Lecture 1 Flashcards
(78 cards)
1
Q
What kind of tissue is injured in a strain?
A
Musculotendinous unit
- mild injury; tissue not torn
2
Q
What kind of tissue is injured in a sprain?
A
Ligament
3
Q
What are the different grades of sprain and describe them
A
Grade 1: ligament stretched but intact
Grade 2: incomplete or partial tear
Grade 3: complete tear
4
Q
What are the types of muscle/tendon rupture or tear?
A
Partial: pain and reduced strength
Complete: no pain and severe weakness
5
Q
What is the difference between a subluxation and dislocation?
A
- subluxation is an incomplete or partial dislocation (includes soft tissue trauma)
- dislocation is a complete loss of anatomical relationship (soft tissue damage, pain, spasms, inflammation)
6
Q
What direction does the shoulder most commonly dislocate? Hip?
A
Shoulder often dislocates anteriorly while hip dislocates posteriorly
7
Q
What is Tendinitis?
A
Inflammation of tendon; resulting scarring or calcium deposits
8
Q
What is tendinosis and its effects?
A
Chronic degeneration without inflammation
- changes tendon’s collagen; weakens tendon
- reduces tensile strength; increase risk of tendon rupture
9
Q
What is tenosynovitis?
A
Inflammation of synovial membrane
10
Q
What is tendovaginitis?
A
Inflammation with thickening of tendon sheath
11
Q
What is synovitis?
A
Inflammation of synovial membrane
- excessive synovial fluid in the joint or tendon
12
Q
What is bursitis?
A
- inflammation of bursa
- synovial pocket inserted between tendon and bony prominence
- common sites : subacromial, elbow, hip, knee, and ankle
13
Q
What is a ganglion?
A
Ballooning of the wall of the joint capsule (RA)
14
Q
What is hemarthrosis?
A
Bleeding into a joint (severe trauma)
15
Q
What is a contusion?
A
Bruising from a direct blow; capillary rupture; edema and inflammatory response
16
Q
How are dysfunctions, adhesions, and contractures related to consequences of Soft Tissue Injury?
A
- Dysfunction: loss of normal function of tissue or region (mechanical loss of normal joint play)
- Adhesion: abnormal adherence of collagen fibers that reduce elasticity of tissue (from immobilization, disuse, surgery)
- Contracture: captive positioning of short tissue (skin, fascia, muscle, capsule) from immobilization, disuse, burns, and spasticity
17
Q
How can you differentially diagnose Dupuytren’s Contracture from other hand pathologies?
A
- gradual onset
- no specific MOI
- pink and ring finger affected
18
Q
What is reflex muscle guarding?
A
- prolonged muscle contraction in response to painful stimulus
- contracting muscle against movement
- pt tenses when therapist moves area that could be painful
19
Q
What is an intrinsic muscle spasm?
A
- Prolonged contraction of a muscle in response to the local circulatory and metabolic changes
- ex. Post whiplash, pt is tense so less circulation. Therefore, more metabolites (lactic acid) and then less mobile
20
Q
What is muscle weakness?
A
- Neurogenic or myogenic factors
- Direct insult to the muscle or inactivity
21
Q
What is Myofascial compartment syndrome?
A
• Increased interstitial pressure in a closed, nonexpanding, myofascial compartment
• Results in ischemia and causes tissue damages
22
Q
What describes a grade I tissue injury?
A
• Mild pain at time of injury/within 24 hrs
• Mild swelling, local tenderness
• Pain (+) when injured tissues are stressed
23
Q
What describes a grade II tissue injury?
A
• Moderate pain that affects daily activities • Stress and palpation increase the pain
• Tissue is partially torn
24
Q
What describes a grade III tissue injury?
A
• Near-complete or complete tear or avulsion of the tissue
• Severe pain
• Stress to tissue is usually painless
• Palpation may reveal the defect
25
What are the 3 stages of Tissue Healing and what are ways a PT can determine which stage a pt is in?
1. Acute Stage (inflammatory reaction):
- pt will experience pain at rest (before tissue resistance encountered)
- pt will experience the hallmarks of inflammation (pain, swelling, redness, etc.)
2. Subacute Stage (Proliferation, repair, and healing)
- pt will experience pain with tissue resistance but not at rest
- pt will not have hallmarks of inflammation (or reduced?)
3. Chronic Stage (maturation and remodeling)
- pain at end range (after tissue resistance)
26
What is the expected timeline for the acute stage?
First 48 hrs—> 4-10 days
27
The pain and impaired movement during the acute stage are the result of what?
• Altered chemical state that irritates the nerve endings
• Increased tissue tension due to edema or joint effusion
• Muscle guarding
28
In the acute phase, what occurs from the actual trauma?
• Cellular death: direct insult or lack of oxygen
• Coagulation: initially vasoconstriction for 5-10 min followed by vasodilation; exudation of blood cells and chemicals around injured tissues; clots, edema, and joint swelling occur over time
• Phagocytosis: Neutrophils and Monocytes move to the injured site to clean dead cells
29
What are PT goals and Interventions during the acute stage?
• Control effects of inflammation (RICE)
• Prevent negative effects of rest
• Nondestructive movement - Passive ROM • Soft tissue mobilization
• Muscle setting with caution
30
What is the timeline for the subacute stage?
48 to 72 hrs—> 6-10 wks
31
What are the 3 processes used for tissue repair?
• Angiogenesis: Growth of capillary beds into area
• Collagen formation: fibroblasts form extracellular matrix and synthesize immature collagen
• Epithelialization: wound surface is covered and contract
32
What is Granulation tissue?
Delicate reddish connective tissue that consists of fibroblasts, collagen, and capillaries
- formation of scar begins
33
What are PT goals/Interventions during the sub-acute stage?
• Develop mobile scar (selective stretching, mobilization/manipulation of restrictions
• Promote healing
• Nondestructive movement –AROM
• Resistive exercise
• Open and closed chain stabilization
• Muscular endurance
• Cardiopulmonary endurance
34
What happens during the chronic stage?
• New collagen continues to increase its tensile strength, lasting up to a year
• Excess production of collagen by fibroblasts leads to hypertrophy of scar formation
• Maturation of connective tissue
• Contracture of scar tissue
• Remodeling of scar
• Collagen aligns to stress
35
What are the clinical signs of the chronic stage?
- absence of inflammation
- pain after tissue resistance
36
What are PT goals/interventions during the chronic stage?
• Increase tensile quality of scar
• Progressive strengthening and endurance exercises
• Develop functional independence
37
Genu valgum resulting in laxity of which ligament?
MCL
38
What soft tissue structure(s) take 5-8 days to heal?
Skin and muscle
39
What soft tissue structure (s) take 3-6 weeks to heal?
Ligaments and tendons (take much longer to heal than skin and muscle)
40
While normal ligaments consist of 85% type I collagen, the remodeled ligaments after injury are ____ collagen and synthesized by _____. Therefore, the mature repaired ligament is __% weaker than uninjured ligament.
Type III
Fibroblasts
30-50%
41
Describe ligament laxity- pathway to osteoarthritis
3 wks: tolerate mild tension
6 wks: resume normal acitivires (low resistance)
12 wks: regained almost max tensile strength
42
Where does a partial tear/ruptures most often occur in tendon injuries?
Muscluotendinous or tenoperiosteal junction
(Less frequent in tendon itself-unless laceration)
43
When is surgical repair needed for tendon injuries?
• Surgical repair essential for full return of function
• If >50% diameter →surgical repair
44
O2 consumption of tendons and ligaments is _ times lower than that of skeletal muscles
7.5 times
tendon healing is limited by limited blood supply
45
Type I collagen fibers are organized ____ along the tendon axis and responsible for the _______ strength
Longitudinally
Mechanical
46
_______ tension of tendon across repair site in first 3 weeks results in a poor outcome
ACTIVE
• Need to perform PASSIVE exercise (gliding) in direction of injured tendon
• Minimizes peritendinous adhesions
• Assists also in fiber orientation!!!
47
When treating tendons, what is usually not allowed in the first 4-6 weeks following a repair?
NO/limited active recruitment of injured muscle-tendon
48
When treating tendons, are pts allowed to move actively at all initially?
Passive movement assist in aligning
collagen fibers
• Can move actively in opposite direction, but not full range
49
What can happen if a pt doesn’t slowly transition from passive—> active-assisted —>active—> resisted motions?
partial tears “overuse tendonitis” develops
50
How long are most tendon rehab programs?
>6 months (sometimes 1-2 yrs)
51
What are the 5 main causes of muscle injury?
1. Mechanical Forces
• Passive stretch
• Contraction (esp. eccentric) • Contusions
• Lacerations
2. Thermal Stresses
• Extreme heat or cold
3. Nerve Injury
4. Myotoxic agents
• Marcaine, lidocaine with epinephrine, corticosteroids
• Certain snake, spider or bee venoms
5. Prolonged Ischemia
• Compartment syndrome
• Tourniquet applications for surgical procedures
52
What does clinical management look like for muscle injures from 2-5 days to after 6 weeks?
2-5 days: short term immobilization to manage acute inflammation and hemorrhage
2-3 wks: balance between tissue extensibility and protection from reinjury
4-6 weeks: gentle AROM, < full range- NO RESISTANCE
After 6 week:
- warm up period and endurance activity
- repaired tissue weaker and less compliant due to scar; more easily re-injured with rapid contraction/stretch
Eccentric contraction can cause injury
53
What is Wolff’s Law?
• Bone is deposited in sites
subjected to stress
• Bone cells will align in such a way as to efficiently withstand stress
• Stress in bones with weight-bearing or tension
• Lack of stress causes bony atrophy
54
What are the 3 Phases of Fracture Repair?
Inflammatory, Reparative, and Remodelling
55
How long does the Inflammatory Phase of Fracture Repair last?
1-2 weeks
56
When does Soft Callus and Hard Callus Formation take place in the reparative phase of fracture repair?
Soft: ~1 week
Hard: several weeks to months
57
Describe the Remodeling Phase of Fracture Repar
• Fracture site is firm and no longer moves, fracture line still appears on x-ray
• Immobilization is no longer required; movement of the related joints is allowed with the caution of avoiding deforming forces at the fracture site
58
About how long does it take for fractures to heal in children?
4-6 weeks
59
About how long does it take for adolescents to heal a fracture?
6-8 weeks
60
About how long does it take adults to heal a fracture?
10-18 weeks
61
What heals faster? UE or LE? Distal or Proximal? Simple or Complex?
UE
Distal
Simple
62
What are favorable conditions for healing?
• Fracture through cancellous bone b/c more vascular
• Adequate blood supply to both
fragments
• Fracture at end of bone (better circulation)
• Soft tissue injury minimal
• Fractured surfaces in close proximity
• Site free from infection
63
What are unfavorable conditions for healing?
• Distraction of bone ends by traction from wide separation of bone ends
• Severe comminution or soft tissue damage
• Shearing or rotary forces acting at fracture site
• Impaired / loss of blood supply
• Infection
• Deficiency diseases
• Osteoporosis / osteopenia
• Smoking
64
Are scars elastic or inelastic?
Inelastic
65
What is the difference between a hypertrophic scar and keloid scar?
Hypertrophic scar is raised but within the bounds of injured region, but keloid scars extend beyond the boundary of the injured site
66
Collagen synthesis is dependent on what?
O2
Prolonged pressure can limit size of scar by limiting O2 available to that tissue
67
What 2 things can chronic inflammation occur due to? And what does it result in?
1. Repeated stress/trauma beyond its ability to repair itself
2. Immune response
• Results in increased fibroblast activity
• Increased production of immature collagen
• Degradation of mature collagen – weakening tissues
68
What is the best modality?
Exercise
69
What is the 4 components of the disablement model?
Pathology — Impairments — Functional Limitations — Disability
70
How does disability differ from Function?
Disability is the result of a complex relationship between an individual’s health condition and personal factors, and of the external factors that represent the circumstances in which the individual lives
71
At what level does this course primarily address?
Impairment
72
What are management guidelines during the acute stage of healing?
• Patient education on expected duration of symptoms (4 to 6 days) and precautions/ contraindications
• First 24-48 hours: Rest (splint, tape, cast), ice, compression, elevation
• Edema and pain control: modalities, massage, gentle joint oscillation (grade I), and assistive devices
• Tissue-specific movement: injured vs. uninjured tissues
• Intensity of movement: too much movement too soon is painful and re-injures the tissues
73
What are modalities that are used to control symptoms in the acute stage?
1. cryotherapy: limits bleeding, reduce swelling and pain by vasoconstriction
- combine w/ compression in first 24-48 hr
2. Electrical stimulation: reduce swelling and pain by alerting cellular permeability
3. Massage: move fluid & prevent adhesion
- Applied cautiously and gently to injured tissue and neighboring area
- When treating muscle lesions, the muscle is usually kept in its shortened position so as not to separate the healing breach
4. Low-dosage joint mobilization
- Grade I or II distraction and glide techniques
to improve fluid dynamics in joint to
maintain cartilage health.
- Grade I or II distraction and oscillation may also reflexively inhibit or gate the perception of pain
5. Exercise (more about in another card)
74
What are specific exercise interventions for uninjured and injured tissues/body parts to prevent adverse effects in the acute stage?
1. Uninjured tissues/ body parts:
• Gentle movement of uninjured tissue to maintain tissue integrity and aid circulation and lymphatic flow
• Resistive exercise and functional activities: prepare patient for use of assistive devices
2. Injured tissues/ body parts:
• Gentle PROM within the limit of pain
• Active movement (AROM) is usually contraindicated at active inflammatory sites unless it is a chronic inflammation
• Stretching at this stage is contraindicated
• Muscle setting: low-intensity, intermittent, isometric muscle contraction within limit of pain; place muscle in the shortened position or resting joint position
75
What is the control-motion phase?
The subacute stage where aim is to promote healing
76
What are management guidelines for subacute stage?
• Patient education on expected time frame for healing (21 days–6 weeks) and home exercises/functional activities
• Promote healing of the injured tissues by monitoring tissue responses to active exercises and stretching (indicator –
clinical signs)
• Restore soft tissue, muscle and joint mobility by progress PROM—> AROM and increase mobility of scar
• Progress from multiple angle isometric exercise to isotonics within patient’s tolerance
• Begin mild resistance
• Encourage AROM in uninvolved sites
• Resume functional activities
77
What modalities can be used to control symptoms in the subacute stage?
1. treatment change from “cold” to “heat” to increase circulation, promote healing, reduce pain, and increase tissue extensibility
2. Electrical stimulation to reduce swelling and facilitate removal of injury byproduct and neuromuscular control by cellular permeability
3. Massage: mobilize soft tissue to reduce adhesions with cross-fiber friction massage to mobilize ligaments, incision sites, and muscle scar tissue or tendon adhesions
4. Joint mobilizations to restore joint mobility
- Grade III sustained or III and IV oscillation
- Joint distraction and gliding techniques to stretch restricting capsular tissue
5. Exercise (more on later card)
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