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251 Cards in this Set
- Front
- Back
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What impairments can lead to altered biomechanics at the shoulder
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*impaired control of scapula by the serratus anterior and lower trap mm
*shortness/stiffness of lateral rotators *shortness of the joint capsule *insufficient activity of lateral rotators *tightness of the pectoralis major m *insufficient activity of the subscapularis m *deltoid dominance *short teres major m |
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What are the 3 main mechanisms of injury caused by a mechanical force?
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acute/traumatic
chronic/cumulative surgically induced |
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What do you look for with chronic/cumulative injuries?
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loss of joint motion
postural deviations atypical movement patterns habitual patterns (sit, stand, sleep) habitual movements |
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DEFINE fixation
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surgical union of bone fractures, typically involving orthopedic hardware, such as plates, screws, wires, or other devices
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DEFINE synovectomy
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removal of the synovial lining of a joint
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DEFINE meniscectomy
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partial or complete removal of a joint meniscus
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DEFINE osteotomy
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cutting of a bone or creating a surgical fracture
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DEFINE arthrodesis
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fusion of a joint
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DEFINE arthroplasty
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resurfacing/construction of a new joint
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DEFINE bone grafts
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promote union of a fracture, fuse a joint, or to fill a defect in a bone
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what are the cardinal signs of inflammation?
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loss of function
pain redness swelling heat |
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DEFINE pain
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it is not a fixed response to a noxious jstimulus, its perception is modified by past experiences, expectations, and even by culture. It has a protective function, warning us that something biologically harmful is happening.
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How much of a tissue's tensile strenght is regained after injury?
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80%
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DEFINE bone
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specialized CT that provides support for the soft tissues
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DEFINE articular cartilage
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tissue that covers the ends of long bones in synovial joints. its primary function is to decrease friction and absorb shock
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what are the main specific soft tissues?
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skeletal mm
tendon lig joint capsule bursa nerve |
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What do all hard and soft tissues contain?
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collagen
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What are the main hard tissues of the body?
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bone and articular cartilage
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What produces collagen?
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fibroblasts
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Where do you normally see Type I collagen?
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`tendons, ligs, bone, organ capsules, skin, fibrous cartilage, and fascia
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Where do you normally find Type II collagen?
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hyaline cartilage and elastic cartilage
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Where do you normally find Type III collagen?
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it is the earliest collagen laid down int he healing process of any soft tissue, it is eventually absorbed by the body and replaced by Type I collagen
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What are the 4 phases of soft tissue healing?
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hemostasis
inflammation/reaction phase regeneration phase remodeling phase |
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When does the hemostasis phase of healing start?
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immediately following injury and lasts for a few minutes (stops blood loss)
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When does the inflammation/reaction phase of healing start?
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immediately following injury and usually ends in 3 days
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DEFINE inflammation
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is a nonspecific biochemical and cellular process that immediately occurs in vascularized tissues in response to lethal or nonlethal injury
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What is the goal of inflammation?
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increase the movement of plasma and blood cells into the tissues surrounding the injury to facilitate "clean up" and then repair
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What are the cardinal signs of acute inflammation?
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loss of function
pain redness swelling heat |
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DEFINE acute inflammation
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continues until the body eliminates the threat; can last up to 14 days
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DEFINE chronic inflammation
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occurs if inflammation persists longer than 2 weeks
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DEFINE granulomatous inflammation
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the body attempts to "wall off" and isolate the infected site (what happens during TB)
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When does the fibroblastic/regeneration phase of healing begin and how long does it last?
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begins 3-4 days post injury
lasts up to 3 weeks |
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DEFINE resolution
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when tissues are injured, but able to regenerate via mitosis. restoration of original structure and physiologic function are achieved
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DEFINE repair
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the replacement of destroyed tissue with scar tissue, which is composed of collagen. Most soft tissues heal via repair
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Why can prolonged inflammation be harmful to the healing process?
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it increases the number and activity of jfibroblasts. Therefore, the longer inflammation persists, more scar tissue develops (greater risk of tissue fibrosis)
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What are some treatment strategies that can decrease soft tissue inflammation?
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*Non-steroidal anti-inflammation drugs (NSAID's)
*oral steroids *steroid injections modalities including cryotherapy and pulsed ultrasound |
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How can too many steroid injections be detrimental to the healing process?
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one injection is fine
two can sometimes be justified 3 or more around the same tendon, steroids will start to eat away and weaken the tendon |
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When does the remodeling or maturation phase of healing begin and how long can it last?
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begins approx 2 weeks post injury
last up to 2 years |
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When is the wound site the weakest after moderate to severe injuries?
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3 to 4 weeks post injury
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Why is the wound for a moderate to severe injury weakest at 3 to 4 weeks post injury?
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The type III collagen is absorbed by the body faster than the type I collagen can take it's place
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What factors can influence healing of tissues?
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general health
ciculation to the area clearing the wound of waste and infection |
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What is Davies' Law for soft tissue?
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soft tissues remodel in response to the mechnaical demands placed on them (IE callouses)
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What specific kind of tissue are muscle and tendon considered
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contractile tissue
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Where does Muscle regeneration occur?
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DOES NOT occur across a laceration site
INSTEAD dense connective scar tissue formation joins the 2 segments together. the m segment distal to the laceration loses its innervation. |
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What are common muscle and tendon injuries?
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contusions
exercise induced tendinitis Strains (grade I, II, III) avulsion fractures |
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DEFINE contusions/bruises
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due to a direct blow w/ 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 |
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DEFINE exercise induced injury
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delayed muscle soreness due to increased/unaccostomed activity
usually dissipates w/in j24-48hrs |
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DEFINE tendinitis
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a global term to indicate inflammation of tendon tissue, usually related to overuse and associeated w/ abnormal biomechanics
*if caught early, resolve in 3 weeks *if caught later, resolves in 6-8 weeks after removing mech of injury |
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DEFINE strains (general)
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a strain 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
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DEFINE grade 1 strain
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injury occurs at the cellular level, w/ no gross disruption of the muscle tendon unit. minimal localized swelling and contusion, with some tenderness but no loss of strength
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what is the recovery time in a grade 1 strain?
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2-21 days
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What occurs during RROM testing if patient has a grade 1 strain?
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strong and painful
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DEFINE grade 2 strain
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some degree of gross disruption of the muscle-tendon unit, resulting in moderate edema and bruising, significant loss of strength in muscle, limitation of AROM in adjacent joints
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how much tissue is disrupted and what is the RROM in a mild grade 2 strain?
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1-25%
strong and painful |
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how much tissue is disrupted and what is the RROM in a moderate grade 2 strain?
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25-75%
strong or weak and painful |
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how much tissue is disrupted and what is the RROM in a severe grade 2 strain
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75-99%
weak and painful |
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What is the helaing time for a grade 2 strain?
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20-90days
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DEFINE grade III strain
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complete rupture of the muscle or tendon unit. extensive edema and bruising w/ 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
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what is the RROM for a grade III strain?
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weak and painless
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What is the healing time for a grade III strain?
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50-180 days (surgical intervention dependent on the injured muscle)
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DEFINE avulsions
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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.
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what are some complications to muscle and tendon injuries?
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contracture
myositis ossificans compartment syndrome adhesions |
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What is the most common complication of muscle or tendon injuries?
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contracture
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how much of the contracture occurs in the tendon vs the muscle?
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75%
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What can a therapist do to decrease the chance of contracture?
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they can decrease initial inflammation and contractures will not occur at immobilized joints for up to 6 weeks
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DEFINE compartment syndrome
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usually assoc w/ crushing injuries to muscle that produce significant inflammation and edema w/in the fascial compartment. since the facia does not "give" the edema fproduces pressure inside the compartment. Blood vessels collapse under this pressure, resulting in ischemia and subsequent necrosis of tissues w/in the compartment
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how is compartment syndrome treated?
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cut the fascia surrounding the compartment (fasciotomy)
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DEFINE adhesions
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scar tissue binds down the tendon to surrounding tissue, not allowing for smooth gliding of the tendon. Occurs w/ excessive inflammation, or with tissues that were mobilized too late
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What are common ligament injuries?
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Sprains (grade I, II, III)
avulsions lig grafts |
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DEFINE sprain (general)
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injury to a lig that occurs when forces stretch some or all of the fibers jbeyond their elastic limit, producing some degree of rupture. the majority of lig injuries are usually accompanied by soft tissue swelling, changes in lig contour, and possible dislocation or subluxation of the involved joint
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What is the main issue that limits healing of ligaments?
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relatively fragile blood supply
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DEFINE grade I sprain
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involves microscopic stretching or minimal tearing of a few fibers, with no gross disruption of the lig. Localized swelling and tenderness is apparaent over the injury site. some lig fibers are torn, but there is no demonstrable loss of lig integrity
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what is PROM grade I sprain?
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painful, but littyle loss of structural integrity
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what is the recovery time for a grade 1 sprain?
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10 days to 2 weeks
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DEFINE grade II sprain
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some degree of gross disruption of lif occurs w/ many but not all of the lig fibers torn, and there is clinical evidence of joint instability. patient feels pain along the course of the intact portion of the lig.
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How much tissue is disrupted in a mild grade II sprain? moderate grade II sprain? severe grade II sprain?
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1-25%
25-75% 75-99% |
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What is the PROM for a grade II sprain?
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painful, with structural integrity dependent on degree of injury
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what is the recovery time for a grade II sprain?
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5 weeks- 2 months
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DEFINE grade III sprain
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complete rupture of the lig with loss of structural integrity. this disruption occurs at the bony attachment or w/in the substance of the lig
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what is the PROM for a grade III sprain?
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major instability with no pain in the lig (possible pain from injury to surrounding tissue)
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what is the recovery time for a grade III sprain?
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7 weeks to 18 months
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what are common interventions to influence inflammation and reduce pain?
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medications
-steroids and NSAIDs (inflammation -numerous drugs for pain modalities -superficial heat -superficial cold -ultrasound rest, compression, elevation combination of all of the above |
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To what depth do cold packs penetrate the body?
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1-2cm
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to what depth do vasocoolant sprays penetrate the body?
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less than .5 cm
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to what depth does superficial heat penetrate the body?
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1cm
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What is the best modality to reduce inflammation/pain in muscles?
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cold packs bc penetrate the farthest into the body (1-2 cm)
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how do heat/cold affect the extensibility of collagen?
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heat increases extensibility of collage
cold decreases extensibility |
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DEFINE manual therapy techniques
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interventions involoving skilled hand movements intedned to improve tissue extensibility; incr. ROM, induce relaxation, mobilize or manipulate soft tissue and joints, modulate pain, and reduce soft tissue swelling, inflammation or restriction
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How do both AOTA and APTA describe manual therapy procedures?
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procedures that include muscle stretching, manual traction, massage, mobilization/manipulation, and PROM
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What does manual therapy help with?
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*allows for hydration and rehydration of CT
*causes the breaking and subsequent prevention of cross-links in collagen fibers *allows for the breaking and prevention of macroadhesions |
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What are the 4 main techniques of manual therapY?
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friction massage
bowstringing general stretching stretch and spray (seldom used) MFR along fascial lines "courtesy stretch" MFR direct tech MFR general tech |
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How can you make manual therapy MOST effective?
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combined with other treatments, particularly exercise
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With which complaints is manual therpay supported by evidence to relieve?
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reduce pain
relax muscles in spasm lengthen shortened muscles imporve range of motion optimize posture/biomech alignment improve function |
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What are CONTRAINDICATIONS for manual therapy?
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acute injuries
acute inflammation tissues that are extremely painful |
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what should you ALWAYS perscribe with manual therapy?
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at least one stretch for the muscle(s) you treated
**can also prescribe a strengthening ex for mm antagonist** |
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DEFINE pain
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an unpleasant sensory and emotional experience assoc with actual or potential tissue damage, or described in terms of such damage
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What is the #1 reason ppl seek medical attention?
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pain
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DEFINE acute, chronic and referred pain
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acute <6mo
chronic >3-6 mo referred-pain occurs in a different area than the pathology |
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What are goals of manual therapy when dealing with acute pain?
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reduce inflammation, modify transmission, facilitate resolution
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What are some secondary affects of chronic pain?
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physically inactive
loss of strength/skill/endurance progressive disability depression/sleep disturbance social isolation |
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How does referred pain happen?
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usually area of pathology and area of musculoskeletal pain are similar embryonic development and both areas have efferent and afferent inn from same nerve
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What are goals for treating someone with pain?
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resolve underlying pathology, if possible
max fx w/in the limitations of the person's pain make person an active participant address the affective component |
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What is the "affective component" of treating pain?
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modify the persons perception of the discomfort
general conditioning and more specifically aerobic exercise |
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how are ultrasound waves produced?
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by application of a high freq alternating current to a piezoelectic crystal
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DEFINE reflection
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wave is deflected away from the surface
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DEFINE refraction
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wave is redirected in the tissues
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DEFINE absorption
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transmitted wave reaches the target tissue
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DEFINE attenuation
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is the reflection, refraction, and absorption of sound
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how does attenuation relate to ultrasound?
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as the ultrasound freq incr so does the attenuation, resulting in a decrease in the propagation of energy available to deeper tissue
*therefore, 1MHz (up to 5cm) penetrates deeper than 3MHz (1-2cm) |
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what tissues have high absorption coefficients with ultrasound?
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those with a high collagen content
(ie-bone, lig, tendon, cartilage) |
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DEFINE intensity
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strength of the ultrasound beam, or the rate of energy delivered per unit area, measured in Watts/cm^2
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DEFINE frequency
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number of cycles per second, measured in MHz
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DEFINE duty cycle
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the proportion of the treatment time that the ultrasound is on (20%, 50%, 100%)
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DEFINE effective radiating area (ERA)
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the area of the transducer from which the US energy radiates
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What effects are you wanting with continuous US?
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thermal
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What kind of effects are you wanting w/ pulsed US?
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non-thermal (20% duty cycle or lower, no net incr in tissue temp)
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What are some of the thermal effects of continuous ultrasound?
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incr collagen extensilbility
alt in blood flow changes in nerve conduction velocity incr pain threshold incr local metabolism |
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how does continuous ultrasound change conduction velocity in nerves?
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may alter or block impulse conduction
incr membrane permeability incr tissue metabolism |
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What are some of the non-thermal effects of pulsed ultrasound?
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incr membrane permeability
incr rate of protein synthesis by fibroblasts incr macrophage responsiveness **particularly effective during the inflammatory phase of repair** |
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What are some indications for US?
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contractures (joint capsule, scar tissue)
pain control dermal ulcers surgical skin incisions tendon injuries calcium depostis |
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what are CONTRAINDICATIONS for US?
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thrombophlebitis
pregnancy tumors radium, radioactive isotopes eyes spinal cord w/out protection joint cement plastic components pacemaker reproductive organs |
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What are PRECAUTIONS for US?
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acute inflammation
epiphyseal plates breast implants fractures impaired circulation or sensation |
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what do you need to check BEFORE applying US?
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patient cognition
light tough sensation sharp v dull pain sensation discriminative temp |
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What are 3 methods of US application?
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direct contact w/ coupling gel/lotion
immersion hydrogel sheet (uncommon) |
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What are 2 application techniques for US?
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stationary (easy to burn tissue/bone)
moving sound head procedure (recommended) |
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DEFINE phonophoresis
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the use of ultrasound to drive medication into the tissues of the body
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What are common medicines that phonophoresis is used with?
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hydrocortisone, dexamethasone, lidocaine, and methyl slicylate
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what is one of the most common and effective applications of US?
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in treating joint capsule fibrosis/adhesions
*apply US then perform joint mobilization |
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DEFINE subluxation
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some part of the articular surfaces are still in contact
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DEFINE dislocation
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articular surfaces are no longer in contact with each other
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What is the stratum synovium of the joint capsule
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generally 1-3 cells in depth, with cells loosely arranged in sheets
highly vascularized but poorly innervated produces the hyaluronic acid component of synovial fluid removes debris from w/in joint space |
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What are the 2 primary sources of joint capusle innervation?
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articular nn: branching from adjacent peripheral nn
branches from nn that supply mm controlling the joint |
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What are type 1 joint receptors?
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located in stratum fibrosum
static and dynamic joint position sense sense speed and direction of movement regulation of postural muscle tone slow adapting; low threshold |
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What are type 2 joint receptors?
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located in the stratum synovium and fat pads
sense changes in speed of movement and change of direction of joint regulate muscle tone at beginning and during movement rapidly adapting; low threshold |
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What are type 3 joint receptors
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inhibitive
located in stratum fibrosum and lig regulate muscle tone during potentially harmful movements very slow adapting; high threshold |
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What are type 4 joint receptors?
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located in the stratum fibrosum, lig, articular fat pads, and periosteum
pain receptors responsive to mech deformation inactive under "normal" conditions high threshold, non adapting |
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What causes acute truama to the joint capsule?
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direct trauma (dislocation)
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what causes chronic trauma?
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repeated mech insult (impingement)
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What are the phases of healing in joint capsule
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acute (1-3 days)
sub acute (3 days to 3-4weeks) sub acute to chronic (day 14-60) chronic 60+days |
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What is the capsular response to trauma in the acute phase?
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(inflammation/reaction)
tissue breakdown exceeds tissue healing inditial stage of scarring very fragile tissue pain |
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What is the capsular response to sub acute trauma phase?
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(fibroblastic/regeneration)
scar incr in bulk if capsule is immobilized; collagen laid down randomely high collagen synthesis type III collagen replace by type I |
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which phase of capsular response to trauma is increasing the joint ROM most effective?
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subacute
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What is the capsular response to sub-acute to chronic trauma?
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(remodeling/maturation)
scar contains collagen 1 gradual transition from cellular to fibrous adhesions gradual incr in scar strength progressive decrease in ability of scar tissue to respond to treatment |
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What is the capsular response to chronic trauma?
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(remodeling/maturation)
complete conversion to collage 1 fully mature scar joint capsule is fibrosed |
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during what stage of trauma to joint capsule are most patients sent to OT/PT?
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chronic
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How do we know if capsule is involved with poor ROM?
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capsular end feel earlier in the ROM than expected
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DEFINE capsular pattern
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a stereotypical limitation of motions at a joint that presents as gradations of loss of motion in distinct directions at the joint, which is caused by shortening of the joint capsule thus producing a capsular end feel for each motion
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CAPSULAR PATTERN glenohumeral joint
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ext rotation>abduction>internal rotation
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CAPSULAR PATTERN elbow (humeroulnar)
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flexion > extension
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CAPSULAR PATTERN elbow (humeroradial
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equal loss of pronation/supination
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CAPSULAR PATTERN wrist
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equal loss of flexion/extension
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CAPSULAR PATTERN mcp, pip, dip joints
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flexion > extension
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What are major causes of capsular fibrosis/adhesions?
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*resolution of an acute articular inflammatory process
*a chronic, low grade articular inflammatory process *immobilization of the joint -self -medical |
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Why does fibrosis cause loss of ROM?
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*loss of mobility between adjacent fibers laid down during inflammatory phase that cause friction and loss of water around joint
*collagen fibers shorten during the remodeling/maturation phase |
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What do you check in the physical exam if there is suspected capsular fibrosis?
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*check the joints above and below to rule out a more extensive pathology
*diminished AROM *diminished PROM with capsular end feel *palpation reveals pain and muscle guarding |
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What do you check in the physical exam if ther is a suspected ligamentous involvement?
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PROM/lig stress test (unstable, painful)
diminished firm, leathery end feel palpation revelas pain along lig edema surround soft tissue |
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how do you treat ligamentous instability?
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*surgery (sometimes)
*immobilization with maintain mobility of joints above/below (can lead to fibrosis) *alleviate inflammation and pain *restore mobility when able (joint mobilization) |
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how do you treat capsular fibrosis?
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*alleviat inflammation and pain
*regain length in capsular tissues *remove capsular adhesion *restor motion at joint (passive and active motion) |
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how can OTs/PTs treat inflammation and pain?
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cryotherapy
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how can OTs/PTs help regain length in capsular tissues when treating capsular fibrosis?
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ultrasound
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how can OT/PT regain length in capsular tissues, remove capsular adhesions and restore motion at the joint with someone w/ capsular fibrosis?
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joint mobilization
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DEFINE joint mobilization
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form of manual therapy that uses a graded oscillatory mobilizations and/or sustained traction to relieve pain, stretch capsular tissue, and/or break up adhesions
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DEFINE accessory motions
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movements w/in 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 |
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what are the most common indications for joint mobilization?
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pain
joint hypomobility (ie capsular pattern) |
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What are CONTRAINDICATIONS for joint mobilization
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malignancy
rheumatoid collagen necrosis fracture joint ankylosis vertebrobasilar insufficiency active inflammatory or infective arthritis |
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What are PRECAUTIONS for joint mobilization
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osteoporosis
pregnancy history of malignancy hypermobility dizziness neurological signs spondylolisthesis |
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What should ALWAYS be included in your history/interview before any modality/treatment?
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prsence of contraindication or precautions
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What is included in your physical exam before joint mobilization?
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assess of all ACCESSORY motions at the joint and the joints above/below
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what are the 2 methods of joint mobilization?
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oscillatory and sustained
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what are maitland's grades of oscillatory mobilization?
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Grade 1: small amplitude movement at beginning of range
Grade 2: large amplitude movement w/in range Grade 3: large amp movement up to limit of available range Grade 4: sm amplitude movement at limit of available range Grade 5: high velocity thrust at limit of available range (popping joints) |
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how long should you perform joint mobilization for both sustained and oscillatory techniques?
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sustained: 20-30 sec
oscillatory: 60-90 sec |
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What are the effects of joint mobilization on capsular tissue?
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effect joint receptors
-types 1-3: active from beginning to end of range -capsular injury=receptor injury -joint proprioception affected incr joint motion |
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What movements do you perform if you want to stimulate type III joint receptors?
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sudden joint movements
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What movements do you perform if you want to stimulate type II receptors?
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gradual initiation of movement
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What are the main professional techniques to performing joint mobilization?
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"intelligent hands"
deliberate placement of hands confident selection and use of grade of oscillation thoughtful mobilization integration of this intervention w/ others |
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What are some good exercises/activties to perscribe for at home after joint mobiliztaion?
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AROM to use new motion
stretch to facilitat new range End ROM stregthening |
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What is the most critical time period of gestation?
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4-8 weeks: when most growth
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by what time in gestation have the bones and skeletal mm developed?
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5 weeks
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During what part of gestation does skeletal ossification begin and differentiation of fingers and toes?
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8 weeks
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During what part of gestation do the synovial joints develop?
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14 weeks
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By what part of gestation has the skeleton ossifed as much as it will be prior to birth?
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20 weeks
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When are the significant "growth spurts" during post-gestational development?
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between 12 mos and 6 yrs
adolescence |
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By what age have epiphyseal plates ("growth plates") fused?
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21-25 years
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Why do joint capsules and ligaments become stiffer with age?
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body lays down more collagen
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What is bone composed of?
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osteoblasts (which form osteocytes)
osteoclasts collagen calcium phosphorus |
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FUNCTION osteoblasts
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produce the organic component (ground substance) of bones--osteocytes
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FUNCTION osteoclasts
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absorbs old bone so that new bone can be laid down
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What is wolff's law for hard tissues?
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hard tissues remodel in response to the mechanical demands/stresses placed on them
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What are the 2 main types of bone?
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cortica
cancellous ("spongy" bone) |
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DEFINE periosteum
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the dense fibrous membrane that covers all bones (except joint surfaces) that is permeated by blood vessels and nerves.
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What is contained within the inner layer of the periosteum?
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osteoblasts that are responsible for generating new bone during growth and repair
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What is the difference between the periosteum of a child than an adults? why?
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periosteum is thick and loosely attached to the cortex in children
this allows for rapid production of new bone |
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DEFINE osteomalacia
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"softening of bones" occurs as a result of decreased deposition of calcium in the bone, and an increased production of unmineralized matrix (aka rickets) associated with vitamin D deficiency
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What changes do you see within the bone with someone with osteomalacia?
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bones become markedly weak and "soft," bending and becoming deformed rather than breaking
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DEFINE osteoporosis
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a decrease in qualitatively normal bone, which renders the individual more susceptible to fractures resulting from an imbalance of bone resorption and bone formation due to inadequate calcium intake
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what are the major risk factors for osteoporosis?
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femal
thin/small frame age family history postmenopause w/out hormone replacement low calcium diet inactive lifestyle smoking excessive alcohol white/asian ethnicity |
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What is Type I osteoporosis?
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"postmenopausal osteoporosis"
decrease estrogen levels cause a decrease in mineral density leading to a 6:1 prevalence amoung females and affects primarily trabecular bone |
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What is type II osteoporosis?
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"age-related osteoporosis"
affects men/women equally after age 70 and causes equal loss of trabecular and cortical bone |
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What are common fracture sites associated with osteoporosis?
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vertebral body
femoral neck distal radius |
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What are the 10 commandments of osteoporosis prevention?
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*adequate vitamin D intake
*Calcium and balanced diet *limit caffeine, salt, protein, and phosphorous *no starvation diets *exercise *hormone replacement post menopause *take estrogen if ovaries removed *avoid drugs that decrease bone mass (ie-steroids) *alcohol in moderation *no smoking |
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What are the 2 main vitamins needed for normal calcium resorption?
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calcium and vitamin D
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how does exercise/activity decrease the chance of osteoporosis?
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wolff's law applied: when stress is applied to a bone during physical activity, the tissue responds by increasing mass, density, and structural properties
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When using exercise to decrease the chance/effects of osteoporosis, which type of exercise is more important: weight bearing or # repetitions
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weight bearing
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What is a good home exercise program to prescribe to postmenopausal women?
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weight bearing activities 3-4 times per week for 45 min per session
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DEFINE fracture
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a break in the continuity of a bone due to an applied
**a fracture ALWAYS produces some degree of soft tissue injury** |
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What are the 5 main types of forces that can produce a fracture?
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*bending/angulatory
*twisting *traction *compression *crushing |
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What are common things described about a fracture?
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*site
*extent -full -partial (ie greenstick or buckle) *Configuration (transverse, oblique, spiral, segmental) *angulation (valgus, varas, ant/post) *relationship of fragments to each other (rotated, impacted, overriding) *relationship of fragments to ext environment *complications |
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DEFINE avulsion fracture
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when a mm/tendon pulls apart a bone.
**if have to chose between tearing tendon/muscle or bone choose bone bc leaves NO scar tissue** |
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What kind of fracture is a salter-harris?
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epiphyseal plate fracture
**this can cause some growth abnormalities (one leg longer than the other)** |
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What are the 6 stages of fracture healing?
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1. impact stage
2. induction stage 3. inflammation stage 4. soft callus stage 5. hard callus stage 6. remodeling stage |
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DEFINE impact stage of fracture healing
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occurs at the moment of injury and lasts until there is complete dissipation of energy
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DEFINE induction stage of fracture healing
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following bony failure, cells possessing osteogenic potential are stimulated to form bone and periosteal and intraoseous osteoblasts around the area of the break are activated, and large #'s of new osteoblasts are formed
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DEFINE inflammation stage of fracture healing
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begins shortly after impact and lasts until the bone ends are united by fibrous union, formed by incr osteoblast activity producing new organic bone matrix ( 1st and 2nd week post fracture)
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DEFINE soft callus stage of fracture healing
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occurs when inflammation begins to subside and the bone ends become "sticky", and are held together by fibrous tissue and cartilaginous tissue (2-3 weeks post fracture)
*osteoclasts begin to appear to absorb portions of dead bone |
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DEFINE hard callus stage of fracture healing
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callus continues to be "sticky" and is considered an "osteogenic sleeve" around the fracture fragments. the callus convert from fibrocartilaginous tissue to fiber bone. the callus begins to be absorbed by osteclasts (3-5weeks)
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DEFINE clinical union
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callus is apparent on x-ray (3-5 weeks)
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DEFINE remodeling stage of fracture healing
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occurs when the fracture is healed, and the diameter of the bone is nearing pre-injury size. callus has been absorbed (radiographic union) around 6-8 weeks but could last up to a few years
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DEFINE radiographic union
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when the fracture is healed and the callus has been mostly absorbed by the body (6-8 weeks)
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What are major factors that influence bone healing?
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age
site and configuration fracture displacement blood supply non-smoker |
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what are the main ways to manage a fracture?
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non-intervention (scapula)
closed reduction (cast) open reduction internal fixation (ORIF) (plate/screws) external fixation (ilizarov and debastiani procedures) |
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DEFINE casting (as in a cast after fracture)
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A STRESS SHARING DEVICE. allows for callus formation and relatively rapid bone healing. immobilizes joints above and below fracture site. Early weight bearing is allowable if fracture pattern stable
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How does wolff's apply to fixation devices?
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fixation devices will absorb a great deal of force, causing the surrounding bone to be less stressed, and thus less dense
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DEFINE open reduction internal fixation (ORIF)
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surgical realignment of fracture fragments, with fragments being held in approximation by hardware such as plates, screw, pins. bone grafts may also be used
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DEFINE external fixation
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associated w/ more severe fractures. ext fixation applies hardware to hold aligned fragments in place, usually consists of an ext frame to which are attached pins that are drilled through various fracture frag (hoffman device, ilizarov/debastiani procedures)
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DEFINE traction osteogenesis
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the use of an ilizarov device to gradually pull bones aparte to elongate them over time.
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DEFINE mal-union
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bone heals in the normal time frame, but not in a normal position
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DEFINE delayed union
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bone healing takes longer to heal than normal, possibly due to poor circulation, movement of frag, etc
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DEFINE non-union
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failure of the fracture to heal, resulting in a fibrous union of the fragments. possibly due to poor circulation, infection, calcium/phosphorous deficiency, hormonal imbalances, osteoporosis
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what are some complications that could arise with a fracture?
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vascular problems
neurological avascular necrosis\ joint stiffness/contracture myositis ossificans degenerative joint disease effects of immobilization |
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DEFINE avascular necrosis
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bone ischemia and/or death due to compromised circulation
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DEFINE degenerative joint disease
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frequently associated w/ intra-articular fractures
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What are some care tips to be mindful of when dealing w/ a cast?
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cast can cause imbalance
need to decrease swelling through ROM and elevation do not use anything to scratch under cast (use corn starch) avoid getting wet know warning signs of cast care |
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DEFINE radiology
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health care field that deals with the acquisition and interpretation of images of the human body
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DEFINE radiologist
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medical consultant for the rest of the medical specialties who interprets the various images collected by radiographers and sonographers
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DEFINE radiography
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the profession in which diagnostic medical images are made using xrays and other radiation
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DEFINE sonography
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the profession that uses equipment that generates high frequency sound waves to obtain images and info of the human body
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DEFINE angiogram
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dye is injected into blood vessels and sometimes into the lymphatic system to assess patency of vessels
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DEFINE arthrogram
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injection of dyes into joints
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DEFINE myelogram
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injection of dye into the spinal canal and around the nerve roots
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DEFINE bone scan/scintigram
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injection of radioactive isotopes that preferentially go to areas of greater circulation
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DEFINE computed tomography (CT)
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uses xrays to obtain sectional images or 3-D reconstructions of body tissues. better at rendering bony tissues
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DEFINE magnetic resonance imaging (MRI)
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uses no xrays; instead uses a magnetic field to produce images. better at rendering soft tissues
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DEFINE ultrasound image
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produced using high frequency sound waves, which are reflected differently depending on the density of the reflecting tissues
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DEFINE radiolucent
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allows xray photons to pass through matter easily and appear as dark structures on a radiograph. The less dense a tissue, the darker it appears on the radiograph
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DEFINE radiopaque
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not easily traversed by xray photons. substances and tissues appear as white or chalky on radiographs. the more dense the tissue/implnt the whiter it is on the radiograph
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DEFINE density
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overall blackening of the film
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DEFINE contrast
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the visible difference between adjacent tissues of varying densities
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DEFINE recorded detail
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the distinct jrepresentation of an objects true borders
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DEFINE distortion
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the misrepresentation of the true size or shape of an object
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What are the cardinal rules jfor making radiographic images
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include proper pt and id
take at least 2 views incl one joint provide best quality |
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what are the cardinal rules for viewing radiographic images
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rt pt, rt procedur
view entire image hang xray as though person is facing you if unilateral extremity, hang in anatomic position, facing you for hands and feet, hang digits up |
