Joint mobilisation 2 Flashcards
what types of forces are connective tissue subjected to during ADLs
tensile
compressive
shear
what force causes the most stress
compression
what force causes the least stress
shear
why is loading necessary
to maintain tissue health especially bone
what does tissue design reflect
Ability to withstand these forces (compression, tension, shear) to provide support and movement
effects of immobilisation on ligaments
Mechanical / Tensile strength decrease in ligaments etc. within weeks
Osteoclastic activity at ligament insertion – weakening, disorganisation of collagen arrangement
effects of immobilisation on cartilage
Loss of mass, volume & strength in bone & cartilage
effects of immobilisation on synovial joint
will affect function of join
what joints are complex joints most likely to be affected by
disease
function of synovial fluid
composition & dynamics to lubricate & nourish
function of hyaline cartilage
must be smooth and subjected to compressive loading & unloading for health and lubrication by fluid
function of ligaments and capsules
balance of stability & mobility
effects of immobilisation on bone
regional osteoporosis i.e. bone mass resorbed
effects of immobilisation on cartilage
decreased activity in chondrocytes – GAG and CS, increase water content, decrease in thickness, stiffness, permeability & capacity to bear load
effects of immobilisation on muscle
atrophy: up to 20-30% ↓ in CSA after 8/52
muscle remodelling after immobilisation
loss of proteins & change in metabolism
muscle atrophy results in
Compensation – other muscles take over or movmt is changed to minimize ms input
effects of immobilisation on menisci
– increased water content, decreased proteoglycans, decreased load-bearing capacity
effects of immobilisation on tendon
protein degradation – decrease in collagen content
effects of immobilisation on synovium
proliferation of fibrofatty CT into joint space and formation of adhesions
other general effects of immobilisation
Cardiovascular Deconditioning
Immune Suppression
Balance Disorders
Strength Deficits
disease on cartilage
osteoarthritis
disease on synovium
rheumatoid arthritis
joint effusion
excess fluid in or around the joint
how is joint effusion treated
Loose-pack joint position adopted – less stable
Experimental introduction of saline to knee joint
effects of tear on ligament
= pain +(increased)/- (decreased)lack of stability
Separation of bony surfaces, deviation from efficient / anatomical alignment
long term effect of torn ACL
long term early onset degenerative joint disease is likely –
AFTER 10-12 YEARS after torn meniscus or ACL on knee what is likely to happen
> 50% will have knee OA vs. 5% in uninjured population
macro overloaded
single traumatic event – large force
tissue failure
Stress-strain curve
obvious injury
macro overload vs micro overload
single traumatic event – large force
vs.
repetitive / constant smaller force
tissue deforms
insufficient recovery timeclinical strategies to lessen impact of immobilisation
Continuous Passive Motion (CPM) devices
principles of acute management
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)
