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THER EX > lecture 1: tissue healing > Flashcards

lecture 1: tissue healing Flashcards

1
Q

what is a strain

A

mild injury , tissue is not torn

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2
Q

where is a strain usually an injury at

A

injury to musculotendious unit

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3
Q

what is a sprain

A

more severe than strain ; tear of soft tissues usually refer to injury of a ligament

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4
Q

what are the different grades for a sprain

A

• Grade I - ligament stretched but intact
• Grade II - incomplete or partial tear
• Grade III - complete tear

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5
Q

what type of mm are strains most common at

A

biarticulate (crosses 2 joints)

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6
Q

what is the difference between a particular and complete muscle/ tendon rupture or tear

A

partial: pain and reduced strength
complete: no pain , severe weakness

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7
Q

what is a subluxation and what does it include

A

incomplete or partial dislocation and included soft tissue trauma

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8
Q

what is a dislocation and what does it include

A

complete loss of anatomical relations and included soft tissue damage , pain , spasms and inflammation

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9
Q

what direction is the shoulder most commonly dislocated

A

anterior

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10
Q

what is the most common dislocation for a hip

A

posterior

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11
Q

what are the posteior hip precautions and anterior

A

flex add and ir

extension abd and ER

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12
Q

what soft tissue lesion is inflammation of tendon; resulting scarring or calcium deposits

A

tendinitis

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13
Q

what soft tissue lesion is a pathology of chronic degeneration without inflammation

A

tendinosis

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14
Q

what is the MOI for tendinosis

A

repetitive micro trauma

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15
Q

what is inflammation of synovial membrane

A

tensoynovitis

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16
Q

what is inflammation with thickening of a tendon sheath

A

tendovagintis

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17
Q

what is synovitis

A

inflammation of a synovial membrane

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18
Q

for synovitis there is excessive synovial fluid where

A

in the joint or tendon sheath

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19
Q

what is a bursitis

A

inflammation of a bursa

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20
Q

what is a bursa

A

synovial pocket inserted between a tendon and a bony prominence

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21
Q

what are the common dysfunctional bursa

A

pre patellar
subacromnion
trochanteric
glute med
sub deltoid
olecrannon

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22
Q

what is a ganglion and what is it common with

A

Ballooning of the wall of a joint capsule

common with rheumatoid arthritis

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23
Q

what is Hemarthrosis and what is the MOI

A

bleeding into a joint from severe trauma

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24
Q

what is a Contusion

A

bruising from a direct blow

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25
Q

what consequences of soft tissue injury is this
• Loss of normal function of tissue or region
• Mechanical loss of normal joint play

A

dysfunction

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26
Q

what consequences of soft tissue injury is this

• Abnormal adherence of collagen fibers
• Reduce elasticity of tissue
• Immobilization, disuse, surgery

A

adhesion

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27
Q

what consequences of soft tissue injury is this

• Adaptive shortening of short tissue (skin,
fascia, muscle, capsule)
• Reduce mobility and flexibility
• Immobilization, disuse, burns, spasticity

A

contracture

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28
Q

what is the building block of tissue

A

collagen

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29
Q

what kind of end feel is pain

A

empty end feel

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30
Q

how does a contracture affect MMT grading

A

they still get a 5

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31
Q

what is reflex mm guarding

A

prolonged mm contraction in response to a painful stimulus

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32
Q

what is a Prolonged contraction of a muscle in response to the local circulatory and metabolic changes

A

intrinsic mm spasm

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33
Q

what is muscle weakness

A

direct insult to the mm or inactivity

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34
Q

what is
• Increased interstitial pressure in a closed, nonexpanding,
myofascial compartment
• Results in ischemia and causes tissue damages

A

myofascial compartment syndromes

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35
Q

• Mild pain at time of injury or within 24 hrs
• Mild swelling, local tenderness
• Pain (+) when injured tissues are stressed

what grade of tissue injury is this

A

1

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36
Q

• Moderate pain that affects daily activities
• Stress and palpation increase the pain
• Tissue is partially torn

what grade of tissue injury is this

A

grade 2

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37
Q

• Near-complete or complete tear or avulsion of the
tissue
• Severe pain
• Stress to tissue is usually painless
• Palpation may reveal the defect

what grade of tissue injury is this

A

3

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38
Q
  1. Microtearing of a few muscle fibers
  2. Local pain of smaller dimensions
  3. Tightness and possible cramping in the posterior thigh
  4. Slight pain with muscle stretching and/or activation
  5. Stiffness that may subside during activity but returns afterwards 6. Minimal strength loss
  6. Less than a 15° deficit with the AKE test

what grade of strain is this

A

grade 1 - mild

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39
Q
  1. Moderate tearing of muscle fibers, but the muscle is still intact 2. Local pain covering a larger area than in a grade I strain
  2. Greater pain with muscle stretching and/or activation
  3. Stiffness, weakness, and possible hemorrhaging and bruising
  4. Limited ability to walk, especially for 24 to 48 hours after injury
  5. A 16° to 25° deficit with the AKE test

what grade of strain is this

A

2 - moderate

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40
Q
  1. Complete tear of the muscle
  2. Diffuse swelling and bleeding
  3. A possible palpable mass of muscle tissue at the tear site
  4. Extreme difficulty or inability to walk
  5. A 26° to 35° deficit with the AKE test

what grade of strain is this

A

grade 2- severe

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41
Q

a grade 1 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel

A

pain - mild within 24 hours

palpation- swelling , tender

stress to tissues - some pain

joint feel - normal

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42
Q

a grade 2 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel

A

pain - mod, stops activity

palpation - painful

stress to tissues - painful

joint feel - increased mobility

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43
Q

a grade 3 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel

A

pain- severe

palpation- can reveal a defect

stress to tissues - painless

joint feel- unstable

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44
Q

what are the 3 stages of healing

A

acute stage (inflammatory reaction)

subacute stage (Proliferation, repair, and healing)

chronic stage ( maturation and remodeling)

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45
Q

how is pain in the acute stage of healing

A

pain before the movement even starts

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46
Q

how is pain in the subacute stage of healing

A

pain as the movement starts

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47
Q

how is pain in the chronic stage of healing

A

pain more towards the end of ROM with over pressure

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48
Q

which stage of healing are neutrophils ,pro inflammatory cytokines and macrophages in

A

acute phase 1

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49
Q

what stage of healing is angiogenesis, fibroblast (collagen , GAGs , elastin) and myofibroblast in

A

phase 2 proliferation subacute

50
Q

how long is the acute phase of healing

A

day of injury to 10 days

51
Q

when is the subacute phase of healing

A

form day 2 to day 22

52
Q

when is the chronic stage of healing

A

from day 15 to over a year

53
Q

what phase of healing is The initial reaction of the body tissue to an injury
and occurs within first 48 hours (up to 4-10 days)

A

acute

54
Q

what are the 5 cardinal signs of healing

A

pain
heat
redness
swelling
loss of function

55
Q

what phase of healing is ROM is painful and patient usually guards against movement before end range is achieved

A

acute

56
Q

pain and impaired movements in the acute phase are a result from what 3 things

A

•altered chemical state that irritated the nerves ‘
•increased tissues tension from edema
•muscle gaurding

57
Q

what 3 things in the acute phase occur from the actual trauma

A

•cellular death
•coagulation
•phagocytosis

58
Q

what 2 things move to the end of the injured sits to clean dead cells in the acute stage

A

Neutrophils and Monocytes

59
Q

what are the 3 PT goals and interventions in the acute stage

A

•protection phase
•control effects of inflammation
prevent negative effects of rest

60
Q

what is the control of inflammation include

A

RICE

rest , ice , compression and elevate

61
Q

what phase of healing is The actual healing phase which extends from the inflammatory phase (48 to 72 hours to approximately 6-10 weeks)

A

repair and regeneration phase , subacute phase

62
Q

what is the processes used for tissue repair int he subacute stage

A

angiogenesis

collagen formation

epithelialization

63
Q

what tissue repair is x Growth of
capillary beds into area

A

angiogenesis

64
Q

what tissue repair si fibroblasts form extracellular matrix and synthesize immature collagen

A

collagen formation

65
Q

what tissue repair si wound surface is covered and contract

A

epithelialization

66
Q

what is granulation tissue

A

dedicate connective tissue

67
Q

what does granulation tissue consist of of

A

fibroblast , collagen and capillaries

68
Q

when does the formation fo scar begin

A

subacute stage when granulation tissue is formed

69
Q

what is the pt goals and innervation for the subacute stage

A

*control motion phase
* develop mobile scare
*promote healing

70
Q

how do u promote healing in the subacute stage

A

• Nondestructive movement –
AROM
• Resistive exercise
• Open and closed chain stabilization
• Muscular endurance
• Cardiopulmonary endurance

71
Q

what is the remodeling phase

A

new collagen continues to increase its tensile strength

72
Q

how long does the remodeling phase last

A

up to a year

73
Q

excess production of collagen by fibroblast leads to what

A

hypertrophy of scare formation

74
Q

what are clinical signs for chronic stage

A

absence of inflammation and pain after tissue resistance

75
Q

what is the pt goals and interventions for the chronic stage of healing

A

*retunr to function
*increase tensile quality of scar
*develop functional independence

76
Q

what is considered the unhappy triad

A

ACL + MCL + medial meniscus tear

77
Q

genu valgum results in laxity of which ligament

A

MCL

78
Q

when does wound closure in skin and muscles happen

A

5-8 days

79
Q

how long does it take for wound closure in ligament and tendons

A

3-6 week’s

80
Q

what is the normal amount of type 1 collagen in ligament

A

85%

81
Q

after injury what type of collagen does the ligaments have

A

type 3

82
Q

mature repaired ligament is how much weaker then uninjuried ligaments

A

30-50%

83
Q

for ligament healing when can it tolerate mild tension

A

by 3 weeks

84
Q

for ligament healing when can u begin to resume to normal activity

A

by 6 weeks

85
Q

for ligament healing when have they regained almost maximum tensile strength

A

by 12 weeks

86
Q

partial tear or rupture of a tendon most often occurs where

A

at the musculotendinous junction or at the tenoperiosteal junction

87
Q

if the tendon injury is > 50% diameter what will it require

A

surgical repair

88
Q

what is tendon healing affected by

A

the limited blood supply in the tendons

89
Q

is o2 computing lower in the tendons and ligaments or that of skeletal muscles

A

ligaments and tendons

90
Q

when is the proliferative stage for tendon healing

A

48-72 hours after injury

91
Q

what kind of collagen is in the proliferative stage of tendon healing

A

type 3 collagen

92
Q

when does the remodeling phase of tendon healing start

A

6-8 weeks after injury and may continue for years

93
Q

what type of collagen is in remoedleing phase of tendon healing

A

type 1 , reduces the amount of type 3

94
Q

how are the type 1 collagen fibers orgazinsed in the remodeling phase of tendon healing

A

longitudinally along the tendon axis and responsible for mechanical strength

95
Q

active tension of tendon across repair site in the first 3 weeks results in what

A

a poor outcome

96
Q

what kind of motion should occur in the first 3 weeks of tendon healing

A

passive exercise

97
Q

what is limited in the first 4-6 weeks following a tendon repair

A

no/limited active recruitment of the muscle tendon

98
Q

what is necessary initially yo assist in aligning collagen fibers for tendon treatment

A

passive movement

99
Q

how long are most tendon rehab programs

A

> 6 months sometimes 1-2 years

100
Q

what are causes of mm injury

A

*mecahnical forces
*thermal stresses
*nerve injury
*myotoxic agents
*prolonged ischemia

101
Q

how long are u immobilized for a mm injury

A

2-5 days

102
Q

when during a mm injury do you balance between tissue extensibility and portoectin of fibers from re injury

A

weeks 2-3

103
Q

what are u focusing on during weeks 4-6 for a mm injury

A

gentle AROM < full range and no resistance

104
Q

what can causes innjury especially with 2 joint mm

A

eccentric contraction or overstretch

105
Q

when is Warm-up period and endurance activities to prevent new or recurring injuries for a mm injury

A

after 6 weeks

106
Q

what is the difference between osteoclast and osteoblasts

A

osteoclast kills the bone and osteoblast makes new bone

107
Q

T/F Bone is in a constant state of construction

A

T

108
Q

• Bone is deposited in sites
subjected to stress
• Bone cells will align in such a way as to efficiently withstand stress
• Stress in bones with weight-bearing or tension
• Lack of stress causes bony atrophy

what law is this

A

wolffs law

109
Q

what are causes of bone fx

A

direct violence
indirect violence
disease of bone
repeated stresses

110
Q

what kind of fx is bone fragments into 3 or more pieces and common in long bones

A

comminuted

111
Q

what kind of fx is ragged break occurs when excessive twisting forces are applied to a bone , common sports fx

A

spiral

112
Q

what kind of fx is bone crushed and common in porous bones ( osteoporotic bones) subjected to extreme trauma as in a fall

A

compression

113
Q

what kind of fx is epiphysis separates from the diaphysis along the epiphyseal place and tends to occur where cartilage cells are dying and calcification of the matrix is occurring

A

epiphyseal

114
Q

what kind of fx is broken bone portion is pressed inward and typically a skull fx

A

depressed

115
Q

what kind of fx does a bone break incompletely , much in the water a green twig breaks . only one side of the shaft breaks and the other side bends.. common in children whose bones have more organic matrix and are more flexible than those of adults

A

greenstick

116
Q

how long is the inflammatory phase for fx repair

A

last 1-2 weeks

117
Q

what phase of fx repair is soft callus formation and when is it

A

reparative phase and one week after injury

118
Q

what phase of fx repair is hard callus formation in and when is it

A

reparaitive phase and several weeks to months

119
Q

what phase of fx repair is Fracture site is firm and no longer moves, fracture line still appears on x-ray

A

remodeling phase

120
Q

what is the order of fx repair

A

hematoma formation > fibrocartilaginous callus formation > bony callus formation > bone remodeling

121
Q

how long does it take children , adolescents , adults and eldrty to heal from a fx

A

children : 4-6 weeks
adolescents: 6-8 weeks
adults: 10-18 weeks
elderly : much longer

122
Q

in adults does the UE or LE heal faster for fx , distal or proximal heal faster , and is a simple fx faster to heal or a complex fx

A

UE
Distal
simple

THER EX (14 decks)

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