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70 Cards in this Set
- Front
- Back
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Toe Region
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straightening of collagen fibers
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Elastic Range
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will return to original shape after stretch
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Plastic Range
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stretched fibers will not return to original length
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microtrauma = ?
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"overuse syndromes"
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repetitive maximal or submaximal tress (movement in the "elastic range") causes: ?
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Pathological microscopic tears or lesions -> inflammation and/or tissue malformation
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Microtrauma is responsible for ? percent of sports injuries
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30%-50%
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Currently accepted theories of DOMS?
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Eccentric contractions -> sarcomeres inhomogeneities + sarcolemma (membrane) disruption
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How do the results of eccentric contractions create DOMS?
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Disturbance in calcium homeostasis reduces ATP production-> reduces concentration of ATP
Intracellular concentration of calcium increases faster than calcium extrusion mechanisms can pump it out Cellular membrane disruption = cell death |
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Tendinitis
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inflammation of tendon or tendon sheath (occurence is rare)
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Tendinosis
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degeneration and deleterious changes in tendon without inflammation
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The problem of tendinopathy is most often accompanied by ?
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collagen disorganization and fiber separation by MUCOID OR LIPOID (INFERIOR) GROUND SUBSTANCE
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Tendinopathy may lead to or contribute to ?
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Complete or partial tendon rupture
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Chronic tendonopathy -> ?
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chronic tendonopathy -> fibrous adhesions -> diminished tissue strength and function
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Although cause and etiology are debatabe, recen opinions purport causes of tendinopathy related to: ?
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Eccentric contractions
malnutrition influence: decrease vitamin A, vitamin C, and copper -> decreased collagen synthesis and crosslinking |
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Inflammation Stage Treatment Implications in General Steps in the healing of tendon microtrauma pathology
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REST (activity cessation)
NSAIDs, oral corticosteroids |
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Fibroplastic Proliferation Pathology, Healing, and Objectives in General Steps in the healing of tendon microtrauma pathology
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increased rate of synthesis by fibroblasts
synthesized collagen fibers need to be aligned |
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Fibroplastic Proliferation Treatment Implications in General Steps in the healing of tendon microtrauma pathology
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stretching -> aligns collagen
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Effects of immobilization on injured tendinous tissue
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Protein degredation exceeds protein synthesis -> net decreased in collagen quality
Reduction in the number of collagen crosslink bonds Atrophy of tissues |
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Benefits of mobilization (movement) on injured tendinous tissue
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Improvement in collagen fiber type and fiber arrangement in the replacement
Greater number of crosslink bonds Better quality of ground substance in tendon |
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Common Therapies for Microtrauma
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NSAID drugs
Corticosteroids (oral and injection) Surgery |
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NSAID drugs as therapy for microtrauma
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Previous reviews conclude approximately 75% of studies show NSAID to be effective (decrease healing time and inflammation)
Other more recent studies show no measurable benefit of NSAIDs and approximately 50% of those using NSAIDs will have adverse side effects |
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Corticosteroids as therapy for microtrauma
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Oral Corticosteroids: short term use of such drugs appear helpful for some ailments but have now shown to be effective -> seldom prescribed
Coritcosteroid (Cortisone): Will reduce pain but usefulness in decreasing inflammation and healing time has not been proven May result in collagen disarray, inferior tissue quality, tendon rupture Possible side effects include skin depigmentation, atrophy at injection site, increased glucose in diabetics Used only after a 6 week trial of rest, NSAIDs, then reconditioning Allow 2-6 weeks after injection before reconditioning Avoid more than 3 injections Avoid injections just prior to competition (decreased pain = increased likelihood of injury exacerbation) |
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Surgery as therapy for microtrauma
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excision/debridement of damaged tissue - release and repair, etc
Replace bad scar with good scar - not always successful (70% to 90%) Does not remove microtraumatic injury stimulus - problems can reappear |
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Chondromalacia
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degeneration & inflammation of articular cartilage
usually affects the underside of the patella |
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Chondromalacia is more common in men/women?
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Women
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Causes of Chondromalacia
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Excessive running with tight hamstrings, calf muscles, and ITB -> pronation
Muscle imbalance resulting in tracking abnormality |
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Treatment of Chondromalacia
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ICE - NSAIDs
Orthotics to correct pronation |
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Patellar tendinitis
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degenration and/or inflammtion
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Characteristics of patellar tendinitis?
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most now agree that most tendon overuse injuries involve little inflammation
mucoid deposits (soft greenish brownish disorganized tissue) are present |
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Causes of patellar tendinitis
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excessive activity
improper mechanics of training Excessive weight on a person with a weight bearing lfestyle |
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Treatment of Patellar Tendinitis
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ICE -emphasis on rest
NSAIDs & corticosteroids have, for the most part, found to be ineffective |
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Patellar tendinosis
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note greenish brown mucoic appearance with tissue degeneration
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Achilles tendinosis
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mucoid or lipoid deposits between fibers
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true achilles tendonitis definition and treatment
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inflammation of paratenon
treated with RICE, orthotics to decrease pronation, NSAIDs |
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Stress Reaction
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sometimes seen on xrays as callus deposition
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Stress fracture
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clear callus deposition
easily seen on xray |
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stress fractures healing
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most stress fractures heal by themselves without clinical manifestation
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stress fracture symptoms
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tenderness & pain
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Tissue healing repair quality depends on
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quality and quantity of revascularization (angiogenesis) i.e. oxygen supply
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epidermis
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avascular but welll innervated 0.3mm to 1mm thick
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Healing of Lacerations, Abrasions, Punctures Inflammatory Phase
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Thromboplastin, hageman factor, and platelets produce platelet aggression
Surface Coagulation Completed - Granular tissue forms |
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Platelet aggression leads to what in the inflammatory phase of Healing of Lacerations, Abrasions, Punctures
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activation of compliment system
fibrin and fibronectin protective scab |
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Healing of Lacerations, Abrasions, Punctures
Inflammatory phase granular tissue formation |
Neutrophils begin to arrive within an hour of wounding
granulation tissue: capillary buds, fibroblasts, macrophages |
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Healing of Lacerations, Abrasions, Punctures fibroplastic (proliferatory) phase
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in extra cellular matrix, hyaluronic acid combines with fibronectin
fibronectin and hyaluronic acid -> scaffold or framework for cell migration |
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Healing of Lacerations, Abrasions, Punctures maturation phase
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clot lysis (early in phase)
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Capillary Angiogenesis step 2
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2. proteases released from activated endothelial cells degrade basement membrane
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Healing by first intention definition and effects
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use sutures
loss of parenchymal tissue -> decrease the amount of scar tissue healing occurs faster less chance of infection |
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Healing by second intention definition and effects
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unable to be closed
increased amount of scar tissue healing occurs slower greater chances of infection |
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Characteristics of scar tissue
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not as vascularized, flexible, elastic, or strong as original tissue
may form adhesions which connect adjacent organs may form contractures |
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classification of muscle injury
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first degree (mild)
second degree (moderate) third degree (severe) |
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muscle contusion -> ?
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blow to muscle -> fiber tearing -> hematoma
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Intermuscular hematoma
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bleeding between muscle fascia
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intramuscular hematoma
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bleeding within a fascia enclosed muscle bundle
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compartment syndrome
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hemorrhage -> increase pressure in muscle unit
most often result from severe contusions |
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General steps in the healing of muscle trauma
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inflammatory stage (days 0-2)
cell disruption -> hemorrhage |
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ligament characteristics
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ligaments are not densely innervated or densely vascularized
in bone-ligament structures ligament is the weakest link |
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ligament sprain classifications
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grade I - slight incomplete tear
grade II - moderate/severe incomplete tear grade III - complete tearing of one or more ligaments |
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ligament healing inflammatory stage
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0-4 days
protect and immobilize <48 hours light passive ROM exercise machines weight bearing exercise & mobilization ASAP |
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ligament healing fibroplastic proliferation stage
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(day 4 - weeks)
fibroplstic & angiogenic cells -> scar matrix decent tensile strength within 3 weeks |
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ligament healing remodeling maturation stage
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weeks to years
near maximum strenght reached within a year but NOT back to 100% of original |
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effects of immobilization on injured ligamentous tissue
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GOOD: less ligament laxity
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benefits of mobiliztion (movement) on inured ligamentous tissue
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ligament scars are wider, stronger, more elastic
in general weight bearing and mobilization are encouraged ASAP |
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tendon can still function with ?% of the fibers intact
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25%
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contributing factors to tendon rupture
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CORTICOSTEROID injections
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primary bone healing
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without external fibrocartilligenous callus formation
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secondary bone healing
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healing with a small gap between bone ends
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Steps in fracture healing step 1
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1. Hematoma formation & inflammatory phase (reparatve phase)
induction (stimulus for bone regeneration caused by decrease in oxygen -> bone necrosis (fractured bone becomes hypoxic immediately) inflammator response 2-9 days following injury neutrophils, macrophages, and lysosomes clear necrotic bone and other debris |
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steps in fracture healing step 2
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Fibrocartillagenous callus formation (referred to as reparative phase)
within 2-3 days these tissues span the break |
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steps in fracture healing step 3
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hard bony callus formation & ossification - last an average of 3 weeks (still in reparative phase)
osteoblasts form trabecullar bone along fracture periphery (exernal callus) ossification (mineralization) starts by 2-3 weeks in a NON IMMOBILIZED fracue more cartilage than bone is laid down fractures should be reduced (immobilized) withing 3-5 days |
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Compression of fractured bone seems to ? electronegativity
this presents as evidence for what? |
increases electronegativity
increased electronegativity -> increased rate of bone deposition this presents as a strong case for using internal or external fixation |
