Intro To Ortho Ue Exam 1: Reptar

Front 1

A key to optimal glenohumeral joint motion [during elevation] is

Back 1

that the head of the humerus remains centered in relationship to the glenoid as motion occurs at the shoulder joint

Front 2

Guiding Concepts of Musculoskeletal (Orthopedic) Assessment

Back 2

-Understand your patient (occupations, environments/contexts)
-Understand typical posture and movements/biomechanics
-Understand the mechanism of injury (formulate a diagnosis)

Front 3

Guiding Concepts of Musculoskeletal (Orthopedic) rehabilitation

Back 3

-Understand and apply knowledge of soft and hard tissue healing
-Manage inflammation and pain (modalities, meds, application of protection/rest as needed)
-Gain Range of Motion at the joint(s)
-Gain muscle length and strength / restore normal posture
-Gain normal movement (movement re-education)
-Address return to function/occupations through exercise, activity, and adaptation (if needed)

Front 4

Acute or Traumatic Injuries characteristics

Back 4

-Sudden onset
-Unexpected in nature
-Typically related to a single act
-Know the location and position of the injured part, and you can usually predict the structure(s) involved

Front 5

Chronic / Cumulative injuries characterstics

Back 5

-Occur over time
-Associated with sustained postures or repetitive activity
-Tougher to pin down; the person often can’t recall the mechanism of injury
-Work-related/Leisure activities/Sleep positions

Front 6

optimal scapular positioning

Back 6

-Vertebral border is parallel to the thoracic spine and is about 3 inches from the midline of the thorax
-Is situated between T2 and T7
-Is flat against the thorax and rotated 30 degrees anterior to the frontal plane

Front 7

optimal humeral positioning

Back 7

-Less than 1/3 of the humeral head protrudes in front of the acromion.
-in neutral rotation so that antecubital fossa faces anteriorly and the olecranon faces posteriorly, palm faces body
-Proximal and distal ends of humerus are in same vertical plane

Front 8

short and long mm. for thoracic kyphosis

Back 8

short- possibly rectus abdominus

long- thoracic extensors

Front 9

short and long mm. for downward rot scapula

Back 9

short- LS, rhomboids

long- UT

Front 10

short and long mm. for upward rot scapula

Back 10

short- UT

long- no long muscle

Front 11

short and long mm. for depressed scapula

Back 11

short- pec major, lat dorsi

long- UT

Front 12

short and long mm. for elevated scapula

Back 12

short- (superior angle elev) > Levator scap
(acromion elevated) > upper trap

Front 13

short and long mm. scapula adducted

Back 13

short- rhomboids, middle trapezius

long- SA

Front 14

short and long mm. scapula abducted

Back 14

short- SA, pec major

long- rhomboids, middle trap

Front 15

short and long mm. tipped or tilted scapula

Back 15

short- pec minor, biceps brachii

long- low trap

Front 16

short and long mm. winged scapula

Back 16

short- subscapularis

long- SA

Front 17

short and long mm. anterior humeral glide

Back 17

short- Pec major, infraspinatus, teres minor, stiff post. Capsule

long- subscapularis

Front 18

short and long mm. Humeral superior glide

Back 18

short- Deltoid, infraspinatous, teres minor, teres major and subscap, joint capsule stiff

long- Rotator cuff muscles are weak (not necessarily long)

Front 19

short and long mm Shoulder medial rotation

Back 19

short- Pec major, latissimis dorsi, lateral rotators may be stiff if scapula is abducted or depressed

long- Infraspinatous and teres minor may be long (if scapular position is correct)

Front 20

short and long mm. Glenohumeral hypomobility

Back 20

short- All scapulohumeral muscles, Joint capsule stiff

long- SA and LT, Cuff is weak

Front 21

fixation definition

Back 21

surgical union of bone fractures, typically involving orthopedic hardware, such as plates, screws, wires, or other such devices.

Front 22

synovectomy definition

Back 22

removal of the synovial lining of a joint

Front 23

menisectomy definition

Back 23

partial or complete removal of a joint meniscus

Front 24

osteotomy definition

Back 24

cutting of a bone or creating a surgical fracture

Front 25

arthrodesis definition

Back 25

fusion of a joint

Front 26

arthroplasty definition

Back 26

resurfacing / construction of a new joint

Front 27

bone grafts definition

Back 27

promote union of a fracture, fuse a joint, or to fill a defect in a bone

Front 28

arthroscopy definition

Back 28

to look within the joint,” and is a surgical procedure orthopedic surgeons use to visualize, diagnose, and treat problems inside a joint.

Front 29

all soft and hard tissues contain

Back 29

collagen

Fibroblasts produce collagen

Front 30

type 1 cartilage

Back 30

tendons, ligaments, bone, organ capsules, skin, fibrous cartilage, and fascia

Front 31

type 2 cartilage

Back 31

hyaline cartilage and elastic cartilage

Front 32

type 3 cartilage

Back 32

earliest collagen laid down in the healing process (the “spare tire” of collagen)

Front 33

4 phases of soft tissue healing

Back 33

Hemostasis
Inflammation / Reaction Phase
Regeneration Phase
Remodeling Phase

Front 34

hemostasis time frame

Back 34

immediately following injury and lasts for a few minutes.

Front 35

Inflammation/ Reaction Phase of Healing time frame

Back 35

immediately following injury and usually ends in three days (but may last longer if mechanism of injury not removed)

Front 36

goal of inflammation

Back 36

increase the movement of plasma (exudate) and blood cells into the tissues surrounding the injury to facilitate ‘clean up’ and then repair

Front 37

3 types of inflammation

Back 37

-Acute: continues until the body eliminates the threat; can last up to 14 days
-Chronic: occurs if inflammation persists longer than two weeks
-Granulomatous: the body attempts to “wall off” and isolate the infected site

Front 38

Fibroblastic or Regeneration Phase of Healing time frame

Back 38

begins 3 – 4 days post injury and can last up to 3 weeks

Front 39

resolution definition

Back 39

when tissues are injured, but able to regenerate via mitosis. Restoration of original structure and physiologic function are achieved

Front 40

repair definition

Back 40

the replacement of destroyed tissue with scar tissue, which is composed of collagen. Most soft tissues heal via repair. Type III first laid down, then absorbed and replaced by Type I collagen

Front 41

prolonged inflammation increases the

Back 41

the number and activity of fibroblasts: i.e. the longer inflammation persists, _more_scar tissue develops (the greater the risk for tissue fibrosis).

Front 42

Remodeling or Maturation Phase of Healing time frame

Back 42

Time frame: begins at about two weeks and can last up to two years

Type III collagen is absorbed, and Type I laid down in its place.

Front 43

for moderate to severe injuries, what is the weakest point for the wound in the healing process?

Back 43

at three to four weeks

Front 44

Davies’ Law for Soft Tissues

Back 44

Soft tissues remodel in response to the mechanical demands placed on them

Front 45

immobilization __the tensile strength of ligaments, tendon, etc

Back 45

decreases

Front 46

- exercise, weightbearing, and continuous motion (active, passive) __the tensile strength of tissues (healing or normal tissue

Back 46

increases

Front 47

exercise or motion, if introduced too early, can

Back 47

stretch out healing tissues, leaving them essentially functionless

Front 48

contusions/bruises characteristics

Back 48

due to a direct blow with increasing muscle trauma and tearing proportional to the severity of trauma

Capillary rupture from the injury can lead to hematoma formation and ecchymosis visible externally

Front 49

Exercise induced injury characteristics

Back 49

-delayed muscle soreness due to increased/unaccustomed activity, etc

-Usually dissipates within 24 to 48 hours

Front 50

tendinitis characteristics

Back 50

-global term to indicate inflammation of tendon tissue, usually related to overuse and associated with abnormal biomechanics
-If caught in the early stages, tendinitis may resolve in as few as three weeks
-with more chronic problems, if the mechanism of overuse or abnormal biomechanics are corrected, tendinitis may resolve in six to eight weeks

Front 51

strains definition

Back 51

-occurs usually as a result of sudden, forced motion causing the muscle/tendon to stretch beyond normal capacity

-Overuse or repetitive trauma can cause strains

Front 52

Grade 1 stain definition

Back 52

-occurs at the cellular level, with no gross disruption of the muscle-tendon unit
-Minimal localized swelling and contusion, with some tenderness but no loss of strength in the injured unit or loss of motion in the adjacent joints

Front 53

RROM Testing results grade 1 strain

Back 53

Strong and Painful

Front 54

recovery time grade 1 strain

Back 54

between 2 and 21 days between 2 and 21 days

Front 55

grade 2 strain definition

Back 55

some degree of gross disruption of the muscle-tendon unit, resulting in moderate edema and bruising, significant loss of strength in the muscle, limitation of active motion in the adjacent joints

Front 56

mild, moderate, and severe grade 2 strain characteristics

Back 56

mild: 1 - 25% of tissue disrupted, mild loss of strength
moderate: 25 - 75% tissue disrupted, moderate loss of strength
severe: 75 - 99% tissue disrupted, significant loss of strength

Front 57

RROM testing results grade 2 strains

Back 57

-Strong and painful for mild grade II
-Weak and painful for severe grade II
-Strong or weak and painful for moderate grade II (depends on percentage of fibers torn)

Front 58

healing time grade 2 strains

Back 58

between 20 and 90 days, depending on the degree of injury

Front 59

grade 3 strain definition

Back 59

complete rupture of the muscle or tendon unit. Extensive edema and bruising with balling of the muscle or a significant change in the contour of the muscle and complete loss of function specific to the injured muscle/tendon

Front 60

grade 3 strain RROM testing results

Back 60

Weak and painless

Front 61

grade 3 strain recovery time

Back 61

Healing time is between 50 and 180 days. Surgical intervention is dependent on the injured muscle...some muscles are not surgically reunited

Front 62

avulsions definition

Back 62

the bony insertion of the tendon fractures away from the bone to which it inserts. The muscle and tendon may be intact, or injured to some degree. The tendon is usually the last to tear… the muscle or the bony insertion will mostly likely give way before the tendon.

Front 63

Complications to Muscle and Tendon Injuries

Back 63

Contracture
Myositis Ossificans
Compartment Syndrome
Adhesions

Front 64

contracture complication characteristics

Back 64

-most common complication of muscle or tendon injuries, with 75 per cent of the shortening occurring in the tendon versus the muscle

-If the therapist can decrease initial inflammation, contractures will not occur at immobilized joints for up to six weeks

Front 65

Compartment Syndrome characteristics

Back 65

-Usually associated with crushing injuries to muscle that produce significant inflammation and edema within the fascial compartment
-Since the fascia does not “give” the edema produces pressure inside the compartment
-Blood vessels collapse under this pressure, resulting in ischemia and subsequent necrosis of tissues within the compartment

Front 66

adhesion complication definition

Back 66

-Scar tissue binds down the tendon to surrounding tissue, not allowing for smooth gliding of the tendon.

-Occurs with excessive inflammation, or with tissues that were mobilized too late

Front 67

manual therapy effectiveness characteristics

Back 67

Manual therapy is an effective adjunct to musculoskeletal rehabilitation, and it is most effective when combined with other treatments, particularly exercise

Front 68

Manual therapy has been proven to:

Back 68

reduce pain
relax muscles in spasm
lengthen shortened muscles
improve ROM
Optimize posture / biomechanical alignment
improve fxn

Front 69

depth of penetration for Cold (cold packs, ice massage)

Back 69

1.0 – 2.0 cm

Front 70

depth of penetration for cold vapocoolant sprays

Back 70

< .5 cm

Front 71

depth of penetration for Superficial heat (hot packs)

Back 71

1.0 cm

Front 72

depth of penetration for Ultrasound (1.0 MHz)

Back 72

up to 5.0 cm

at intensity of 1.5 – 2.0 W/cm2

Front 73

depth of penetration for Ultrasound (3.0 MHz)

Back 73

1.0 – 2.0 cm

at intensity of 0.5 W/cm2

Front 74

mysositis ossificans definition

Back 74

calcifications occur at the site of injured muscle,

Front 75

Sprain characteristics

Back 75

-injury to a ligament that occurs when forces stretch some or all of the fibers beyond their elastic limit, producing some degree of rupture
-usually accompanied by soft tissue swelling, changes in ligament contour, and possible dislocation or subluxation of the involved joint

Front 76

blood supply of ligaments characteristics

Back 76

-When compared to other tissues, ligaments have a relatively fragile blood supply
-Although less vascularized than tendon, some degree of repair is possible via collagen formation (this is highly dependent on the degree of sprain).

Front 77

grade 1 sprain

Back 77

-involves microscopic stretching or minimal tearing of a few fibers, with no gross disruption of the ligament. -Localized swelling and tenderness is apparent over the injury site
-Some ligament fibers are torn, but no demonstrable loss of the integrity of the ligament

Front 78

grade 1 sprain return to activity

Back 78

Pain primarily dictates whether the person can perform an activity, and return to full physical activity usually occurs within 10 days to 2 weeks

Front 79

PROM grade 1 sprain

Back 79

stress to the injured ligament is _painful_, but there is _little loss of structural integrity_

Front 80

grade 2 sprain characteristics

Back 80

-Some degree of gross disruption of ligament occurs with many but not all of the ligament fibers are torn, and there is clinical evidence of joint instability
-patient feels pain along the course of the intact portion of the ligament
-Stress testing reveals some laxity, and pain on testing

Front 81

grade 2 sprain mild, moderate, and severe characteristics

Back 81

mild: 1 - 25% of tissue disrupted, mild instability
moderate: 25 - 75% tissue disrupted, moderate instability
severe: 75 - 99% tissue disrupted, significant instability

Front 82

PROM grade 2 sprains

Back 82

stress to the injured ligament is painful, with structural integrity dependent on degree of injury

Front 83

return to activity grade 2 sprains

Back 83

Pain dictates whether the person can perform an activity; return to full physical activity usually occurs within 10 days to 2 weeks. More severe sprains may take 5 weeks -2 months for return to activity

Front 84

grade 3 sprain characteristics

Back 84

–complete rupture of the ligament with loss of structural integrity
-This disruption occurs at the bony attachments (avulsion fracture) or within the substance of the ligament
-typically the muscles around the joint must provide stability

Front 85

PROM testing grade 3 sprain characteristics

Back 85

shows _major instability_, with _no pain_in the ligament, but _possible pain_from injury to surrounding tissue

Front 86

grade 3 ligament healing time

Back 86

Ligamentous healing times vary, depending on which ligament was injured, the degree of injury, and the vascular supply to the area. Healing times range from 7 weeks to 18 months

Front 87

Interventions to Influence Inflammation and Reduce Pain

Back 87

-Medications
Steroids and NSAID’s for inflammation (and pain)
Numerous pharmaceutical avenues to address pain
-Modalities
Superficial heat (reduces pain, not inflammation)
Superficial cold
Ultrasound
-Rest, compression, and/or elevation
-Combination of all of the above

Front 88

Integrating Manual Therapy with Other Treatment Strategies

Back 88

-You should never perform manual therapy in isolation
-Always prescribe at least one stretch for the muscle(s) you treated
-Consider prescribing a strengthening exercise for the muscle’s antagonist
I-ncorporate short-term taping for postural correction

Front 89

subluxation definition

Back 89

some part of the articular surfaces are still in contact

Front 90

dislocation definition

Back 90

articular surfaces are no longer in contact with each other

Front 91

sratum fibrosum characteristics

Back 91

-Composed of dense fibrous tissue, histologically similar to ligament
-Primarily Type 1 collagen
-Varies in thickness - thin membrane -> strong ligamentous band
-Can be an effective check to prevent motion
-Attached to periosteum by Sharpey’s fibers
-Poorly vascularized but highly innervated

Front 92

stratum synovium characteristics

Back 92

-Generally 1 - 3 cells in depth, with cells loosely arranged in sheets
-Highly vascularized but poorly innervated (insensitive to pain, but responds to changes in temperature)
-Produces the hyaluronic acid component of synovial fluid.
-Removes debris from within the joint space

Front 93

joint capsule blood supply

Back 93

-Comes from branches off arteries that provide blood supply for muscles that cross the joint
-Comes from periosteal blood supply and from sub-chondral bone

Front 94

Joint Capsule Innervation 2 primary sources

Back 94

-articular nerves branching from adjacent peripheral nerves
-branches from nerves that supply muscles controlling the joint

Front 95

type 1 joint receptors

Back 95

– postural / proprioceptive
-Located in the stratum fibrosum; numerous
-static and dynamic joint position sense
-sense speed and direction of movement
-regulation of postural muscle tone
-slow adapting; low threshold

Front 96

type 2 joint receptors

Back 96

-dynamic / kinesthetic
-Located in the stratum synovium and fat pads; sparse
-sense changes in speed of movement and change of direction of joint
-regulate muscle tone at beginning of and during movement
-rapidly adapting; low threshold

Front 97

type 3 joint receptors

Back 97

- inhibitive
-Located in the stratum fibrosum and in ligaments
-sense direction of movement
-regulation of muscle tone during potentially harmful movements (stretch at end range)
-very slow adapting; high threshold

Front 98

type 4 joint receptors

Back 98

-nociceptive
-Located in the stratum fibrosum, ligaments, articular fat pads, and periosteum
-pain receptors
-responsive to mechanical deformation or tension; mechanical or chemical irritation
-inactive under “normal” conditions
-high threshold, non-adapting

Front 99

truma to joing capsule types

Back 99

Acute/traumatic injury
Chronic/overuse/cumulative trauma injury
Surgically-induced
Sustained postures / habitual movement patterns

Front 100

Joint Capsule Response to Trauma: Phases of Healing for Moderate to Severe Injuries (acute, sub-acute, sub-acuter to chronic, chronic)

Back 100

Acute: days 1-3
Sub-acute: days 3-4 to weeks 3 - 4
Sub-acute to chronic: days 14 - 60
Chronic: days 60+

Front 101

thermal effects of continuous ultrasound

Back 101

-Increases collagen extensibility
Excellent adjunct to joint mobilization (lab practical # 1)
-Alterations in blood flow
-Changes in nerve conduction velocity
selectively heats peripheral nerves
may alter or block impulse conduction (including pain)
increase membrane permeability
increase tissue metabolism
-Increase pain threshold
-Increase local metabolism

Front 102

non thermal effects of pulsed ultrasound

Back 102

-Increased membrane permeability
accelerated ion diffusion
increased intracellular calcium
-Increased rate of protein synthesis by fibroblasts
-Increased macrophage responsiveness
-“[Pulsed] ultrasound is particularly effective during the inflammatory phase of repair…”

Front 103

Prolonged Inflammation ( ) the number and activity of fibroblasts: i.e. the longer inflammation persists, more ( ) develops.

Back 103

Prolonged Inflammation increases_ the number and activity of fibroblasts: i.e. the longer inflammation persists, more_ scar tissue develops.

Front 104

best phase of healing to increase ROM?

Back 104

Sub-acute phase of healing

Treatment to increase joint ROM and function - very effective (possibly too effective)

Front 105

Capsular patterns of the Upper Extremity- GH joint

Back 105

External rotation > Abduction > Internal Rotation

Front 106

Capsular patterns of the Upper Extremity- elbow/humeroulnar

Back 106

flexion > extension

Front 107

Capsular patterns of the Upper Extremity- elbow/humeroradial

Back 107

equal loss of pronation and supination

Front 108

Capsular patterns of the Upper Extremity- wrist

Back 108

equal loss of flexion and extension

Front 109

Capsular patterns of the Upper Extremity- MP, PIP, and DIP joints

Back 109

flexion > extension

Front 110

Development of Capsular Fibrosis/Adhesions generally due to:

Back 110

-Resolution of an acute articular inflammatory process
-A chronic, low grade articular inflammatory process
-Immobilization of a joint

Front 111

US heats tissues with high absorption coefficients generally those with ( ) a collagen content

Back 111

high collagen content

Joint capsule and ligament are comprised mostly of collagen

Front 112

joint mobilization definition

Back 112

-A form of manual therapy
-Use of graded oscillatory mobilizations and/or sustained traction to relieve pain, stretch capsular tissue, and/or break up adhesions

Front 113

joint mobilization used to:

Back 113

-Stimulate receptors to relieve pain
-Gain range of motion at the joint
-Gain optimal arthrokinematics by _restoring accessory motions_at the involved joint(s)

Front 114

Accessory Motions definition

Back 114

Movements within the joint and surrounding tissues that are necessary for full ROM but cannot be performed actively by the patient.
-Spin
-Roll
-Glide/slide
-Compression
-Distraction/traction

Front 115

most common indication for joint mob

Back 115

Pain

Joint Hypomobility - majority of the time you are treating a capsular pattern

Front 116

history/interview before joint mob includes asking about:

Back 116

presence of contraindications or precautions

Front 117

Your physical examination (PE) before joint mob consists of an assessment of all:

Back 117

accessory motions at the joint, including the joint above the suspected area of restriction, and the one below. (Keep moving to the next proximal or distal joint if stiffness is noted in those joints.)

Front 118

During joint mob, your treatment targets only those accessory motions that are

Back 118

diminished with joint mobilization (determined in your PE)

Front 119

Maitland’s Grades of Oscillatory Mobilization Grade 1 characteristics

Back 119

Grade I: Small amplitude movement at beginning of range > used to treat _pain

Front 120

Maitland’s Grades of Oscillatory Mobilization Grade 2 characteristics

Back 120

Grade II: Large amplitude movement within range (but not at end of range) > used to treat _pain_

Front 121

Maitland’s Grades of Oscillatory Mobilization Grade 3 characteristics

Back 121

Grade III: Large amplitude movement up to limit of range > used to treat _pain_and _increase ROM_

Front 122

Maitland’s Grades of Oscillatory Mobilization Grade 4 characteristics

Back 122

Grade IV: Small amplitude movement at limit of range > used to _increase ROM

Front 123

Maitland’s Grades of Oscillatory Mobilization Grade 5 characteristics

Back 123

Grade V: High velocity thrust at limit of range > used mainly to _increase ROM_but can _decrease pain_once greater ROM is achieved

Front 124

Grades of Sustained Traction /Mobilization- Grade 1 characteristics

Back 124

Traction Grade I: small amplitude with no appreciable movement > used to treat _pain_

Front 125

Grades of Sustained Traction /Mobilization- Grade 2 characteristics

Back 125

Traction Grade II: sustained movement within ROM to the restriction (taking up the “slack”) > used to treat _pain_and to __gain ROM_

Front 126

Grades of Sustained Traction /Mobilization- Grade 3 characteristics

Back 126

Traction Grade III: sustained movement at end of range through the restriction > used to _increase ROM_

Front 127

During joint mob, when a restrictive barrier occurs:

Back 127

-loss of range of motion is apparent
-a new pathological neutral is established

Front 128

During joint mob importance of restrictive barrier

Back 128

-You should always examine accessory motions in the joint’s neutral (also known as loose-packed) position.
-These concepts are essential for the application of other manual therapy techniques.

Front 129

Joint mob treatment- pain before resistance

Back 129

Begin Oscillation Grade I progress to Grade II or use TX I

Front 130

Joint mob treatment- pain and resistance

Back 130

Oscillation Grade II progressing to Grade III or IV (if tolerated) or use TX I or TX II

Front 131

Joint mob treatment- resistance before pain

Back 131

Oscillation Grade III to Grade V or TX II to TX III

Front 132

Most critical events with regard to musculoskeletal development happen between the ( ) and ( ) weeks of gestation

Back 132

4th and 8th weeks

Front 133

At ( ) weeks, the synovial joints develop

Back 133

14 weeks

Front 134

At ( ) weeks, the skeleton is as ossified as it will be prior to birth

Back 134

20 weeks

Front 135

wolff's law for hard tissues

Back 135

Hard tissues remodel in response to the mechanical demands/stresses placed on them

Front 136

Epiphyseal plates fuse between what ages?

Back 136

the ages of 21 and 25 years

Front 137

periosteum characteristics

Back 137

-The dense fibrous membrane that covers all bones, except for joint surfaces (which are covered with articular cartilage).
-outer layer- blood vessels and nerve fibers
-inner laywer- contain osteoblasts

Front 138

osteomalacia characteristics

Back 138

-“Softening of the bones” occurs as a result of decreased deposition of calcium in the bone, and an increased production of unmineralized matrix
-bone is more likely to deform rather than fracture
-Commonly associated with Vitamin D deficiency

Front 139

osteoporosis characteristics

Back 139

-decrease in qualitatively normal bone, which renders the individual more susceptible to fractures.
-imbalance between bone resorption and bone formation.
-Results when the body has not obtained adequate calcium from the environment.
-Results when mechanical load on the bone is insufficient for the development of new bone.

Front 140

Type 1 osteoporosis characteristics

Back 140

-"Postmenopausal Osteoporosis”
-Decrease in mineral density that occurs when circulating estrogen levels decrease
-Affects primarily trabecular bone and is most prevalent among 55-70 year olds

Front 141

type 2 osteoporosis characteristics

Back 141

-“Age-related Osteoporosis”
-Affects men and women equally
-Occurs usually after age 70
-Equal loss of trabecular and cortical bone

Front 142

common fractures associated with osteoporosis

Back 142

Vertebral Body
Femoral Neck
Distal Radius

Front 143

Ten Commandments of Osteoporosis Prevention

Back 143

1. Adequate vitamin D intake
2. Get enough calcium in a balanced diet
3. Limit caffeine, salt, protein, and phosphorous
4. Don’t go on starvation diets
5. Exercise regularly
6. Hormone replacement following menopause
7. Take estrogen if your ovaries have been surgically removed
8. Avoid drugs that decrease bone mass (such as long term use of steroids)
9. Drink alcohol in moderation
10. Don’t smoke

Front 144

A fracture ________produces some degree of soft tissue injury

Back 144

always

Front 145

fracture healing stages

Back 145

1. Impact Stage
2. Induction Stage
3. Inflammation Stage
4. Soft Callus Stage
5. Hard Callus Stage
6. Remodeling Stage

Front 146

impact stage (1) characteristics

Back 146

occurs at the moment of injury and lasts until there is complete dissipation of energy

Front 147

induction stage (2) characteristics

Back 147

-following bony failure, cells possessing osteogenic potential are stimulated to form bone
-Periosteal and intraoseous osteoblasts around the area of the break are activated, and large numbers of new osteoblasts are formed

Front 148

inflammation stage (3) characteristics

Back 148

begins shortly after impact and lasts until the bone ends are united by fibrous union, formed by increased osteoblast activity producing new organic bone matrix (occurs during the first and second weeks)

Front 149

Soft callus stage (4) characteristics

Back 149

-occurs when inflammation begins to subside and the bone ends become "sticky", and are held together by fibrous tissue and cartilaginous tissue (approximately 2-3 weeks)
-minerals that comprise the inorganic component of bone are beginning to be deposited in the fibrous matrix
-Osteoclasts begin to appear in large numbers and absorb portions of dead bone fragments
-Pain is greatly decreased by this time
-callus is not yet apparent on x-ray

Front 150

Hard callus stage (5) characteristics

Back 150

-the callus continues to be "sticky" and is considered an "osteogenic sleeve" around the fracture fragments
-converts from fibrocartilaginous tissue to fiber bone
-bone begins to mature as mineralization continues and the callus begins to be absorbed by osteoclasts. -fracture fragments are firmly united by bone.
-callus is apparent on x-ray, and the fracture is considered to have undergone clinical union. (Occurs at approximately _3 to 5 weeks_).

Front 151

Stage of remodeling (6) characteristics

Back 151

-occurs when the fracture is healed, and the diameter of the bone is nearing pre-injury size
-callus has been or is close to being completely reabsorbed.
-fracture has undergone radiographic union
-fiber bone is converted to lamellar bone and the medullary canal is reconstituted
-usually occurs at __6 to 8 weeks_however, remodeling can last up to a few years before it is complete

Front 152

Only tissue to heal without a scar?

Back 152

bone

Front 153

Fracture management characteristics

Back 153

-Non-intervention
-Closed Reduction: external realignment of fragments
Cast: a stress sharing device often used with closed reductions
-Open Reduction Internal Fixation (ORIF): surgical realignment of fragments, typically using some type of hardware (plates, screws, etc.)
-External Fixation
-Ilizarov and Debastiani Procedures

Front 154

casting characteristics

Back 154

-stress-sharing device
-allows for callus formation and thus relatively rapid bone healing
-joint above and the joint below the fracture are immobilized in the cast to prevent rotation and translation of the fracture fragments
-Early weight bearing is allowable if the fracture pattern is stable
-Occassionally weight bearing must be delayed until sufficient callus has developed to prevent displacement

Front 155

Wolff’s Law and Fixation Devices

Back 155

Fixation devices (both internal and external) will absorb a great deal of force, causing the surrounding bone to be less stressed, and thus less dense.

Front 156

Open Reduction Internal Fixation (ORIF) definition

Back 156

-surgical realignment of fracture fragments, with fragments being held in approximation by hardware such as plates, screws, pins, wires, nails, intramedullary rods, etc.
-Bone grafts may also be used with fractures in which the fragments are not in close proximity to each other

Front 157

External Fixation definition

Back 157

-Associated with more severe fractures
-applies hardware to hold aligned fragments in place, usually consists of an external frame to which are attached pins that are drilled through the various fracture fragments.
-Hoffman Devices
-Ilizarov and Debastiani Procedures

Front 158

cast type of fixation

Back 158

short of long

Front 159

cast biomechanics

Back 159

stress sharing

Front 160

cast type of bone healing

Back 160

secondary (callus)

Front 161

cast rate of bone healing

Back 161

fast

Front 162

cast weight bearing

Back 162

early

Front 163

most frequently used form of treament?

Back 163

cast

Front 164

rod type of fixation

Back 164

reamed or unreamed

Front 165

rod biomechanics

Back 165

stress sharing

Front 166

rod type of bone healing

Back 166

secondary (callus)

Front 167

rod rate of bone healing

Back 167

fast

Front 168

rod weight bearing

Back 168

early

Front 169

rod- reamed vs unreamed

Back 169

Reamed is most frequently used

unreamed often used in open fractures

Front 170

plate type of fixation

Back 170

compression

Front 171

plate biomechanics

Back 171

stress shielding

Front 172

plate type of bone healing

Back 172

Primary (no callus)

Front 173

plate rate of bone healing

Back 173

slow

Front 174

plate weight bearing

Back 174

late

Front 175

plate requires:

Back 175

secondary support

Front 176

pin, screw or wire biomechanics

Back 176

stress sharing

Front 177

pin, screw or wire type of bone healing

Back 177

secondary (callus)

Front 178

pin, screw or wire rate of bone healing

Back 178

fast

Front 179

pin, screw or wire weight bearing

Back 179

delayed

Front 180

pin, screw or wire are frequently used with

Back 180

other types of fixation

Front 181

external fixator type of fixation

Back 181

exoskeleton

Front 182

external fixator type of bone healing

Back 182

secondary (callus)

Front 183

external fixator biomechanics

Back 183

stress sharing

Front 184

external fixator rate of bone healing

Back 184

fast

Front 185

external fixator weight bearing

Back 185

early

Front 186

external fixator mostly associated with

Back 186

soft tissue injuries

Front 187

ilazarov type of fixation

Back 187

exoskeleton

Front 188

ilazarov biomechanics

Back 188

wolff's law

Front 189

ilazarov type of bone healing

Back 189

distraction osteogenesis

Front 190

ilazarov rate of bone healing

Back 190

approx. 1 cm per month

Front 191

ilazarov weight bearing

Back 191

early

Front 192

primary use ilazarov

Back 192

lengthen bones

Front 193

fracture healing complications

Back 193

-Vascular
-Neurological
-Avascular Necrosis: bone ischemia and/or death due to compromised circulation
-Joint Stiffness / Contracture
-Myositis Ossificans
-Degenerative Joint Disease (DJD): frequently associated with intra-articular fractures
-Effects of Immobilization: contracture, capsular fibrosis, muscle atrophy, altered biomechanics

Front 194

angiogram definition

Back 194

dye is injected into blood vessels and sometimes into the lyphatic system to assess patency of the vessels

Front 195

Myelogram definition

Back 195

injection of dye into the spinal canal and around nerve roots

Front 196

Bone Scan/Scintigram definition

Back 196

injection of radioactive isotopes that preferentially go to areas of greater circulation

Front 197

Computed Tomography (CT) definition

Back 197

uses x-rays to obtain sectional images or 3-dimensional reconstructions of body tissues. Better at rendering bony tissues

Front 198

Magnetic Resonance Imaging (MRI) definition

Back 198

uses no x-rays; instead, it uses a magnetic field to produce images. Better at rendering soft tissues.

Front 199

Ultrasound Image definition

Back 199

produced using high frequency sound waves, which are reflected differently depending on the density of the reflecting tissues

Front 200

most common images that occupational therapists and physical therapists will access to gather information about a patient's musculoskeletal problem(s)?

Back 200

radiographs

Front 201

Cardinal Rules for Making Radiographic Images

Back 201

-Images should include proper patient identification
-At the very least, take two views
-Include one joint
-Provide the best quality possible

Front 202

Cardinal Rules for Viewing Radiographic Images

Back 202

-Right patient, right procedure
-View the entire image
-Hang the radiograph as though the “person” is facing you
-If unilateral extremity, hang in anatomic position, facing you
-For hands and feet, hang digits-up
-Develop a pattern of scanning the entire image, ie: start at top left corner, scan left to right, all the way to the bottom of the image;
-Look at all tissues
-Apply your knowledge of “normal” anatomy to what you see and what you don’t see
-Avoid tunnel vision.... Don’t just look: See.

Front 203

AROM assesses

Back 203

patient willingness to move

Front 204

PROM assesses

Back 204

non contractile structures

an idea of how much ROM is present at the joint

Front 205

RROM assesses

Back 205

contractile structures, the muscle and tendon