TherEx: tissue injury and healing

Question 1

mild injury; tissue not torn

Answer 1

strain

Question 2

strain refers to an injury at what unit

Answer 2

musculotendinous unit

Question 3

more severe than strain; tear of soft tissues

Answer 3

Sprain

Question 4

sprain refers to injury of a ___

Answer 4

ligament

Question 5

inflammation of tendon; resulting scarring or calcium deposits

Answer 5

tendinitis

Question 6

a pathology of chronic degeneration without inflammation

Answer 6

tendinosis

Question 7

inflammation of synovial membrane

Answer 7

tenosynovitis

Question 8

inflammation with thickening of a tendon sheath

Answer 8

tendovaginitis

Question 9

inflammation of a synovial membrane
-excessive synovial fluid in the joint or tendon sheath

Answer 9

synovitis

Question 10

-inflammation of a bursa
-synovial pocket inserted between a tendon and a bony prominence

Answer 10

bursitis

Question 11

where are the common dysfunctional bursa

Answer 11

Subacromial

Question 12

ballooning of the wall of a joint capsule
-RA

Answer 12

ganglion

Question 13

hemarthrosis

Answer 13

bleeding into a joint
severe trauma

Question 14

contusion

Answer 14

bruising from a direct blow
capillary rupture, bleeding
edema and inflammatory response

Question 15

dysfunction

Answer 15

-loss of normal function of tissue or region
-mechanical loss of normal joint play

Question 16

adhesion

Answer 16

-abnormal adherence of collagen fibers
-reduce elasticity of tissue
-immobilization, disuse, surgery

Question 17

contracture

Answer 17

-adaptive shortening of short tissue
-reduce mobility and flexibility
-immobilization, disuse, burns, spascity

Question 18

reflex muscle guarding

Answer 18

prolonged muscle contraction in response to a painful stimulus

contracting muscles against movement

Question 19

intrinsic muscle spasm

Answer 19

prolonged contraction of a muscle in response to the local circulation and metabolic changes

Question 20

muscle weakness

Answer 20

-neurogenic and myogenic factors
-direct insult to the muscle or inactivity

Question 21

myofascial compartment syndrome

Answer 21

increased interstitial pressure in a closed, nonexpanding myofascial compartment
-results in ischemia and causes tissue damage

Question 22

what is
-pain
-palpation
-stress to tissue
-joint end feel

at grade 1

Answer 22

-pain: mild within 24 hrs
-palpation: swell, tender
-stress to tissue: some pain
-joint end feel: normal

Question 23

what is
-pain
-palpation
-stress to tissue
-joint end feel

at grade 2

Answer 23

-pain: moderate, stops activity
-palpation: pain
-stress to tissue: pain
-joint end feel: increased mobility

Question 24

what is
-pain
-palpation
-stress to tissue
-joint end feel

at grade 3

Answer 24

-pain: severe
-palpation: can reveal defects
-stress to tissue: painless
-joint end feel: unstable

Question 25

when is the acute phase of inflammation

Answer 25

within 48 hrs up to 4-10 days

Question 26

5 cardinal signs of inflammation

Answer 26

pain heat red swell loss of function

Question 27

in acute stage: pain and impaired movement are a result from:

Answer 27

- altered chemical state that irritates the nerve endings - increase tissue tension due to edema or joint effusion - muscle guarding

Question 28

in the acute phase, what occurs from the actual trauma

Answer 28

cellular death coagulation phagocytosis

Question 29

PT goals and intervention - acute

Answer 29

-protection phase-early -control effects of inflammation (RICE) -prevent negative effects of rest

Question 30

what does RICE stand for

Answer 30

rest ice compression elevation

Question 31

how do you prevent negative effects of rest in acute phase?

Answer 31

-nondestructive movement-passive ROM -soft tissue mobilization -muscle setting with caution

Question 32

when is the subacute stage?

Answer 32

extends from inflammatory phase 48-72 hrs to 6-10 weeks

Question 33

what 3 processes are used for early (acute) tissue repair?

Answer 33

-angiogenesis -collagen formation -epithelialization

Question 34

what is angiogenesis?

Answer 34

growth of capillary beds into area

Question 35

what is collagen formation?

Answer 35

fibroblasts from extracellular matrix and synthesize immature collagen

Question 36

what is epithelialization?

Answer 36

wound surface is covered and contract

Question 37

what is granulation tissue?

Answer 37

connective tissue

Question 38

what does granulation tissue consists of?

Answer 38

fibroblast, collagen, capillaries

Question 39

what color is granulation tissue?

Answer 39

reddish granular mass of Connective tissue

Question 40

what does granulation tissue indicate?

Answer 40

formation of scar tissue

Question 41

PT goals and intervention in subacute phase

Answer 41

-controlled motion phase- intermediate -develop mobile scar -promote healing

Question 42

in subacute phase what range of motion for intervention?

Answer 42

AROM

Question 43

Goals to promote healing in subacute stage?

Answer 43

restrictive exercise AROM open/closed chain stabilization muscular endurance cardiopulm endurance

Question 44

what is the remodeling phase?

Answer 44

-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

Question 45

in chronic phase: tissue responses and characteristics include?

Answer 45

-maturation of connective tissue -contracture of scar tissue -remodeling of scar -collagen aligns to stress

Question 46

what are the clinical signs in remodeling phase?

Answer 46

-absence of inflammation -pain after tissue resistance

Question 47

PT goals in chronic stage?

Answer 47

-return to function -increase tensile quality of scar (progressive strengthening and endurance) -develop functional independence

Question 48

how long does it take wound closure for skin and muscles?

Answer 48

5-8 days

Question 49

how long does it take wound closure for ligament and tendon?

Answer 49

3-6 weeks

Question 50

normal ligament is what type of collagen

Answer 50

type 1

Question 51

after injury what type of collagen is the ligament?

Answer 51

type 3

Question 52

mature repaired ligament is ___% weaker than uninjured ligament

Answer 52

30-50%

Question 53

ligament laxity by week 3 pt can tolerate ____ tension

Answer 53

mild

Question 54

ligament laxity by week 6 the patient can do?

Answer 54

resume normal activities (low resistance)

Question 55

ligament laxity by week 12?

Answer 55

pt has regained almost max tensile strength

Question 56

where does partial tear and rupture of tendons most often occur?

Answer 56

musculotendinous junction or at tenoperiosteal junction

Question 57

what repair is done for a tendon injury for full return of function?

Answer 57

surgical repair if >50% diameter

Question 58

O2 consumption of tendons and ligaments is ____ times lower than that of skeletal muscles

Answer 58

7.5

Question 59

in proliferative stage of tendon healing what type of collagen synthesis predominates?

Answer 59

type 3 collagen

Question 60

how are collagen fibers oriented in proliferative stage of tendon healing?

Answer 60

randomly

Question 61

when does proliferative stage begin in tendon healing?

Answer 61

48-72 hrs

Question 62

when does remodeling begin in tendon healing?

Answer 62

6-8 weeks after injury can continue for yrs

Question 63

in remodeling how does collagen type change?

Answer 63

reduce type 3 increase type 1

Question 64

what collagen type is response for mechanical strength in remodeling?

Answer 64

type 1

Question 65

active tension of tendon across repair site in first ___ weeks results in a POOR OUTCOME

Answer 65

3

Question 66

why is it important to do PASSIVE exercises in direction of the uninjured tendon?

Answer 66

- minimizes peritendinous adhesion - assits in fiber orientation

Question 67

what is Wolff's Law?

Answer 67

-bone is deposited in sites with stress -bone cells align to withstand stress -stress in bones with WB or tension -lack of stress causes bone atrophy

Question 68

fracture repair stages in order

Answer 68

-inflammatory phase (1-2 wks) -reparative phase (soft --> hard callus) -remodeling phase

Question 69

soft callus formation occurs when?

Answer 69

1 wk after injury

Question 70

hard callus formation occurs when?

Answer 70

several weeks to months

Question 71

fracture healing time for children?

Answer 71

4-6 wks

Question 72

fracture healing time for adolescence?

Answer 72

6-8 wks

Question 73

fracture healing time for adults?

Answer 73

10-18 wks

Question 74

does UE or LE heal faster?

Answer 74

UE

Question 75

does distal or proximal heal faster?

Answer 75

distal

Question 76

does simple or complex fracture heal faster?

Answer 76

simple