Midterm 2 Flashcards
(48 cards)
Types of connective tissue
ligament
tendon
bones
wrappings (perimysium)
epithelial
neural
What is the shape/direction of healthy collagen LCL? How does that reflect the function?
What are the 3 types of collagen? (time frame)
TRIPLE helix and rope-like = tensile forces
type 1: 100 days to build (skin, tendon, bones, organs)
type 2: gives shape to cartilage (meniscus for compressive forces rather than ligament for tensile)
type 3: short term, weaker collagen (reticulate)
How do cells/ECM support the collagen fibres? How does the ratio or proportion of cells/ECM to collagen fibres? What types of cells are there?
- support the collagen fibres (gel-like) - temperature sensitive and provides them nutrients
- determines if it’s tensile like ligament (high collagen to cells/ECM), cartilage (high cells/ECM to collagen)
- bone (osteoblast), cartilage (chondroblast), tendon (tenoblast)
What are the 3 ways a tissue can be overloaded? What are the 3 types of loads?
1) acute overland event - load over comes physical tolerance
2) repetitive, fatigue process - “paperclip” analogy
3) combination
compression, tensile, shear
Explain the Length vs. Load graph?
1) initially there is no change in length because the collagen is being un-scrunched
2) it hits the elastic zone - if released, it would return to its original shape
3) it passes the point of irreversible damage, approaches max
4) POP - failure
MOI
3 Load factors?
4 Tissue factors?
- magnitude (ie. body weight)
- direction (with or against body’s anatomical design)
- rate (fast or slow?)
- length: shorter tendon/CT attachment = short distance to failure
- temperature: colder - stiffer - higher risk for damage
- stiffness: tolerance to DEFORMATION (if tendon is stiff then a low force could greatly deform it)
- strength: ABS force - x-sectional relationship
What are the 3 stages post-injury? (list them)
inflammation
repair
remodeling
1: Inflammation
Duration?
Features (2)
Acronym for SIGNS of inflammation?
3 other signs/”conditions” - where would we see these?
72 hrs - short lived
features - often over-exaggerated (dependent on the individual), GENERIC in there is a perceived threat by the immune system
swelling, heat, altered function, redness, pain
- hematoma: occur in tissues with DENSE VASCULATURE (thigh vs. Achilles), increased blood flow and blood pooling, associated with clotting -myositis (can lead to calcified muscle - solid to palpation)
- joint effusion: joint specific - enlargened knee joint due to the synovial joint producing excess fluid in response to trauma
- edema: water expansion over whole limb or body (medical imbalance, pregnancy)
2.Repair/fibrosis
Duration?
2 main steps?
Why is this phase still have a risk for injury?
In terms of RTP, can players go back during this time?
How is the overall status of the patient at this stage?
3-6 weeks - dependent on the injury (tapers in after inflammation)
1) clean up: remove dead tissues, extra fluid from inflammation
2) repair - fibroblasts lay down type 3 collagen fibres as a temporary template - WEAK therefore high risk for re-injury
depends on the skill level of the player - RISK MANAGEMENT (weekend warrior vs. trained athlete)
significant improvements and lower pain
- Remodeling
Duration?
What happens to the template?
How do the tissues become stronger and how can rehab help? (2)
up to 2 yrs (ie. ACL)
lysis of collagen 3, synthesis of collagen 1
- rehab = increase muscle strength and functionality
- graded into 100% (strength, activity level, duration, etc)
1) IOS - funnel thinking
2) Severity and stage of healing - level of fxn
3) Different diagnosis
Elaborate on each.
IOS - index of suspicion
different diagnosis….if current one is not improving
In terms of testing…what are the 5 steps we will take?
HOP --> IOS ROM testing (active and passive) resisted strength tests special tests palpation
2 principles when doing tests
1) TEST BILATERALLY - start with good side for practice and comparison
2) CLEAR COMMUNICATION with verbal and kinesthetic cues + demo
Describe the resistance the tester should provide when testing active ROM?
graded isometric resistance
low-peak-low
testing in the middle of the their ROM
Questions to consider:
- Is ROM limited?
- What’s being stressed, squished?
- How do they feel?
If the patient says their knee joint feels “stuck” or “stickiness” when they are actively extending their leg? Is it more likely a muscle injury or knee joint?
Would it hurt during this muscle activation?
Would it hurt when you passively extend their leg? With limited ROM…?
knee joint - structure
no pain
maybe…probably a meniscal problem
If they feel pain when you passively take them into the end ROM…what could it be?
ligament injury
In what case can there be an increased ROM?
ligament is disconnected
few weeks into the healing process..it may heal “looser”
it’s not uncommon to have more eversion after a sprain or pathology (immediate or history)
3 notes to make in our testing chart?
- to indicate pain
ROM
Resistance (* and grade)
When we are going down our IOS list…what 2 things are we trying to do….while consider what 2 things about the tests?
reproduce the initial MOI
reproduce the symptoms
consider:
specificity of the test - how SPECIFIC to a given structure or condition
sensitivity of the test - how EASILY can an injury can be detected
Turf Toe
Which joint? Which structure on the plantar surface of the foot? Which muscles may be involved? Optimal position for injury? 3 contributing factors?
1st MTP (synovial), plantar plate
muscles: FHL, FHB (tendons run along plantar plate)
DF of TC joint
hyper-EX of MTP
PLUS BODY WEIGHT AS AXIAL LOAD
footwear (flexible)
artificial turf (higher coeff of friction…gets caught)
body mass
Differentiate sign vs. symptom
sign - objective from gathering patient’s data
symptom - subjective to the patient
Recognition of a turf toe
Pain location?
ROMs effected?
Ankle ROM? Which muscles would be tight?
If only the capsule was damaged, what would you expect to see in the strength tests?
If the FHL tendon was damaged…what AROM or PROM would hurt and be weak?
localized to the plantar plate and MTP joint
Active FL - little pain
Active EX - maybe pain
Passive FL - no pain
Passive EX - a lot of pain *
decreased ankle (limited DF) and tight plantar flexors
negative strength tests
active FL would hurt
active EX may hurt
passive FL - little pain because damaged fibres are not activation
passive EX - would hurt a bit more (stretching the fibres)
When caring for a turf toe, consider the healing cycle….4 goals/things to do?
pain control
reduce injury risk - allow for rest
modify training
What are the two options for turf toe in terms of support?
1) moleskin - limiting ex
2) the boot - more for major cases requiring surgery - no movement of TC joint or toes
