II. Classifications
A. Closed
1. Contusions
2. Hematomas
3. Ecchymoses
4. Crush
5. Strains—muscles
6. Sprains—ligaments
a. First degree—mild
b. Second degree—moderate
c. Third degree—severe. These often are complex, unstable injuries that must be referred to the physician for definitive care/surgery.
7. Ruptures
a. Both muscles and ligaments
b. Need immediate referral to the physician for definitive care/surgery
c. Characterized by
i. Instability
ii. Inability to move injured extremity
iii. Swelling
III. Etiology/incidence/predisposing factors
A. Trauma
1. Blunt
2. Rotational
3. Shear forces
B. Exercise
C. Overuse syndromes
D. Sports
E. Autoimmune diseases such as systemic lupus erythematosus (SLE), scleroderma, and rheumatoid arthritis (RA)
F. Soft tissue injury commonly seen in all age groups; more frequent in those younger than age 35
G. Obesity
IV. Subjective findings
A. Pain
B. Swelling
C. History of precipitating event
D. Feeling of instability of joint
V. Physical examination findings
A. Muscle tears/ruptures
1. Decreased or absent range of motion (ROM) of joint/joints affected by the muscle
2. Swelling with hematoma formation
3. Ecchymosis of skin over muscle
4. Palpable discontinuity of muscle belly with obvious defect on careful palpation
5. Abnormal contour of muscle
B. Ligaments
1. Strains
a. Pain on palpation and ROM
b. Mild swelling
c. Rarely, hematoma formation
2. Sprains
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a. Pain on palpation and ROM
b. Moderate swelling with decreased ROM
c. Possible hematoma formation
d. Lachman’s test: possible joint laxity of the anterior/posterior cruciate ligaments during special maneuvers; sensation of the joint acting hypermobile during stressing maneuvers
ii. The patient relaxes the leg while the examiner holds the knee flexed at 30 degrees and pulls forward/pushes backward on the tibia.
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