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Musculotendinous tissues Flashcards

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1
Q

How are MSK injuries usually caused?

A

mechanical forces that cause direct trauma, compression, friction, or repeated over-stretching

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2
Q

What else is damaged with an MSK injury?

A
  • connective tissue
  • blood vessels
  • nerves
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3
Q

What are the 4 phases of healing?

A
  • hemostasis
  • inflammation
  • proliferation
  • remodeling
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4
Q

What is primary healing vs secondary healing?

A

Primary:
- healing that occurs because of the injury itself

Secondary:
- response to the healing that is done by the healing process via inflammation

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5
Q

What does hemostasis include?

A

Stops the bleeding

Includes:
- vasoconstriction
- clot formation
- cells drawn to area via growth factors (fibroblasts)

0-6/8 hours

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6
Q

What is the difference between highly vascular vs less vascular structures when it comes to bleeding?

A

Highly vascular bleeds longer than those that are less vascular

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7
Q

What does the inflammatory phase do and what does it include?

A

Cleans up wound site

Stimulated by chemical mediators of the bleeding stage
Main mediators:
- histamine
- bradykinin
- prostaglandins

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8
Q

What is the inflammatory resolution?

A

Neutrophil apoptosis -> macrophages gobble up dying cells -> macrophages switch jobs and secrete cytokines and help regen tissue

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9
Q

What are the clinical signs during the inflammatory phase?

A
  • redness, swelling, heat
  • loss of function
  • pain at rest or w/ active movement
  • potential muscle guarding
  • pain w/ passive movement before tissue resistance
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10
Q

What is the main management in the acute phase of an injury?

A

Protective phase
- control pain, edema, and inflammation
- restore full ROM, prevent atrophy, maintain soft tissue integrity
- enhance function

Use PRICEMEM

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11
Q

What does PRICEMEM stand for?

A
  • protection
  • rest
  • ice
  • compression
  • elevation
  • manual therapy
  • early motion
  • medications
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12
Q

What does the proliferation phase do and how long does it last?

A

4-22 days (Peak at 2-3 weeks)

Rebuilds damaged structures and strengthens wound

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13
Q

What marks the peak of the proliferation phase?

A

2-3 weeks after injury when bulk of scar material is formed

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14
Q

What are 2 ways tissue is grown?

A

1) regeneration: regrowth of original tissue
2) Repair: formation of scar tissue (connective tissue)

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15
Q

What are the processes that take place in the proliferation phase?

A
  • Epithelialization (reestablishes the epidermis)
  • Collagen production (type III -> type I)
  • Wound contraction
  • Neovascularization (angiogenesis)
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16
Q

What are the clinical signs during the proliferative phase? Lets you know you are IN the proliferation phase

A

1) decrease in pain
2) erythema resolved
3) no active effusion (could have residual swelling)
4) increase in pain-free AROM/PROM
5) pain is present w/ passive movements at point of tissue resistance

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17
Q

What is the management like during the proliferation phase?

A

Controlled motion phase of rehab
GOAL: create a strong extensible scar
- protect forming collagen
- direct collagen orientation
- prevent cross-linking & scar contracture
- modify faulty joint mechanics

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18
Q

What are the intervention approaches during the proliferation phase of rehab?

A
  • educate patients about s/s of overstressing healing tissue
  • transition from passive interventions toward progressive stress of tissue
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19
Q

What is the mechanism that helps tissues heal through loading?

A

mechanotransduction

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20
Q

What is the 3-step process in mechanotransduction?

A

1) mechanocoupling: mechanical trigger
2) cell to cell communication: distribution of the message
3) effector cell response: tissue factory that produces & assembles

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21
Q

How long is the remodeling phase and what does it do?

A

few days to 2 years

modifies scar tissue into mature form

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22
Q

What is included in the remodeling phase of healing?

A

Process of collagen turnover: reabsorption and deposition
- fibroblast synthesize, deposit, and remodel ECM

new collagen is thicker, stronger, and more organized

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23
Q

Will scar tissue be back to normal strength?

A

NO
- in 3 weeks = 30% strength
- in 3 months = 80% strength

will NEVER be 100% again

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24
Q

What are the clinical signs during the remodeling phase? lets you know you are in the remodeling phase

A

1) progressed to pain-free function & activity
2) pain is felt at end range of PROM AFTER tissue resistance is met

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25
What is management like in the remodeling phase?
*Return to function phase* GOAL: restore big picture movement related to activity - progressive increase speed and neuromuscular control
26
What are some causes and contributing factors to chronic inflammation?
- overuse, repetitive strain, and cumulative trauma - trauma with subsequent microtrauma - scarring - imbalance between length and strength of muscles - muscle weakness - excessive repeated eccentric demand
27
What are some local factors affecting healing?
- type, location, size of injury - infection - vascular supply - movement (early vs late)
28
What are some systemic factors affecting healing?
- age - disease (diabetes, autoimmune) - medications - nutrition - hormones
29
Which tissues have the lowest to the highest healing potential?
- cartilage - meniscus/disc - ligament - tendon - bone - muscle
30
What is the basal lamina?
- scaffold in the muscle for healing
31
What are satellite cells in muscle?
- muscle stem cells
32
What are some properties of muscle tissue?
- makes body mobile and gives stability - viscoelastic properties (creep, stress, strain)
33
What are some factors that affect muscle performance under load?
- age - temperature - immobilization
34
What is the difference between a strain and a sprain?
- strain = muscle - sprain = ligament
35
What are some MOIs of muscles?
- excess strain/stretch - excess tension - blunt force/contusion - laceration - disease - prolonged disuse
36
What are the muscle phases of healing?
Destruction -> Repair -> Remodeling
37
What is included in the destruction phase of muscle healing?
- necrosis of damaged muscle tissue - factors released and hemostasis/inflammation response - hematoma & edema begin - leukocytes activate satellite cells
38
What is included in the repair phase of muscle healing?
- hematoma formed - inflammatory cells arrive and satellite cells continue proliferation - new myofibers form - neuromuscular junction reestablished (as best as possible)
39
What is included in the remodeling phase of muscle healing?
- regenerated tissue matures and tensile strength increases - scar contracts and reorganized - type III -> type I ratio improved
40
What are different ways a contusion can form?
- blunt trauma - myositis ossificans (calcified hematoma) - hematoma (inter OR intramuscular)
41
Where does most of the damage occur during a muscle strain?
at the musculotendinous junction
42
What happens to the concentric force of a muscle after a strain?
- force reduction of 10-30% which lasts for hours
43
What happens to the eccentric force of a muscle after a strain?
- force reduction of 50-60% which lasts for 1-2 weeks
44
What type of tissue changes occur with a muscle strain that occurs during a concentric/eccentric muscle contraction?
Concentric: - NO damaging effects Eccentric: - damage to sarcomere - disrupts extracellular matrix - intramuscular edema - increase in creatinine kinase
45
What classifies a grade 1, 2, or 3 degree strain?
Grade 1: - only few musculotendinous fibers torn - pain only w/ limited swelling - no loss of function Grade 2: - disruption of moderate number of fibers - increased pain - some loss of strength and function Grade 3: - complete rupture of some musculotendinous units - loss of function with little pain - MT junction site - less pain
46
What are some clinical signs of muscle injury?
- sudden onset of trauma - pain during ecc activation - localized tenderness over MT junction - weak/painful w/ strength testing - possible swelling or ecchymosis
47
What is the best course of management of a strain in the protective phase?
*0-2 wks* - PRICEMEM - PROM, AAROM, AROM
48
What is the best course of management of a strain in the controlled motion phase?
*2-4 wks* - AAROM, AROM, flexibility - submax isos -> multiangle submax isos -> multiangle max isos - propriception/balance activities - corrective exercise of biomechanical deficiencies
49
What is the best course of management of a strain in the return to function phase?
*4-6 wks* - endurance/strength concentric -> eccentric - general return to activity - speed, power, agility exercises
50
What do tendons look like and what are they made of?
- glistening white - collagen fibers tightly packed into bundles with elastin (2%) - ECM is made of proteoglycans and GAGs - avascular and aneural
51
Where do tendons get their nutrients from?
- osteotendinous junction and myotendinous junction
52
What are some of tendons properties?
- transmit force from muscle to skeleton - store and release elastic energy - high tensile strength - responds to adaptive loading (mechanotransduction is required for homeostasis) - VERY slow healing after injury
53
How do tendon injuries occur?
Loading: - suddenly - repetitively - rapid unloading Overuse loads: - tension + compression - shearing + friction - fascicle on fascicle
54
What are some intrinsic factors for tendon injury?
- high body weight - malalignments, imbalances, weakness - gender - age
55
What are some extrinisc factors for tendon injury?
- excess volume, speed, magnitude of loading - abrupt change to amount or type of load - poor equipment - medications - prolonged immobilization
56
What are common types of injuries in tendons?
- rupture - laceration - overuse (tendinopathies)
57
What is tendinopathy and how does it occur?
Blanket term for tendon conditions arising from overuse 1) cumulative trauma 2) weakened collagen cross-links 3) degraded ECM and vascular elements
58
What are the 4 overlapping stages of chronic tendon injuries?
1) tendinitis 2) tendinosis 3) complete rupture 4) tendinosis w/ other changes (fibrosis or calcification)
59
What is the difference between tendinitis and tendinosis?
Tendinitis: - pain, swelling, dysfunction of tendon - tendon is inflamed Tendinosis: - degeneration of tendon structures - pain is not always present
60
What are the 4 main histological changes involved with tendinosis?
- angiofibroblastic hyperplasia - disorganized + immature collagen - hypercellularity + increased ground substance - increase of neurochemicals
61
What are some indicators of tendinosis?
- thickened - yellow-brown or grey tendon - partial/complete rupture - disorganized - adhesion of para- & epi- tendon
62
What are some clinical signs of tendon injury?
- well localized w/ little referral beyond tendon - strong but painful response to load - pain w/ stretch or palpation - pain resolves quickly when load is withdrawn
63
What are good ways to manage reactive/early disrepair phase of a tendon?
- relative rest and education - anti-inflammatory modalities - address kinetic chain - rest between sessions - NSAIDs
64
What are good ways to manage late disrepair/regeneration phase of a tendon?
Encourage collagen synthesis - Ecc and conc exercise - static stretching - address kinetic chain - cross friction massage - rest between sessions

MSK 1 (4 decks)

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