Orthopedic Tx 400 -- Dislocations and atrophy Flashcards
not able to hinge at hip?
trip another approach to same movement
–> E.g. flex at hip instead of bending forward
active support
E.g. support to the joint structures coming from E.g. muscle tissue
I.e.
Support from contractile tissue
atrophy is
loss/wasting of mm tissue
“A decrease in the size and number of your muscle fibers causes sarcopenia. With muscle atrophy, there’s a reduction in the size of the fibers, but the amount of fibers stays the same. Everyone experiences some amount of muscle loss as they age.”
—> NOTES SAY OPPOSITE (??):
“Atrophy is due to the reduction in the number of muscle fibers within the muscle as a whole, or in connection with a lesion (myogenic atrophy) or with nerve damage (neurogenic atrophy).”
myogenic atrophy – aka
disuse atrophy
Loss of mass and strength.
Caused by a lack of physical exercise/<ADL’s, often due to pain, sedentary lifestyle, medical conditions, or <activity levels, prolonged immobility (bed rest, cast).
Can usually be reversed with exercise, unless severe (damage).
During aging, there is a gradual reduction in MM function and mass. This is known as sarcopenia, and may be distinct from atrophy in its pathophysiology.
neurogenic atrophy
with nerve damage
NEUROGENIC ATROPHY (AKA true atophy)
This is the most severe type of atrophy.
Caused by the loss of motor innervation to a MM, from an injury or disease.
It occurs more suddenly than myogenic atrophy.
common causes of muscle atrophy
Alcohol-associated myopathy
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
Burns
Dermatomyositis and polymyositis
Guillain-Barre syndrome
Injury
Long-term corticosteroid therapy
Malnutrition
Motor neuropathy (such as diabetic neuropathy)
Muscular dystrophy
Not moving (immobilization)
Osteoarthritis
Polio
Rheumatoid arthritis
Spinal cord injury
Stroke
causes to specifically note
Alcohol-associated myopathy
Guillain-Barre syndrome
Long-term corticosteroid therapy
Osteoarthritis
Rheumatoid arthritis
Stroke
DISLOCATION
A dislocation is the complete dissociation of the articulating surfaces of a joint.
A subluxation is when the articulating surfaces of a joint remain in partial contact with each other.
A joint reduction is the medical term for the tractioning of the dislocated joint surfaces.
dislocatons can occur at
may occur at any joint, certain joints are more susceptible due to anatomical configuration.
most frequently dislocated joint
The Glenohumeral joint is the most frequently dislocated. Only a portion of the articulating surface of the humeral head comes into contact with the shallow glenoid fossa. It relies on ligaments and MM support.
other commonly dislocated jts
ACJ is also classified as separation/sprain (more typically classified as sprain)
Other commonly dislocated joints include the acromialclavicular joints, metacarpals, and interphalangeals.
the events during dislocation
In a dislocation injury, a portion of the joint capsule and surrounding ligaments are either completely torn or partially ruptured.
The nearby tendons, synovial sheaths, and articular cartilage may also be damaged.
Other soft tissue injuries, such as stains and contusions occur.
Complications may occur, such as NN & BV damage, and FX.
during subluxaiton
In a subluxation, the joint capsule is stretched. Sprains may be present.
cause of dislocaiton
The cause of a dislocation is a trauma-related sudden twist or wrench of the joint beyond its normal ROM. Can be direct or indirect.
what happens when a join is disocated once?
The dislocated joint is more susceptible to future dislocations or subluxations, leading to joint instability.
what about likelihood of pain after one dislocation?
This unstable structure may become painfully hypermobile.
some risk factors / contributing factors for dislocaiton
Pathologies
(E.g. RA, hemiplegia),
Congenital Lig. Laxity,
Previous dislocations.
GH jt dislocation
Commonly anteriorly dislocated (subcoracoid).
GH dislocation common MOI
excessive ABD. and ER. Humeral head forced through the inf. Joint capsule (foramen of Weitbrecht) where it lodges inferior the the coracoid process.
what can happen to anterior glenoid labrum during anterior dislcaiton of GH jt
There may be damage to the anterior glenoid labrum (Bankart lesion).
anterior glenoid labrum LESION
Bankart lesion
which nerve is comonly damaged during anteiror GH dislocaiton
Axillary NN can be injured.
GH jt tx
Tx
reduction, sling
treat softtissue damage that occurred simultaneously
posterior GH dislocaiton
Posterior dislocation is less frequent.
MOI- flexion, adduction, and internal rotation.
patella dislocaiton
Patella
Dislocates Laterally
MOI- ER of the Tibia with knee flexion.
lunate dislocaiton
FOOSH injury.
Radius displaces the lunate palmarly.
Open reduction may be required.
Median NN lesions possible
lunate necrosis possible.
elbow dislocaiton (HU)
Usually w/ a fracture. Caused by a FOOSH. Radius and Ulna forced posteriorly.
Brachial artery and Median NV can be involved.
coronoid process commonly fractured
hip dislocaoitn
Uncommon. Femur forced posterior. Acetabular fracture and sciatic NV may occur.
MVA (seated – knee hits dashboard)
SSx acute
Snapping or popping noise is heard at the time of injury.
P is intense.
Joint appears deformed prior to reduction.
Local edema and heat.
Joint effusion may occur with capsular damage.
Hematoma is RED, BLACK, and BLUE.
<ROM from protective MM spasm, edema and P.
Cannot continue activity.
Post reduction: joint may be taped, splinted, casted, or in a sling.
acute dislocaiton – complicaitons
Complications: strains, contusions, blood vessel and NV injury, fracture.
early subacute – SSx – dislocaitons
Joint unstable. Hematoma is BLACK and BLUE.
P, edema and inflammation are reduced.
Adhesions are developing.
MM spasms decrease.
TrP’s in MM crossing the joint and compensatory.
Joint is taped, splinted, in a sling.
ROM is reduced (Dr. will advise for allowable range).
SSx – late subacute (dislocaiton)
Hematoma is YELLOW, GREEN, and BROWN.
P, edema, and inflammation diminished.
Adhesions are maturing.
Spasms are replaced with > MM tone.
Joint is supported or immobilized.
<ROM.
MM crossing the joint are stabilizing the joint.
dislocaiton (late stage – chronic) – SSx
Local P with joint stress. Adhesions matured.
HT and TrP’s present.
ROM is restricted.
A pocket of chronic edema may remain local to a ligament.
Tissue may be cool to touch.
Joint may be unstable in the direction of injury unless surgically repaired.
The joint may be immobilized up to 9 weeks post surgery.
There is loss of proprioception at the joint.
MM weakness or disuse atrophy can occur.
Supportive taping may be needed for activities that stress the joint.
CIs – dislocaiton
During acute and subacute, testing other than P-free ROM is CI’d to prevent further injury.
Avoid removing MM splinting in acute and early sub-acute.
Distal circulatory work not appropriate in acute and early sub-acute.
Be aware of placing the joint in the MOI position.
No joint play.
No prolonged or severe H20 in acute/early sub-acute stages.
No remedial exercised during the acute stage.
If restoring ROM in the direction of MOI, ensure strength has fully returned.
Do not restore full ROM in a joint that has been surgically repaired.
treatment goals – Acute
Reduce inflammation: Elevate, Ice.
Reduce edema: Lymph drainage, nodal pumping, unidirectional effleurage, stationary circles – all proximal.
Do not remove protective MM spasm.
On site work is contraindicated.
Maintain ROM: mid range PROM is used on Prox joints. (IF SAME MM NOT CROSSING PROXIMAL JOINTS)
tx – early subacute (dislcaiton)
Contrast H2O
Continue to reduce edema.
Reduce (but do not remove) MM spasms.
Reduce TrP’s.
On site work is NOW INDICATED:
vibrations, gentle stroking, gentle finger tip kneading.
NOTE EARLY SUBACUTE DISLOCAITON
ONSITE WORK IS INDICATED
late subacute tx -dislocaiton
Contrast H2O
Reduce HT and TrP’s.
Prevent excess adhesions: onsite; small area is tx each time. Longitudinal MM separations; followed with cross-fiber stroking/gentle frictions. Ice post Tx.
Maintain ROM: Gentle joint play (not in direction of MOI), P-free active assisted ROM & mid range PROM
chronic dislocaiton – tx
Deep moist heat.
Reduce adhesions: Cross fiber frictions to adhesions followed by passive stretch, then ice.
homecare – dislocaiton
Acute: P-free AROM of prox. Joints. That’s all!
Early Sub-acute: P-free AROM prox. and dist. Submaximal P-free isometric exercises.
Late Sub-acute: Maximal P-free resisted isometric exercises. Gradually progress to isotonic; avoid full range in direction of MOI.
Chronic: Isotonic active resisted in all ranges. Gradually return to ADL’s.
