Deep Transverse fractures* Flashcards

1
Q

how do we stress test ligaments (see that they are in tact)?

A

stretch the ligament and see that they are pain

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2
Q

how do we stress test tendon (see that they are in tact)?

A

resisted test - where the pain is helps differentiate between muscle and tendon.

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3
Q

how do we stress test muscle (see that they are in tact)?

A

resisted test - isometric contraction

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4
Q

deep transverse friction is a subclassification of

A

swedish remedial massage

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5
Q

definition of deep transverse friction

A

A repetitive, specific, non-gliding technique that produces movement between the fibres of dense connective tissue*; increasing tissue extensibility & promoting ordered alignment of collagen within the tissues

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6
Q

passive restraint

A
non contractile tissue 
stopping point at end of range
guide joint motion 
connect bone to bone
prevent excessive motion
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7
Q

dynamic restraint

A

connect muscle to bone

transmit tensile load to produce joint motion or maintain posture

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8
Q

upper limb synovial sheaths

A

between greater and lesser tubercle of humerus in intertubercular groove

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9
Q

major structural component of connective tissue

A

collagen

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10
Q

how is collagen aligned

A

oriented along axis of principal tensile physiological loading of CT
Roughly aligned in parallel bundles with scattered fibroblasts

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11
Q

elongation

A

straightening out of crimping

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12
Q

micro-failure

A

e.g. in cumulative overload

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13
Q

failure

A

(tearing): e.g. macrofailure or clinical strain / fracture

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14
Q

effects of injury and immobilisation on tendon

A
Irregular collagen arrangement
Different collagen types
Higher H2O content
More random crosslinks between fibres, bundles & adjacent tissues
Lower tensile stiffness
Lower ultimate strength of CT
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15
Q

deep transverse friction analgesic effects

A

Counterirritant effect – stimulating (low-level) pain will activate body’s analgesic methods
Pressure / touch stimulus  Pain gate effect via stimulating large diameter mechanoreceptors which inhibit transmission of pain impulses
Resorption of local irritating metabolites (by-products of healing process)

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16
Q

deep tissue friction effects - mobilisation

A

Mobilisation & remodelling of healing tissue  reduced ‘stiffness’
Increase extensibility between tissue layers by producing a widthways stretching across fibres separating them and lengthening cross bridges between collagen fibres, thus restoring interfibre mobility
Increase extensibility between tissue and neighbouring surfaces e.g. Bone
Reduction in muscle tone

17
Q

deep tissue friction effects - circulation

A

Local hyperaemia aiding the resolution of inflammation

Local ‘damage’  H substance released causing vasodilatation

18
Q

stages of inflammation

A

acute inflammatory phase
proliferative phase
remodelling phase

19
Q

acute inflammatory phase

A
vasodilation/constriction
phagocytosis - neutrophil + monocytes
72 hrs - heat, swelling, redness pain
tissue sensitivity 
altered chemical state
20
Q

proliferative phase

A

fibroelastic infiltration

collagen formation producing granulation and scar tissue damage

21
Q

remodelling phase

A

-contraction of scar
-vascularity reduces
-tensile strength of
collagen 
-starts end of second
week – up to 1 year

22
Q

deep tissue friction effects neurlogically

A

Neuromotor Excitability

Decrease in H-reflex (muscle tone) illustrating a reduction in neuromotor excitability when DTF applied to

23
Q

mechanistic effects of deep transverse friction

A

reduced excitability
increased range of motion
increased supinator strength

24
Q

contraindications of deep transverse friction

A

rheumatoid arthritis
calcification of soft tissue
over peripheral nerves- neuropraxia

25
why is rheumatoid arthritis a contraindication for deep transverse friction
Potential for collagenous weakening due to RA  CI relevant to CT of affected joint(s) only e.g. ligt
26
why is calcification a contraindication for deep transverse friction
muscle or tendon e.g. Myositis Ossificans (Quads) Calcified SST Pellegrini-Steida Lesion (MCL)
27
deep transverse friction technqiue
use area of hands to match target tissue size apply accurately to site of tissue damage apply at 90 degrees to tissue fibres take tissues thu their full transverse sweep/ end feel patients skin moves w/ finger over target tissue warn patient it may be painful pain must be within. patients pain tolerance target tissue on stretch or shortened position
28
muscle tissue is in stretch or shortened position
shortened
29
tendon tissue is in stretch or shortened position
stretch
30
tendon-synovial sheath complex is in stretch or shortened position
stretch
31
deep transverse friction treatment parameters
depth of lesion intensity - depends on stage of healing and pts pain tolerance duration - 5-20 minutes patient position - stretch or shortened position
32
when should deep transverse friction is used in a clinical setting
Ideal for small isolated musculo-tendinous or ligamentous lesion Effects are both MECHANICAL & NEUROPHYSIOLOGICAL, but never used as sole treatment technique