Exam 1 Flashcards
What are the key patient supervision skills?
-Teamwork
-Seek, understand, and relay information
-To the PT and Team
-Have a warm personality
What are Cardiovascular red flags?
-Chest pain, L UE pain, or any symptoms of an MI
-Pulsating Pain
-Constant, severe LE pain
What are the red flags for cancer?
-Chronic night pain
-Constant pain unrelieved by position/activity
What are the Gastrointestinal red flags?
Frequent or severe abdominal pain
What are the Neurological red flags?
Frequent or severe headaches
What are the cardinal signs of inflammation?
-Pain
-Redness
-Heat
-Swelling
-Decrease in ROM
What type of surgery have a high risk (40-70%) of the pt. developing a DVT if not given prophylaxis?
LE Joint Replacement
Which test can indicate a DVT?
Homan’s Sign
What are the risk factors for a DVT?
-Immobility
-Trauma: fx, surgery
-Hx, DM obese, hormone change
-Hypercoagulation
What is used to calculate the risk score interpretation for DVTs?
Wells Prediction Rule
What are the signs and symptoms for a DVT?
-Peripheral edema
-Warmth
-Skin discoloration
-Prominent superficial veins
-Leg pain
-Tenderness
How can a PTA decrease the risk of a DVT in a pt.?
Get them moving
Is Brawny (hard/chronic) edema normal?
Yes
Is pitting in the edema site normal?
Yes
Is bilateral edema normal?
No
What is Compartment Syndrome, and where is it most commonly found?
It is a dangerous type of edema most commonly found in the anterior compartment of the calf.
-Pt. typically loses sensation in web space between 1st and 2nd toe
Definition: Creating a situation by using probing questions and appropriate communication skills, accountability, listening, and responsibility, so that active responses occur rather than simply reacting once something happens
Proactive
Empathy vs. Sympathy
-Empathy is actively trying to understand the person’s point of view
-Sympathy is more of just acknowledging that the person has certain feelings without truly trying to put yourself in their shoes and find a solution
Does the PTA have the ultimate responsibility for the physical therapy interventions provided?
Yes
What are the 5 components of patient supervision?
-Gather relevant information and data
-Fully understand the POC
-Assist in the management of the pt.
-Establish rapport, trust, and confidence with the pt.
-Create an environment where the pt. can feel comfortable voicing concerns about their problem
Appropriate medical language used with the patient and their family helps to convey…
Understanding, sensitivity, warmth, and reassurance
Definition: An effective communication tool that demonstrates interest and concern for the patient and their individual needs.
Listening
A professional relationship with the patient should be based on…
Trust and respect
Blood in urine would indicate which type of red flag?
Gastrointestinal
Symptoms
-Palpable cord (vein is hardened along its length)
-Redness
-Subcutaneous vein distension
-Warmth
Superficial Vein Thrombosis
Symptoms
-Discoloration or cyanosis
-Pain or tenderness of affected area
-Pain with placement of blood pressure cuff around calf inflated to 160-180
-Positive Homan’s sign
-Unilateral tenderness or leg pain usually in calf
-Unilateral swelling
-Warmth of skin
Deep Vein Thrombosis
Symptoms
-Edema of an entire extremity (usually unilateral)
-Pain may or may not be present
-Paresthesias (tingling or prickling sensation)
-Skin is taut and shiny
-Stemmer sign (taut skin on dorsum of foot)
-Worse with dependent positions
Lymphedema
Type of Lymphedema where accumulation of protein-enriched fluids may be secondary to a developmental disorder of the lymphatic system.
Primary Lymphedema
Type of Lymphedema that is the result of obstruction or damage to the lymphatic system (nodes, vessels, and organs). Most common type.
Secondary Lymphedema
What is the most abundant material of Connective Tissue?
Collagen
What are the types of Connective Tissue?
-Bone
-Ligament
-Tendon
-Muscle
-Cartilage
-Neurovascular
Which type of collagen is most common; seen in tendons/ligaments, bones, mature scars, meniscus/disk): thick bundle/very strong?
Type I
Which type of collagen is thin supporting filaments; 1/2 life of 3 months; seen in hyaline and elastic cartilage?
Type II
Which type of collagen is thin filaments; strong but supple and elastic; seen in fresh scars, blood vessels prevalent in newborns)?
Type III
Which type of collagen is not assembled into fibers; with other fibers it forms the base membrane?
Type IV
What type of connective tissue is found in capsules?
Dense irregular
What type of connective tissue is found in ligaments?
Dense regular
What type of connective tissue is found in tendons?
Dense regular
What are the Phases of Healing?
- Inflammatory response (acute stage)
- Repair Sequence/ Fibroplastic (subacute stage)
- Remodeling/ Connective tissue formation (chronic stage)
What is Autolytic wound debridement, and which phase of healing is it found in?
-When good cells come in to clean the area
-Inflammatory response phase
Exudate vs. Effusion
-Exudate is increased protein and phagocytic cells (pus)
-Effusion is fluid escaping into a compartment (knee joint)
When does the Repair/Fibroplastic phase of healing occur?
Approximately 5-21 days post injury
Characteristics of which phase of healing?
-Purpose: new tissue to integrate into the area
-Granulation tissue visible
-Angiogenesis: new blood supply to area
-Proliferation of new collagen, elastin, and proteins
-Low tensile strength of tissue at 20%; causing risk of reinjury
Phase 2: Repair/Fibroplastic
When does the Remodeling phase of healing occur?
2-3 weeks post injury
Characteristics of which phase of healing?
-Connective tissue formation
-Tissue is aligning
-Increased fibrous formation
-Maturation of scar
Phase 3: Remodeling
The medical term for the cardinal sign of pain is…
Dolar
Exudate flows into the area in which phase of healing?
Inflammation
Which type of cartilage is found on joint surfaces, ribs, and fetal skeletons?
Articular (Hyaline) Cartilage
Which type of cartilage are found at tendon/ligament insertions, and is the meniscus and disks made out of
Fibrocartilage
What type of cartilage is found in the external ear and trachea?
Elastic
Characteristics of which type of Cartilage?
-Avascular (poor healing)
-2-4 mm thick
-Frictionless
-Force distributor
-Permeable (allows gasses or liquids to pass through it)
-Type II collagen
-Nourished by synovial fluid
Articular (Hyaline) Cartilage
What does OATS stand for?
Autologous Chondrocyte Transplant
Characteristics of which type of Cartilage?
-Vascular along rims
-Mechanoreceptors
-Shock absorbing
-Contributes to joint stability
-Ex. meniscus, disk, labrum
-Type I collagen
Fibrocartilage
Which type of collagen is found in articular (hyaline) cartilage?
Type II
Which type of collagen is found in fibrocartilage?
Type I
Which part of the meniscus is vascularized?
The outer 10-30%
What do surgeons do to an injured outer 10-30% of the meniscus?
Surgical repair via arthroscopy
What do surgeons do to an injured inner area of the meniscus?
Partial or total meniscectomy
What are the Post-op precautions for a surgical repair of the meniscus?
-NWB to FWB later
-Limit flexion ROM
-Slower progression to full flexion ROM
What are the Post-op precautions for a meniscectomy?
-FWB early
-Progressive AROM
-Prog. Strengthening
What type of collagen is found in ligaments?
Type I
Do you sprain or strain a ligament?
Sprain
Do you sprain or strain a muscle?
Strain
Which grade of sprain?
-Microscopic tearing
-No joint laxity
-No/minimal swelling
-Local tenderness
-(-) joint stress test
Grade I
Which grade of sprain?
-Incomplete tearing
-Moderate joint laxity
-Localized swelling
-Pain with WB
-Ecchymosis (bleeding)
-Mild (+) stress test
Grade II
Which grade of sprain?
-Complete tear/rupture
-Profound joint laxity and instability
-Unable to WB
-Significant pain and swelling/ecchymosis
-Mod/severe joint stress test
Grade III
Do extra- or intra-articular ligaments have..
-predictable and structured healing pattern
-healing of various rates and degrees
-ultimate healed tensile strength of 50-70%
Extra-articular ligaments
Do extra- or intra-articular ligaments have..
-decreased spontaneous healing process
-because synovial fluid interferes with the healing process
Intra-articular ligaments
How long does it generally take Grade III sprains to heal?
> 40 weeks
When do surgeons decide to surgically repair a sprained ligament?
When there is functional instability
Functional movement of the human body is performed by the interaction of how many skeletal muscles?
Over 600
What is the structure of a muscle?
Muscle > Fascicle > Myofiber > Myofibril/Sarcomere
What is the basic contractile unit of a muscle?
Myofibril
Characteristics of which type of muscle fiber..
-Red fibers
-Adapted for aerobic activity
-Fatigue resistant
Slow twitch- Type I
Characteristics of which type of muscle fiber..
-White fibers
-Designed for anaerobic activity
-Fatigues easily
Fast twitch- Type II
Which part of the muscle is strained the most?
The musculotendinous junction
During which type of contraction do muscle strains most typically occur?
Eccentric contraction/loading
What is the fastest healing of all the connective tissues?
Muscle
In what order are connective tissues from fastest healing to slowest healing?
Muscle > Bone > Tendon/Ligament
What are the goals for Muscle rehabilitation at the Acute stage?
Facilitate healing and decrease inflammation and pain
-RICE, modalities
-Controlled movement using PROM, AAROM
What are the goals for Muscle rehabilitation at the Subacute stage?
Restore full ROM and initiate strengthening
-Progress to AROM and stretching
What are the goals for Muscle rehabilitation ate the Chronic stage?
Remodeling of collagen
-Functional exercise, endurance training
-Plyometrics when pain free
What is tendon avulsion?
When a small chunk of bone attached to a tendon gets pulled away from the main part of the bone
What is Mallet Finger and how does it happen?
When the tendon of a finger is avulsed at the DIP. It happens when the DIP is suddenly and forcefully flexed
What is common during Tendon healing?
Adhesion formation due to vascularity from surrounding tissue
When is a tendon repair at it’s weakest?
7-10 days post op
What is Tendonitis?
Inflammatory response to tendon due to injury
What is Tendinosis?
Degeneration of a tendon without inflammatory process
What is Tenosynovitis
Inflammation of a tendon’s synovial membrain
Your patient is a 24 YO soccer player who sustained a 2nd degree strain on her gastrocnemius muscle. At what stage of rehabilitation would you expect to begin low load and high repetition strengthening?
Subacute Stage (1-3 weeks)
______ migrate to the injury site directly after trauma and release specific growth factors and chemical mediators, which stimulate homeostasis and initiate the repair process.
Platelets
What is the neovascular budding that helps reestablish oxygen-rich and growth factor-rich blood to new, fragile healing tissue?
Angiogenesis
The connective tissue membrane surrounding the entire muscle is called ________.
Epimysium
T or F: There are essentially three types of collagen found in musculoskeletal tissue.
True
Which phase of ligament repair occurs as the ligament retracts and looks highly disorganized?
Phase I
What is Ligamentization?
Tendon repair to ligament-like tissue
T or F: Ligaments lose up to 20% of their weight after 8 weeks of immobilization
True
To orient collagen fibers and promote a functional scar, _____ must be applied.
Progressive controlled stress
After injury or surgery to a ligament, protection against ________ must be strictly enforced.
Unwanted forces
What are the canals and the surrounding lamellae of bone called?
The Haversian System
What are Bone forming cells called?
Osteoblasts
What are Bone maintaining cells called?
Osteocytes
What are Bone matrix dissolving cells called?
Osteoclasts
Where is the Haversian System located?
In Cortical/Compact bone
How porous is Coritcal/Compact bone?
30%
How porous is Cancellous bone?
50-90%
What is the longitudinal growth of bone called?
Endochondral Ossification
What is the latitudinal growth of bone called?
Intramembranous Ossification
What is in the Medullary canal of long bones, and what happens there?
Bone marrow, and it is the cite of bone cell production.
What is very rich in nerve supply, and probably where we feel pain the most when we break a bone.
Endosteum and Periosteum
Which law states: Load intermittently applied to bone stimulates growth
Wolff’s Law
What is the method used to grade fractures that occur in children and involve the growth plate?
The Salter-Harris Classification System
Which is the most common Salter-Harris fracture and what is the worry with this type of fracture?
Type II (fracture through the growth plate and metaphysis). The worry is that the bone may not grow to normal length.
Which is the worst prognosis of the Salter-Harris Classification System?
Type V (compression fracture through the growth plate)
T or F: Bone is very brittle and can tolerate small deformation.
True
Which form of cell is a giant cell multinucleated bone resorption cell?
Osteoclast
What are the two distinct forms of microscopic organization and classification of bone tissue?
-Normal, mature lamellar bone
-Weak, fragile, immature woven bone
Which type of bone is more commonly seen in embryos and newborns but can also be seen in adults in fracture repair callus, bone tumors, and various bon pathologies?
Woven Bone
T or F: Intermittent physiologic loads create osteoblastic activity.
True
Which law states that compression forces limit bone growth, whereas tensile stress stimulates growth?
Hueter-Volkman
Mature bone begins formation at about age __________, and comprises most of the skeleton by age _______.
-1 month after birth
-4 years
The three distinct complications of bone healing are ______.
Delayed union, nonunion, and malunion
T or F: Compact bone heals faster than cancellous bone
False
T or F: Collagen constitutes about 50% of the dry weight of bone, whereas lipids and proteins constitute the remaining 50%
False
Collagen makes up what percent of bone?
90%
