Midterm 1 Flashcards
1
Q
what is a fracture?
A
-structural separation in the continuity of bone, epiphyseal plate, or cartilaginous joint surface
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
3
Q
what are risk factors for fractures? KNOW
A
-high energy trauma or sudden impact
-osteoporosis
-history of falls
4
Q
what are examples of high energy trauma or sudden impact?
A
-MVA
-abuse
-fall from height
5
Q
what populations have increased history of falls?
A
-older age
-low BMI
-low PA
6
Q
what can fractures in the center of the body result in?
A
-damage to internal organs, spinal cord, or brain
7
Q
what are some examples of soft tissue involvment in fractures?
A
-fracture blister
-adherent scar
8
Q
what fractures result from bending/angulatory force?
A
-transverse and oblique
-greenstick in children
-fx is on convex side
9
Q
what fracture results from twisting/torsional force??
A
-spiral
10
Q
what fracture results from a pull/traction force?
A
-avulsion
-tension failure from pull of ligament or muscle
11
Q
what fracture results from a crushing/compression force?
A
-compression, burst
-torus in children
12
Q
what fracture results from repetitive microtrauma force?
A
-fatigue, stress
-small crack
13
Q
what fracture results from normal force on abnormal bone?
A
-pathological fracture
-due to osteoporsis, tumor, or other disease
14
Q
what are the 6 ways a fracture will be described?
A
-site
-extent
-configuration/pattern
-relationship of fragments
-relationship to environment
-complications
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
16
Q
what is a comminuted fracture?
A
-more than 2 fragments
17
Q
what is cortical bone?
A
-compact bone
-outer layer of long bone
18
Q
what are the healing phases of cortical bone?
A
-inflamation phase
-reparative phase
-remodeling phase
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
20
Q
what is the stage of radiological union?
A
-fracture callus replaced by mature bone
-bone is healed
21
Q
what type of bone heals faster?
A
-cancellous/spongy bone
22
Q
what can epiphyseal plate fractures lead to?
A
-growth disturbances
-bone deformity
23
Q
what is a stress sharing device?
A
-permits some transmission of load across fracture site
-casts, rods, pins, wires
24
Q
what is a stress shielding device?
A
-protects the fracture completely from mechanical stress
-transfers stress to fixation device
-plate, external fixators
25
what is the tissue response due to immobilization from fracture?
-connective tissue weakens
-articular cartilage degenrates
-muscle atrophy occurs
-circulation slows
-scar
-contracture, adaptive shortening
26
what should you examine for post-immobilization from fracture?
-decresed ROM, joint plat, flexibility
-atrophy
-poor endurance, strength, power
-pain
-scar
-motor control
-balance
27
what are interventions post fracture immobilization?
-streching (proximal to fracture site until radiological healing)
-muscle preformance (proximal to facture site)
-fuctional activities
-scar tissue mobilization
-correct movement impairments
28
when can streching be done post fracture immobilization?
-PROXIMAL to fracture site until radiological healing has occured
29
where can muscle preformance activites be preformed post fracture immobilization?
-begin proximal to fracture site
30
what are some complications of fracture?
-compartment syndrome
-infection
-fat embolism
-refracture
-fixation device failture
-delayed or malunion
31
what are characteristics of impact exercise to prevent fracture?
-dynamic
-induce high bone strain
-apply load rapidly
-short bouts with rest
-diversify the loading
-progressive, multidirectional, novel
32
what should the intensity and volume of impact exercise to prevent fracture be?
-moderate to high
->2 x BW
-10-50 impacts/day
-3x week pre menopausal
33
what should be the volume and intensity of progressive reisstance traning to prevent fracture?
-high load
-80-85% 1 RM
-2x a week
-target large muscles crossing hip and spine
34
what is low risk of fracture?
-Tscore above -1
-normal BMD
-asymptomatic
-not fall risk
35
what is moderate risk of fracture?
-Tscore -1 to -2.5
-low BMD
-functional or clinical risk factors
36
what is high risk of fracture?
-very low BMD
-Tscore below -2.5
-osteoporosis
-number of clinical or functional risk fctors
37
what are some functional and clinical risk factors of falls and fracture?
-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
38
what are the 5 deficits to rate fragility?
1. weakness
2. low PA
3. slow walk speed
4. exhausion
5. unintended weight loss
39
what score is considered frail?
3+ deficeits
-1-2 deficits = prefrail
40
what are high impact activities?
->4 BW
-drop landing, star jump, vertical jump, tuck jump
41
what are moderate impact activities?
-2-3 BW
-jump rope, running, bounding, hops, side hops, highland dancing
42
what are impact modifcations for OA?
-reduce or eliminate high ground reaction forces
-substitute power training
-want high muscle contraction forces like take off in jup without impact landing
43
what are impact modifications for fragility or NM impariments?
-heel drop instead of jump
-supervision
-use support surface
44
what are impact modifcations for CVP disease?
-keep intensty below what causes ischemia or dyspnea
45
what are progressive resistance training modifications for OA?
-correct form
-pain free range
-weight machines for support
-alter intensity
-consult with PCP about meds
46
what are progressive resistance training modifications for fragility or NM inpairments?
-decrease intensity
-supervision
47
what are progressive resistance training modifications for CVP disease?
-keep intesity below angina or ischemia
-seated exercise
-avoid valsalva
48
what are the stats on getting an MRI?
-6x more likely for surgery
-5x more likely to get injection
-4x more likely to have ER visit
49
what are some examples of soft tissue lesions?
-sprain
-strain
-dislocation
-subluxation
-synovistis
-hemoarthrosis
-bursistis
-overuse syndromes
50
what is hemosrthrosis?
bleeding into tissue or joint
51
what is a strain?
muscle and tendon
52
what is a sprain?
ligament
53
what is a grade I/ first degree sprain/strain?
-no loss of continuity
-mild
-joints are still stable
-likely wont see this in the clinic
54
what is a grade II/second degree sprain/strain?
-moderate pain
-unable to continue activity
-significant number of fibers torn
-pain with palpation
-ligament tear = increased joint mobility and less stability
55
what is a grade III/ third degree spain/strain?
-severe pain
-near complete or complete tear
-stress to tissue usually painless
-ligament makes unsable joint
56
what are the stages of inflamation and repair for soft tissue injury?
1. acute stage: inflammation reaction
2. subacute stage: repair and healing
3. chronic stage: maturation and remodeling
57
should pain receed as you heal?
YES
58
what is the physiological resonses in the acute stage?
-inflamation
-48hrs
-can last 4-6 days
-clot formation, phagocytosis, early fibroblastic activity
59
how will the patient present in the acute stage?
-swelling, redness
-loss of fucntion
-pain with palpation
-nerve ending irritated do to altered chemical states
-guarding
-limitations in ROM
60
what are our goals in the acture stage?
PROTECTION
-pt education
-prevent adverse effects of immobility
-decrease pain
61
what are our interventions in the acute stage?
-PROM
-grade I joint mob for pain relief
-muscle setting
-massage, ice, compression
62
what are the precautions of interventions in the acute stage?
-signs of increasing inflamation after intervention
63
what are contraindications of interventions in the acute stage of healing?
-no streching or resistance exercise at the site of inflamed or swollen tissue
64
what is psychological responses in subacute stage of healing?
-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
what is the progression of mobility used in the subacute stage of healing?
-warm the tissues
-muscle relaxation techniques
-joint mobilization
-streching techniques
-use of the new range
66
what are intervnetions used in the subacute stage of healing?
-multiple angle isometrics
-AROM
-muscle endurance exercises
-protected weight bearing
67
what are signs of excessive stress?
-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
what are the physiological responses in the chronic stage?
-21 to 60 days
-fibroblasts easily removed
-qulity of collagen and reduction of wound size
-remodeling of tissue
69
what are invervnetions used in the chronic stage of healing?
-discontinue hands on interavtions
-progresses exercises and streching
-SAID
-developing NM control, strength, power, and endurance
-return to high demand activites
70
what is the most commonly injured hamstring?
-biceps femoris
71
how is the biceps femoris strained?
-high speed running
72
how is the semimebranosis strained?
-dancing or kicking
-either slow or fast
-knee ext and hip flex
-prolongued recovery
73
what are non modifable risk factors for hamstring strain?
-hx of hamstring strain
-23+
-acl injuries, calf strains, other knee and ankle ligaments
74
what are modifable risk factors for hamstring injuries?
-hamstring weak ness
-fatigue
-strength and coordinatation deficits of the pelvis and trunk
75
what contributes to high rate of hamstring reinjury?
-persistent weakness
-reduced extensability due to scar tissue
-adaptive biomechanical changes
-strength and control of lumbopelvic muscles
76
what is the volume of nordic curls needed to prevent hamstring injury?
-1x week, 2 sets 6 reps
77
what is the intervention framework for soft tissue injuries?
1. protection
2. controlled motion
3. return to function
78
what are some phase 1 interventions for hamstring injury?
-planks
-diver
-supine extender
79
what are phase 2 interventions for hamstring injury?
-side plank
-bridges
-glider
-windmill
80
what are phase 3 interventions for hamstring injury?
-skipping
-rotating plank
-sport specific drills
-forward backward acceletation
81
what is physical activity?
-anything more than laying in bed
-requires energy above resting levels
82
what is exercise?
-planned
-purposeful PA designed to improve fitness
83
what is physical fitness?
-set of attributes
-includes CV endurance, body composition, strength
-includes athletic ability (agility, speed, corrdination)
84
what does Physical fitness allow for?
-enjoy life without fatigue and stress
85
what is a social determinant of health?
-non medical factor that influences health
86
what is CV endurance?
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
what is muscle endurance?
-ability of isolated muscle group to perform repeated contraction over period of time
88
what is central fatigue?
-in brain, stress, emotional
89
how can you measure CV endurance?
-VO2 max
-gold standard
90
what is VO2 max?
-highest rate of O2 the body can consume during max exercise
91
what are normal responses to aerobic exercise?
-increase SBP
-no change in DBP
-increase tidal volume and RR
-increase HR linear
92
what is your response to aerobic exercise influenced by?
-age
-fitness level
-type of activity
-disease
-meds
-blood volume
-enviornment
93
what adaptations should you see increase in response to CV endurance training?
-heart weight
-heart volume
-SV, CO
-hemoglobin
-capillary formation
-VO2 max
-energy levels
94
what adaptations should you see decrease in response to CV endurance traning?
-resting and submax HR
-time required to return to resting levels
-SBP and DBP
-resting and submax RR
-body fat
-hemoglobin A1c
95
what are heart muscle issues that can cause impaired aerobic capacity?
-CAD
-pericarditis
-congestive heart failure
-aneurism
96
what are nervous system issues that can cuase imparier aerobic capacity?
-arrhythmias
-tachy and bradycardia
97
what are issues that can cause impaired aerobic capacity?
-rheymatic fever
-endocardidits
-mitral valve prolapse
-congenital deformities
98
what are pulmoary issues that can cuase decreased aerobic capacity?
-COPD
-asthma
-pneumaonia
-cystic fibrosis
-lung cancer
99
what are physical representations seen with COPD?
-more developed upper traps, scalenes, and SCM
-from using those muscles during respir
100
bed bound status results in decreased what?
-skeletal muscle mass
-strength
-CV function
-orthostatic tolerance
-exercise tolerance
-BMD
101
what are clinical s+s of aerobic exercise in tolerance?
-severe SOB
-abnormal sweating
-pallor
-cynaosis
-cold, clammy skin
-vertigo, axatia, gait disturbances, confusion (CNS
-leg cramps or intermittent clauducation
102
what is intermittent claudication?
-often bilateral deep ache
-due to ischemia
103
what are major warning signs of heart attack?
-retrosternal angina
-pain in left arm, jaw, back, lower neck, pressure
104
what kinds of medications can affect HR?
-beta blockers
-diuretics
105
what are non modifable risk factors for CAD?
-increasing age
-male
-black >> white
-family hx
-post menopausal
106
what are modifiable risk factors for CAD?
-physical inactivity
-smoking
-elevated serum cholersterol
-elevated BP
-impaired fasting glucose
-BMI > 30
-unhealthy diet
107
what are major signs of CVP disease?
-pain in chest, neck, jaw
-SOB at rest or mild exertion
-dizziness or syncope
-orthopnea
-ankle edema
-palpitations
-ischemia/claudation
-heart murmur
108
what is considered low risk for submax exercise?
-man < 45
-woman <55
-no more than 1 risk factor
109
what is considered moderate risk for submax exercise?
-men >45
-women > 55
-2 or more risk factors
110
what is considered high risk for sub max exericise?
-1+ s+s or known CVP or metabolic disease
111
what are maximal graded exercise tests?
-MD supervision
-with ECG
-workload increases over 8-12 mins
-used to determine presence of CHD, CAD
112
what are submax graded exercise tests?
-estimates Vo2 max
-used to document change
113
what are anthropometric characteristcs?
-fat to muscle ratio
-hydrostatic, DEXA, BMI, skinfold measurements
114
what is BMI?
wt/ht x 703
115
what can vitals signs reflect?
-BP
-HR, rhythm and pattern
-RR, rhythym and pattern
-O2 saturation
116
what are the determinants of CV training?
1. mode
2. training type
3. training sequence
4. intensity
117
what are some modes of CV traning?
-walk, jog, cycle, rowing, tennis, cardio machines, etc
118
what are some traning types?
1. continuous traning
2. interval traning
3. circuit traning
119
what is interval traning?
-multiple bouts of high intensity with short periods of rest/light acitivy
120
what is circuit training?
-individual rotates through series of exercise stations
-performed at rate to reach cardio goals
121
what is traning sequence?
1. warm up
2. exercise with increasing intensity
3. cool down
122
what is exercise intensity?
-based on SAID principle
-on basis of HR, HR reserve, VO2 max
-60-80% of HR max for HEALTHY individuals
123
what is the karvonen formula?
-target HR range for exercise intensity
-takes into account HR rest and HR exercise
124
what does ACSM say for CV exercise recomendations?
-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
what are precautions for CV exercise?
-hx >1 heart attack
-impaired L ventricle function with EF of 54-40%
-angina pectoris
126
what are contraindications for CV exercise?
-arrhythmias at rest
-multivessel athersclerosis
-low serum K+
127
what are absolute contraindications for CV exercise?
-MI in last 7 days
-acute cardiac event
-unstable angina
-uncontrolled arrhythmias
-acute Pulmonary embolum
-acute myocarditis, pericarditis
-acute inflection
-dissecting aneurysm
128
what should you educate a pt about when it comes to CV exercise?
-warm up and cool down
-negative signs when to stop
-maintience program with discharge
129
what are the reccomendations for childhood exercise?
-regular activity
-BP lower and HR higher
-lower intensity in hot climated b/c less body heat regulation
-60+ mins a day
130
what are exercise recommendations for elderly?
-30 mins 5days a week
131
what should you evalulate in surgery preop visit?
-ROM
-pain
-skin integrity
-muscle preformance
-posture
-gait
-functional status
132
what should you eduate about in surgical pre-op?
-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
what should you examine in post-op visit?
-icsision status
-edemna and effusion
-complications
134
what can influence a post-op rehab program?
-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
what are the three pahses of post-op rehab?
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
what is required to progress an exercise program post op?
-must meet timing and criteria
137
what are some post-op complications of the CV system?
-DVT
-PE
138
what are some post op complications of the MSK system?
-subluxation or dislocation
-adhesions or scars resistricting motion
-failure or loosening of fixation
139
what are S+S of DVT?
-dull aching severe pain, swelling, or skin changes
-heat and redness
-only 25% of time have these symptoms
140
what are S+S of PE?
-suddentSOB, rapid shallow breating, and chest pain
141
what are some additional risk factors besides wells scale for DVT?
->60
-obese
-heart failure
-oral contraceptives
-pregnancy
-dirivng or flying
142
what are three common surgical approaches?
-open
-arthroscopic
-arthroscopically assisted
143
what are three types of grafts?
-autograph = from self
-allograph = from other/cadaver
-synthetic graft
144
what do SLAP and Hip labral repairs do?
-soft tissue collected and anchored to bone to recreate/repair labrum?
