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Interventions II > Interventions Lecture 1 > Flashcards

Interventions Lecture 1 Flashcards

1
Q

Musculoskeletal Diagnosis..Now what? - What 2 things should you consider

A
  1. Evaluation procedures: determine the source and degree of dysfunction
  2. Tissue healing parameters
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2
Q

When setting up a treatment plan, what factors will you consider?

A
  • tissues involved
  • precautions
  • pt’s normal activities
  • how much skilled PT is required
  • how long pt will have access to skilled care
  • what has worked for similar patients
  • your skill level as a PT
  • any referalls required
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3
Q

Impairments being treated must be related to

A

functional deficits

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4
Q

Intervention decisions are based on

A

-normal tissue healing; modified based on patient response to treatment

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5
Q

Inflammation, pain, an edema must be addressed ___ to more agressive or manual therapy

A

BEFORE

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6
Q

All programs must include a

A

self-management component

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7
Q

A facture is a

A

“soft tissue injury with a broken bone underneath it”

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8
Q

Fracture considerations

A
  • Location
  • Configuration
  • Extent
  • skin
  • soft tissue injury
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9
Q

Fracture healing inflammatory phase

A
  • Hematoma formation

- Cell proliferation

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10
Q

Fracture healing reparative phase

A
  • soft callus unites the site

- ossification: hard callus

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11
Q

Fracture healing remodeling phase

A

-consolidation and remodeling of bone

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12
Q

Children healing time from fracture

A

4-6 weeks

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13
Q

Adolescents healing time for a fracture

A

6-8 weeks

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14
Q

adult healing time for a fracture

A

8+ weeks

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15
Q

Fracture medical management

A
  • closed reduction
  • open reduction internal fixation
  • external fixator
  • skeletal traction
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16
Q

Effects of immobilization

A
  • Sluggish circulation
  • Muscle atrophy
  • articular cartilage degeneration
  • joint adhesions
  • contracture development
  • connective tissue weakening
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17
Q

PT Role in fracture management during immobilization

A
  • minimize complications
  • decrease effects of inflmmation
  • decrease effects of immobilization on non-involved joints
  • maintain ROM/strength in major muscle groups
  • teach functional adaptations
  • maintain CV conditoning
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18
Q

PT Role in fractures post-immobilization

A 
Increase joint mobility/ROM
Increase strength/stability 
Weight bearing progression (LE) 
Increase propioception/fine motor control 
correct faulty movement patterns 
return to function
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19
Q

Post-immobilization considerations

A

-Immobilization of soft tissues
- weakned 2deg lack of activity
-inelastic soft tissue 2deg of scarring
Pt likely to be painful when starting to move
Progress stretching, strengthening, balance and functional activites per gudeliens for subacute/chronic stages
*MONITOR TISSUE RESPONSE

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20
Q

Bone spurs do not equal

A

pain/inflammation

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21
Q

wolf’s law

A

bone in a healthy person or animal will adapt to the loads under which it is placed

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22
Q

Bone spur interventions

A
  1. decrease inflammation
  2. find the source of biomechenical stress & minimize it
    - compression
    - postural stresses
    - movement dysfunction/control
    - strenght
    - ROM
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23
Q

OA does not equal

A

pain; no relationship between the amount of degeneration and pain level/function

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24
Q

PT intervention goals for OA

A
  • decrease stiffness
  • decrease pain (@ rest & from mechanical stresses)
  • increase ROM
  • prevent deformities
  • improive physical conditioning
  • improve overall function
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25
Q

Cemented joint replacements

A

WBAT

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26
Q

Non-cemented joint replacements

A

NWB/TTWB

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27
Q

Early post-op healing for joint replacements

A

ROM, joint protection, function w/ assisted device

28
Q

Late healing for joint replacement

A

ROM, strength, Increase function

29
Q

Protocols & joint replacements

A

-must be strictly adhered to when provided

30
Q

dysfunction

A

loss of normal function of a tissue/region

31
Q

joint dysfunction

A

loss of normal joint mobility

32
Q

contractures

A

adaptive shortening fo skin, fascia, muscle etc

33
Q

adhesions

A

abnormal collagen fibers to surrounding structure

34
Q

reflex muscle guarding

A

prolonged contraction of a muscle in response to a painful stimuli

35
Q

Intrinsic Muscle spasm

A

prolonged contractions of a muscle in response to local circulatory or metabolic changes when the muscle is in a state of prolonged contraction

36
Q

Conditions resulting in soft tissue pathology

A
  • muscle weakness

- compartment syndromes; increased interstital pressure in a closed myofascial compartment

37
Q

Grade 1 tear

A
  • few fibers
  • mild pain
  • minimal; no swelling
  • local tenderness
  • pain with stress; no laxity
  • no/minor functional loss
38
Q

grade II tear

A
  • approx 1/2 of the fibers
  • (+) swelling
  • moderate pain with stress/palpation
  • moderate-major functional loss
39
Q

Grade III tear

A
  • all fibers
  • severe pain (++) swelling
  • local tenderness
  • no pain with stress
  • joint instability ?
  • moderate-major functional loss
40
Q

Non-contractile tissue injuries

A
  1. sprains (ligaments) (grade I, II, III)
  2. Capsules (hyper vs. hypo)
  3. internal derangement
  4. loose bodies
  5. articular cartilage
  6. nerve lesions
41
Q

Contractile tissue injuries

A
  1. strains
  2. contusion
  3. tendiopathy
42
Q

Contusions first degree

A
  • microscopic deformation of tissue
  • mild-moderaate inflammatory response
  • minimal discomfort
  • mild-moderate disability
  • no palpable defect
43
Q

2nd degree contusion

A
  • more painful
  • significant inflammatory response
  • may limit extreme ROM and strength
  • moderate deformation of tissu e
  • palpable defect on exam
44
Q

3rd degree contusion

A
  • maximal tissue deformation
  • significant inflammatory response
  • more pain
  • more swelling
  • more bleeding
  • interventions: based on the stage of the injury
45
Q

Contusion contraindications/precautions

A

Acutely: no heat/thermal use

limit stress placed on tissue early in healing; dont want to increase bleeding

46
Q

myositis ossifications

A

calcification within the muscle (quad femoris, bicep brachii, hamstrings)

47
Q

Strain within the muscle itself grade 1

A

strong, some pain

48
Q

strain within the muscle itself grade 2

A

weak, and painful

49
Q

strain within the muscle itself grade III

A

weak and painless

50
Q

tendinopathy

A

activity limiting condition typically characterized by thickening/swelling, localized tendon pain and loss of function

51
Q

tenosynovitis

A

acute or chronic inflammation or fibrosis of the synovial sheath around the tendon

52
Q

enthesopathy/enthesitis

A

injuries/irritation of the enthesisis

53
Q

primary tendinopathy

A

no predisposing medical condition or event to blame for the occurence of tendon pathology
(+) mechanical factors or advancing age

54
Q

Secondary tendinopathy

A

distinctly related to another medical conditon or event

55
Q

Primary tendinopathy acute traumatic

A
  • triggered by an inciting event (contusion, surgical procedure)
  • typical soft tissue stages of inflammation and repair
  • abundant type III collagen
  • hypervascularity
  • may be fibrosis and adhesions between tendon and surrounding sheath/bursa
  • increased cross-sectional area of tendion
56
Q

Primary tendinopathy acute overuse

A
  • associated with history of repetitive or altered loading
  • preceding period of cumulative damage to tendon that was asymptomatic
  • < 4 weeks: indications of active inflammation/repair
57
Q

Primary tendionopathy chronic

A
  • failed healing model
  • healthy tendon: able to adapt to loads within the load capacity
  • with aging or sedentary behavior, load capacity and adaptive responses decline
  • risk factors: diabetes, high cholestor, family history
  • when cumulative load exceeds ability to adapt injury becomes accumulate - decreases load capacity
58
Q

Tendon stress strain curve

control vs tendinopathy

A

areas with microstructural disturbances experienced higher localized strains during loading

59
Q

primary tendinopathy chronic (2)

A
  • proliferation of sensory nn and blood vessels
  • disorganized collagen; higher type III and GAG
  • thickening of the tendon
  • chronic inflammation-repair features; fibrin, fibroblasts, mast cells
  • calcification present on imaging
  • absence of neutrophils
60
Q

Tendinopathic tissue

A
  • hypercellular and hypervascular
  • increaed sensory innervation
  • higher water/GAG content
  • smaller, disorganized, collagen fibers
  • thickening of tendon
61
Q

primary tendinopathy history

A
  • recent change in loading
  • pain during/after tendon loading activity
  • pain in the tendon (can also be general)
  • gradual onset
  • longstanding complaints
  • thickening and tender when palpating
  • decreased ROM/flexibility
  • decreased strength
  • pain with loading acitivites
  • movement dysfunction
62
Q

Patient Education (tendinopathy)

A

-nature of condition and likely cause
-how to mitigate symptoms
competitive athletes: typically need to stop activity
-recreational activities: equal success rates with/without stopping activity
NOT a straightforward answer
-pain monitoring approach: 5/10 pain is OK - anything more; stop

63
Q

tendinopathy resistance training

A
  • strength, power, endurance deficits in tendinopathy are well documented
  • resistance exercise improves the rate of clinical improvement in tendinopathy
  • eccentric exercise; not a stand-alone Rx
  • can result in muscle lengthening (add sarcomeres)
  • in theory, this can reduce strain through the tendon
64
Q

Resistance training analgesic effect

A

small reproduction in pain following resistance training

NOT dependent on the type of muscle contraction

65
Q

Tendinopathy stretching

A

include if ROM/length deficits are present

-sport specific dynamic stretching before activity recommended during the return to sport phase

66
Q

Neuromuscular training tendinopathy

A
  • focus initially on quality and control of motion
  • patient education/coaching
  • manual cueing
  • self-monitoring
  • integrate entire kinetic chain
  • later increase load and integrate functional activites
67
Q

Other interventions for tendinopathy

A 
manual therapy 
dry needling 
taping/bracing 
-reduce pain during work/spirt
-improve patient confidence 
-improve propioception 
-improve muscle strength and endurance

Interventions II (11 decks)

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