Med Surg-Quiz 8 Flashcards by Christina Heeg

Overstretching, overexertion, overuse of soft tissue: tends to be less severe than a sprain, occurs from slight trauma or unaccustomed repeated trauma of a minor degree. This term is frequently used to refer specifically to some degree of disruption of the musculotendinous unit.

Strain

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Sever stress, stretch, or tear of soft tissues, such as joint capsule, ligament tendon, or muscle. This term is frequently used to refer specifically to injury of a ligament and is graded as first- (mild), second- (moderate), third- (severe) degree pain.

Sprain

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Displacement of a part, usually the boney partners in a joint, resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm.

Dislocation

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An incomplete or partial dislocation of the boney partners in a joint that often involves secondary trauma to surrounding soft tissue.

Subluxation

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If a rupture or tear is partial, pain is experienced in the region of the breach when the muscle is stretched or when it contracts against resistance. If a rupture or tear is complete, the muscle does not pull against the injury, so stretching or contraction of the muscle does not cause pain.

Tendon rupture/Muscle tear

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The general term that refers to chronic tendon patholgy

Tendinopathy

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The inflammation of a tendon; there may be resulting scarring or calcium deposits.

Tendinitis

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Inflammation of a synovial membrane; an excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease.

Synovitis

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Inflammation of the synovial membrane covering a tendon.

Tenosynovitis

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Inflammation with thickening of a tendon sheath.

Tenovaginitis

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Degeneration of the tendon due to repetitive microtrauma.

Tendinosis

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Bleeding into a joint, usually due to severe trauma.

Hemarthrosis

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Ballooning of the wall of a joint capsule or tendon sheath. Ganglia may arise after trauma, and they sometimes occur with rheumatoid arthritis.

Ganglion

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Inflammation of a bursa.

Bursitis

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Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory response.

Contusion

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protect the integrity of the post-op or damaged tissues. Manage inflammation and pain. Begin PROM exercises as allowed by protocol. Mobilize or immobilize as necessary. Isometric exercise. Gentle manual therapy.
See K/C pg. 319 Box 10.1
*See precautions and contraindications!

ACUTE STAGE- Protection phase

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*proliferation beginning- tissues starting to organize, yet still fragile; too much stress can cause re-injury; too little stress can cause unorganized healing of tissues. inflammation and healing have become controlled and mobility is increasing. Will have lack or decreased pain at rest and some pain-free ROM. Focus on correct body mechanics to optimize return to function. Initiate low resistance strengthening activities. See K/C pg. 321 Box 10.2

SUBACUTE STAGE- Moderate protection phase

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*RETURN TO FUNCTION stage; full or WFL AROM of affected areas. Return to prior functional activities by gradually increasing strength. Achieve equal strength and flexibility of bilateral extremities, or equal strength and flexibility throughout all of trunk
See K/C pg. 324 Box 10.4

CHRONIC STAGE-Minimal protection phase

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Surgical Procedure: invasive. Lengthy incision, extensive disruption of soft tissues to enable surgeon to see the underlying structures.

Open procedures

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Surgical Procedure: less invasive. Smaller incisions, multiple incisions, minimal disruption of soft tissues. Surgeon visualizes underlying structures through a scope. Fluid is injected during procedure to allow an enlarged joint space and clear view.

Arthroscopic procedures

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after a complete tear or rupture of a muscle. Best to wait 48-72 hours prior to surgery to let inflammation go down and acute symptoms calm down. Will be immobilized in a shortened position.

Muscle repair

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Complete tear results in little pain and no movement. Incomplete tear will allow some movement with extreme pain.Best to have done immediately to avoid tendon contraction. Will be immobilized in a shortened position. Heals slowly due to low vascular supply.

Tendon repair

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Surgical Procedure: approximating and suturing the torn ligament. Then allowing appropriate WB and ROM.

Ligament repair

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Reconstruction: tissue graft taken from a donor site and re-attached to new joint.

Ligament reconstruction

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Reconstruction: Reduce capsular laxity. Can be open or arthroscopic procedure.

Capsule reconstruction

Realignment: alters the line of pull for a muscle. Does not always change the action of the muscle unless the tendon is reattached to a new bone. Can be reattached on same bone in a new spot or can be reattached to a different bone. Will be immobilized in a shortened position.

Tendon transfer

cut through muscle

Myotomy

cut through tendon

Tenotomy

cut through fascia

Fasciotomy

removal of the synovium. Occurs with excessive joint inflammation. May have immobilization post-op? Definite need to monitor exercise levels and avoid excessive stress. Will cause a recurrence.

Synovectomy

arthro-scopically remove loose and jagged cartilage

Articular cartilage debridement

drilling of articular cartilage in order to resurface the area.

Abrasion chondroplasty

cutting of bone, realigning as necessary. Redistribute weight bearing on the surface of the joint. May be used to correct congenital deformities or chronic damage. May have weight bearing or ROM precautions.

Osteotomy

fusion of a joint. Commonly performed in the spine. Can be done to the extremities. Surgeon will decide the optimal functional position based on the patient’s needs.

Arthrodesis

replacement of a joint with artificial prosthesis (TKA, THA, TSA, TAA, etc.)

Arthroplasty

Impaired mobility Impaired muscle performance Impaired balance Functional limitations

Signs/Symptoms for all types of arthritis

Develops gradually from excess stress to a joint, therefore commonly in WB joints Cartilage damage with change in joint alignment and mechanics Asymmetrical Stiffness in AM for ~ 30 minutes Crepitus (crackling, popping, grinding) Heberden and Bouchard Nodes

Osteoarthritis

Develops quickly Symmetrical presentation Systemic effects that have exacerbation and remission periods; fatigue, malaise, fever; cardiac, hematologic, pulmonary and ocular changes Inflammation and synovitis leave irreversible damage to joint structure Presents with stiffness in AM > 30 minutes Redness, swelling, warmth in joints

Rheumatoid Arthritis

Juvenile RA- onset is by age 16. Idiopathic etiology. May be related to genetics, stress, infection, or trauma. Same presentations as adult RA. Diagnosis- xrays, blood tests, joint fluid biopsy

Juvenile Rheumatoid Arthritis

a build-up of uric acid in the blood stream that causes it to be deposited in the joints in the form of crystals.

Gouty Arthritis - Gout

affects 20% of the persons with psoriasis. Progressive destruction of joints over a very long period of time

Psoriatic Arthritis

Chronic, regional pain syndrome. Specific trigger point in a muscle that corresponds to a typical referred pain pattern. *Piriformis syndrome is most common *See K/C pg. 340 figure 11.8 and the section on “Management: Myofascial Pain Syndrome”

Myofascial Pain Syndrome

Decreased mineral deposits in the bone that lead to its weakening. Predisposing factor for fractures; pathological, compression or stress…

Osteoporosis

``` AVOID flexion and rotation combinations with exercise!!! Stick with straight plane movements. Calcium and vitamin D consumption Weight bearing activities (Wolff’s Law) Active lifestyle No smoking Limit alcohol consumption Regular bone density scans ```

Osteoporosis Prevention

Trauma. Injury to or dislocation of the hip joint — which can occur during car accidents or from playing contact sports such as football or hockey — can cause a hip labral tear.

Hip Labrum Tears (Cause 1)

Structural abnormalities. Some people are born with hip problems that can accelerate wear and tear of the joint and eventually cause a hip labral tear.

Hip Labrum Tears (Cause 2)

Signs and symptoms include hip pain or a "catching" sensation in your hip joint

Hip Labrum Tears

abnormal formation of the acetabulum, femoral head, or both. Causes hip joint to be out of place. Pediatricians perform the “click tests.” Hip abduction- if click then hip popping out of place. Indicates need for US verification and visit with pediatric orthopedist.

Hip Dysplasia

straps around infant’s trunk and legs, attached at feet. Holds the hip joint in flexed and abducted position. Allows for controlled movement with healing and proper alignment. 90% recovery.

Pavlik Harness (hip dysplasia)

more restrictive. Used 6 months to 1 year old. After 1 year old, poorer prognosis. May require surgery and use of spica cast after. May need THA or hip osteotomy later in life. May require THA later in life

Spica Cast or brace (hip dysplasia)

lack of blood supply to a bony area

Avascular Necrosis

Idiopathic childhood version of femoral head avascular necrosis

Legg-Calve’-Perthes Disease

IT Band rubs against the trochanteric bursa.

Trochanteric Bursitis

“traditional” approach. Still most commonly utilized in this area. Post-op precautions: no flexion beyond 90⁰, no adduction beyond neutral, and no IR. Restrictions can be permanent!

Posterior approach- Total Hip Arthroplasty

no precautions except avoid hyperextension in early rehab stages

Anterior approach- Total Hip Arthroplasty

The piriformis muscle crosses over the sciatic nerve and causes increased radiating pain. Will have specific tender point to palpation

Piriformis Syndrome

Will display tenderpoint pain at proximal anterior hip and will experience pain with resisted hip flexion

Iliopsoas tendonitis

It is characterized by the dropping of the pelvis on the unaffected side of the body at the moment of heelstrike on the affected side

Trendelenburg gait

If the glute meds are weak, the hip/pelvis is not stabilized during gait and the patient develops a Trendelenberg gait pattern

Glute Med Weakness and Trendelenburg Gait

Can get irritated and cause lateral knee pain. Common in runners

IT Band Syndrome

softening of the articular cartilage of the patella

Chondromalacia

Patella glides off track

Patellar-Femoral Pain Syndrome

pain usually inferior to patella along the patellar tendon

Patellar Tendonitis

Etiology: patellar tendon irritation causing disruption of immature bone at the tibial tuberosity. Traumatic cause, repetitive stress injury, increased Q angle at knee Causes abnormally large tibial tuberosities

Osgood Schlatter Syndrome

Etiology: irritation from remnants of embryological synovial tissue surrounding the patella

Plica Syndrome

Signs/symptoms: joint line pain, “catching” or “locking” of knee, edema

Meniscal Tears

Indicated with end stage OA

Total Knee Arthroplasty

Repetitive stress injury from mechanical overload causes tissue disruption and pain

Repetitive Stress Shin Pain (Shin Splints)

Increased fluid pressure in the fascia, usually due to inflammation. Compresses the nerves and blood vessels, which causes pain and risk of ischemia

Compartment Syndrome

usually affects the lateral ligaments (anterior and posterior talofibular and calcaneofibular)

Ankle Sprains

both medial and lateral malleoli are fractured.

Bimalleolar

both malleoli and the talus are fractured.

Trimalleolar

achilles is stressed to the point where it tears away from the calcaneous and takes a part of the calcaneous with it

Achilles tendon and calcaneal avulsion=

Inflammation of the plantar fascia. Usually from over-use, repetitive stress, poor arch support, tight soleus and gastrocnemius. Clinical signs: Pain upon first WB in AM. Palpable pain in center of heel.

Plantar Fasciitis

Sudden softening of the bones of the foot. Can cause fractures and disfigurement of the foot, leaving it with a rocker-bottom appearance.

Charcot Foot

Tibial nerve neuropathy at the posterior medial malleolus. | Common etiologies: excessive pronation of foot, flat foot (“fallen arches”) or malleolar fracture

Tarsal Tunnel Syndrome

Hyperextension sprain of the first metatarsophalangeal joint

Turf Toe

commonly associated with a bunion. The 1st metatarsal shifts laterally (Varus) and pushes the 1st phalanges medially (Valgus) A bunion, or bursa inflammation and fibrosis of the tissue, forms overtop and creates a problem. Treatment: Can be surgically removed, in conjunction with an osteotomy to correct the metatarsal deformity, can correct mild deviations with orthotics. Modalities PRN, manual therapy techniques, restore balance to foot intrinsic muscles

Hallux Valgus