Exam 1 Flashcards
1
Q
Inflammation is triggered by?
A
Histamine
2
Q
What are the 5 cardinal signs of inflammation
A
- Heat
- Pain
3.Redness - Swelling
5.Loss of Function
3
Q
Is an injury to a ligament
A
Sprain
4
Q
Is an injury to a muscle or tendon
A
Strain
5
Q
What happens immediately after injury that causes platelet plug formation to help stop bleeding
A
Hemostasis
6
Q
What does PRICE stand for?
A
Protection, Rest, Ice, Compression, Eleveation
7
Q
What stage is associated with
1. Inflammation,
- some fibroblast which produce type III collagen
- Last 4-7 Days
A
Acute
8
Q
What stage is associated with
- Tissue begins to regenerate
- Fibroblast produce significant amount of Collagen
- Collagen creating granulation tissue
- 2-4 weeks in duration ( from when Inflammation decreases)
A
Subacute
9
Q
What Stage is associated with
- Tissues Remodels
- Maturation
3 Collagen is most easily manipulated in the first 10 weeks.
- When Subacute phase ends up to 12-18 months .
A
Chronic
10
Q
Hemostasis and degenration of week fragile tissue is associated with which phase of ligament healing, and what is the timeline.
A
Hemostasis or Phase 1
Immediate
11
Q
Vasodilation and scar formation; break down and remove dead cells; unstable type 3 collagen are characteristic of which stage of ligament healing and what is the timeline?
A
Inflammation Stage
Days 3-14
12
Q
angiogenesis; very gradual changes in type 3 collagen strength; tissue changes from cellular to fibrous, is associated with what stage of ligament healing and what is the timeline.
A
Proliferation
Day 14-60
13
Q
Associated with production of type 1 collagen aligning with the scar. What is it’s timeline?
A
Remodeling and Maturation
Day 60-120
14
Q
What stage of Muscle and Tendon healing is associated with the list below and please provide the timeline.
- Rupture of blood an lymphatic vessels with initial vasoconstriction. Coagulation.
- Clot formation
- Vasodilation
- Phagocytosis
- Chemical mediators control inflammatory process
A
Acute Stage
Immediate-6 days
15
Q
What stage of Muscle and Tendon healing associated with the list below and please provide the timeline.
- Decrease inflammation
- Decrease in clot size
- Increase in granulation tissue(fibroblast, myofibroblast, and capillaries
- Repair process initiated
- Angiogenesis( new blood supply to the area)
A
Subacute
Day 3-3 weeks
16
Q
What stage of Muscle and Tendon healing associated with the list below and please provide the timeline.
- Remodling of scar
- Collagen Thickens and strengthens
A
Chronic Stage
3 weeks to years after
17
Q
What stage of bone healing are the following characteristics associated with and please provide the timeline.
- Hematoma formation at the fracture site.
- Inflammation with cytokine release.
- Formation of a fibrin clot.
A
Stage 1 (Bleeding and Hematoma)
0 days to 1 week
18
Q
What stage of bone healing are the following characteristics associated with and please provide the timeline.
- Fibroblasts and chondrocytes proliferate at the fracture site.
- Formation of a soft callus made of collagen and cartilage.
- Capillary ingrowth begins.
A
Stage 2 or (Granulation)
19
Q
What stage of bone healing are the following characteristics associated with and please provide the timeline.
- Soft callus is replaced by a hard, bony callus made of woven bone.
- Bone remodeling begins with osteoblast activity.
A
Stage 3 (Osteoblast)
3 weeks to 6 Months
20
Q
What stage of bone healing are the following characteristics associated with and please provide the timeline.
- Woven bone is replaced by lamellar bone.
- Bone continues to remodel with osteoclast
- Fracture site returns to normal bone structure.
A
Stage 4 ( Osteoclast Reabsorption)
6 months- 1 year
21
Q
What type of cartilage is associated with these characteristics?
-Found in Joint surfaces (ex knee, hip
- Smooth cartilage.
- Made up of type II collagen, chondrocytes, and extracellular matrix.
-Avascular -Nutrients come from synovial fluid.
- Provides a smooth, low-friction surface for joint movement.
- Distributes joint load and pressure.
- Minimal regeneration or repair after injury due to lack of vascular supply.
- Healing mainly through chondrocyte migration from the surrounding cartilage or synovial fluid
A
Articular or (hyaline)
22
Q
What type of cartilage is associated with these characteristics?
-Found in the Menisci and the labrum
- Dense collagen fibers,
-primarily type I collagen
- Has a fibrous structure, making it more durable with less elasticity
- Partial vascular supply
-only the outer region of the meniscus and labrum have a blood supply.
- The inner part will be avascular
- Acts as a shock absorber and stabilizer in joints
- Supports load distribution, in weight-bearing joints.
-Better healing potential compared to articular cartilage
The outer regions with vascular supply can heal with cell migration and blood flow.
- The inner, avascular areas heal poorly, often requiring surgical intervention
A
Fibrocartilage
23
Q
What is the most common type of hip fracture?
A
Intertrochamteric
24
Q
This type of hip fracture occurs in the femoral neck, which is the bridge between the femoral head and the shaft of the femur
A
Intracapsular fractures
25
This type of fracture occurs in the intertrochanteric area, which is the space between the greater and lesser trochanters
Intertrochanteric fractures
26
This type of fracture occurs in the upper femoral shaft, which is below the femoral nec
Subtrochanteric fractures
27
This type of collagen is very strong in mature scars and is associated with alignment
Primarily found in bones, providing strength and rigidity to the skeletal system.
Type 1
28
Is primarily found in cartilage. It is less dense and more flexible than Type I.
Type 2
29
This type of collagen is more elastic in immature scars and is associate with a low degree of alignment.
Found in smaller amounts in the articular cartilage of the hip joint
Present in ligaments around the hip
synovial membrane of the hip joint
Type 3
30
Acute inflammation of a muscle or tendon is called?
Tendinitis
31
No inflammation (chronic condition of muscle and tendon)
Tendinosis
32
Inflammation of paratenon only
Peritendinitis
33
Inflamed Tendon Sheath
Tendovaginitis
34
Inflammation of synovial
Tenosynovitis
35
This grade is associated with a microscopic tear of a muscle or tendon
Grade 1
36
This grade is associated with a partial or moderate tear of a muscle or tendon
Grade 2
37
This grade is a total rupture or max tear of a muscle or tendon
Grade 3
38
When bones develop inside a muscle it is called _____ or _____?
Heterotrophic Bone Formation or myositis ossification
39
What is considered the max protection phase during the healing process
Acute
40
PRICE, PROM, AAROM, Manual therapy and Isometric exercises are interventions for what stage of tissue healing
Acute
41
What is considered the moderate protection phase during the healing process
Subacute
42
What is considered the minimum protection phase during the healing process
Chronic
43
PRICE, gentle exercise, AROM, gentle stretching, low resistance are interventions for what stage of healing
Subacute
44
Progressive exercise, stretching, return of function are interventions for what stage of healing.
Chronic
45
This grade of ligament sprain is associated with minimal joint laxity
Grade 1
46
This grade of ligament sprain is associated with moderate joint laxity
Grade 2
47
This grade of ligament sprain is associated with severe joint laxity
Grade 3
48
8 effects of Immobilization
1. Reduced Physiological motion
2. Decreased afferent neural input
3. Muscular Atrophy
4.Ligament Shortening
5. Reduced ligament size, weight, strength
6. Adhesion Formation
7. Increased Ligament Laxity
8. Joint stiffness related to synovial membrane adherence
49
Immobilization of an injured ligament can cause what % of weight loss after 8 weeks
20%
50
Wound Healing for Skin / Muscle is
5-8 days
51
Healing for Ligaments and Tendons is
3-6 weeks
52
Synthesize type I collagen in bones
Osteoblast
53
Clean up, reabsorb tissue in bones
Osteoclast
54
Common in women over 40, occurs when osteoclast absorb bone faster than than osteoblast.
Osteoporosis
55
This is an early sign of osteoporosis in which bone density is lower than normal for your age, but not low enough to be considered osteoporosis
Osteopenia
56
This type of bone is located at the metaphysis of long bones, the vertebrae, and other cuboid bones
Cancellous or trabecular Bone
57
This type of bone is located in the diaphyseal portion of long bone?
Cortical or Compact bone
58
This classification of bone tissue is associated with being weak and fragile.
Woven
59
This classification of bone tissue is associated with being normal and mature.
Lamellar
60
Bones are vascular or avascular?
Vascular
61
When a bone experiences increased loading, it will remodel itself to become stronger is ________ law?
Wolff's Law
62
Osteoblast will eventually turn into ________________?
Osteocytes
63
What are the 5 stages of bone healing in order.
1. Fracture occurs
2. Bleeding & Hematoma
3. Granulation (Soft callus)
4. Osteoblast build new bone to for (Hard Callus)
5.Osteoclast reabsorbed callus
64
Surgically exposing the fracture site to reduce, approximate, and align bone fragments is referred to as?
Internal Fixation or open reduction with internal fixation (ORIF)
65
How many weeks does it typically take for children's bones to heal?
4-6 Weeks
66
How many weeks does it typically take for adolescents bones to heal?
6-8 Weeks
67
How many weeks does it typically take for adult bones to heal?
10-18 Weeks
68
Name 5 ways to classify bone fractures.
Direction (Spiral, oblique, Horizontal)
Location
Environment (open or closed)
displaced or non-displaced
Complications (Delayed Union, Nonunion, Malunion
69
The adult skeleton receives 5%-10% of the body's total cardiac output. The bone receives blood supply from three distinct but interconnected system.
1. Nutrient Artery
2. metaphyseal-epiphyyseal system
3. Periosteal system
70
This type of cartilage contains Type II collagen, Avascular, relies on Synovial Fluid, and is found at the end of bones and to stay healthy. It needs movement from the joints to stay healthy.
Articular / Hyaline
71
In this zone cartilage is more likely to repair due to its close proximity to bone which is more avascular?
Deep
72
In this zone cartilage is less likely to repair due to its further proximity to bone.
Superficial
73
Direct stimulation of the mesenchymal stem cells in the subchondal bone directing those cells to initiate a healing response is referred to as________? Requires 4 to 6 weeks of Non-weight bearing or restricted weight bearing.
Microfracture
74
What are the 3 progressively overlapping events of degeneration to articular cartilage ( put the in order)
1. Fraying or fibrillate
2. Blistering
3. Splitting or clefting
75
76
What 3 areas are fibrocartilage found?
1. menisci- Knee
2. Labrum- Hip, shoulder
3. Intervertebrale disc
77
This zone of the meniscus is very vascular.
Red on Red
78
This zone of the meniscus is where the periphery is more vascular, while the inner portion has less vascularity?
Red on White
79
This zone of the meniscus is essentially avascular?
White on White
80
Also know as a "bucket handle" tear frequently occur in combination with traumatic event like an ACL tear. Symptoms can include locking and catching in the knee.
Vertical ( longitudinal or circumferential)
81
This tear occurs at the junction of the posterior and middle meniscal body. Often occurs in the white on white zone.
Oblique
82
This tear is oriented perpendicular to the circumferential fibers and are commonly seen in the later meniscus after an ACL injury. Can occur in white on white zone to red on red zone depending on size of the tear.
Radial
83
A tear in the Labrum is similar to what type of tear?
White on White
84
Three factors generally lead to development of DVT. What are they?
1. Hypercoagulability
2. Venous Stasis
3. Venous Injury
85
Signs are what you _______.
See
86
Symptoms are what the patient_______.
Feels
87
__________ is a comprehensive screening that includes specific test and measure
Examination
88
The act of considering or examining something to judge its value, quality, importance, extent, or condition.
Evaluation
89
The identification of an illness or disorder in a patient based on physical examination, medical test, or other procedures.
Diagnosis
90
Symptoms that affect the whole the whole body and imply there is a possibility that a systemic disease or illness process exits.
Constitutional Symptoms
91
A medical opinion regarding the likely course and outcome of disease.
Prognosis
92
Name 6 Red flag symptoms.
1. Infection
2. Inflammation
3. Cancer
4. Heart Attack
5. CVA (stroke)
6. Fracture
93
If the calf is warm, red and painful it could be a symptom of __________?
DVT
94
Diffuse Chest, Dyspena, Fever, Bloody Sputum, Tachycardia, or possible sudden death are all symptoms of __________?
PE
95
A drop of 20mmHg or more going from lying to standing is a condition know as__________?
Orthostatic Hypotension
96
Chest pain, pallor, sweating, nausea, palpitations and dyspenia are red flags for what condition.
Heart Attack
97
What does Fast stand for when considering a stroke?
F: Face drooping or weakness on one side of the face
A: Arm weakness or numbness in one arm or leg
S: Speech difficulty, such as slurred speech or trouble understanding what you say
T: Time to call emergency services
98
Name two common imbalances
Hip abductor --> TFL Dominance
Hip Extensors (glute) weakness --> Overworked hamstrings
Piriformis syndrome
99
Ischogluteal bursitis will cause pain when _______? Its also called???
1.Sitting
2. Taylors Bottom
100
Psoas Bursitis will cause pain during_____?
Hip Flexion
101
Trochantaric Bursitis is associated with what friction?
IT band friction
102
When looking for a laberal tear or impingement which test would be used
Hip scour
103
When looking for reproducible pain what test should we use.
Faber
104
Which test is used to test for IT band tightness
Ober
105
When testing for hip flexor tightness, which test would be used?
Thomas
106
Used to assess the integrity of the anterior cruciate ligament (ACL)
This test involves the examiner applying an anterior (forward) force to the tibia while stabilizing the femur.
Lachmans
107
This test evaluates the integrity of the anterior cruciate ligament (ACL).
The examiner places knee at 90degress pulls the tibia forward (anteriorly) while keeping the femur (thigh bone) in place.
Anterior Drawer Test
108
Assess for ACL instability thru a combo of knee flexion and internal rotation
Pivot shift or macintosh test
109
This test assesses the integrity of the posterior cruciate ligament (PCL).
The examiner stabilizes the foot (often sitting on it) and applies pressure to the tibia, pushing it posteriorly (backwards)
Posterior Drawer Tes
110
This test checks for injury to the medial collateral ligament (MCL).
The examiner holds the patient's ankle and applies an outward force ( to the knee, attempting to open up the medial (inner) side of the joint.
Valgus Stress Test
111
This test is used to evaluate the posterior cruciate ligament (PCL) integrity.
The patient lies on their back with both knees flexed to 90 degrees (the hips should be flexed as well).
The examiner supports the patient's legs under the heels and observes the position of the tibia
Godfrey/Posterior Sag Test
112
Used to assess for meniscal tears
The examiner places their heel on the patient's foot to stabilize the leg while holding the proximal tibia (shin bone).
The examiner then applies downward pressure (compression) to the tibia, while simultaneously rotating the tibia (internal and external rotation).
Apley’s Compression Test
113
It is particularly useful for assessing medial or lateral meniscal tears
To test the medial meniscus, the examiner externally rotates the tibia (shin) and slowly extends the knee while applying a valgus stress (outward pressure) on the knee. This forces the medial meniscus to bear weight and can highlight any tears.
To test the lateral meniscus, the examiner internally rotates the tibia and extends the knee while applying a varus stress (inward pressure)
McMurray Test
114
The hip precautions listed below are associated with which type of surgical approach.
No Hip Extension
No External rotation
No ABduction
Anterior
115
The hip precautions listed below are associated with which type of surgical approach.
No hip ADduction
No internal rotation
NO Hip flexion of 90 degrees or greater
Direct posterior, posterolateral, direct lateral, anterolateral
116
The process of carefully comparing and
contrasting patient data points with the goal of
appropriate exclusion and inclusion that
terminate with the development of intervention
strategies
Differential Diagnosis
117
Who does or can do a differential diagnosis
PT
118
This type of muscle fiber:
1. Is specialized for muscular endurance exercises
2. Aerobic work
3. have a relatively large amount of triglycerides, and oxidative enzymes.
Type 1 slow twitch
119
This type of muscle fiber:
1. Not as vascular
2. are used for strength, speed, power
3. Contain a high level of myosin and ATPase
4. Used for anaerobic work
Type 2 Fast twitch
120
Occurs when a bone fracture fails to heal altogether
Non-union
121
Occurs when a bone heals incorrectly, meaning the fracture heals in an abnormal position, leading to deformity or functional impairment.
Mal-union
122
Refers to a situation where the bone is taking longer than expected to heal, but healing is still occurring
Delayed Union
123
Harvesting articular cartilage from the individual receiving the procedure (autografts)
Autologous tissue repair
124
Means of tissue harvesting in whichthe tissue is similar or resembles the type of tissue being repaired, even though it is not from the same individual or the same type of tissue (Allograft)
Analogous tissue repair
125
Prevents anterior translation of the tibia relative to femur and prevents hyperextension
ACL
126
120 degrees of knee flexion should be achieved within 4 weeks and avoiding open chain knee extension after what ligament reconstruction
ACL
127
If the is an MCL tear that is isolated, would the pt. require surgery.
No
128
When discussing knee pathologies, locking, clicking, and joint line tenderness would be associated with what area of knee
Meniscus
129
Plant and pivot injury or degeneration is associated with which area of the knee.
Meniscus
130
A knee repair in the meniscus that has a high risk of osteoarthritis is?
Meniscectomy
131
Red on Red and Red on White tears (conservative) of the meniscus would most likely result in what procedure of the meniscus.
Repair
132
White on White tears of the meniscus would most likely result in what procedure of the meniscus.
Meniscectomy
133
ACL and Meniscus tears are most commonly seen in what gender?
Female
134
A lateral release or a realignment procedure can be involved in what knee pathology
PFPS
135
Patellar fractures greater than 3mm that become displaced and require ORIF with kischner wires?
Surgical
136
Patellar fractures with less than 3mm displacement are considered?
Non-surgical
137
Supracondylar Femur Fractures(Fx) non-displaced that require a hinge brace, require what type of treatment?
Non-surgical
138
Supracondylar Femur Fractures(Fx) that are displaced require a ORIF, require what type of treatment?
Surgical
139
In a tibial plateau fracture you will always have a period of?
NWB
140
A femoral nerve block or inhibition is associated with what knee pathology?
Total Knee Arthroplasty
141
Usually if you're getting a total knee replacement it's most likely from severe?
Osteoarthritis or Degeneration
142
Name 4 universal Red flags for knee and hip surgeries
1. DVT, PE, Infection, Loosening of hardware
143
In an ACL repair what is a potential complication post op, that is different than most other knee repairs
Avascular Necrosis
144
Presentation: Posterior knee pain, instability, difficulty walking or running, swelling.
Mechanism of Injury: Trauma to the knee (e.g., dashboard injury in car accidents) or hyperextension.
Treatment: Non-surgical management (physical therapy, bracing) for mild injuries; surgery (reconstruction) for more severe injuries.
Complications/Precautions: Long-term instability, potential for associated injuries (meniscal tears, etc.)
PCL
145
Presentation: Medial knee pain, tenderness, swelling, instability.
Mechanism of Injury: Direct blow to the outside of the knee (often in contact sports) or a sudden twist.
Treatment: Mild injuries often heal with rest, ice, and rehabilitation; more severe tears may require surgery.
Complications/Precautions: Risk of developing chronic knee instability, risk of meniscal injury
MCL
146
Presentation: Lateral knee pain, swelling, instability.
Mechanism of Injury: Direct trauma to the inner side of the knee, often in sports or contact situations.
Treatment: Similar to MCL injuries; mild cases treated conservatively, severe cases may require surgery.
Complications/Precautions: Rarely isolated, often occurs with other ligament injuries (ACL, PCL)
LCL
147
Presentation: Anterior knee pain, especially with activities like running or climbing stairs. Crepitus (grinding noise) may occur.
Mechanism of Injury: Overuse, misalignment of the patella, or abnormal tracking.
Treatment: Physical therapy (strengthening of quadriceps and hamstrings), anti-inflammatory medications, knee brace, and sometimes surgical interventions.
Complications/Precautions: Risk of developing osteoarthritis if untreated.
Chondromalacia
148
A bruise or injury to the soft tissues, typically from direct trauma causing blood vessels to break, leading to swelling and pain.
Presentation: Pain, swelling, discoloration (ecchymosis).
Treatment: Rest, ice, compression, and elevation (R.I.C.E.). Severe cases may need further evaluation.
Complications/Precautions: Hematoma formation, prolonged pain if not managed properly.
Contusion
149
Presentation: Joint pain, stiffness, decreased range of motion, crepitus.
Mechanism of Injury: Degenerative joint disease, often related to aging, overuse, or trauma to the joint.
Treatment: Weight management, pain control (NSAIDs), physical therapy, joint injections, or surgical intervention (joint replacement).
Complications/Precautions: Chronic pain, functional limitation, need for joint replacement in advanced stages.
Osteoarthritis
150
Presentation: Severe hip pain, inability to bear weight, deformity, external rotation of the leg.
Mechanism of Injury: Falls, especially in the elderly. It can also occur from high-impact trauma.
Treatment: Surgical intervention (e.g., hip replacement or internal fixation) is typically required.
Complications/Precautions: High mortality rates, particularly in the elderly (10-20% mortality within a year post-fracture). Complications include infection, deep vein thrombosis, and loss of mobility.
Hip Fracture
151
What it is: Bleeding into the joint cavity, often following trauma or in conditions like hemophilia.
Presentation: Swelling, pain, warmth, reduced range of motion.
Treatment: Aspiration of blood, rest, ice, and elevation. Blood transfusions in severe cases.
Complications/Precautions: Repeated episodes can lead to joint damage or hemophilic arthropathy.
Hemarthrosis
152
Presentation: Pelvic pain, difficulty walking, inability to bear weight, bruising.
Mechanism of Injury: High-impact trauma (e.g., car accidents, falls from height).
Treatment: Stabilization, pain management, surgical intervention in severe fractures.
Complications/Precautions: Internal bleeding, damage to organs (bladder, colon), risk of death, long recovery.
Pelvic Fracture
153
What it is: Surgical replacement of the hip joint with a prosthesis.
Indications: Severe OA, hip fractures, avascular necrosis.
Complications/Precautions: Infection, dislocation, loosening of the implant, blood clots. Lifespan of the prosthesis can be around 15-20 years.
THA
154
What it is: A childhood condition where the blood supply to the femoral head is temporarily disrupted, causing bone death and deformity.
Presentation: Hip pain, limping, limited range of motion.
Treatment: Conservative (rest, physical therapy) or surgical (osteotomy) depending on severity.
Complications/Precautions: Early osteoarthritis and hip deformity if not treated properly.
Legg-Calve-Perthes Disease
155
Presentation: Knee pain, swelling, locking, or clicking of the knee joint.
Mechanism of Injury: Twisting motion or trauma to the knee, common in sports.
Treatment: Rest, ice, physical therapy, or surgery (arthroscopic meniscectomy or repair).
Complications/Precautions: Risk of knee instability and long-term osteoarthritis if untreated.
Meniscal Tear
156
Presentation: Anterior knee pain, worse with activities like squatting, kneeling, or running.
Mechanism of Injury: Overuse, abnormal patellar tracking, weak quadriceps.
Treatment: Physical therapy (strengthening the quadriceps), activity modification, patellar taping/bracing.
Complications/Precautions: Can lead to chondromalacia if untreated
Patelofemoral syndrome
157
What it is: Surgical replacement of the knee joint with a prosthesis, typically performed in advanced OA or severe knee damage.
Complications/Precautions: Infection, prosthesis failure, blood clots, limited range of motion, and rehabilitation challenges.
TKA
158
Presentation: Severe pain, swelling, inability to bear weight, deformity.
Mechanism of Injury: Trauma, falls, or accidents.
Treatment: Surgery (internal fixation or joint replacement) for displaced fractures.
Complications/Precautions: Risk of joint instability, osteoarthritis, and complications from surgery
Knee Fractures
159
Presentation: Severe hip pain, inability to move the leg, leg shortened and rotated inward.
Mechanism of Injury: High-impact trauma (e.g., car accidents).
Treatment: Immediate reduction of the dislocation, followed by physical therapy.
Complications/Precautions: Nerve or blood vessel damage, avascular necrosis, arthritis, permanent disability if not treated properly.
Hip Dislocation
