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45 Cards in this Set
- Front
- Back
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The proper use of therapeutic exercise in the management of musculoskeletal disorders depends on the therapist being able to determine a pt's
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Impairments Functional limitations Disabilities
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Strain
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Overstretching, overuse, or overexertion of tendon/muscle
Less severe than a Sprain |
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Dislocation
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Displacement of a part, usually the bony partners in a joint that often involves secondary trauma to surrounding soft tissue
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Subluxation
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An incomplete of partial dislocation of the bony partners in a joint that often involves secondary trauma to surrounding soft tissue
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TENDINITIS
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Symptom degeneration of tendon w/ vascular disruption & an inflammatory response
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TENDONOSIS
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Degeneration w/o inflammatory response Chronic
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Hemarthrosis
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Bleeding into a joint, usually due to severe trauma
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Adhesions |
Abnormal adherence of collagen fibers to surrounding structures during immobilization, after trauma, or as a complication of surgery, which restricts normal elasticity and gliding of structures involved
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What are the stages of healing?
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Ligament Injuries Grade I
(Inflammation) 1-6 days |
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Ligament Injuries Grade II
(Proliferation phase) 2-4 days after injury -6wks |
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Ligament Injuries
Phase III: (Chronic) 2wks-18 mo. |
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Ligaments Injuries Phases
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Healings rate depending on: Extra-articular vs. Intra-articular lig Vascularity of lig |
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Define Angiogenesis
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Process of new growth of blood vessels
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What affects the healing process for ligament injuries?
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TORN LIG MUST BE IN CONTACT |
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What are the PT implications to healing ligaments?
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Grades I &II are most common/responds to nonsurgical tx.
Immobilization after injury/surgery can have negative effects. Exercise produces hypertrophy & ↑tensile strength Controlled motion & exercise stimulates lig repair Careful progression of exercises & PLOF Protect lig |
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What are the different bone cells?
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Microscopic Organization
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Normal, mature
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This type of bone structure is located in the diaphyseal portion of long bones and less than 30% porous. It is considered dense & unyielding, also called compact or cortical bone.
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Macroscropic organization
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Cancellous bone is less _________ with large surface area therefore has an increased metabolic activity. It is typically________% porous.
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dense; 50-90
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Bone Fractures Classifications depend on:
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Site of injury (proximal, distal)
Extent of injury (complete/incomplete) Direction of abnormality (2 or more frags) Relationship of fracture frags to each other (displaced/nondisplaced) Relationship of fracture frags to environments (open/closed) Complications (Delayed union, malunion, nonunion) |
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What are lengths of time does it usually take for bones to heal?
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*MD must evaluate healing clinically and radiologically |
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Bone treatment during immobilization
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Improve overall fitness, continue motion/use of non-affected side
Minimize muscle atrophy and improve when possible Protect healing structures Teach safe & effective mobility techniques Non-immobilized structures should be exercised Involved are can do isometrics |
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What is the P.R.I.C.E. method?
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P: Protection
R: Rest I: Ice C: Compression E: Elevation |
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Bone treatment post-immobilization
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Muscle atrophy ↓ ROM, flexibility, & jt play Consult MD for specific restrictions
P/t education for limitation; HEP Protection until healed Active exercises ↑ jt, soft tissue, strength, muscle endurance, improves cardiorespiratory fitness |
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What are the PT implications for bone fracture intervention?
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Passive ROM
Rehab tissues that were immobilized Gentle joint mobs Gentle strengthening (isometrics) ↓ Loading when indicated |
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Cartilage
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Articular cartilage is avascular and 2-4 mm thick. Resistant to wear and permeable
Poor response to healing |
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Cartilage healing
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Injury-Jt instability, degeneration, trauma, & immobilization
Healing & repair Superficial injury-poor healing Deeper-spontaneous healing properties |
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PT implications for cartilage healing
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Maintain close to normal ROM
May need reduce vertical compressive load (stairs climbing, squats) Restrict ROM to pain-free range/Isometrics |
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Cartilage Healing (Meniscus) depends on location on injury
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Red zone (peripheral); Red on red: good chance of healing
Red on white: questionable if healing will occur White zone (central area without good blood supply) White on white: healing is unlikely |
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Cartilage Healing: Meniscus PT IMPLICATIONS
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Progress in rehab dependent on whether meniscectomy or meniscal repair
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Define Meniscectomy
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ROM exercises & WB activities can usually begin immediately
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Meniscal Repair
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WB & ROM initiated in relation to healing tissues→ too soon will disrupt healing process
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Osteoarthritis Gen info
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Most common type of arthritis/painful/disabling jt disorder ↑ w/ age & is more common in women over 45 Associated risk factors: obesity, trauma infection, & repeated jt over use
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Osteoarthritis symptoms
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Primarily affects the articular cartilage
Affects WB jts (Hip, Knee, Spine, CMC, PIP, DIP) Symptoms: Pain w/ act., relieved by rest Stiffness in morning lasting 20-30 min Jt locking, cretius, effusion |
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Management of Osteoarthritis
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Obesity Addition of Vit A & D
Muscle weakness & repetitive motions or trauma contribute to the onset of OA Educate p/t about jt protection, health changes, and importance of exercise |
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Rheumatoid Arthritis (RA) General info
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Affects the synovial lining, which then expands, damaging the extracellular matrix, cartilage, & bone
Activates T cells secretes cytokines- ↑ activation of fibroblasts like cells & macrophages leading to breakdown of cartilage & bone |
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RA Symptoms
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Fatigue, weight loss, fever, & pain Swelling, tenderness, & stiffness in specific jts (fingers, hand)
Morning stiffness can last hours/all day Extra articular manifestation can affect the lungs, heart, blood vessels, eyes, skin, & other organs |
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Management of RA
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Prevent pain, deformities, loss of normal function, & loss of social, physical & work capabilities
Exercise routine w/ stretching & ROM exercises in pain-free ranges Implement dynamic exercise prevent contractures & muscular atrophy |
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Muscle Injury
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Type I: Direct/indirect trauma to muscle fibers w/o affecting extracellular matrix, blood supply, or innervation
Type II: Injury to a muscle tissue & nerve supply w/o affecting extracellular matrix or vascular supply Type III: Muscle fiber, matrix, nerve, & vascular supply damaged |
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What affects muscle healing?
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High vascularity-Speed of healing dependent Muscle injury-Neovascularization
Degradation of damaged tissue Tissue, repair w/ cytokines & growth factors Heterotopic bone formation-form outside bone Myositis ossificans: occurs after blunts trauma to muscle Periosteal reaction→ cartilage formation → Calcification & neovascularization → bone dispositions |
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Muscle Healing: Practical Considerations
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Rehab aim to maintain strength & minimum atrophy during healing period Isometrics →Concentric → Eccentric Reduce Pain, eliminate swelling, improve function
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Microtrauma
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Paratendinitis (Inflammation of outer layer of tendon)
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Macrotrauma
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Commonly occur at musculotendinous junctions
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Tendon Healing: Practical applications
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PRICE Rehab depends on injury and surgical repair/immobilization Restoring length, strength in fundamental goal. Inflammation is present- consider cold pack, electrotherapeutic modalities Stretching (Low load) if muscle length is inadequate
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