Lecture Material Flashcards
what is the diff btw traumatic vs insidious onset?
Traumatic (macrotrauma - instantaneous onset) might be a more serious lesion
Insidious (microtrauma - gradual onset)
- Could be from repetitive movts, poor posture = micro-trauma
- Less serious lesion, can take hrs, days before inflammatory process settle
provide a description and an example of pain type
pain can be: pain stiffness, weakness, paresthesia, locking, impinging or others
Any innervated structure can generate pain
- Somatic pain: Caused by injury to skin, ms, bone, jt, CT, Deep somatic pain – dull or aching & localized, Superficial somatic pain – often sharper
- Visceral pain: from internal organs (dull & vague) 623
- Neuropathic pain: Caused by nerve injury or malfunction – burning, electrical
Examples:
Muscle: cramping, dull, aching, weakness, stiffness
Ligs/caps: dull, aching, stiffness/hypomobility, hypermobility/instability
Nerve: sharp, bright, burning, electric feeling, tingling, shooting, pins & needles sensation
what is a pain pattern?
- when the pain increases (movement activity posture, what directions, at what part of range, with muscle contraction, impngement, etc)
- when the pain decreases
- what time does it occur?
reminder: how long is each healing phase?
what 3 things do we need to know about patient’s pain?
1) pain site
2) pain type
3) pain pattern
describe what the nature of pain means
what is pain severity vs irritability
what is scanning vs biomechanical assessment?
Usually scan is not sufficient to yield diagnosis… will need to do the biomechanical Ax
Biomechanical AX includes:
Passive accessory glide
Special test(s)
- Ligament stress test
- Flexibility test
- MMT
- All other special tests….
what does STT allow us to find out? what are the 4 components?
what does STT AROM assess?
what does STT PROM assess?
what is a capsular pattern of restriction?
what is a non-capsular pattern of restriction and what does it indicate?
what is end feel and what does it indicate?
MMT - what type of contraction is RISOM and what positions can it be tested in?
STT testing what is the presentation of an inert vs contractile structure?
describe the different intepretations of STT in terms of strength and pain combinations
1) Movt strong & pain-free:
Normal contractile structure (but can have an inert structure problem)
If no pain with ms stretch: Contractile & elastic component can be considered as normal
2) Movt weak & pain-free:
Neuropathy (PHTH-560 & 623)
Contractile structure rupture (ms/tendon) (chronic &/or gr3)
General deconditioning
3) Movt strong & painful:
Contractile structure lesion - Minor lesion (grade 1 or 2 ms strain)/Contusion, tendinopathy
Exceptions – inert structure lesion: bursitis, tenosynovitis
4) Movt weak & painful:
Could be a sign of serious condition
Recent severe contractile structure rupture (gr 2, 3) - gr 3 some pain, but still < gr 2
Fracture
Neoplasm
5) Every movts are painful:
Serious or acute condition - Could be inert structure lesion (sprain, fracture, bursitis - weakness inhibition)
Psychogenic pain
for STT what does it indicate (relative to resisted movement) when there is Pain throughout the full ROM vs when there is Pain when ms is stretched but no pain when it is shortened?
in STT what is INTERPRETATION relative to resisted movt for gr 1-3 ms and tendon strains
Grade I: ms & tendon
Tear of few fibres
Minor swelling & discomfort
No or min loss of strength & restriction of movt
Local tenderness, ↑ when stress applied to it
Usually, normal ADL
if not wk but pain, gr 1 for sure
Grade II: ms & tendon
Greater damage to ms
Clear loss of strength
Pain with ADL
Moderate to severe pain
Grade III: ms & tendon
Tear across the whole ms belly or tendon
Severe weakness, severe loss of function
Severe pain or no pain depending on integrity of tissue
describe the palpation part of STT - when is it done?
describe osteokinematic vs arthrokinematics
Physiological motion (osteokinematic)
Movts done voluntarily
Controlled through forces generated by contractile tissue
Result of concentric or eccentric active ms contractions
Bones moving about an axis or through flexion, extension, abduction, adduction or rotation
_Accessory motion (Arthrokinematics)_ Motions of articular surfaces relative to one another
Associated with physiological movt
Necessary for full range of physiological motion to occur
Lig & jt capsule involvement in motion
Can only be achieved passively (not actively controlled) - Cannot be voluntary performed
define joint accessory movement
describe mechanical vs chemical pain in terms of subjectie, objective, treatment
describe hypomobility vs hypermobility vs instability
Hypomobility
Decreased mobility in one or more directions
Physiological & accessory movt proportionally limited
Early capsular EF
Capsule (lig) - fibrosis, scar tissues
Hypermobility
Increased mobility in one or more directions
Movt beyond normal physiological limit but Beneath anatomical limit
Accessory movt will be increased but firm (normal) EF
Instability
Anatomical limit is weakened
Physiological movt may be normal
Accessory mobility is ↑ in one or more directions with Soft EF
One or more ligament(s) stress test(s) are (+)ve
- no fibres holding the joint (whereas hypermobility still has some fibres)
- feels like the skin is preventing further movement, grade 3 = instability
what are factors that may alter mobility?
how do you assess hypomobility?
what is joint mobilization?
what are osteokinematics?
Osteokinematics:
Study of the motion of bone in space
Movt of bone around its mechanical axis
Consists of rotation (spin/swing) & translation
Physiological motion: Flexion, Extension, IR, ER…
what are the degrees of motion for a bone?
3 possible dimensions through which a bone can be moved
3 planes of motion through which a bone can be voluntarily moved
what are the degrees of freedom?
The number of independent axes a bone can move around
Axes are perpendicular to each other
what is arthrokinematics?
Study of movt of one articular surface on another
what are the 3 joint types?
1) fibrous
2) cartiligenous
3) synovial
what is a fibrous joint?
what is a cartiligenous joint?
what is a synovial joint? - and its components
components:
Articular cartilage - Reduces friction, Absorbs shock
Articular capsule - Surrounds joint
Synovial membrane - Lining the joint space qIt secretes synovial fluid, Fills the joint space, Provides lubrication, Nourishment to Art cartilage
Synovial cavity - Separates articulating bones, Content synovial fluid
what is the synovial joint classification system? (by complexity)
what are the 3 main types of shapes of synovial joint articular surfaces?
- Planar Joint
- Ovoid joint
- Sellar or Saddle joint
describe the synovial planar joint
describe the synovial ovoid joint
describe the synovial modified ovoid joint
describe the synovial sellar joint (modified and unmodified)
(saddle shape)
- Both articular surfaces have a convex & concave
- The surface of one fits into the complementary surface of another - Sellar jts tend to be more stable, require less ligs & peri-articular ms for stability
Unmodified
Joint surfaces are concave in one plane & convex in the other plane
Jt surfaces are perpendicular to each other
-Allows 2 DOF (1st CMC joint)
Modified sellar jt:
-Concave & convex surfaces are not at right angles to each other.
- Allow 1 DOF (subtalar jt, calcaneocuboid jt)
what are the rules of motion for rolling/sliding/gliding?
what is the convex/concave rule?
describe close packed position
Articular surfaces are maximally congruent.
Capsule & most of ligaments are taut
Significance:
Most stable position
- Likely to fracture in this position
- Most efficient position - If absent it can result in ms overuse syndrome
Position used to test ligament laxity
Cannot mobilize or manipulate in this position
Important for joint lubrication
Avoid resting or splinting in this position
describe loose packed position
All positions other than the CPP
Articular surfaces are not congruent
Capsule & some ligaments are lax
describe least packed position
what are contraindications for mobilization?
what are precautions for mobilization?
go over the mobilization assessment procedure
describe the neutral zone for joint mobilization (in terms of hypermobility, hypomobility, and instability)
what are the indications for mobilization treatments?
what are the effects of joint mobilization?
Mechanical effect:
Improves the mobility of a hypomobile joint by stretching thickened CT (scar tissue)
- Hypomobility caused by: Micro-macro trauma of capsule/ligament (sprain), Immobilization…
Neurophysiological effect: Think: gate control theory
It stimulates mechanoreceptors to decr. pain
Affect ms spasm (nociceptive stimulation) -Chemical/mechanical insult: Activates nociceptors which will cause pain
Nutritional effects:
Distraction or small gliding movements (gr I &/or II)
- Cause synovial fluid movement
- Movt can improve nutrient exchange if there is joint swelling & immobilization
describe the joint mobs grading scale
Grades I & II: primarily used for pain - Manage pain & spasm – neurophysiological effect
Grade I: Small amplitude rhythmic oscillating movt at the beginning of ROM
Grade II: Large amplitude rhythmic oscillating movt within the midrange of movt
Grades III & IV: Primarily used to improve range of motion within the joint
- Grade III: Large amplitude rhythmic oscillating movt to mid-point of resistance (R1) up to the point of the limitation (R2) in ROM - Stretches capsule & CT structures
- Grade IV: Small amplitude rhythmic oscillating movt at the very end range of movement - Used when resistance limits movt in absence of pain
how to choose which gr mobility technique based on pt pain/rom (and therefore phase of healing)
describe the 4 types of swelling (how they feel)
