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205 Cards in this Set
- Front
- Back
A key to optimal glenohumeral joint motion [during elevation] is
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that the head of the humerus remains centered in relationship to the glenoid as motion occurs at the shoulder joint
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Guiding Concepts of Musculoskeletal (Orthopedic) Assessment
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-Understand your patient (occupations, environments/contexts)
-Understand typical posture and movements/biomechanics -Understand the mechanism of injury (formulate a diagnosis) |
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Guiding Concepts of Musculoskeletal (Orthopedic) rehabilitation
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-Understand and apply knowledge of soft and hard tissue healing
-Manage inflammation and pain (modalities, meds, application of protection/rest as needed) -Gain Range of Motion at the joint(s) -Gain muscle length and strength / restore normal posture -Gain normal movement (movement re-education) -Address return to function/occupations through exercise, activity, and adaptation (if needed) |
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Acute or Traumatic Injuries characteristics
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-Sudden onset
-Unexpected in nature -Typically related to a single act -Know the location and position of the injured part, and you can usually predict the structure(s) involved |
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Chronic / Cumulative injuries characterstics
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-Occur over time
-Associated with sustained postures or repetitive activity -Tougher to pin down; the person often can’t recall the mechanism of injury -Work-related/Leisure activities/Sleep positions |
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optimal scapular positioning
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-Vertebral border is parallel to the thoracic spine and is about 3 inches from the midline of the thorax
-Is situated between T2 and T7 -Is flat against the thorax and rotated 30 degrees anterior to the frontal plane |
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optimal humeral positioning
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-Less than 1/3 of the humeral head protrudes in front of the acromion.
-in neutral rotation so that antecubital fossa faces anteriorly and the olecranon faces posteriorly, palm faces body -Proximal and distal ends of humerus are in same vertical plane |
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short and long mm. for thoracic kyphosis
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short- possibly rectus abdominus
long- thoracic extensors |
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short and long mm. for downward rot scapula
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short- LS, rhomboids
long- UT |
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short and long mm. for upward rot scapula
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short- UT
long- no long muscle |
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short and long mm. for depressed scapula
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short- pec major, lat dorsi
long- UT |
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short and long mm. for elevated scapula
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short- (superior angle elev) > Levator scap
(acromion elevated) > upper trap |
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short and long mm. scapula adducted
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short- rhomboids, middle trapezius
long- SA |
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short and long mm. scapula abducted
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short- SA, pec major
long- rhomboids, middle trap |
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short and long mm. tipped or tilted scapula
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short- pec minor, biceps brachii
long- low trap |
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short and long mm. winged scapula
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short- subscapularis
long- SA |
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short and long mm. anterior humeral glide
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short- Pec major, infraspinatus, teres minor, stiff post. Capsule
long- subscapularis |
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short and long mm. Humeral superior glide
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short- Deltoid, infraspinatous, teres minor, teres major and subscap, joint capsule stiff
long- Rotator cuff muscles are weak (not necessarily long) |
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short and long mm Shoulder medial rotation
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short- Pec major, latissimis dorsi, lateral rotators may be stiff if scapula is abducted or depressed
long- Infraspinatous and teres minor may be long (if scapular position is correct) |
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short and long mm. Glenohumeral hypomobility
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short- All scapulohumeral muscles, Joint capsule stiff
long- SA and LT, Cuff is weak |
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fixation definition
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surgical union of bone fractures, typically involving orthopedic hardware, such as plates, screws, wires, or other such devices.
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synovectomy definition
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removal of the synovial lining of a joint
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menisectomy definition
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partial or complete removal of a joint meniscus
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osteotomy definition
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cutting of a bone or creating a surgical fracture
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arthrodesis definition
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fusion of a joint
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arthroplasty definition
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resurfacing / construction of a new joint
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bone grafts definition
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promote union of a fracture, fuse a joint, or to fill a defect in a bone
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arthroscopy definition
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to look within the joint,” and is a surgical procedure orthopedic surgeons use to visualize, diagnose, and treat problems inside a joint.
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all soft and hard tissues contain
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collagen
Fibroblasts produce collagen |
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type 1 cartilage
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tendons, ligaments, bone, organ capsules, skin, fibrous cartilage, and fascia
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type 2 cartilage
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hyaline cartilage and elastic cartilage
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type 3 cartilage
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earliest collagen laid down in the healing process (the “spare tire” of collagen)
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4 phases of soft tissue healing
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Hemostasis
Inflammation / Reaction Phase Regeneration Phase Remodeling Phase |
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hemostasis time frame
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immediately following injury and lasts for a few minutes.
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Inflammation/ Reaction Phase of Healing time frame
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immediately following injury and usually ends in three days (but may last longer if mechanism of injury not removed)
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goal of inflammation
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increase the movement of plasma (exudate) and blood cells into the tissues surrounding the injury to facilitate ‘clean up’ and then repair
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3 types of inflammation
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-Acute: continues until the body eliminates the threat; can last up to 14 days
-Chronic: occurs if inflammation persists longer than two weeks -Granulomatous: the body attempts to “wall off” and isolate the infected site |
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Fibroblastic or Regeneration Phase of Healing time frame
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begins 3 – 4 days post injury and can last up to 3 weeks
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resolution definition
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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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repair definition
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the replacement of destroyed tissue with scar tissue, which is composed of collagen. Most soft tissues heal via repair. Type III first laid down, then absorbed and replaced by Type I collagen
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prolonged inflammation increases the
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the number and activity of fibroblasts: i.e. the longer inflammation persists, _more_scar tissue develops (the greater the risk for tissue fibrosis).
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Remodeling or Maturation Phase of Healing time frame
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Time frame: begins at about two weeks and can last up to two years
Type III collagen is absorbed, and Type I laid down in its place. |
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for moderate to severe injuries, what is the weakest point for the wound in the healing process?
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at three to four weeks
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Davies’ Law for Soft Tissues
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Soft tissues remodel in response to the mechanical demands placed on them
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immobilization __the tensile strength of ligaments, tendon, etc
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decreases
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- exercise, weightbearing, and continuous motion (active, passive) __the tensile strength of tissues (healing or normal tissue
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increases
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exercise or motion, if introduced too early, can
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stretch out healing tissues, leaving them essentially functionless
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contusions/bruises characteristics
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due to a direct blow with increasing muscle trauma and tearing proportional to the severity of trauma
Capillary rupture from the injury can lead to hematoma formation and ecchymosis visible externally |
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Exercise induced injury characteristics
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-delayed muscle soreness due to increased/unaccustomed activity, etc
-Usually dissipates within 24 to 48 hours |
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tendinitis characteristics
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-global term to indicate inflammation of tendon tissue, usually related to overuse and associated with abnormal biomechanics
-If caught in the early stages, tendinitis may resolve in as few as three weeks -with more chronic problems, if the mechanism of overuse or abnormal biomechanics are corrected, tendinitis may resolve in six to eight weeks |
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strains definition
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-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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Grade 1 stain definition
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-occurs at the cellular level, with no gross disruption of the muscle-tendon unit
-Minimal localized swelling and contusion, with some tenderness but no loss of strength in the injured unit or loss of motion in the adjacent joints |
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RROM Testing results grade 1 strain
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Strong and Painful
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recovery time grade 1 strain
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between 2 and 21 days between 2 and 21 days
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grade 2 strain definition
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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 the muscle, limitation of active motion in the adjacent joints
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mild, moderate, and severe grade 2 strain characteristics
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mild: 1 - 25% of tissue disrupted, mild loss of strength
moderate: 25 - 75% tissue disrupted, moderate loss of strength severe: 75 - 99% tissue disrupted, significant loss of strength |
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RROM testing results grade 2 strains
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-Strong and painful for mild grade II
-Weak and painful for severe grade II -Strong or weak and painful for moderate grade II (depends on percentage of fibers torn) |
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healing time grade 2 strains
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between 20 and 90 days, depending on the degree of injury
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grade 3 strain definition
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complete rupture of the muscle or tendon unit. Extensive edema and bruising with balling of the muscle or a significant change in the contour of the muscle and complete loss of function specific to the injured muscle/tendon
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grade 3 strain RROM testing results
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Weak and painless
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grade 3 strain recovery time
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Healing time is between 50 and 180 days. Surgical intervention is dependent on the injured muscle...some muscles are not surgically reunited
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avulsions definition
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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. The tendon is usually the last to tear… the muscle or the bony insertion will mostly likely give way before the tendon.
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Complications to Muscle and Tendon Injuries
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Contracture
Myositis Ossificans Compartment Syndrome Adhesions |
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contracture complication characteristics
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-most common complication of muscle or tendon injuries, with 75 per cent of the shortening occurring in the tendon versus the muscle
-If the therapist can decrease initial inflammation, contractures will not occur at immobilized joints for up to six weeks |
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Compartment Syndrome characteristics
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-Usually associated with crushing injuries to muscle that produce significant inflammation and edema within the fascial compartment
-Since the fascia does not “give” the edema produces pressure inside the compartment -Blood vessels collapse under this pressure, resulting in ischemia and subsequent necrosis of tissues within the compartment |
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adhesion complication definition
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-Scar tissue binds down the tendon to surrounding tissue, not allowing for smooth gliding of the tendon.
-Occurs with excessive inflammation, or with tissues that were mobilized too late |
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manual therapy effectiveness characteristics
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Manual therapy is an effective adjunct to musculoskeletal rehabilitation, and it is most effective when combined with other treatments, particularly exercise
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Manual therapy has been proven to:
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reduce pain
relax muscles in spasm lengthen shortened muscles improve ROM Optimize posture / biomechanical alignment improve fxn |
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depth of penetration for Cold (cold packs, ice massage)
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1.0 – 2.0 cm
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depth of penetration for cold vapocoolant sprays
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< .5 cm
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depth of penetration for Superficial heat (hot packs)
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1.0 cm
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depth of penetration for Ultrasound (1.0 MHz)
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up to 5.0 cm
at intensity of 1.5 – 2.0 W/cm2 |
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depth of penetration for Ultrasound (3.0 MHz)
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1.0 – 2.0 cm
at intensity of 0.5 W/cm2 |
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mysositis ossificans definition
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calcifications occur at the site of injured muscle,
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Sprain characteristics
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-injury to a ligament that occurs when forces stretch some or all of the fibers beyond their elastic limit, producing some degree of rupture
-usually accompanied by soft tissue swelling, changes in ligament contour, and possible dislocation or subluxation of the involved joint |
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blood supply of ligaments characteristics
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-When compared to other tissues, ligaments have a relatively fragile blood supply
-Although less vascularized than tendon, some degree of repair is possible via collagen formation (this is highly dependent on the degree of sprain). |
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grade 1 sprain
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-involves microscopic stretching or minimal tearing of a few fibers, with no gross disruption of the ligament. -Localized swelling and tenderness is apparent over the injury site
-Some ligament fibers are torn, but no demonstrable loss of the integrity of the ligament |
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grade 1 sprain return to activity
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Pain primarily dictates whether the person can perform an activity, and return to full physical activity usually occurs within 10 days to 2 weeks
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PROM grade 1 sprain
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stress to the injured ligament is _painful_, but there is _little loss of structural integrity_
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grade 2 sprain characteristics
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-Some degree of gross disruption of ligament occurs with many but not all of the ligament fibers are torn, and there is clinical evidence of joint instability
-patient feels pain along the course of the intact portion of the ligament -Stress testing reveals some laxity, and pain on testing |
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grade 2 sprain mild, moderate, and severe characteristics
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mild: 1 - 25% of tissue disrupted, mild instability
moderate: 25 - 75% tissue disrupted, moderate instability severe: 75 - 99% tissue disrupted, significant instability |
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PROM grade 2 sprains
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stress to the injured ligament is painful, with structural integrity dependent on degree of injury
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return to activity grade 2 sprains
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Pain dictates whether the person can perform an activity; return to full physical activity usually occurs within 10 days to 2 weeks. More severe sprains may take 5 weeks -2 months for return to activity
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grade 3 sprain characteristics
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–complete rupture of the ligament with loss of structural integrity
-This disruption occurs at the bony attachments (avulsion fracture) or within the substance of the ligament -typically the muscles around the joint must provide stability |
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PROM testing grade 3 sprain characteristics
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shows _major instability_, with _no pain_in the ligament, but _possible pain_from injury to surrounding tissue
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grade 3 ligament healing time
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Ligamentous healing times vary, depending on which ligament was injured, the degree of injury, and the vascular supply to the area. Healing times range from 7 weeks to 18 months
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Interventions to Influence Inflammation and Reduce Pain
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-Medications
Steroids and NSAID’s for inflammation (and pain) Numerous pharmaceutical avenues to address pain -Modalities Superficial heat (reduces pain, not inflammation) Superficial cold Ultrasound -Rest, compression, and/or elevation -Combination of all of the above |
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Integrating Manual Therapy with Other Treatment Strategies
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-You should never perform manual therapy in isolation
-Always prescribe at least one stretch for the muscle(s) you treated -Consider prescribing a strengthening exercise for the muscle’s antagonist I-ncorporate short-term taping for postural correction |
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subluxation definition
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some part of the articular surfaces are still in contact
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dislocation definition
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articular surfaces are no longer in contact with each other
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sratum fibrosum characteristics
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-Composed of dense fibrous tissue, histologically similar to ligament
-Primarily Type 1 collagen -Varies in thickness - thin membrane -> strong ligamentous band -Can be an effective check to prevent motion -Attached to periosteum by Sharpey’s fibers -Poorly vascularized but highly innervated |
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stratum synovium characteristics
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-Generally 1 - 3 cells in depth, with cells loosely arranged in sheets
-Highly vascularized but poorly innervated (insensitive to pain, but responds to changes in temperature) -Produces the hyaluronic acid component of synovial fluid. -Removes debris from within the joint space |
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joint capsule blood supply
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-Comes from branches off arteries that provide blood supply for muscles that cross the joint
-Comes from periosteal blood supply and from sub-chondral bone |
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Joint Capsule Innervation 2 primary sources
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-articular nerves branching from adjacent peripheral nerves
-branches from nerves that supply muscles controlling the joint |
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type 1 joint receptors
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– postural / proprioceptive
-Located in the stratum fibrosum; numerous -static and dynamic joint position sense -sense speed and direction of movement -regulation of postural muscle tone -slow adapting; low threshold |
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type 2 joint receptors
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-dynamic / kinesthetic
-Located in the stratum synovium and fat pads; sparse -sense changes in speed of movement and change of direction of joint -regulate muscle tone at beginning of and during movement -rapidly adapting; low threshold |
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type 3 joint receptors
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- inhibitive
-Located in the stratum fibrosum and in ligaments -sense direction of movement -regulation of muscle tone during potentially harmful movements (stretch at end range) -very slow adapting; high threshold |
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type 4 joint receptors
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-nociceptive
-Located in the stratum fibrosum, ligaments, articular fat pads, and periosteum -pain receptors -responsive to mechanical deformation or tension; mechanical or chemical irritation -inactive under “normal” conditions -high threshold, non-adapting |
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truma to joing capsule types
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Acute/traumatic injury
Chronic/overuse/cumulative trauma injury Surgically-induced Sustained postures / habitual movement patterns |
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Joint Capsule Response to Trauma: Phases of Healing for Moderate to Severe Injuries (acute, sub-acute, sub-acuter to chronic, chronic)
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Acute: days 1-3
Sub-acute: days 3-4 to weeks 3 - 4 Sub-acute to chronic: days 14 - 60 Chronic: days 60+ |
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thermal effects of continuous ultrasound
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-Increases collagen extensibility
Excellent adjunct to joint mobilization (lab practical # 1) -Alterations in blood flow -Changes in nerve conduction velocity selectively heats peripheral nerves may alter or block impulse conduction (including pain) increase membrane permeability increase tissue metabolism -Increase pain threshold -Increase local metabolism |
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non thermal effects of pulsed ultrasound
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-Increased membrane permeability
accelerated ion diffusion increased intracellular calcium -Increased rate of protein synthesis by fibroblasts -Increased macrophage responsiveness -“[Pulsed] ultrasound is particularly effective during the inflammatory phase of repair…” |
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Prolonged Inflammation ( ) the number and activity of fibroblasts: i.e. the longer inflammation persists, more ( ) develops.
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Prolonged Inflammation increases_ the number and activity of fibroblasts: i.e. the longer inflammation persists, more_ scar tissue develops.
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best phase of healing to increase ROM?
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Sub-acute phase of healing
Treatment to increase joint ROM and function - very effective (possibly too effective) |
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Capsular patterns of the Upper Extremity- GH joint
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External rotation > Abduction > Internal Rotation
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Capsular patterns of the Upper Extremity- elbow/humeroulnar
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flexion > extension
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Capsular patterns of the Upper Extremity- elbow/humeroradial
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equal loss of pronation and supination
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Capsular patterns of the Upper Extremity- wrist
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equal loss of flexion and extension
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Capsular patterns of the Upper Extremity- MP, PIP, and DIP joints
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flexion > extension
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Development of Capsular Fibrosis/Adhesions generally due to:
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-Resolution of an acute articular inflammatory process
-A chronic, low grade articular inflammatory process -Immobilization of a joint |
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US heats tissues with high absorption coefficients generally those with ( ) a collagen content
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high collagen content
Joint capsule and ligament are comprised mostly of collagen |
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joint mobilization definition
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-A form of manual therapy
-Use of graded oscillatory mobilizations and/or sustained traction to relieve pain, stretch capsular tissue, and/or break up adhesions |
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joint mobilization used to:
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-Stimulate receptors to relieve pain
-Gain range of motion at the joint -Gain optimal arthrokinematics by _restoring accessory motions_at the involved joint(s) |
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Accessory Motions definition
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Movements within the joint and surrounding tissues that are necessary for full ROM but cannot be performed actively by the patient.
-Spin -Roll -Glide/slide -Compression -Distraction/traction |
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most common indication for joint mob
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Pain
Joint Hypomobility - majority of the time you are treating a capsular pattern |
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history/interview before joint mob includes asking about:
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presence of contraindications or precautions
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Your physical examination (PE) before joint mob consists of an assessment of all:
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accessory motions at the joint, including the joint above the suspected area of restriction, and the one below. (Keep moving to the next proximal or distal joint if stiffness is noted in those joints.)
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During joint mob, your treatment targets only those accessory motions that are
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diminished with joint mobilization (determined in your PE)
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Maitland’s Grades of Oscillatory Mobilization Grade 1 characteristics
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Grade I: Small amplitude movement at beginning of range > used to treat _pain
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Maitland’s Grades of Oscillatory Mobilization Grade 2 characteristics
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Grade II: Large amplitude movement within range (but not at end of range) > used to treat _pain_
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Maitland’s Grades of Oscillatory Mobilization Grade 3 characteristics
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Grade III: Large amplitude movement up to limit of range > used to treat _pain_and _increase ROM_
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Maitland’s Grades of Oscillatory Mobilization Grade 4 characteristics
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Grade IV: Small amplitude movement at limit of range > used to _increase ROM
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Maitland’s Grades of Oscillatory Mobilization Grade 5 characteristics
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Grade V: High velocity thrust at limit of range > used mainly to _increase ROM_but can _decrease pain_once greater ROM is achieved
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Grades of Sustained Traction /Mobilization- Grade 1 characteristics
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Traction Grade I: small amplitude with no appreciable movement > used to treat _pain_
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Grades of Sustained Traction /Mobilization- Grade 2 characteristics
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Traction Grade II: sustained movement within ROM to the restriction (taking up the “slack”) > used to treat _pain_and to __gain ROM_
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Grades of Sustained Traction /Mobilization- Grade 3 characteristics
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Traction Grade III: sustained movement at end of range through the restriction > used to _increase ROM_
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During joint mob, when a restrictive barrier occurs:
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-loss of range of motion is apparent
-a new pathological neutral is established |
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During joint mob importance of restrictive barrier
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-You should always examine accessory motions in the joint’s neutral (also known as loose-packed) position.
-These concepts are essential for the application of other manual therapy techniques. |
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Joint mob treatment- pain before resistance
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Begin Oscillation Grade I progress to Grade II or use TX I
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Joint mob treatment- pain and resistance
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Oscillation Grade II progressing to Grade III or IV (if tolerated) or use TX I or TX II
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Joint mob treatment- resistance before pain
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Oscillation Grade III to Grade V or TX II to TX III
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Most critical events with regard to musculoskeletal development happen between the ( ) and ( ) weeks of gestation
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4th and 8th weeks
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At ( ) weeks, the synovial joints develop
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14 weeks
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At ( ) weeks, the skeleton is as ossified as it will be prior to birth
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20 weeks
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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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Epiphyseal plates fuse between what ages?
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the ages of 21 and 25 years
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periosteum characteristics
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-The dense fibrous membrane that covers all bones, except for joint surfaces (which are covered with articular cartilage).
-outer layer- blood vessels and nerve fibers -inner laywer- contain osteoblasts |
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osteomalacia characteristics
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-“Softening of the bones” occurs as a result of decreased deposition of calcium in the bone, and an increased production of unmineralized matrix
-bone is more likely to deform rather than fracture -Commonly associated with Vitamin D deficiency |
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osteoporosis characteristics
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-decrease in qualitatively normal bone, which renders the individual more susceptible to fractures.
-imbalance between bone resorption and bone formation. -Results when the body has not obtained adequate calcium from the environment. -Results when mechanical load on the bone is insufficient for the development of new bone. |
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Type 1 osteoporosis characteristics
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-"Postmenopausal Osteoporosis”
-Decrease in mineral density that occurs when circulating estrogen levels decrease -Affects primarily trabecular bone and is most prevalent among 55-70 year olds |
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type 2 osteoporosis characteristics
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-“Age-related Osteoporosis”
-Affects men and women equally -Occurs usually after age 70 -Equal loss of trabecular and cortical bone |
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common fractures associated with osteoporosis
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Vertebral Body
Femoral Neck Distal Radius |
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Ten Commandments of Osteoporosis Prevention
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1. Adequate vitamin D intake
2. Get enough calcium in a balanced diet 3. Limit caffeine, salt, protein, and phosphorous 4. Don’t go on starvation diets 5. Exercise regularly 6. Hormone replacement following menopause 7. Take estrogen if your ovaries have been surgically removed 8. Avoid drugs that decrease bone mass (such as long term use of steroids) 9. Drink alcohol in moderation 10. Don’t smoke |
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A fracture ________produces some degree of soft tissue injury
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always
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fracture healing stages
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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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impact stage (1) characteristics
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occurs at the moment of injury and lasts until there is complete dissipation of energy
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induction stage (2) characteristics
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-following bony failure, cells possessing osteogenic potential are stimulated to form bone
-Periosteal and intraoseous osteoblasts around the area of the break are activated, and large numbers of new osteoblasts are formed |
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inflammation stage (3) characteristics
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begins shortly after impact and lasts until the bone ends are united by fibrous union, formed by increased osteoblast activity producing new organic bone matrix (occurs during the first and second weeks)
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Soft callus stage (4) characteristics
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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 (approximately 2-3 weeks)
-minerals that comprise the inorganic component of bone are beginning to be deposited in the fibrous matrix -Osteoclasts begin to appear in large numbers and absorb portions of dead bone fragments -Pain is greatly decreased by this time -callus is not yet apparent on x-ray |
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Hard callus stage (5) characteristics
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-the callus continues to be "sticky" and is considered an "osteogenic sleeve" around the fracture fragments
-converts from fibrocartilaginous tissue to fiber bone -bone begins to mature as mineralization continues and the callus begins to be absorbed by osteoclasts. -fracture fragments are firmly united by bone. -callus is apparent on x-ray, and the fracture is considered to have undergone clinical union. (Occurs at approximately _3 to 5 weeks_). |
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Stage of remodeling (6) characteristics
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-occurs when the fracture is healed, and the diameter of the bone is nearing pre-injury size
-callus has been or is close to being completely reabsorbed. -fracture has undergone radiographic union -fiber bone is converted to lamellar bone and the medullary canal is reconstituted -usually occurs at __6 to 8 weeks_however, remodeling can last up to a few years before it is complete |
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Only tissue to heal without a scar?
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bone
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Fracture management characteristics
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-Non-intervention
-Closed Reduction: external realignment of fragments Cast: a stress sharing device often used with closed reductions -Open Reduction Internal Fixation (ORIF): surgical realignment of fragments, typically using some type of hardware (plates, screws, etc.) -External Fixation -Ilizarov and Debastiani Procedures |
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casting characteristics
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-stress-sharing device
-allows for callus formation and thus relatively rapid bone healing -joint above and the joint below the fracture are immobilized in the cast to prevent rotation and translation of the fracture fragments -Early weight bearing is allowable if the fracture pattern is stable -Occassionally weight bearing must be delayed until sufficient callus has developed to prevent displacement |
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Wolff’s Law and Fixation Devices
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Fixation devices (both internal and external) will absorb a great deal of force, causing the surrounding bone to be less stressed, and thus less dense.
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Open Reduction Internal Fixation (ORIF) definition
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-surgical realignment of fracture fragments, with fragments being held in approximation by hardware such as plates, screws, pins, wires, nails, intramedullary rods, etc.
-Bone grafts may also be used with fractures in which the fragments are not in close proximity to each other |
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External Fixation definition
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-Associated with more severe fractures
-applies hardware to hold aligned fragments in place, usually consists of an external frame to which are attached pins that are drilled through the various fracture fragments. -Hoffman Devices -Ilizarov and Debastiani Procedures |
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cast type of fixation
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short of long
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cast biomechanics
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stress sharing
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cast type of bone healing
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secondary (callus)
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cast rate of bone healing
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fast
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cast weight bearing
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early
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most frequently used form of treament?
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cast
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rod type of fixation
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reamed or unreamed
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rod biomechanics
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stress sharing
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rod type of bone healing
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secondary (callus)
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rod rate of bone healing
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fast
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rod weight bearing
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early
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rod- reamed vs unreamed
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Reamed is most frequently used
unreamed often used in open fractures |
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plate type of fixation
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compression
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plate biomechanics
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stress shielding
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plate type of bone healing
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Primary (no callus)
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plate rate of bone healing
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slow
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plate weight bearing
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late
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plate requires:
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secondary support
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pin, screw or wire biomechanics
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stress sharing
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pin, screw or wire type of bone healing
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secondary (callus)
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pin, screw or wire rate of bone healing
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fast
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pin, screw or wire weight bearing
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delayed
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pin, screw or wire are frequently used with
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other types of fixation
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external fixator type of fixation
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exoskeleton
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external fixator type of bone healing
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secondary (callus)
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external fixator biomechanics
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stress sharing
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external fixator rate of bone healing
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fast
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external fixator weight bearing
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early
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external fixator mostly associated with
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soft tissue injuries
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ilazarov type of fixation
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exoskeleton
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ilazarov biomechanics
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wolff's law
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ilazarov type of bone healing
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distraction osteogenesis
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ilazarov rate of bone healing
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approx. 1 cm per month
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ilazarov weight bearing
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early
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primary use ilazarov
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lengthen bones
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fracture healing complications
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-Vascular
-Neurological -Avascular Necrosis: bone ischemia and/or death due to compromised circulation -Joint Stiffness / Contracture -Myositis Ossificans -Degenerative Joint Disease (DJD): frequently associated with intra-articular fractures -Effects of Immobilization: contracture, capsular fibrosis, muscle atrophy, altered biomechanics |
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angiogram definition
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dye is injected into blood vessels and sometimes into the lyphatic system to assess patency of the vessels
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Myelogram definition
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injection of dye into the spinal canal and around nerve roots
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Bone Scan/Scintigram definition
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injection of radioactive isotopes that preferentially go to areas of greater circulation
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Computed Tomography (CT) definition
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uses x-rays to obtain sectional images or 3-dimensional reconstructions of body tissues. Better at rendering bony tissues
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Magnetic Resonance Imaging (MRI) definition
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uses no x-rays; instead, it uses a magnetic field to produce images. Better at rendering soft tissues.
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Ultrasound Image definition
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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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most common images that occupational therapists and physical therapists will access to gather information about a patient's musculoskeletal problem(s)?
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radiographs
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Cardinal Rules for Making Radiographic Images
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-Images should include proper patient identification
-At the very least, take two views -Include one joint -Provide the best quality possible |
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Cardinal Rules for Viewing Radiographic Images
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-Right patient, right procedure
-View the entire image -Hang the radiograph as though the “person” is facing you -If unilateral extremity, hang in anatomic position, facing you -For hands and feet, hang digits-up -Develop a pattern of scanning the entire image, ie: start at top left corner, scan left to right, all the way to the bottom of the image; -Look at all tissues -Apply your knowledge of “normal” anatomy to what you see and what you don’t see -Avoid tunnel vision.... Don’t just look: See. |
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AROM assesses
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patient willingness to move
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PROM assesses
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non contractile structures
an idea of how much ROM is present at the joint |
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RROM assesses
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contractile structures, the muscle and tendon
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