Orthopedic Pathology 2 Flashcards
Hypotonia and Hypertonia
Hypotonia: decreased muscle tone
Hypertonia: increased muscle tone
Muscle tone
Resistance of a relaxed muscle to passive stretch or elongation, resistance of muscles and CT to palpation. Continuous and passive partial contraction of muscle in response to the stimulation of the nervous system
Trigger points
Hyperirritable spot, usually within a taut band of skeletal muscle or its fascia. Healthy muscle do not contain trigger points
Etiology and pathogenesis of Trigger points
Not well understood, Theorized that muscle fibers become damaged in a trauma, and damaged sacroplasmic reticulum allows calcium to spill out onto the sacromeres causing sustained, uncontrolled contraction. Exacerbated by sedentary lifestyle
Contributing and perpetuating factors
shortened position muscle for prolonged duration
Metabolic imbalances, psychological factors, chronic infection, impaired sleep, mechanical stress (bony asymmetries) postural stress, muscle constrictions (e.g. back pack, sporting equipment) nutritional imbalances
Characteristics of Trigger point
Is an area of increased metabolism and decreased circulation
Local vasoconstriction possibly a reflexive attempt to control the metabolism
Palpation produces a local twitch response
Classification of Trigger points
Active
Latent
Primary
Secondary
Satellite
management of Trigger point
Stretching, strengthening, heat, nutrition, massage, chiropractic, injections, spray
laxations
Partial (subluxation) or complete (dislocation)dissociation of articulating surfaces of a joint
Some joints are more unstable due to their configuration
Dislocation of Glenohumeral joint
Most common is anterior dislocation (person falls backwards onto an outstretched hand)
Dislocation of posterior dislocation of GH
Falls forward on a flexed elbow
Dislocation of Lunate
a fall on the outstretched hand, forcing the wrist into hyperextension
Dislocation of Elbow
usually accompanied by a fracture, a fall on an outstretched hand or in a motor vehicle accident (the ulna and radius are displaced posteriorly)
Dislocation of Hip
Uncommon but can occur during motor vehicle accident, if the person is seated, the femur is forced posteriorly by direct impact to the knee
Dislocation of the knee
usually dislocates in a lateral direction
Cruciate ligament (ACL, PCL)
ACL resists pull of the quadracepts, prevent knee extension, anterior movement. Injured by a blow to the lateral knee, forced hyperextension with internal rotation of the tibia, often injured along with a medial collateral ligament
PCL resists the pull of the hamstrings, PCL is stronger than ACL, and is therefore injured less often. a blow to the anterior tibia, excessive hyperextension or in motor vehicle accidents where the tibia is forced posteriorly (dashboard injury)
Treatment of Knee dislocation
Support, rest, exercise, rehab, meds, surgery, Continued Passive Movement (CPM), complications can include reflex sympathetic dystrophy syndrome (RSDS), complex regional pain syndrome (CRPS, body tends to cause a lot of pain for no reason, problem with CNS)
Menisci injury
Middle and inner portions of the menisci are avascular, only outer portion is vascularized. Medial Menisci attaches to Medial collateral ligament. Lateral meniscus doesn’t attach to LCL. Menisci is injured by twisting while foot is weight bearing and anchored to the ground.
The knee may give away, buckle or lock.
Bursitis
Inflammation of a bursa
subacromial (b/w acromion and supraspinatus)
Subscapular (b/w deltoid and humerus)
Iliopectineal (b/w Iliopsoas and iliofemoral lig)
Ishial (b/w glut max and ischial tub)
Olacranon (b/w olecranon and fascia)
Trochanteric (b/w glut and trochanter)
Pes anserine (b/w satorious, gracillis, semitendinousis and tibia)
Bunion
first MTP joint capsule formed by excessive bone growth (exostosis) due to joint hypermobility, poor biomechanics
Baker’s cyst
synovial cyst that usually appears at the medial side of the popliteal space, can spontaneously resolve
Fibrosis
formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process
Fibrositis
a term to describe local tenderness and hardness in a muscle
Hypermobility
increase degree of motion at a joint, can cause joint instability. stretching and joint mobilization contraindicated
Strengthening of the muscles surrounding the joint
Hypomobility
Loss of motion at joint including loss of normal joint plan
Indication for massage, Mobilizations, chiropractic
Contraindications : do not mobilize joint that is stabilized with rods, screws and plates. or surgically shortened ligaments
