Joint mobilisation 2

Question 1

what types of forces are connective tissue subjected to during ADLs

Answer 1

tensile
compressive
shear

Question 2

what force causes the most stress

Answer 2

compression

Question 3

what force causes the least stress

Answer 3

shear

Question 4

why is loading necessary

Answer 4

to maintain tissue health especially bone

Question 5

what does tissue design reflect

Answer 5

Ability to withstand these forces (compression, tension, shear) to provide support and movement

Question 6

effects of immobilisation on ligaments

Answer 6

Mechanical / Tensile strength decrease in ligaments etc. within weeks
Osteoclastic activity at ligament insertion – weakening, disorganisation of collagen arrangement

Question 7

effects of immobilisation on cartilage

Answer 7

Loss of mass, volume & strength in bone & cartilage

Question 8

effects of immobilisation on synovial joint

Answer 8

will affect function of join

Question 9

what joints are complex joints most likely to be affected by

Answer 9

disease

Question 10

function of synovial fluid

Answer 10

composition & dynamics to lubricate & nourish

Question 11

function of hyaline cartilage

Answer 11

must be smooth and subjected to compressive loading & unloading for health and lubrication by fluid

Question 12

function of ligaments and capsules

Answer 12

balance of stability & mobility

Question 13

effects of immobilisation on bone

Answer 13

regional osteoporosis i.e. bone mass resorbed

Question 14

effects of immobilisation on cartilage

Answer 14

decreased activity in chondrocytes – GAG and CS, increase water content, decrease in thickness, stiffness, permeability & capacity to bear load

Question 15

effects of immobilisation on muscle

Answer 15

atrophy: up to 20-30% ↓ in CSA after 8/52

Question 16

muscle remodelling after immobilisation

Answer 16

loss of proteins & change in metabolism

Question 17

muscle atrophy results in

Answer 17

Compensation – other muscles take over or movmt is changed to minimize ms input

Question 18

effects of immobilisation on menisci

Answer 18

– increased water content, decreased proteoglycans, decreased load-bearing capacity

Question 19

effects of immobilisation on tendon

Answer 19

protein degradation – decrease in collagen content

Question 20

effects of immobilisation on synovium

Answer 20

proliferation of fibrofatty CT into joint space and formation of adhesions

Question 21

other general effects of immobilisation

Answer 21

Cardiovascular Deconditioning
Immune Suppression
Balance Disorders
Strength Deficits

Question 22

disease on cartilage

Answer 22

osteoarthritis

Question 23

disease on synovium

Answer 23

rheumatoid arthritis

Question 24

joint effusion

Answer 24

excess fluid in or around the joint

Question 25

how is joint effusion treated

Answer 25

Loose-pack joint position adopted – less stable

Experimental introduction of saline to knee joint

Question 26

effects of tear on ligament

Answer 26

= pain +(increased)/- (decreased)lack of stability

Separation of bony surfaces, deviation from efficient / anatomical alignment

Question 27

long term effect of torn ACL

Answer 27

long term early onset degenerative joint disease is likely –

Question 28

AFTER 10-12 YEARS after torn meniscus or ACL on knee what is likely to happen

Answer 28

> 50% will have knee OA vs. 5% in uninjured population

Question 29

macro overloaded

Answer 29

single traumatic event – large force
tissue failure
Stress-strain curve
obvious injury

Question 30

macro overload vs micro overload

Answer 30

single traumatic event – large force
        vs.
repetitive / constant smaller force
tissue deforms
insufficient recovery time

Question 31

clinical strategies to lessen impact of immobilisation

Answer 31

Continuous Passive Motion (CPM) devices

Question 32

principles of acute management

Answer 32

POLICE
P- Protection of the injured area against further damage
OL – Optimal Loading
I- Ice (pain, bleeding,oedema)
C- Compression (support, oedema)
E- Elevation (bleeding, oedema)