Orthopedics 5.19.99

•	Memeorize the five D’s and Three N’s and the A
•	Refer to page 17 in terrett

VBAI follwing SMT
•	Compressing or stretching of th eVA resulting in a subintimal hematoma
•	Intimal tear which results in clot formation
•	Intimal tear with embolitic formation into the  lumen
•	Vessel wall dissection where blood flows between the layers of the vessel wall blood then frequently compresses, and a hemmorhage can rupture through the intima
•	Vessel wall dissection with pseudoaneurysm
•	Perivascular bleeding which allows blood to leak into the fascia.

Soft tissue injury
•	Muscle injury is called a strain
•	Can be graded( primary, secondary, tertiary, or mild, moderate or severe)
•	Grade 1- mild injury do to too much work. 
•	Symptoms are self limiting
•	No treatment needed, however, some people prone to these injuries may need rehabilitation.
•	Grade 2- moderate 
•	Tearing of fibers and bleeding in the muscle
•	Production of a toxic state
•	Takes longer to heal and may produce scar tissue
•	Rehabilitation may be indicated to bring the muscle back to base line strength and to prevent other associated injuries.
•	W/out treatment, healing may be incomplete and hypersensitive to pain.
•	Grade 3- Severe where some part of the muscle has ruptured
•	Require treatment and don’t heal on their own
•	Some permanent loss of function, but can be minimized by treatment
•	Common treatment is surgical repair
•	Degeneration is often the cause due to age and these patients are not always a surgical candidate
•	Ligament injury is called a sprain
•	Grade1- microscopic damage
•	Ligaments are nonvascular and healing depends the content of the collagen of the ligament. 
•	Grade 2- Moderate
•	Minimal hypermobility
•	Instablility can also occur.
•	Grade 3- Severe- Must be surgically repaired