Exam Prep Flashcards
What does muscle insertion refer to?
The muscle insertion is attached to the more mobile bone, usually more distal
What is kyphosis?
Kyphosis is the hunchback of the spine. Kyphosis is defined as a curvature of the spine measuring 50 degrees or greater on an X-ray
What is more superior, the nose or the knees?
Nose
What is inflammation?
Response to tissue damage or threat of invasion by antigens.
What is inflammation triggered by? (4)
- physical trauma
- hormones
- invasion with foreign bodies
- autoimmune activity
What is the purpose of inflammation?
Protect from pathogenic invasion, limit contamination, prepare damaged area for healing
Common causes of tissue damage?
- trauma
- infection
- surgery
- immune responses
- ischemic damage
- chemical/radiation damage
- extreme heat/cold
What is vasoconstriction ?
The constriction of blood vessels, which increases blood pressure.. Vasoconstriction is short lived, and protective
Mast cells?
- located in tissues vulnerable to injury
- release histamines to prolong inflammatory response
Monocytes and macrophages?
WBC’s
Monocytes: large, white, mobile blood cells
Macrophages: permanently fixed monocytes
associated with end stage inflammation, clean up debris
What year did the Society of Trained Masseuses begin?
1895
What year was massage introduced as it’s own profession in the US?
1917
What is vasodilation?
Widening of blood vessels. Caused by chemicals released by endothelium and mast cells.
What does vasodilation do?
- increases permeability of capillaries
- reinforces capillary dilation
- attracts platelets
- slows blood away from the area
What are the components of inflammation?
- vascular: vasoconstriction and vasodilation
- cellular: endothelial cells, platelets, WBC’s
- chemical mediators
Lymphocytes?
- work with macrophages to clean up debris
- promote scar tissue
- angiogenesis (new blood vessels)
Fibroblasts?
- produce collagen
- drawn to local blood clots, proliferate (increase rapidly) to form new scar tissue
Granulocytes?
- smallest, fastest
- neutrophils first on the scene for bacterial infection, musculoskeletal injury
- eosinophils for allergies, parasites
- basophils for allergies and histamine release
What are the 3 types of granulocytes?
- neutrophils
- eosinophils
- basophils
What are the 2 types of healing?
Primary/ 1st intention: occurs when there is some tissue loss, wound edges are approximated
Secondary/ 2nd intention: occurs when there is extensive tissue loss, wound edges do not meet/ cannot be brought together easily. Healing takes longer
What takes longer to heal, Primary/ 1st intention or secondary/2nd intention healing?
Secondary/ 2nd intention healing takes longer
What are the stages of healing? (4)
Acute
Subacute
post acute/ late acute
chronic inflammation
What happens in the acute stage of healing?
- damaged cells release chemicals
- edema develops
- platelets, early WBC’s arrive
- tissue exudate (pus, fluid) begins to form
How long is the acute stage?
Depends on severity, 1-3 days usually
What is the subacute stage also called?
proliferate stage
What happens in the subacute stage?
- cells accumulate to fill in damaged area: endothelial cells fill in to grow new capillaries, fibroblasts create collagen fibers
- slower WBC’s arrive to start cleanup
How long is the subacute stage?
depends, early subacute is usually 2 days to 3 weeks
What happens in the post acute/ late acute stage?
-collagen becomes denser and aligns according to force
What is the post/ late acute stage also called?
maturation stage
How long does the post/ late acute stage last?
generally the 2nd to 3rd week of the subacute stage
What is chronic inflammation?
-Happens when the inflammatory process is not successful
What does chronic inflammation cause?
- pathogens/ irritants are not removed (leads to cysts, abscesses)
- extensive scar tissue interferes with organ function (sinuses of fistula develop)
- musculoskeletal structures never regain full function (tendinosis)
- excessive external scar tissue
How long does chronic inflammation last?
overlaps latter part of subacute and can continue for up to 1-2 years
What are the signs and symptoms of inflammation? (5)
- dolor (pain)
- calor (heat)
- rubor (redness)
- tumor (swelling)
- functio laesa (loss of function)
What is the acronym for signs and symptoms of inflammation?
S: swelling H: heat A: associated symptoms R: redness P: pain
How can massage benefit the tissue during maturation or post acute stage?
- fluid turnover
- mechanical influence on scar tissue
What would be massage goals in the subacute stage?
- Goals: decreased inflammation, pain, swelling, spasms, maintaining ROM
- can treat tissues peripheral but not distal to the injury
What would be massage goals of post acute/ late subacute stage
- decrease remaining edema
- reduce trigger points, pain, adhesions
- improve ROM and strength
Massage goals of chronic inflammation?
- reduce restrictive adhesions and trigger points
- restore ROM and strength
- treat compensatory areas
How can you use deep pressure without being forceful?
- work with clients breaths
- work with tissue (be patient, )
- work with body mechanics
What are the 4T’s of palpation?
- Tone
- Texture
- Tenderness
- Temperature
What is scar tissue?
Collagen based tissue that develops because of inflammatory process
What are the causes of scar tissue?
- inflammatory response due to wounds, burns, musculoskeletal trauma, inflammatory arthritides, or late stage osteoarthritis
- prolonged immobilization
- paralysis or paresis of a structure due to a PNS or CNS lesion
What are the types of scar tissue? (8)
- Contracture (shortening of CT over or around a joint)
- adhesion (reduced ROM allows cross links to form along collagen fibers)
- scar tissue adhesion (adhesions or contractures form in random pattern within or between skin, muscles, joints, tendons)
- fibrotic adhesion (occurs in chronic inflammation)
- irreversible contracture (fibrotic tissue or bone replaces muscle and CT)
- proud flesh (thick, dermal, granulation… wound will not epithelize)
- hypertrophic scarring (overgrowth of dermal tissue, collagen fibers are randomly organized)
- keloid (extends beyond boundaries of original wound in a tumor like growth)
What are the principles of massage?
proximal-distal-proximal
peripheral-central-peripheral
general-specific-general
superficial-deep-superficial
What acts are applicable for informed consent?
HCCA (Health Care Consent Act)
PHIPA (Personal Health Information Act)
MTA (Massage Therapy Act)
SDA (Substitute Decision Makers Act)
What does LORDFICARAHM stand for?
Location Onset Radiating Duration Frequency Intensity Characteristic Aggravating Relieving Associated signs and symptoms History Medication
Who invented SOAP notes?
Dr. Lawrence Weed, 1950’s
What are Swedish techniques?
Soft tissue techniques:
- Stroking
- Effleurage
- Petrissage
- Vibrations
- Tapotement
Effects & Uses of Stroking?
Uses: introductory/ closing. creates awareness and sense of connection of the body. temp differences can be palpated
Effects: Repetitive stroking is soothing, decreases sympathetic NS. reflexive effect on nervous system
Effects and uses of effleurage?
Uses: spreads lubricant. intro to touch. palpation of tone, temp, texture
Effects: vary depending on rate, depth, rhythm. less pressure= more reflexive effect on circulation. more pressure= more mechanical effect on circulation. repetitive, sweeping effleurage increases venous and lymphatic return, increases local circulation and reduces edema
Effects and Uses of Petrissage?
Used after tissue is warmed up, can be used to assess for adhesions
Effects: increase local circulation, muscle fiber and CT adhesions can be loosened, superficial fascia can be addressed, muscle hypertonicity can be reduced, can be soothing or stimulating
Effects and uses of vibrations?
Used at any time, no lubricant necessary
Effects: create different stimulation, fine- soothing, can loosen mucus, decrease muscle tone
Effects and uses of tapotement?
Uses: used any time, no lubricant needed
Effects: loosen mucus, heavy increases circulation, can be stimulating, if done for awhile can be soothing, heavy can elicit stretch reflex and increase tone
Effects and uses of shaking?
Used on tight muscles, anytime during treatment
Effects: reduces muscle tone, confuse proprioceptors (awareness of surroundings), increases sensory input
What is extension?
Straightening a joint. When you straighten your knee or elbow, for example, you increase the angle between the bones at these joints.
What is flexion?
bending a joint. When you bend your knee or elbow, you decrease the angle of the bones at these joints.
What is abduction?
Movement away from the center of your body. A good example is doing jumping jacks or lifting your arm or leg to get dressed.
What is adduction?
Movement towards your body. Movement back to the center of the body. A good example is returning your arm to your side after waving or standing with your legs together.
What ROM can the hip perform?
- flexion
- backward extension
- abduction
- adduction
- Lateral rotation: (rotation away from the center of the body)
- Medial rotation: (rotation towards the center of the body)
What ROM can the knees perform?
Extension and flexion
What ROM can the ankle perform?
- plantar flexion (toes down, planting the foot)
- dorsal flexion (toes up)
What ROM can the feet perform?
inversion (inward) and extension (outward)
What ROM can the shoulder perform?
Flexion Extension Abduction Adduction Lateral rotation Medial rotation
What ROM can the elbow perform?
- Flexion
- supination
- pronation
Anterior vs Posterior?
Anterior- front of the body
Posterior- back of the body
What is Anterior also known as?
Ventral
What is posterior also known as
dorsal
Superior vs Inferior?
Superior means above, or towards the head
Inferior means below, or towards the feet
Proximal vs Distal?
Used to describe location on same limb
Proximal is closer to where arm or leg inserts into body
Distal- further away from where arm or leg inserts into body
Medial vs Lateral?
Medial- closer to the midline of the body
Lateral- further from the midline
Sagittal plane?
Left and right portions, like a lengthwise cut
Can be mid-sagittal (through the middle) or para-sagittal (not even in midline)
Frontal Plane?
Divides Anterior and Posterior
Transverse plane?
Divides inferior and superior
Landmark for back drape?
PSIS
What are the draping landmarks, supine, for anterior leg?
Greater trochanter, ASIS
What are the draping landmarks, supine, for abdomen?
ASIS, xiphoid process (inferior “sword-like” extension of sternum)
What are the draping landmarks, prone, for posterior leg?
Greater trochanter
What are the draping landmarks, prone, for posterior leg including gluteals?
Iliac crest, lateral border of the sacrum
What are the draping landmarks, sidelying, for back?
PSIS
What does PSIS stand for?
posterior superior iliac spine
What does ASIS stand for?
anterior superior iliac spine, bony prominence of iliac bone, aka hipbones
SOAP stands for..
Subjective
Objective
Assessment/action
Plan
Describe the S in SOAP notes
Subjective: Clients chief complaint, health history info, client info, results of other health care providers, effects of previous treatments, clients description of symptoms
Describe the O in SOAP notes
Objective: Information based and focused on your observations, palpation findings, ROM testing, etc. Our assessments
Describe the A in SOAP notes
Assessment/Action: Techniques used, what we did, the results of our techniques, results of assessments. Treatment provided
Describe the P in SOAP notes
Plan: Home care, treatment goals/ plan, CI’s, referrals,, frequency of treatment, self care
Elements needed for Informed Consent? (3)
- Competent choice
- Voluntary consent- no coercion or deceit
- Adequate, relevant, understood information
What must you include for Informed consent?
- Nature of treatment- outcome/purpose/ areas to be treated/ draping
- Cautions/ contraindications
- benefits
- risks/ complications
- consequences
- empowerment- can stop/modify at any time
- client care
- alternatives- health care possibilities
- opportunity for questions
- specific request “do I have consent for treatment”
