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Ortho 1-first half > Soft tissue and post op > Flashcards

Soft tissue and post op Flashcards

(57 cards)

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1
Q

physiology of CT repair

A

affected by age, lifestyle, and systemic factors

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2
Q

microstructure of CTs

A
  • fibers (collagen, elastin)
  • ground substance (glycosaminoglycans)
  • cellular substances (fibroblasts, fibrocytes)

function of CTs depends on portions of intracellular and extracellular components

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3
Q

response to loading

A
  • Tensile loads-primarily resisted by collagen fibers
  • if tissue is elongated beyond 4%, plastic changes begin to occur (x-links begin to fail)
  • yield point is where increase in strain occurs w/o increase in stress
  • cyclic loading produces microstructural damage that accumulates with each cycling loading cycle
  • failure from cyclic loading=fatigue failure
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4
Q

viscoelastic properties

A

creep and relaxation allow CTs to adapt and function in a variety of loading conditions without being damaged

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5
Q

creep

A

tissue lengthens in response to a constant load

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6
Q

relaxation

A

amount of force necessary to maintain new length decreases

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7
Q

phases of healing

A
  • needed to formulate a plan of care
  • allows for matching the loading capability to intervention
  • understanding provides the tools to treat a variety of injury and surgical conditions
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8
Q

characteristics phase 1 healing- inflammatory response

A

3-5 days

  • palpable pain, tenderness, swelling
  • release of chemical substances (protaglandins, bradykinin)
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9
Q

treatment of phase 1 healing

A
  • decrease pain and inflammation

- maintain mobility and strength of adjacent joints and soft tissues if possible

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10
Q

characteristics of phase 2 healing- repair and regeneration

A
  • up to 8 weeks
  • new collagen forming (primarily type 3)
  • edema is resolved during this phase
  • bone-callus phase
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11
Q

treatment of phase 2 healing

A
  • focus on normal tissue relationships, optimal loading
  • changes become habitual in this stage!
  • ROM exercises and joint mobilization, WBing
  • end of this stage-mobility and strength base should be established
  • bone-limited activity allowed
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12
Q

characteristics of phase 3 healing- remodeling and maturation

A
  • deposition of type 1 collagen (end of phase 2)

- decreased synthetic activity and extracellularity

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13
Q

treatment of phase 3 healing

A
  • tension/resistance becomes more important in orientation of collagen
  • normal loading is necessary for bone remodeling - Wolff’s law
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14
Q

restoration of normal tissue relationships

A

after CT injury, relationship and integrity of tissues are altered

possible interventions:

  • active muscle contractions
  • passive joint motion
  • mobilization
  • stretching
  • begin preventative interventions as early as healing process allows!
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15
Q

optimal loading

A

**chose tx procedures that don’t disrupt the healing process

requires:

  • choosing a load that doesn’t under or overload the tissue
  • considering biomechanical effects of daily activities
  • understanding of mechanism of injured tissue loading
  • individual factors- age, tissue quality, nutrition, fitness
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16
Q

signs of overload

A

1: increased pain that doesn’t resolve within the next 12 hours
2: pain that is increased over the previous session or comes on earlier in the exercise session
3: increased swelling, warmth or redness in the injury area
4: decreased ability to use the part

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17
Q

specific adaptations to imposed demands (SAID)

A
  • includes QUANTITY and TYPE of activity
  • extension of Wolff’s low
  • guides exercise rx parameters
  • stage of healing and optimal loading parameters closely reflect the specific demands on the pt’s functional tasks
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18
Q

prevention of complications

A

GOAL: minimize effects of immobilization while an injury is healing

  • e-stim or isometric contractions
  • AROM at joints above and below injury sites
  • WB exercises when feasible to load articular cartilage and prevent degradation
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19
Q

Sprain

A

acute injury to a ligament or joint capsule without dislocation
-may resolve with short term immobilization, controlled activity and rehab exercises

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20
Q

sprain classification

A

grade I: mild, ligament is stretched, no discontinuity

grade II: moderate, some fibers stretched/torn, some joint laxity

grade III: severe, complete ligament disruption with resultant laxity

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21
Q

sprain examination and evaluation

A

-observation to assess ecchymosis and edema
-observe functional ROM, AROM and PROM
-assess joint integrity and mobility
laxity-manual/instrument
instability- apprehension/instability
-palpation to identify primary and secondary injuries- surrounding joints and soft tissues

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22
Q

strain

A

musculotendinous injury
=acute injury to the muscle or tendon from an abrupt or excessive muscle contraction

-usually a result of a quick overload to the muscle-tendon unit whereby the tension generated > tissue’s capacity

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23
Q

strain classification

Study These Flashcards
A

1: mild
2: moderate
3: severe

based on clinical examination- pain, edema, loss of motion, tenderness

24
Q

contributing factors to strain

Study These Flashcards
A

poor flexibility
poor warm up exercise
insufficient strength or endurance
poor coordination

25
strain exam and eval
- thorough history - palpation- ms/tendon junction, muscle belly - reproduce clinically through active or resisted contraction- ms may need to be put on stretch - localized swelling and warmth may be observed
26
application of treatment principles for phase I healing
Principle: optimal loading; prevent secondary complications Loading zone: balance of rest and loading Modalities: cryotherapy w/ compression/elevation Exercise intervention: Isometric contractions
27
application of treatment principles for phase II healing
Principle: restore normal tissue relationships; prevent complications Loading zone: loading is important- orientation of collagen fibers Modalities: Joint mobs; stretching; massage; postural education Exercise intervention: contraction of lengthened ms in shortened range
28
application of treatment principles for phase III healing
Principle: fine tune; convert baseline strength and mobility into functional movement patterns Loading zone: graded, progressive exercise is necessary to maintain improvements Modalities: pt maintenance program; postural education, stretching; strengthening, etc Exercise intervention: more whole body patterns and functional activity
29
Tendinitis and tendon injuries
- failure occurs due to micro- or macrotrauma - outcomes are lengthy BUT predictable - categories/classifications have evolved
30
classification of tendon injuries
1: macrotrauma: 2: microtrauma: 3: tendinosis
31
macrotrauma
commonly occur at musculotendinous junction
32
microtrauma
paratendinitis (inflammation of outer layer of tendon)
33
tendinosis
degeneration w/o inflammatory response
34
tendinitis
symptomatic degeneration of tendon with vascular disruption and an inflammatory response
35
exam and eval of tendon injuries
- history and subjective symptoms are of primary importance (acute/chronic, CT/localized inflammation, onset/predisposing factors) - ROM, muscle performance, posture, joint integrity, mobility tests - observe structural or postural abnormality - document nodules, palpable defects, crepitus
36
treatment principles and procedures for tendon injuries
- tx based on specific tendon injury - restoring length, strength: fundamental - stretching (low load) if muscle length is inadequate - if inflammation is present- consider cold packs, estim, into - eccentric activities: slow/light -> fast/heavy - appropriate rehab activities (w/ appropriate modifications)
37
classification of cartilage injuries
mechanical non-mechnical: infection, inflammatory conditions, prolonged jt immobilization
38
exam and eval of cartilage injuries
- cause of damage - area of damage - classification/health of cartilage - general health - lifestyle factors - body weight - joint alignment - ROM - ms performance - joint integrity - mobility
39
treatment principles of cartilage injuries
- Primary goal= restoration of motion - freedom of motion - equitable load distribution - stability - increased muscle performance and normalization of gait
40
contusion
- results from a blow and can occur in any area of the body - blood vessels below skin become damaged - accumulation in deeper tissues (hematoma) may develop - if untreated, may progress to myositis ossifications
41
exam and eval of contusions
- history of "blow" provides best info - size, location, and direction lend a window into location and extent of soft tissue injury - palpation, joint mobility, ms performance, flexibility, and function tests help guide tx procedures
42
treatment principles for contusions
- simple contusions resolve in a timely manner - use & monitor measures of pain, muscle length, muscle performace to guide aggressiveness of treatment - ROM must be restored as quickly as possible - use ice to control swelling and local inflammation - restore muscle performance - submax isometrics may be initiated in early stages
43
management of impairments associated with fractures
fracture=break in the continuity of bone
44
classification of fractures
1: open fractures: breaks through skin surface 2: closed fractures: doesn't break skin 3: nondisplaced: all sides of fx remain in anatomic alignment 4: displaced: the ends of the bones are not in anatomic alignment
45
types of fractures
``` transverse spiral oblique-transverse/butterfly oblique comminuted metaphyseal compression ```
46
application of treatment principles for fractures
- consider associated soft tissues - healing of fx is primary - rehab of soft tissue may be more challenging
47
fracture intervention
- tx focuses on recovery of initial trauma, rehabing tissues that were immobilized - initially-gentle jt mobilization, stretching - decrease loading when indicated (stress fx) - gentle strengthening (isometrics) - NMES, SEMG-feedback for atrophy - as impairments improve, incorporate activities to alleviate remaining functional limitations **keep loads w/in optimal zone!
48
soft tissue procedures
- ligament reconstruction - tendon surgery - debridement - synovectomy - decompression - soft tissue stabilization and realignment - meniscal and labral repairs
49
bony procedures
- debridement/abrasion chondroplasty - osteochondral autograft transplantation (OAT) or (mosaicplasty) - autologous chondrocyte implantation - open reduction and internal fixation - fusion - osteotomy
50
primary goal of joint arthroplasty
PAIN RELIEF | -generally, any increase in ROM, strength, function is secondary to pain relief
51
joint arthroplasty is categorized by..
- component design- constrained/unconstrained - fixation: cement vs biological (cementless) - materials: metals vs plastics (hybrids)
52
rehab considerations for joint arthroplasty
- rehab is joint and prosthesis specific - restore motion, strength, function - address underlying cause of surgery as well as adjacent joints
53
total knee arthroplasty (TKA)
unicompartmental (partial) arthroplasty (UKA) -replaces WB surface secondary to OA, RA, trauma rehab considerations: - CPM - early protected WB w. ADs - monitor for infection, effusion, DVT post op - acute-> SNF ->home care -> OP
54
total shoulder arthroplasty (TSA)
common precautions: - avoid hyperextension/anterior capsule stretch - avoid aggressive IR stretch of ER movement - avoid WB and lifting
55
total hip arthroplasty (THA)
Cementless: believed to last longer; revisions difficulty Cemented: immediate stability (>70 y/o) - loosening via cracked, fragmented cement - bone resorption around implant Resurfacing: less risk of dislocation -younger, active patients (<60 y.o)
56
THA rehab considerations
Posterior surgical approach: - no hip flexion beyond 90 - no crossing the legs (hip ADD beyond neutral) - no hip IR past neutral Pt education: - put a pillow between legs if you lie on your side - sit only on elevated chairs or toilet seats - don't bend over from the hips to reach or tie shoes anterior hip approach: -positions that involve extreme hip extension and ER will dislocate the hip
57
summary
- composition and structure of CTs provide info regarding mechanical properties and function - unique viscoelastic characteristics are the result of fluid and solid constituent materials - when CTs are loaded, the stress of change per unit length gives info about the tissue's ability to withstand loads - stages of healing & knowledge of injury give clinical guidelines for intervention throughout care - restoration of tissue relationships, SAID principle, prevention of secondary complications-guide treatment - acute soft tissue injuries necessitate early intervention to avoid secondary complications - management of tendon injuries and prognosis varies according to injury classification - interventions used in tx of bony or surgical procedures should have foundations in basic science and require an understanding in anatomy and kinesiology of the area

Ortho 1-first half (10 decks)

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