises
of involved extremity
Arthroplasty