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PHTH 450 > pathologies > Flashcards

pathologies Flashcards

1
Q

what is a brusae

A

a flattened sac like structure that is line with synovial membrane and filled w/ synovial fluid which allows smooth and fricitonless motion b/w continguous ms, tendons, bones, ligaments and skin

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2
Q

in the case of injury to the bursae, will there be pain in AROM, PROM or both

A

both since its considered to be an inert structure

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3
Q

how is the bursae under normal conditions

A

not very palpable

flattened and smooth

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4
Q

what is a bursitis

A

results from the inflammation of the bursae which generally occurs when the synovial fluid gets irritated due to excessive movements or as a result of direct trauma to the bursae

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5
Q

what happens to the synovial cells in an injured bursae

A

the bursae will inflame and the synovial cells will thicken

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6
Q

what are signs and symptoms associated w/ a bursitis

A 
inflammation
localized tendernesswarmth
edema
redness of the skin in the case of a superficial bursitis
loss of function from pain
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7
Q

what are some common bursae that get inflammed

A 
-subacromial bursitis
olecranon bursitis
illiopsoas bursitis
trochanteric bursitis
ischial bursitis
infrapatellar bursitis
anserine bursitis
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8
Q

how can a PT treat a bursitis

A

-generally pts present during the acute/inflammatory phase and hence principles to reduce inflammation are used PRICEMEM
Once the inflammatory phase is finished its important to reassess the strength, posture and mvmt patterns ti determine why the bursae is irritated

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9
Q

should pain from an insidious onset bursae even after treatment be reoccuring?

A

it can if the mvmt or pain provoking action/posture is not resolved. as opposed to if onset was traumatic, its generally will not return

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10
Q

what is the role of a tendon

A

attacges ms to bone at the periosteum

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11
Q

what is the role of a ligament

A

connects bones together at a joint in order to strengthen and stabilize that joint

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12
Q

what are ligaments made out of

A

dense connective tissue

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13
Q

how does a tendon compare to a ligament

A

a tendon will become taut or slack depending on if its shortened or lengthened as the ms belly is contracting while a ligament should remain taut throughout full ROM

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14
Q

how do injuries to tendons generally arise?

A

due to microtrauma to the tissue of the tendon as a result of repeptitive load from external forces s/a the incorrect use of training techniques, improper use of equipment and innapropriate footwear

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15
Q

can anatomical predispositions results in tendon pathology?

A

inflexibility
weakness
malposition

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16
Q

what are the main causes to tendon pathologies

A

mechanical over use

aging and poor vascular supply which causes tendons to weaken and become stiffer

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17
Q

what is a tendinitis

A

an inflammatory rxn to a injured tendon due to microscopic tearing of the tendon. it generally results from fatigue

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18
Q

if the patients show’s up with a tendinitis in the sub-acture phase, will PROM be painful,

A

since a tendon is a contractile tissue, it shouldnt be painful in PROM if patient is properly relaxed

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19
Q

what is a tendinosis

A

its a degenerative process of the tendon due to thickening of the tendon which is characterized by the presence of dense populations of fibroblasts, vascular hyperplasia and disorganized collagen
there should not be any inflammatory cells present as this is not an inflammatory reactions but rather a continuous repair cycle of the tendon leading to scar tissue formation

20
Q

in what population group are tendinosis commonly seen in

A

people over the age of 35

21
Q

What are common sites for tendon pathology

A
  • rotator cuff of the shoulder –> supraspinatus and bicep tendon get pinched
  • wirst extensors and flexors (lateral epicondylitis/medial epicondylitis)
  • patellar tendon of the knee –> common in teens due to growth spurt
  • insertion of the posterior tibial tendon leading to shin splints
  • achilles tendon
22
Q

what are signs that are indicative of a tendon pathology

A
  • RISOM will be strong but painful

- will usually be tender with palpation

23
Q

what methods are generally used to treat an tendon pathology

A

-if present in the inflammatory phase PT must use PRICEMEME (not effective in the case of tendinosis)
-once inflammatory phase is over need to work on factors causing tendinosis which generally involves correction of posture, flexibility and ms strengthening
thus important to locate any imbalances

24
Q

provide an example on treatment of a rotator cuff tendinosis (supraspiantus)

A

pt will generally present with rounded shoulder thus have a weak ER (infra/teres minor and tight IR (subscap) thus the RC muscles will need to be strengthened and improve posture

25
Q

what is a sprain

A

a ligament injury

26
Q

how do ligament injuries generally arise

A

MOI is generally traumatic

27
Q

what is important for the PT to know/ask in the case of a ligament sprain?

A
  • the position of the joint at the time of trauma
  • direction and site of impact
  • when the trauma happened
28
Q

what is evaluated by the PT in an objective exam for a ligament sprain

A
  • point of tenderness, joint effusion, presence of bruising (not always)
  • presence of a positive sign for a ligament stress test
29
Q

what is a grade 1 sprain injury

A
  • ligament is stretched with minimal torn fibers
  • on a ligament stress test there will be pain, no gap and a normal EF
  • no bruising
  • minimal loss of structural integrity
  • minimal loss of function
30
Q

how can a grade 1 sprain be treated

A

main treatment goal is to work on proprioception inorder to prevent lack of balkance and possibility of reoccurant sprains

31
Q

what is a grade 2 sprain injury

A
  • partial ligament tear
  • ligament stress test will present with pain, gap, and normal EF
  • shows significant structural weakness
  • presence of bruising and swelling that can be treated with PRICEMEM
  • greater tendency of reoccurance
  • needs protection from further injury which can be provided by taping or a brace
32
Q

what type of treatment is done to a grade 2 ligament sprain

A

work on proprioception and strengthen the ms around the joint to prevent reinjury

33
Q

what is a grade 3 ligament sprain

A

complete ligament tear
initially lots of pain but generally not painful once the inflammatory phase passes
presence of bruising and swelkling
signs in the ligament stress test: pain (depending when assessed), gap and soft end feel (like breaking bread, mvmt is not inhibited)
loss of structural integrity
significant abnormal motion
permanent instability (may require surgical intervention depending on affected ligament)

34
Q

what treatment does the PT use to fix a Grade 3 ligament sprain

A

improve proprioception and muscle strength

may need surgery s/a in shoulder but not in the ankle

35
Q

what is a muscle strain?

A

a muscle that is pulled/overstretched or torn as a result of fatigue, overuse or improper use

36
Q

what is a mild/1st degree strain

A
  • tear of a few ms fibers with minor swelling and discomfort
  • minimal or no significant loss of function and mvmt restriction
  • presence of local tenderness
  • pts can generally resume with normal activities just avoid overuse not to exacerbate pain and injury
37
Q

what is a moderate/2nd degree strain

A
  • greater ms damage
  • obvious loss of strength
  • pain that causes loss of function
  • moderate/severe level or pain
  • presnece of bruising and swelling
  • loss of functional joint stability
  • rehab b/w 3-28 days
38
Q

how to treat first and 2nd degree strains

A

in the inflammatory phase: PRICEMEM
strengthen muscles w/ eccentric, concentric and functional work
improve proprioception

39
Q

what is a3rd degree strain

A
  • tear extends across entire ms belly
  • severe pain and loss of function in inflammatory phase but once this resolves there may be no pain
  • unable to contract ms, makes use of synergists to produce mvmt at joint
  • pain increases with work
  • surgery is often needed
  • healing b/w 3 weeks to 3 motnhs
40
Q

with a grade 1 and 2 ms strain when is pain generally felt

A

when the ms contracts or stretches

41
Q

the amount of availible motion at a joint is based on a number of factors such as

A

shape of articulating surface
health of the joint and the surrounding tissues
load/deformation history of the joint

42
Q

what is joint hypomobility

A

mvmt at the joint is less than normal compared to the other side
decreased ROM and early capsular EF

43
Q

how to treat for hypomobility of a joint

A

ROM exercises and mobilisations

44
Q

what is generalized hypermobility

A

results from hyperlaxity and increased ROM bilaterally and at multiple joints

45
Q

what is local hypermobility

A

occurs as a rxn to neighboring hypomobility/stiffness

ROM is increased compared to the other side, EF is normal

46
Q

how to treat for local hypermobility

A

find the stiffness that the patient is compensating for and work on the hypomobility
educate pt not to stay at end range for prolonged periods of time
strengthen ms around the joint

PHTH 450 (14 decks)

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