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Ther Ex 1 > exam 1: clinical mgmt, soft tissue injury, post op > Flashcards

exam 1: clinical mgmt, soft tissue injury, post op Flashcards

1
Q

5 things you need to know to clinically manage your patient

A
  1. nature of dysfunction ie decreased AROM
  2. stage of condition ie acute vs subacute
  3. tissue reactivity ie high vs low
  4. subject reactivity ie high vs low
  5. functional goals ie what does patient want to get back to?
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2
Q

3 stages of tissue healing

A
  1. inflammatory (acute): 0-6 days
  2. proliferative (subacute)
    - repair and healing 4-21 days
    - repair and regeneration 48hrs-8weeks
  3. maturation and remodeling (chronic) 14+ days
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3
Q

muscle pain/spasm cycle

A

trauma/pain/inflammation–>

  1. restricted movement
  2. circulatory stasis (retention of metabolites, tissue ischemia)
  3. pain
  4. muscle spasm
  5. back to restricted movement
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4
Q

stages of healing and ROM

A

acute: pain before reaching tissue resistance
early subacute: pain at beginning of tissue resistance
late subacute (settled): pain at end of resistance

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5
Q

goals in acute stage

A

decrease pain, effusion/edema, maintain function/mobility, pt. ed, facilitate movement into subacute stage

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6
Q

ther ex during acute stage

A
  1. rest and protection
  2. classical PROM
  3. submax muscle setting (w/o pain)

contraindications: AROM, stretching/resistance exercises

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7
Q

MEAT vs RICE

A

MOVEMENT
EXERCISE
ANALGESICS
TREATMENT

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8
Q

effects of PROM

A

prevents: contractures, fluid stasis, thrombus formation

Decreases pain, nourishes cartilage, distributes synovial fluid, stimulates healing along lines of stress

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9
Q

specific interventions/dosages for acute (protection) phase

A
  1. PROM
  2. mild jt mobs
  3. muscle setting
  4. massage

*workout associated/nearby areas to maintain strength/function

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10
Q

impairments during subacute stage

A

contractures, weakness, decreased functional use of associated areas

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11
Q

exercises during subacute stage

A 
multiple angle submax isometrics
AROM
muscular endurance
protected weight bearing exercises
no heavy eccentrics early on
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12
Q

progression of stretching during subacute stage

A
  1. warming up tissue ie bike ride
  2. inhibition techniques (prevent muscle guarding)
  3. jt mobs
  4. stretching
  5. massage
  6. use new ROM
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13
Q

pathophysiological characteristics during acute stage

A

inflammatory stage:vascular changes, exudate,clot, phagocytosis, early fibroblastic activity

treatment:decreases pain, prevent progressive inflammation, maintain mobility/strength of other areas

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14
Q

pathophysiological characteristics during subacute stage

A

repair and healing:removal of noxious stimuli,capillary beds, granulation tissue, collagen formation, fibrous healing aligns to stress, TISSUE IS FRAGILE

treatment: ROM, jt mobs, scar mobs, light resistance, bone loading

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15
Q

pathophysiological characteristics during chronic stage (maturation and remodeling)

A

maturation and remodeling: contracture, alignment of stress, maturation to collagen type I

treatment: provide stress (stretch, active contraction, estim), bone loading

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16
Q

chronic inflammation

A
  • fail to eliminate injuring agent
  • weakens tissue
  • continued pain, swelling
  • muscle guarding lasting hours post activity, stiffness and loss of ROM 24 hrs post exercise
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17
Q

3 mechanisms of chronic inflammation

A
  1. repetitive/cumulative trauma
  2. re-injury: tissue is weaker
  3. poor posture, structure dysfunctions –>vulnerable
18
Q

chronic inflammation impairments

A

pain, contractures/adhesions, poor mm endurance, mm weakness, muscle imbalance, faulty position or movement pattern

19
Q

chronic inflammation goals

A 
decrease pain (reduce irritating factors)
mobility/flexibility
tissue support ie braces
strong/mobile scar tissue
muscle balance in length/strength
functional independence
environ factors
20
Q

4 environmental factors in chronic inflammation

A
  1. shoes
  2. grip size of equipment
  3. driving
  4. computer screen
21
Q

signs of overloading connective tissue

A

increased pain that doesn’t go away after 24 hrs
increased redness, warmth, swelling
pain increased over previous session
decreased ability to use part

22
Q

ways to prevent complications of CT

A

minimize effects of immobilization by:

  1. estim
  2. isometrics
  3. motion at joints above/below
  4. weight bearing
23
Q

sprain

A

joint capsule/lig affected
grade I: stretched, no loss of continuity
grade II: stretched, some fibers torn
grade III: complete or near complete ligament disruption

24
Q

exam for sprain

A

check for edema, ecchymosis
palpation for superficial joints
contractile tissues typically normal

25
Q

strain

A

muscle/tendon injury, usually at M-T junction (abrupt/excessive muscle contraction):mild, mod, severe
-pain, tenderness, edema, ecchymosis, loss of function

26
Q

exam for strain

A

history
palpation for tenderness/defect
tissue tension: contraction/stretch
edema/ecchymosis

27
Q

contusion

A

blow to any area of body w/ no broken skin

ecchymosis/hematoma may form

28
Q

contusion exam

A

history, observation/palpation for hematoma/ecchymosis/edema, ROM and strength
-biceps/quads susceptible to HO

29
Q

contusion/sprain/strain management

A

phase I: optimal loading, prevent complications
ie assistive devices, PRICE, PROM/AROM w/o pain
phase II: restore motion, light resistive exercises, friction massage
phase III:SAID, convert strength and mobility into functional movement patterns

30
Q

exam for tendonitis/tendon injuries

A

history: acute (MOI), chronic (predisposing factors, equipment, etc…)
tests/measures: tenderness, tissue tension, nodules/swelling, crepitus

31
Q

intervention for tendonitis/tendon injuries

A

restore length/strength through optimal loading
inflammatory stage: PRICE,ROM,gentle stretch as tolerated
remodeling: stretch, light resistance to realign collagen; progress to isolated eccentric (can vary speed), integrate functional activities

32
Q

diagnosis of RA

A 
• Morning stiffness at least 1 hr
• At least 3 jt areas have swelling
– Swelling in wrist, MCP or PIP jts
• Symmetrical arthritis
• Rheumatoid nodules
• Serum rheumatoid factor
• X-ray changes, erosions or osteopenia in hand 
and or wrist
33
Q

RA management in active stage

A 
• Patient education
• Joint protection
– Short exercise session
– Alternate activities
• Energy conservation
• Joint mobility
– Gentle grade 1 & II distraction and oscillation
– NO STRETCHING when swollen
• Exercise: Active if possible
• Functional training
34
Q

Fibromyalgia Management

A 
• Cochrane Review
– Aerobic exercise
– Resistance exercises
– Not enough info on flexibility ex
– One study:
• Walking at very low intensity (25-60% THR) had 
better outcomes than those who exercised
35
Q

MPS trigger point characteristics

A 
– Hyperirritable area in a tight band of mm
– Pain is dull, aching and deep
– Decreased ROM when mm stretched
– Increased pain with stretch mm
– Decreased strength in mm
– Active: classic pain pattern
– Latent: asymptomatic unless palpated
36
Q

possible causes of MPS trigger points

A 
– Chronic overload of mm due to repetitive 
activity or postures
– Acute overload of mm
– Poorly conditioned mms
– Postural stresses
– Poor body mechanics
37
Q

osteoporosis prevention

A

heavy/intense strength training (16/20 on borg scale for trunk exercise); no smoking, limit EtOH

38
Q

ottawa ankle rules

A

• Ankle radiograph series only if pain in malleolar
area and any of these present
– Bone tenderness at posterior edge or tip of lateral
malleolus
– Bone tenderness at posterior edge or tip of medial
malleolus
– Unable to bear weight immediately and in ED
• Foot radiograph series only if pain in the midfoot
and any of these present
– Bone tenderness at base of 5th MT
– Bone tenderness at Navicular
– Unable to bear wt immediately and in ED

39
Q

fracture healing times

A

– Children 4-6 wks
– Adolescents 6-8 wks
– Adults 10-18 wks

40
Q

stress fractures management

A 
– Unload!!
– Educate
– Refer as needed
– Maintain CV fitness 
and function of other 
joints/muscles
41
Q

management of surgically stabilized fractures

A

– Similar treatment as sprains/strains/contusions
– Communicate with surgeon re: fixation
– Stability and fixation guide rehab
– Key is optimal loading – no overload or
underload
– Pay attention to CV fitness; uninvolved
joints/extremities

Ther Ex 1 (2 decks)

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