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Musculoskeletal I > Soft Tissue Injury > Flashcards

Soft Tissue Injury Flashcards

1
Q

What 3 main factors contribute to connective tissue repair?

A
  • Age
  • Lifestyle
  • Systemic factors
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2
Q

What are the 3 microstructure components of connective tissues?

A
  • Fibers (collagen and elastin)
  • Ground substance (glycosaminoglycans)
  • Cellular substances
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3
Q

What microstructure properties have an affect on the function of connective tissues?

A
  • Proportion of intracellular to extracellular components
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4
Q

In what type of tissue is type I collagen found?

A
  • Bone
  • Ligament
  • Tendon
  • Fibrocartilage
  • Capsules
  • Synovial lining
  • Skin
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5
Q

In what type of tissue is type II collagen found?

A
  • Cartilage

- Fibrocartilage

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6
Q

In what type of tissue is type III collagen found?

A
  • Blood vessels
  • Synovial lining of tissues
  • Skin
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7
Q

In what type of tissue is type IV collagen found?

A
  • Basement membranes
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8
Q

What type of fibers primarily resist tensile loads?

A
  • Collagen
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9
Q

Beyond what degree of elongation does plastic change occur in collagen fibers? What causes the change?

A
  • Past 4%

- X-links fail

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10
Q

What is the yield point of a tissue?

A
  • The point at which an increase in strain occurs without an increase in stress
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11
Q

How do sub plastic changes result in damage over time?

A
  • Microstructural damage accumulates over each loading cycle
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12
Q

What is the failure caused by cyclic loading termed?

A
  • Fatigue failure
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13
Q

What type of fracture is caused by fatigue failure?

A
  • Stress fractures.
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14
Q

Describe the stress-strain curve of tissues.

A
  • Stress on y-axis, strain on x-axis
  • Curve rises to elastic limit (area under curve up to this point is elastic range)
  • Curve rises further to the yield point (area under this part of the curve undergoes microfailure)
  • Curve rises to its ultimate strength point, and then dips to the rupture strength
  • The plastic region stretches from the elastic limit to the ultimate strength, past which the tissue fails.
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15
Q

How is the stress-strain curve of glass or another brittle substance shaped?

A

The curve is a straight line with a combined elastic limit, ultimate strength, and rupture point.

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16
Q

As load is applied faster to cortical bone, what is the effect?

A

The bone has more of an elastic property.

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17
Q

What is creep?

A
  • Tissue lengthens in response to a constant load.
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18
Q

What is relaxation?

A
  • Amount of force necessary to hold length of tissue decreases
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19
Q

What do creep and relaxation allow?

A

Adaptation of connective tissues to adapt to loading conditions without being damaged.

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20
Q

What type of property does creep and relaxation demonstrate?

A

Viscoelastic.

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21
Q

What are the 3 characteristics of phase I of the inflammatory response?

A
  • Occurs for 3 - 5 days
  • Pain, tenderness, and swelling are palpable
  • Prostaglandins, bradykinins and other chemical substances are being released.
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22
Q

What are the 2 focuses of treatment during the acute stage of the inflammatory response?

A
  • Decrease pain and inflammation

- Maintain strength and mobility of adjacent joints/ soft tissue if possible

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23
Q

What is phase II of the inflammatory response?

A

Repair and regeneration.

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24
Q

What are the 4 characteristics of repair and regeneration?

A
  • Occurs up to 8 weeks
  • New collagen forms (primarily type III)
  • Edema typically resolves during this phase
  • Bony callus is formed
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25
Q

What are the 4 focuses of treatment during the repair and regeneration phase?

A
  • Regain normal tissue relationships; optimal loading (changes during this stage become habitual)
  • ROM exercises
  • Joint mobs
  • Weight bearing
  • Establish strength base
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26
Q

What is phase III of soft tissue repair?

A
  • Remodeling and maturation.
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27
Q

What are the 2 characteristics of remodeling and maturation?

A
  • Deposition of type I collagen

- Decreased synthetic activity and extracellularity

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28
Q

What are the 2 focuses of treatment during remodeling and maturation?

A
  • Tension/ resistance training (want to orient collagen(

- Normal loading to remodel bone correctly

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29
Q

What are 4 interventions for the restoration of normal tissue relationships?

A
  • Active muscle contraction
  • Passive joint motion
  • Mobilization
  • Stretching
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30
Q

When does restoration of normal tissue relationships begin?

A

As soon as healing allows.

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31
Q

What is the most important consideration when choosing the amount of load to apply to a healing tissue?

A

Do not disrupt the healing process.

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32
Q

What 4 considerations must be considered when choosing a load?

A
  • Don’t over or under load tissue
  • Consider biomechanical effects of daily activities
  • Understand the mechanism of injury
  • Individual factors (age, nutrition, fitness, etc.)
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33
Q

What are 4 signs of overload?

A
  • Increased pain unresolved within 12 hours
  • Pain increases over previous session, or presents earlier in exercise
  • Swelling, warmth, or redness increase in injured area
  • Decreased function
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34
Q

What is SAID?

A
  • Specific Adaptations to Imposed Demands
  • Extension of Wolff’s Law
  • Prescribe exercise according to optimal loading and specific demands of patient’s functional tasks
35
Q

How can the effects of immobilization be minimized while an injury is healing?

A
  • E-stim or isometric ocntractions
  • AROM above and below injury site
  • WB exercises to prevent joint/ cartilage degredation
36
Q

Describe a grade I, II, and III ligament sprain.

A

I: Mild, ligament stretched, no discontinuity
II: Moderate, some fibers stretched/ torn, some joint laxity
III: Severe, complete ligament disruption, with resultant laxity

37
Q

What is a strain?

A

An acute injury to the muscle or tendon from an abrupt or excessive muscle contraction.

(QUICK muscle overload)

38
Q

What is the clinical strain classification? What is the classification based on?

A
  • Mild
  • Moderate
  • Severe

Based on: Pain, edema, ROM deficiency, Tenderness

39
Q

Where can a muscle strain be palpated?

A
  • Muscle-tendinous junction

- Muscle belly

40
Q

Slide 26

A

Slide 26

41
Q

What are the 4 classifications of tendon injuries?

A
  • Macrotrauma
  • Microtrauma
  • Tendinosis
  • Tenditis
42
Q

Where does macrotrauma typically occur?

A

At the musculotendinous junction.

43
Q

Where does microtrauma typically occur?

A

Inflammation at the outer layer of the tendon.

44
Q

What is tendinosis?

A

Degeneration without inflammatory response.

45
Q

What is tendinitis?

A
  • Degeneration of tendon
  • With vascular disruption
  • Inflammatory response
  • Symptomatic
46
Q

What subjective information is important in tendinous injuries?

A
  • Acute or chronic?
  • Localized inflammation?
  • Onset?
  • Predisposing factors
47
Q

What tests should be performed for tendinous injuries?

A
  • ROM
  • MMT
  • Posture
  • Joint integrity
  • Mobility
48
Q

What can be palpated in tendinous injuries?

A
  • Nodules
  • Defects
  • Crepitis
49
Q

What are fundamental treatments in tendon injuries?

A

Restoring length and strength.

- Eccentric activities to begin

50
Q

What modalities should be considered for inflammation?

A
  • Cold packs
  • E-stim
  • Iontophoresis
51
Q

What are the classifications of cartilage injuries?

A
  • Mechanical

- Nonmechanical

52
Q

What are some examples of non-mechanical cartilage injury?

A
  • Infection
  • Inflammation
  • Joint immobilizaiton
53
Q

What are 10 objective and subjective features that should be assessed in cartilage injury?

A
  • Mechanism of injury
  • Area of damage
  • Classification/ health of cartilage
  • General health
  • Lifestyle factors
  • Body weight
  • Joint alignment
  • ROM
  • Muscle performance
  • Joint integrity
  • Mobility
54
Q

What are 6 goals of treatment of cartilaginous injuries?

A
  • Restore motion
  • Create freedom of motion
  • Distribute loads in joints equally
  • Increase stability
  • Increase muscle performance
  • Normalize gait
55
Q

What may occur in deeper tissues due to a contusion?

A
  • Collection of blood (hematoma)

- If untreated –> myositis/ ossificaitons

56
Q

What in a history provides the best information about a contusion?

A

The size, location, and direction of a significant “blow”.

57
Q

What manual techniques can help assess a contusion?

A
  • palpation
  • Joint mobility
  • Muscle performance
  • Flexibility
  • Funcitonal tests
58
Q

What must be restored ASAP in contusion injuries?

A

ROM.

59
Q

How can swelling and local inflammation be controlled in contusion injuries?

A

Ice.

60
Q

What can guide the aggressiveness of treatment in contusion injuries?

A
  • Pain
  • Muscle length
  • Muscle performance
61
Q

What exercise may be used in early stages to begin treatment in contusion injuries?

A

Submaximal isometric contractions.

62
Q

What are 4 classficiations of fractures?

A
  • Open
  • Closed
  • Displaced
  • Non displaced
63
Q

What may be injured in addition to bone in a fracture?

A

Associated soft tissue.

64
Q

What is the focus of fracture treatment?

A
  • Recovery of initial trauma

- Rehabilitating tissues that were immobilized

65
Q

What is the initial intervention for recovery from fracture (after immobilization)?

A
  • Gentle joint mobilization and stretching

- Gentle strengthening

66
Q

What are 7 soft tissue surgical procedures?

A
  • Ligament reconstruction
  • Tendon surgery
  • Debridement
  • Synovectomy
  • Decompression
  • Softtisue stabilization/ realignment
  • Meniscal and labral tears.
67
Q

What are 6 bony tissue surgical procedures?

A
  • Debridement/ abrasion chondroplasty
  • Osteochondral autograft transplantation (OAT/ mosaicplasty)
  • Autologous chondrocyte implantation
  • Open reduction and internal fixation
  • Fusion
  • Osteotomy
68
Q

What is the primary goal of treatment following a joint arthroplasty?

A
  • Pain relief
69
Q

What are 3 categories of joint arthroplasty?

A
  • Component design (constrained/ unconstrained)
  • Fixation (cement vs biological)
  • Materials (metals vs plastics)
70
Q

What should be addressed following pain in treatment following a joint arthroplasty?

A
  • Restore motion, strength, and function

- Address underlying cause of surgery as awell as adjacent joints

71
Q

What 3 conditions may lead to a TKA?

A
  • OA
  • RA
  • Trauma
72
Q

What treatments should be implemented early following a TKA?

A
  • Continuous passive motion

- Protected WB with an Assistive Device

73
Q

What should be monitored throughout treatment following a TKA?

A
  • Infection
  • Effusion
  • DVTs
74
Q

What health facilities will a patient with TKA progress through?

A
  • Acute
  • SNF
  • Homecare
  • Outpatient
75
Q

What are 3 common precautions for a Total Shoulder Arthroplasty?

A
  • Avoid hyperextension/ anterior capsule stretch
  • Avoid aggressive IR stretch or ER movement
  • Avoid WB and lifting
76
Q

What type of total hip arthroplasty is expected to last the longest?

A
  • Cementless
77
Q

What is the drawback of a cementless THA?

A
  • Revisions are difficult
78
Q

What type of THA is recommended for patients over 70? Why?

A

Cemented for immediate stability

79
Q

What are drawbacks of cemented THA?

A
  • Cement cracks and fragments, loosening the THA.

- Bone resorption around the THA

80
Q

What type of THA is recommended for active patients under the age of 60?

A

Resurfacing.

81
Q

What is the advantage of a resurfaced THA?

A

Less risk of dislocation.

82
Q

What are some precautions for a THA using a posterior surgical approach? How should the patient be educated?

A
  • No hip flexion beyond 90 degrees
  • No cross legs (adduction beyond neutral)
  • No hip IR past neutral
  • “Put a pillow between your legs if you lie on your side”
  • “Sit only in elevated chairs or toilet seats”
  • “Don’t bend over from the hips to reach objects or tie shoes”
83
Q

What positions should be avoided for a THA using the anterior approach?

A
  • Hip extension and external rotation

- Will dislocate the hip.

Musculoskeletal I (8 decks)

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