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62 Cards in this Set
- Front
- Back
There are 4 etiological factors of joint dysfunction:
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Trauma (macro trauma or repeated microtrauma)
• Sustained postures • Immobilization • Following the resolution of a more serious pathological condition |
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Stanley paris joint dysfunction definition
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A state of altered mechanics, either an increase or decrease from the expected normal, or thepresence of an aberrant motion (Paris)
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Menell's amount of joint play theory
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The amount of joint play is less than 1/8 inch
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Characteristics of a single hypomobile segment:
(5) |
Loss of physiological motion
• Loss of accessory motion at the involved segment • Increased pain at endrange • Tissue texture abnormalities • Presence of positional faults |
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Characteristics of a single hypermobile segment:
(7) |
• Increased segmental mobility
• Full general spine mobility (may be limited if muscle guarding is present) • Pain produced by prolonged stretch • Muscle stiffness follows prolonged stretching • Muscle stiffness relieved by exercise or movement • Ligamentous tenderness in the accessible ligaments • Joint predisposed to joint locking |
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Panjabi and White (33) define clinical instability as follows:
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The loss of the ability of the spine under physiological loads to maintain its pattern ofdisplacement so that there is no initial or additional neurological deficit, no major deformity, andno incapacitating pain.
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Neutral zone
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a small range of movement near the joint’s neutral position where minimalresistance is given by the ligamentous structures. Increased neutral zone may be a good indicator of hypermobility. Size of the neutral zone increases with injury. |
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Synarththroses
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bony connections, named for the type of tissue that connects them
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Syndesmosis
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fibrous tissue (interosseous membrane between radius and ulna)
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Synostosis
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bone (sutrues in cranium)
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Symphysis
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fibrous cartilage
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shoulder cpp; rp
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Abduction and ExternalRotation 55 degrees abduction, 30degrees horizontal adduction |
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ulnohumeral cpp: rp
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Extension 70 degrees flexion, slightsupination |
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radiohumeral cpp; rp
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90 degrees flexion, 5 degreessupination Full extension/supination |
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wrist
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Dorsiflexion and RadialDeviation Neutral, slight ulnar deviation |
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MCP 2-5
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full flexion semi flexion |
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IP
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extension semiflexion |
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first cmc
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Full opposition Neutral position of thumb |
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hip
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Extension, Internal rotationand Abduction 30 degrees flexion, 30 degreesabduction, 20 degrees ER |
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knee
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Full extension 25 degrees flexion
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ankle
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Dorsiflexion Neutral position
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tarsal joint |
Full supination Semiflexion |
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MTP 1 |
Dorsiflexion Neutral position |
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MTP 2-5 |
Flexion
Neutral position |
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vertebral
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extension; neutral position |
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Cervical, thoracic and lumbar spine
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extension, sb, and rotation are equally limited
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OA joint cap pattern
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ext, sb are equally limited
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c1- c2 cap pattern
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equal limitation of rotation
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GHJ
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ER, Abd, IR
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ac, sc
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pain at end range or movement |
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elbow
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flexion, extension
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wrist
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flexion and ext equally limited |
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first cmc
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abd, ext |
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mcp and IP
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flexion then extension
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mcp and ip |
flexion, extension |
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hip
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flexion, abd, ir, although sometimes IR is most limited |
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knee
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flexion, extension |
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TC joint
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pf, df |
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subtalar jt
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decreased varus |
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red flags- name 5
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- Violent trauma
o Constant, progressive, non-mechanical pain o Previous history of cancer, systemic steroids, drug abuse or HIV o Systemically unwell o Widespread neurology o Structural deformity o Presentation age <20 years or >55 years o Signs of infection (temp>100 degrees, BP>160/95, resting pulse> 100/min, resting respiration >25/min) |
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8 signs indicative of serious pathology
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1. A patient who presents with a back ache, having a history of malignancy during the
previous 2 years, must be assumed to have secondary malignant deposits in the spine until this is proven otherwise, even though the onset is mild and the signs and X-rays are negative. 21 2. When the onset of back pain is late in life, without any previous history of back symptoms, the patient is more likely to have osteoporosis or secondary deposits than some simple mechanical fault. 3. When there is serious loss of spinal function, or shock, or vomiting after trivial spinal injury or strain, the patient is likely to have a pathological fracture of the spine. 4. Severe pain, deformity and muscle spasm in areas of the spine other than the lower cervical and lower lumbar regions should arouse suspicion of disease. For example, a lateral shift in the thoracic spine is never a result of a simple movement dysfunction. 5. Constitutional signs, which accompany back pain, suggest disease (fever, unexplained weight loss >10 lbs, malaise and excessive weakness). 6. Loss of power that is too widespread to be accountable by a single nerve root lesion suggests neurological disease. 7. Loss of sphincter control is never due to simple mechanical causes. 8. Continuous pain unrelated to posture is unlikely to be mechanical in origin. |
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Mobilization/manipulation CPR
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Mobilization/manipulation
More recent onset of symptoms (<16 days) Hypomobility at any level Not having symptoms distal to the knee FABQ work subscale score <19 Hip IR with 1 or both hips > 35 degrees Diagnostic accuracy: reference standard for success with spinal manipulation When at least 4 of the 5 criteria were met: +LR =13.2 When only 1 or 2 of the criteria were met: -LR = .10 |
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s/s of traction
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Symptoms
Radiating pain below the knee Weight bearing worsens pain Better with non-weight bearing Signs Both flexion and extension peripheralize pain Positive neurological signs, with a + crossed SLR present Postural deviations that can’t be corrected conventionally |
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Stabilization prediction signs
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Age less than 40 years
Average SLR >91 degrees Positive prone instability test Aberrant motion present Reference standard for success with a program of lumbar stabilization exercises: When at least 3of the 4 criteria were met: +LR = 4.0 When only 1 of the 4 criteria was met: -LR =.20 When only 2 of the 4 criteria were met: -LR = .30 |
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4 building blocks of collagen
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water- ground substance- collagen fibers- fibroblasts |
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ground substance made up of 2 macro-molecular complexes
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proteogylcans |
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metabolic turnover rate of ground substance
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2-10
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metabolic turnover rate of collagen fibers
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approx 300 days |
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inflammatory phase
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With connective tissue injuries, bleeding in the tissue usually takes place. After the bleeding isstopped, the inflammation process gets started. Depending on the severity of the injury, this canlast from 1 to several days. The inflammation activates the fibroblasts in the injured area. Therewill be increased permeability of the capillaries, which leads to edema in the tissue. White bloodcells infiltrate the area. The goal of this inflammatory phase is to clean up the injured tissue andactivate the cells necessary for repair.
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proliferation phase
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With the activation of the fibroblasts, the healing process gets started. This usually happens 4-5days after the injury. There is a strong proliferation of capillaries, which together with thefibroblasts invade the wound. Together they form granulation tissue. There is a fast accumulationof new collagen fibers. The newly formed scar tissue is still weak. Wound contraction is takingplace.
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maturation phase
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This phase can last from several months to more than a year. There is continued synthesis ofcollagen fibers, albeit slowly. The strength of the scar tissue is being adapted to the demandsbeing put on the tissue. The collagen fibers are being oriented according to the lines of stress.This is a lengthy process.
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rate of healing in first 2 weeks
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50% in the first 2 weeks |
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rate of healing in first 6 weeks
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80% in the first 6 weeks
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rate of healing in first 12 weeks
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100%
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high reactivity
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pain is felt before restriction; oscillations |
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moderate reactivity
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pain is felt with restriction; oscillate-stretch-oscillate
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low reactivity
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stretch
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remodeling is influenced by:
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MotionBlood supply and oxygen supply to the injured tissueVitamin CAdequate protein intakeAnti inflammatory drugs
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scar formation chart: scar tissue remains stretchable for how long? |
8-10 weeks |
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scar tissue shrinkage completed when ?
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6-12 month |
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wound closure for tendons and ligaments completed when?
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3-5 weeks
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wound closure for skin and muscle completed by?
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5-8 days |