Lecture 4 (9-21) Flashcards
What is the up down proprioception test called
Position test
What is the mirror or follow test called
Passive motion sense
What is kinesthesia
Dynamic, passive awareness of movement
What does hyporeflexia signify
Lower motor neuron lesion
What does hyperreflexia signify
Upper motor neuron lesion
What make are the UMN
Brain and spinal cord
What make are the LMN
Nerves and nerve roots
What dermatome is the biceps biased towards
C5
What dermatome is the brachioradialis biased towards
C6
What is an athletic build
Mesomorphic
What is a round or curvy build
Endomorphic
What is a very skinny low body fat build
Ectomorphic
What are special tests
Regional tests designed to confirm whether or not a specific condition is present
True or False:
There are often many special tests per conditition
True
True or False:
Special tests are not provocative and don’t require the PT to be sensible or judiciou
FALSE
Are special tests used in conjunction with other examination data
Yes’m
Are special tests the be all end all of DPT
NOOOOO
Why is test validity questionable with special tests
Skill of examiner and presence of multiple conditions
What are the uses of special tests (5)
- To confirm a tentative diagnosis
- To make a differential diagnosis
- To differentiate between structures
- To understand unusual signs
- To unravel difficult signs and symptoms
What are the 2 types of injury
- Primary
2. Secondary
What is a primary injury
Acute or chronic in nature
What are the 2 types of primary injury
- Macrotrauma
2. Microtrauma
What is a macrotrauma
Produces immediate pain and disability
What are examples of macrotrauma
Fracture, dislocation, sprain, strain, and contusion
What is a microtrauma
An overuse injury that results from repetitive loading or incorrect mechanics from normal or abnormal loads
What are examples of microtrauma
Tendinitis, tenosynovitis, and bursitis
What is a secondary injury
A destructive and self-propogating biological change in cells and tissues that leads to their dysfunction or death over hours to weeks after the initial insult
What are the 5 signs of imflammtion
- Heat
- Pain
- Swelling
- Pain
- Loss of function
What is the latin word for heat
Calor
What is the latin word for redness
Rubor
What is the latin word for swelling
Tumor
What is the latin word for pain
Dolor
What is the latin word for loss of function
Functio laesa
What causes heat
Increased vascularity to tissues
What causes redness
Increased vascularity to tissues
What causes swelling
Blockage of lymphatic drainage
What causes pain
Pressure or chemical irritation of pain sensitive structure
What causes loss of function
Occurs as a result of pain and swelling
What are the 3 main phases of healing
- Imflammatory phase
- Proliferation phase
- Maturation phase
What is another name for the inflammatory phase
Acute or protective stage
What is another name for the proliferation phase
Subacute or controlled motion stage
What is another name for the maturation phase
Chronic or return to function stage
True or False:
Without the hemostasis phase you would bleed out
True
What are the 3 phases of hemostasis
- Body goes thru period of vasoconstriction
- Platelets start to get sticky and form plug
- Clotting of blood due to fibrin and erythyrocytes
When does hemostasis occur
Before inflammation
How long does the inflammatory phase last
0-6 days
True or False:
Inflammation is critical to the entire healing process
True
True or False:
Inflammation can only occur in areas with vascularity
True
What is the process of inflammation (6)
- Disposal of injury by product
- Localized to trauma area - local vascular changes
- Protective response
- Sets the stage for repair
- Disturbed fluid exchange
- Migration of leukocytes from blood to tissues
What is the clinical picture of inflammation (4)
- Painful movement
- Patient guarding
- Increased tissue tension
- Increased edema
How long does the proliferation phase last
3-20 days
What is the purpose of the proliferation phase
Cover the wound and impact strength to the injury site
True or False:
The injured site does not have the most amount of collagen
False
How much lower can the tensile strength of the tissue be
15%
What is the process of proliferation (4)
- Growth of capillary buds into wound is stimulated by lack or oxygen
- Increased blood flow to the area delivering nutrients for regeneration
- Collagen fibers deposit in random fashion scarring the tissues
- As tensile strength increases and fibroblastic activity decreases
What does fibroblastic activity decreasing indicate
The beginning of the maturation phase
What is the clinical picture of the proliferation phase (3)
- Signs and symptoms of inflammation subside
- Patient may indicate tenderness to touch
- Patient will typically complain of pain when movement stresses injured tissue
How long does the maturation phase last
20 days - 3 years
What is the purpose of the maturation phase
Realignment or remodeling of the collagen fibers that make up scar tissue
What are the clinical presentations of the maturation phase (4)
- No signs of inflammation
- Contractures or adhesions may limit motion
- Pain felt well after tissue resistance, typically with passive exposure
- Function is limited
What limits function in the maturation phase (3)
- Weakness
- Poor endurance
- Poor neuromuscular control
what are the rehab considerations for the maturation phase
Wolff’s law and aggressive AROM and strengthening key at the start of this phase
What is Wolff’s Law
Tissues respond to the demands placed upon them causing remodeling or realignment of fibers along lines of tensile force
What are the 12 factors that impact the rate of healing
- Extent of injury
- Edema
- Hemorrhage
- Poor vascular supply
- Separation of tissue
- Muscle spasm
- Atrophy
- Corticosteroids
- Keloids and hypertrophic scars
- Infection
- Humidity, climate, oxygen tension
- Health, age, nutrition
What are the types of injury extent
Microtrauma and macrotrauma
If you increase pressure what happens to blood flow and secondary injury
Blood flow decreases and secondary injury increases
What is hemorrhaging do to
Chemical changes due to increased blood flow that causes cell death
What does poor vascular supply do
Leads to cell death because of the lack of nutrients
What happens if there is separation of the tissue
It takes a long time to heal
What does muscle spasms cause
The patient to be in the inflammatory stage longer
How many corticosteroid shots can be administered per year
3
Why only 3 corticosteroid shots per year
It reduces tensile strength of the tendon causing ruptures
What does infection cause
Slow healing
What scab color is good
Brown
What scab color is bad
Black
What is chronic inflammation
Acute inflammatory response does not sufficiently eliminate the injury agent and restore tissue to its normal state
What does chronic inflammation cause (4)
- Damage to connective tissue
- Tissue necrosis and fibrosis
- Appears to be related to microtrauma
- Resistant to physical and pharmocological treatment
What is pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
What do we know about pain (6)
- Subjective
- Past experience impacts perception of pain
- Warning mechanism
- Protects against injury
- Prevents further injury
- Can persist long after it is no longer useful
What are the types of pain (5)
- Acute
- Chronic
- Referred
- Radiating
- Deep somatic
What is acute pain
Experienced after injury has taken place and tissue damage is occurring
What is chronic pain
Pain lasting longer than 6 months
What is referred pain
Pain perceived to be in an area that has little relation to the pathology
Why can referred pain be long lasting (4)
- Altered reflex patterns
- Continued mechanical stress on muscles
- Learned habits of guarding
- Development of trigger points
What is radiating pain
Caused irritation of nerves and nerve roots
What is deep somatic pain
Pain emanating from a sclerotome
True or False:
There is often a discrepancy between the site of the pain and the location of pathology with deep somatic pain
True
