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MSK lower body > VIVA > Flashcards

VIVA Flashcards

(93 cards)

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1
Q

what are the healing stages (tissue)?

A

inflammation, proliferation, remodelling

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2
Q

what happens in the inflammation stage of tissue healing (vascular)?

A

hyperaemia
vasodilation
exudation
leukocytes

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3
Q

what happens in the inflammation stage of tissue healing (cellular)?

A

phagocytosis
lymphocytes orchestrate immune response
fibroblasts build tissue

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4
Q

what is hyperaemia

A

increased blood flow to the area

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5
Q

what is vasodilation?

A

widening of blood vessels

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6
Q

what is exudation?

A

leaking of proteins and fluids from capillaries to tissues

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7
Q

what chemicals are released in inflammation?

A

prostoglandins, histamine, bradykinins

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8
Q

what is phagocytosis?

A

phagocytes (neutrophils, monocytes, macrophages) engulf foreign bodies to prevent infection

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9
Q

what happens in the proliferation stage of tissue healing?

A

fibroplasia
angiogenesis
myofibroblasts

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10
Q

what is fibroplasia?

A

formation of fibrous tissue (granulation tissue)

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11
Q

what do fibroblasts secrete?

A

collagen III, PGs and fibronectins

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12
Q

what is angiogenesis?

A

creation of blood vessels

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13
Q

what promotes angiogenesis?

A

hypoxia and chemical messengers from inflammation phase

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14
Q

what are myofibroblasts?

A

derived from fibroblasts, make wound smaller

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15
Q

what happens in the remodelling phase of tissue healing?

A

collagen III -> collagen I
reduced cellular and vascular content, increased fibrous content
orientation of fibres along lines of stress

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16
Q

what do the tissue healing stages mean for rehab?

A

inflammation - rest, ice, protect
proliferation - ROM, isometric
remodelling - strengthen

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17
Q

how long do the healing stages take in muscle repair?

A

inflammation - 0-4 days
proliferation - 4 days - 4 weeks
remodelling - 4-12 weeks

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18
Q

what happens in fracture healing?

A

inflammation and haematoma
soft callus
hard callus
bone remodelling

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19
Q

what happens in inflammation/haematoma phase of fracture healing?

A

haematoma - ruptured blood vessels
necrotic bone endds
influx of migrating cells
exudation, phagocytosis
osteoclasts resorb dead bone ends
fibroblasts proliferate
angiogenesis

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20
Q

what is the soft callus?

A

cartilaginous phase
fibroblasts become collagenblasts, chondroblasts, osteoblastsw

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21
Q

what is the hard callus?

A

calcium salts laid down to form immature bone
soft callus undergoes endochondral ossification to become woven bone

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22
Q

what happens in the remodelling phase of fracture healing?

A

consolidation - new haversian systems, growth of blood vessels, more osteoblasts.
woven bone -> mature bone
strengthened along lines of stress

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23
Q

what is the time scale for fracture healing?

A

inflammation and haematoma 0-10 days
soft callus 25 days - 2-3 weeks
hard callus 8-12 weeks
remodelling 1-2 years

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24
Q

why do tendons take longer to heal than bones?

A

heavier collagen make up
longer and more complex remodelling process
less tolerant of stretching, quicker, sharper forces and varied loads

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25
what happens in tendinopathy?
overload tenocytes change shape more PGs and GAGs, swelling and inflammation, increase in pain inducing chemicals more collagen III, less collagen I (disorganised, reduced tensile strength) new blood vessels and nerve fibres - increased pain sensitivity
26
why shouldnt you use NSAIDs in tendinopathy?
delays recovery - decreases hormone that triggers inflammation which is needed for healing
27
what is the tendinopathy continuum theory?
cook and purdem reactive tendinopathy tendon dysrepair degenerative tendinopathy
28
what is reactive tendinopathy?
tenocytes change shape, increased PGs and GAGs, tendon thickens to reduce stress
29
what is tendon dysrepair?
tendon dysrepair - not offloaded, increased PGs and GAGs, disorganisation of collagen. increased vascularity and nerve fibres, increased pain sensitivity
30
what is degenerative tendinopathy?
degenerative tendinopathy - irreversible changes, cell death, disorganised matrix, more susceptible to rupture
31
what happens in OA?
articular cartilage changes subchondral bone synovial membrane
32
what are the articular cartilage changes in OA?
loss of PGs, increase in water content, cartilage softening, loss of cartilage thickness, reduced joint space
33
what happens to subchondral bone in OA?
hardening of subchondral bone, increased type I collagen, increased osteoblastic activity, osteophytes (bony spurs)
34
what happens to the synovial membrane in OA?
synovitis / inflammation due to cartilage breakdown
35
what are the british athletic grade for a muscle injury?
MRI changes, anatomical location
36
what are 0-4 muscle injury grades?
0-DOMS 1-small injury/tearing 2-moderate injury/tearing 3-extensive injury/tearing 4-full tear
37
what are A-C muscle injury gradings?
A - myofascial B - muscle-tendon junction C - intratendinous
38
what are 3 predisposing factors for muscle injuries?
two joint muscles muscles contracting eccentrically muscles with higher proportion of type II fibres
39
why are two joint muscles more at risk of injury?
motion at joint increases passive tension and leads to overstretching
40
why are muscles more at risk of tear during eccentric exercise?
lengthening under tension
41
why are muscles with more type II fibres more at risk of tear?
low endurance
42
what are type II fibres?
fast twitch. fast, powerful, explosive, high fatiguability
43
what is the SLR test (neural?)
passive SLR positive if radicular pain below knee / pain at 30-70 degree hip flexion/back pain (disc herniation)
44
why does pain increase in SLP with neck flexion / ankle DF?
stretches nerve
45
how to bias sciatic nerve in SLR?
DF
46
how to bias tibial nerve in SLR?
DF + eversion
47
how to bias sural nerve in SLR?
DF + inversion
48
how to bias peroneal nerve in SLR?
PF + inversion
49
what is radicular pain caused by
compression/inflammation of the nerve root which triggers ectopic firing of the nerve signals from the dorsal root causing a sharp shooting pain along the nerve pathway
50
what is radicular pain feel like?
sharp shooting thin band
51
what is somatic pain caused by?
nociceptive afferent signals that may converge to shared spinal neurons, sometimes causing pain to be referred to distal areas
52
what does somatic pain feel like?
dull, aching, difficult to localise
53
what is radiculopathy?
where conduction down the nerve root is reduced / blocked
54
what are the symptoms of radiculopathy?
loss of nerve function - reduced dermatomes / myotomes / reflexes
55
what is the pain gate theory?
non painful stimuli (like rubbing it better) activates A beta fibres, inhibits transmission of pain signals (closes the gate) to reduce pain
56
what are some complications of fracture healing?
DVT - blood clot complex regional pain syndrome - ANS changes, burning, swelling, sweating compartment syndrome - increased pressure, reduced blood flow. 5 p's
57
what outcome measure would you use for hip OA and what is it?
HOOS hip disability and OA outcome score
58
why is GTPS more common in post menopausal women?
oestrogen has anabolic effect on tendon health improving collagen synthesis and tensile strength. reduced oestrogen increases risk of tendinopathy (cowan et al 2022)
59
what is coxa vara and why can it lead to GTPS?
reduced femoral neck shaft ankle. increases hip adduction angles, greater compressive load
60
what outcome measure would you use for GTPS?
side bridge test Visa-G
61
what outcome measure would you use for hamstring tear?
single bridge test
62
what outcome measure would you use for patella tendinopathy?
visa p questionnaire
63
what outcome measure would you use for PFPS?
AKPS
64
what did barton et al say about PFPS?
multimodal treatment pain relief empowerment (active) education strengthen glutes and quads
65
what outcome measure would you use for ACL tear?
KOOS
66
what are the 6 stages of post op care after ACL reconstruction (melbourne)?
pre op - swelling, ROM phase 1 - recovery - ROM, swelling phase 2 - strenght and neuromuscular control - balance phase 3 - running, agility, landings phase 4 - RTS phase 5 - prevention of reinjury
67
what outcome measure can you use for meniscus tear?
KOOS
68
what outcome measure can you use for achilles tendinopathy?
VISA-A
69
what outcome measure can you use for hallux valgus?
manchester oxford foot questionnaire
70
what is the pathophys of spondylosis?
degenerative changes in the intervertebral discs, vertebra and facet joints usually begin in the discs. decreased PGs and GAGs, reduced water content, decreased mechanical resistance increased stress on vertebral bodies and facet joints formation of osteophytes
71
what can cause radiculopathy?
mechanical pressure - disc herniation, facet joint irritation, tumour chemical irritation
72
what is a disc herniation?
nucleus pulpous protrudes through annulus fibrosis
73
what are the stages of a disc herniation?
bulge/degeneration - annular fibres are in tact protrusion - localised bulging, some damage to annular fibres extrusion - extended bulge with loss of annular fibres but disc in tact sequestration - fragment of disc broken from nucleus pulpous
74
what outcome score would you use for back problems?
oswestry disability index
75
what is spondylolisthesis?
one vertebra is anteriorly displaced compared to the vertebra below. most common L4/5
76
what are the grades of spondylolisthesis?
1 - 0-25% 2 - 25-50% 3 - 50-75% 4 - 75-100% 5 - totally displaced (spondyloloptosis)
77
what is spondylolisthesis dysplastic?
congenital defect of facets (upper S1 or lower L5 facets). adolescence, phalen dickson sign
78
what is spondylolisthesis isthmic?
repeated extension causes pars interarticularis fracture
79
what is spondylolisthesis degenerative?
compromised intersegmental stability caused by aging, degenerative disc disease, OA
80
what is the phalen dickson sign?
lumbar lordosis flexed hips bent knees tight hamstrings waddling gait
81
what does the HOOS questionnaire assess?
pain, symptoms, ADLs, sport and recreation, function, QoL
82
what do the visa questionnaires assess?
pain, function, sport
83
what does MOFQ assess?
pain, walking/standing, social interaction
84
what does AKPS assess?
anterior knee pain scale specific to PFPS 13 questions on pain and function
85
what does the oswestry disability score assess?
10 sections pain, personal care, lifting, walking, sitting, standing, sleeping, social life, travelling, employment gold standard for low back pain disability assessment
86
why would you use start back tool instead of oswestry disability score?
quicker and easier guides initial treatment includes psychological factors
87
what is HAGOS
hip and groin outcome score similar to HOOS but also includes participation better for young and athletic patients
88
what does KOOS assess?
pain, symptoms, ADLs, sport and recreation, QoL validated by research Collins 2016
89
where does the pain come from in inflammation?
chemical mediators sensitise nociceptors
90
what can you do to help swelling?
ice, compression, elevation
91
how do compression and elevation help?
help venous return
92
does ice help?
reduces swelling but interrupts healing
93

MSK lower body (7 decks)

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