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Therex 2 > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

what is a fracture?

A

-structural separation in the continuity of bone, epiphyseal plate, or cartilaginous joint surface

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2
Q

what are the signs and symptoms of fracture? KNOW

A

-localized pain increasing with movement
-muscle guarding with passive movement
-pain with weight bearing
-cannot weight bear
-decreased function of body part
-unwilling to move
-swelling
-deformity
-abnormal movement
-sharp specific pain
-crepitus

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3
Q

what are risk factors for fractures? KNOW

A

-high energy trauma or sudden impact
-osteoporosis
-history of falls

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4
Q

what are examples of high energy trauma or sudden impact?

A

-MVA
-abuse
-fall from height

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5
Q

what populations have increased history of falls?

A

-older age
-low BMI
-low PA

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6
Q

what can fractures in the center of the body result in?

A

-damage to internal organs, spinal cord, or brain

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7
Q

what are some examples of soft tissue involvment in fractures?

A

-fracture blister
-adherent scar

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8
Q

what fractures result from bending/angulatory force?

A

-transverse and oblique
-greenstick in children
-fx is on convex side

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9
Q

what fracture results from twisting/torsional force??

A

-spiral

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10
Q

what fracture results from a pull/traction force?

A

-avulsion
-tension failure from pull of ligament or muscle

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11
Q

what fracture results from a crushing/compression force?

A

-compression, burst
-torus in children

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12
Q

what fracture results from repetitive microtrauma force?

A

-fatigue, stress
-small crack

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13
Q

what fracture results from normal force on abnormal bone?

A

-pathological fracture
-due to osteoporsis, tumor, or other disease

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14
Q

what are the 6 ways a fracture will be described?

A

-site
-extent
-configuration/pattern
-relationship of fragments
-relationship to environment
-complications

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15
Q

how is position of fragments described in fracture?

A

-how the distal segment relates to the proximal fragment
-ex: nondisplaced, medial, distracted, rotated laterally

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16
Q

what is a comminuted fracture?

A

-more than 2 fragments

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17
Q

what is cortical bone?

A

-compact bone
-outer layer of long bone

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18
Q

what are the healing phases of cortical bone?

A

-inflamation phase
-reparative phase
-remodeling phase

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19
Q

what is the stage of clinical union?

A

-fx firm enough that is doesnt move
-motion of limb permissble but CAREFUL not to stress site

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20
Q

what is the stage of radiological union?

A

-fracture callus replaced by mature bone
-bone is healed

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21
Q

what type of bone heals faster?

A

-cancellous/spongy bone

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22
Q

what can epiphyseal plate fractures lead to?

A

-growth disturbances
-bone deformity

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23
Q

what is a stress sharing device?

A

-permits some transmission of load across fracture site
-casts, rods, pins, wires

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24
Q

what is a stress shielding device?

A

-protects the fracture completely from mechanical stress
-transfers stress to fixation device
-plate, external fixators

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25
Q

what is the tissue response due to immobilization from fracture?

A

-connective tissue weakens
-articular cartilage degenrates
-muscle atrophy occurs
-circulation slows
-scar
-contracture, adaptive shortening

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26
Q

what should you examine for post-immobilization from fracture?

A

-decresed ROM, joint plat, flexibility
-atrophy
-poor endurance, strength, power
-pain
-scar
-motor control
-balance

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27
Q

what are interventions post fracture immobilization?

A

-streching (proximal to fracture site until radiological healing)
-muscle preformance (proximal to facture site)
-fuctional activities
-scar tissue mobilization
-correct movement impairments

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28
Q

when can streching be done post fracture immobilization?

A

-PROXIMAL to fracture site until radiological healing has occured

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29
Q

where can muscle preformance activites be preformed post fracture immobilization?

A

-begin proximal to fracture site

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30
Q

what are some complications of fracture?

A

-compartment syndrome
-infection
-fat embolism
-refracture
-fixation device failture
-delayed or malunion

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31
Q

what are characteristics of impact exercise to prevent fracture?

A

-dynamic
-induce high bone strain
-apply load rapidly
-short bouts with rest
-diversify the loading
-progressive, multidirectional, novel

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32
Q

what should the intensity and volume of impact exercise to prevent fracture be?

A

-moderate to high
->2 x BW
-10-50 impacts/day
-3x week pre menopausal

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33
Q

what should be the volume and intensity of progressive reisstance traning to prevent fracture?

A

-high load
-80-85% 1 RM
-2x a week
-target large muscles crossing hip and spine

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34
Q

what is low risk of fracture?

A

-Tscore above -1
-normal BMD
-asymptomatic
-not fall risk

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35
Q

what is moderate risk of fracture?

A

-Tscore -1 to -2.5
-low BMD
-functional or clinical risk factors

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36
Q

what is high risk of fracture?

A

-very low BMD
-Tscore below -2.5
-osteoporosis
-number of clinical or functional risk fctors

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37
Q

what are some functional and clinical risk factors of falls and fracture?

A

-BMD
-increasing age
-fragiliyt
-sacropenia
-low BW
-hx osteoporosis
-loss of height
-cancer
-low testosterone
-steroids
-nutrition
-alcohol, smoking
-hx of fall or fracrure
-previous PA
-balance, gait
-ROM
-strength
-vision

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38
Q

what are the 5 deficits to rate fragility?

A
  1. weakness
  2. low PA
  3. slow walk speed
  4. exhausion
  5. unintended weight loss
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39
Q

what score is considered frail?

A

3+ deficeits
-1-2 deficits = prefrail

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40
Q

what are high impact activities?

A

->4 BW
-drop landing, star jump, vertical jump, tuck jump

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41
Q

what are moderate impact activities?

A

-2-3 BW
-jump rope, running, bounding, hops, side hops, highland dancing

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42
Q

what are impact modifcations for OA?

A

-reduce or eliminate high ground reaction forces
-substitute power training
-want high muscle contraction forces like take off in jup without impact landing

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43
Q

what are impact modifications for fragility or NM impariments?

A

-heel drop instead of jump
-supervision
-use support surface

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44
Q

what are impact modifcations for CVP disease?

A

-keep intensty below what causes ischemia or dyspnea

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45
Q

what are progressive resistance training modifications for OA?

A

-correct form
-pain free range
-weight machines for support
-alter intensity
-consult with PCP about meds

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46
Q

what are progressive resistance training modifications for fragility or NM inpairments?

A

-decrease intensity
-supervision

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47
Q

what are progressive resistance training modifications for CVP disease?

A

-keep intesity below angina or ischemia
-seated exercise
-avoid valsalva

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48
Q

what are the stats on getting an MRI?

A

-6x more likely for surgery
-5x more likely to get injection
-4x more likely to have ER visit

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49
Q

what are some examples of soft tissue lesions?

A

-sprain
-strain
-dislocation
-subluxation
-synovistis
-hemoarthrosis
-bursistis
-overuse syndromes

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50
Q

what is hemosrthrosis?

A

bleeding into tissue or joint

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51
Q

what is a strain?

A

muscle and tendon

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52
Q

what is a sprain?

A

ligament

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53
Q

what is a grade I/ first degree sprain/strain?

A

-no loss of continuity
-mild
-joints are still stable
-likely wont see this in the clinic

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54
Q

what is a grade II/second degree sprain/strain?

A

-moderate pain
-unable to continue activity
-significant number of fibers torn
-pain with palpation
-ligament tear = increased joint mobility and less stability

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55
Q

what is a grade III/ third degree spain/strain?

A

-severe pain
-near complete or complete tear
-stress to tissue usually painless
-ligament makes unsable joint

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56
Q

what are the stages of inflamation and repair for soft tissue injury?

A
  1. acute stage: inflammation reaction
  2. subacute stage: repair and healing
  3. chronic stage: maturation and remodeling
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57
Q

should pain receed as you heal?

A

YES

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58
Q

what is the physiological resonses in the acute stage?

A

-inflamation
-48hrs
-can last 4-6 days
-clot formation, phagocytosis, early fibroblastic activity

59
Q

how will the patient present in the acute stage?

A

-swelling, redness
-loss of fucntion
-pain with palpation
-nerve ending irritated do to altered chemical states
-guarding
-limitations in ROM

60
Q

what are our goals in the acture stage?

A

PROTECTION
-pt education
-prevent adverse effects of immobility
-decrease pain

61
Q

what are our interventions in the acute stage?

A

-PROM
-grade I joint mob for pain relief
-muscle setting
-massage, ice, compression

62
Q

what are the precautions of interventions in the acute stage?

A

-signs of increasing inflamation after intervention

63
Q

what are contraindications of interventions in the acute stage of healing?

A

-no streching or resistance exercise at the site of inflamed or swollen tissue

64
Q

what is psychological responses in subacute stage of healing?

A

-14-21 days after injury onset
-last 6-8 weeks
-deposition of new collagen by fibroblasts
-ver fragile and easy to reinjure
-new capillary beds

65
Q

what is the progression of mobility used in the subacute stage of healing?

A

-warm the tissues
-muscle relaxation techniques
-joint mobilization
-streching techniques
-use of the new range

66
Q

what are intervnetions used in the subacute stage of healing?

A

-multiple angle isometrics
-AROM
-muscle endurance exercises
-protected weight bearing

67
Q

what are signs of excessive stress?

A

-soreness that does not drecease after 4 hours and does not go away after 24 hours
-increase in pain
-increase stifness
-decrease ROM
-swelling redness in healing tissue
-progressive weakness
-decreased function

68
Q

what are the physiological responses in the chronic stage?

A

-21 to 60 days
-fibroblasts easily removed
-qulity of collagen and reduction of wound size
-remodeling of tissue

69
Q

what are invervnetions used in the chronic stage of healing?

A

-discontinue hands on interavtions
-progresses exercises and streching
-SAID
-developing NM control, strength, power, and endurance
-return to high demand activites

70
Q

what is the most commonly injured hamstring?

A

-biceps femoris

71
Q

how is the biceps femoris strained?

A

-high speed running

72
Q

how is the semimebranosis strained?

A

-dancing or kicking
-either slow or fast
-knee ext and hip flex
-prolongued recovery

73
Q

what are non modifable risk factors for hamstring strain?

A

-hx of hamstring strain
-23+
-acl injuries, calf strains, other knee and ankle ligaments

74
Q

what are modifable risk factors for hamstring injuries?

A

-hamstring weak ness
-fatigue
-strength and coordinatation deficits of the pelvis and trunk

75
Q

what contributes to high rate of hamstring reinjury?

A

-persistent weakness
-reduced extensability due to scar tissue
-adaptive biomechanical changes
-strength and control of lumbopelvic muscles

76
Q

what is the volume of nordic curls needed to prevent hamstring injury?

A

-1x week, 2 sets 6 reps

77
Q

what is the intervention framework for soft tissue injuries?

A
  1. protection
  2. controlled motion
  3. return to function
78
Q

what are some phase 1 interventions for hamstring injury?

A

-planks
-diver
-supine extender

79
Q

what are phase 2 interventions for hamstring injury?

A

-side plank
-bridges
-glider
-windmill

80
Q

what are phase 3 interventions for hamstring injury?

A

-skipping
-rotating plank
-sport specific drills
-forward backward acceletation

81
Q

what is physical activity?

A

-anything more than laying in bed
-requires energy above resting levels

82
Q

what is exercise?

A

-planned
-purposeful PA designed to improve fitness

83
Q

what is physical fitness?

A

-set of attributes
-includes CV endurance, body composition, strength
-includes athletic ability (agility, speed, corrdination)

84
Q

what does Physical fitness allow for?

A

-enjoy life without fatigue and stress

85
Q

what is a social determinant of health?

A

-non medical factor that influences health

86
Q

what is CV endurance?

A
  1. ability of whole body to sustain prolongued exercise
  2. achieved through aerobic training
  3. to achieve physical fitness
    -multiple muscles working together
    -walking, biking, running for long period of time
87
Q

what is muscle endurance?

A

-ability of isolated muscle group to perform repeated contraction over period of time

88
Q

what is central fatigue?

A

-in brain, stress, emotional

89
Q

how can you measure CV endurance?

A

-VO2 max

-gold standard

90
Q

what is VO2 max?

A

-highest rate of O2 the body can consume during max exercise

91
Q

what are normal responses to aerobic exercise?

A

-increase SBP
-no change in DBP
-increase tidal volume and RR
-increase HR linear

92
Q

what is your response to aerobic exercise influenced by?

A

-age
-fitness level
-type of activity
-disease
-meds
-blood volume
-enviornment

93
Q

what adaptations should you see increase in response to CV endurance training?

A

-heart weight
-heart volume
-SV, CO
-hemoglobin
-capillary formation
-VO2 max
-energy levels

94
Q

what adaptations should you see decrease in response to CV endurance traning?

A

-resting and submax HR
-time required to return to resting levels
-SBP and DBP
-resting and submax RR
-body fat
-hemoglobin A1c

95
Q

what are heart muscle issues that can cause impaired aerobic capacity?

A

-CAD
-pericarditis
-congestive heart failure
-aneurism

96
Q

what are nervous system issues that can cuase imparier aerobic capacity?

A

-arrhythmias
-tachy and bradycardia

97
Q

what are issues that can cause impaired aerobic capacity?

A

-rheymatic fever
-endocardidits
-mitral valve prolapse
-congenital deformities

98
Q

what are pulmoary issues that can cuase decreased aerobic capacity?

A

-COPD
-asthma
-pneumaonia
-cystic fibrosis
-lung cancer

99
Q

what are physical representations seen with COPD?

A

-more developed upper traps, scalenes, and SCM
-from using those muscles during respir

100
Q

bed bound status results in decreased what?

A

-skeletal muscle mass
-strength
-CV function
-orthostatic tolerance
-exercise tolerance
-BMD

101
Q

what are clinical s+s of aerobic exercise in tolerance?

A

-severe SOB
-abnormal sweating
-pallor
-cynaosis
-cold, clammy skin
-vertigo, axatia, gait disturbances, confusion (CNS
-leg cramps or intermittent clauducation

102
Q

what is intermittent claudication?

A

-often bilateral deep ache
-due to ischemia

103
Q

what are major warning signs of heart attack?

A

-retrosternal angina
-pain in left arm, jaw, back, lower neck, pressure

104
Q

what kinds of medications can affect HR?

A

-beta blockers
-diuretics

105
Q

what are non modifable risk factors for CAD?

A

-increasing age
-male
-black&raquo_space; white
-family hx
-post menopausal

106
Q

what are modifiable risk factors for CAD?

A

-physical inactivity
-smoking
-elevated serum cholersterol
-elevated BP
-impaired fasting glucose
-BMI > 30
-unhealthy diet

107
Q

what are major signs of CVP disease?

A

-pain in chest, neck, jaw
-SOB at rest or mild exertion
-dizziness or syncope
-orthopnea
-ankle edema
-palpitations
-ischemia/claudation
-heart murmur

108
Q

what is considered low risk for submax exercise?

A

-man < 45
-woman <55
-no more than 1 risk factor

109
Q

what is considered moderate risk for submax exercise?

A

-men >45
-women > 55
-2 or more risk factors

110
Q

what is considered high risk for sub max exericise?

A

-1+ s+s or known CVP or metabolic disease

111
Q

what are maximal graded exercise tests?

A

-MD supervision
-with ECG
-workload increases over 8-12 mins
-used to determine presence of CHD, CAD

112
Q

what are submax graded exercise tests?

A

-estimates Vo2 max
-used to document change

113
Q

what are anthropometric characteristcs?

A

-fat to muscle ratio
-hydrostatic, DEXA, BMI, skinfold measurements

114
Q

what is BMI?

A

wt/ht x 703

115
Q

what can vitals signs reflect?

A

-BP
-HR, rhythm and pattern
-RR, rhythym and pattern
-O2 saturation

116
Q

what are the determinants of CV training?

A
  1. mode
  2. training type
  3. training sequence
  4. intensity
117
Q

what are some modes of CV traning?

A

-walk, jog, cycle, rowing, tennis, cardio machines, etc

118
Q

what are some traning types?

A
  1. continuous traning
  2. interval traning
  3. circuit traning
119
Q

what is interval traning?

A

-multiple bouts of high intensity with short periods of rest/light acitivy

120
Q

what is circuit training?

A

-individual rotates through series of exercise stations
-performed at rate to reach cardio goals

121
Q

what is traning sequence?

A
  1. warm up
  2. exercise with increasing intensity
  3. cool down
122
Q

what is exercise intensity?

A

-based on SAID principle
-on basis of HR, HR reserve, VO2 max
-60-80% of HR max for HEALTHY individuals

123
Q

what is the karvonen formula?

A

-target HR range for exercise intensity
-takes into account HR rest and HR exercise

124
Q

what does ACSM say for CV exercise recomendations?

A

-150 mins moderate intensity a week
-30-60 of moderate for 5 days OR 20-60 high intensity for 3 days
-continuous or short burst are both good

125
Q

what are precautions for CV exercise?

A

-hx >1 heart attack
-impaired L ventricle function with EF of 54-40%
-angina pectoris

126
Q

what are contraindications for CV exercise?

A

-arrhythmias at rest
-multivessel athersclerosis
-low serum K+

127
Q

what are absolute contraindications for CV exercise?

A

-MI in last 7 days
-acute cardiac event
-unstable angina
-uncontrolled arrhythmias
-acute Pulmonary embolum
-acute myocarditis, pericarditis
-acute inflection
-dissecting aneurysm

128
Q

what should you educate a pt about when it comes to CV exercise?

A

-warm up and cool down
-negative signs when to stop
-maintience program with discharge

129
Q

what are the reccomendations for childhood exercise?

A

-regular activity
-BP lower and HR higher
-lower intensity in hot climated b/c less body heat regulation
-60+ mins a day

130
Q

what are exercise recommendations for elderly?

A

-30 mins 5days a week

131
Q

what should you evalulate in surgery preop visit?

A

-ROM
-pain
-skin integrity
-muscle preformance
-posture
-gait
-functional status

132
Q

what should you eduate about in surgical pre-op?

A

-post op exercises
-overvoew POC
-post op precautions
-bed mobility and transfers
-gait training
-wound care
-improve endurance/strength of both MSK and CV

133
Q

what should you examine in post-op visit?

A

-icsision status
-edemna and effusion
-complications

134
Q

what can influence a post-op rehab program?

A

-extent of tissue damage
-extent of preop impariments
-age
-meds
-TABACCO
-comorbidities
-goals, expectation
-motivation/cognition
-stage of healing
-response to immobilization
-surgical procedure
-philosophy of seugeon

135
Q

what are the three pahses of post-op rehab?

A
  1. max protection (6-8 weeks)
  2. mod protection (8-12 weeks)
    -minimum protection (6-12 weeks post op to 6 months post op)
136
Q

what is required to progress an exercise program post op?

A

-must meet timing and criteria

137
Q

what are some post-op complications of the CV system?

A

-DVT
-PE

138
Q

what are some post op complications of the MSK system?

A

-subluxation or dislocation
-adhesions or scars resistricting motion
-failure or loosening of fixation

139
Q

what are S+S of DVT?

A

-dull aching severe pain, swelling, or skin changes
-heat and redness
-only 25% of time have these symptoms

140
Q

what are S+S of PE?

A

-suddentSOB, rapid shallow breating, and chest pain

141
Q

what are some additional risk factors besides wells scale for DVT?

A

->60
-obese
-heart failure
-oral contraceptives
-pregnancy
-dirivng or flying

142
Q

what are three common surgical approaches?

A

-open
-arthroscopic
-arthroscopically assisted

143
Q

what are three types of grafts?

A

-autograph = from self
-allograph = from other/cadaver
-synthetic graft

144
Q

what do SLAP and Hip labral repairs do?

A

-soft tissue collected and anchored to bone to recreate/repair labrum?

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