Principles of Intervention Flashcards
Examples of Musculoskeletal Disorders
- Strain
- Sprain
- Dislocation
- Subluxation
- Muscle/tendon rupture or tear
- Tendinous lesions/tendinopathy
- Synovitis
- Hemarthrosis
- Ganglion
- Bursitis
- Contusion
- Overuse syndromes, cumulative trauma disorders, repetitive strain injury
Examples of Clinical conditions resulting from trauma or pathology
- Dysfunction
- Joint dysfunction
- Contractures
- Adhesions
- Reflex muscle guarding
- Intrinsic muscle spasm
- Muscle weakness
- Myofascial compartment syndromes
List the grades of soft tissue lesions from least to most severe
Grade 1
Grade 2
Grade 3
3 Stages of inflammation and repair
1) Acute Stage
2) Subactue Stage
3) Chronic Stage
What occurs during the acute stage?
Characterized by inflammation
-involves cellular, vascular, and chemical responses in the tissue
How long does the acute stage normally last?
1-6 days
How should you treat a patient in the acute stage?
Most important to protect the injured tissue
- PROM - Low-dosage joint mobilization techniques - Muscle setting - Massage - ROM - Muscle performance - Functional activities - Circulation
What occurs during the subacute stage?
Characterized by repair and healing
- Inflammation begins to decrease - Clot starts resolving - Repair of the injured site begins
How long does the subacute stage normally last?
Usually lasts days 3-20, but may last up to 6 weeks
Wound closure usually takes __ to __ days in muscle and skin
5-8
Wound closure usually takes __ to __ weeks in tendons and ligaments
3-6
How should you treat a patient in the sub acute stage?
Manage pain and inflammation and begin initiation of active exercises
- Multiple-angle, submaximal isometric exercises
- AROM exercises
- Muscular endurance
- Protected weight-bearing exercises
Initiation and progression of stretching
- Warming the tissues
- Inhibition techniques
- Joint mobilization
- Stretching techniques
- Massage
- Use of the new rangeWhat occurs during the chronic stage?
Maturation and remodeling occur as collagen fibers become thicker and reorient in response to stresses placed on the connective tissue
When does the chronic stage begin?
Usually day 9 and on
How should you treat a patient in the chronic stage?
Continue to progress until they are able to return to high-demand activities
What is Chronic Recurring Pain?
Etiology of chronic inflammation leading to prolonged or recurring pain due to…
- Overuse, cumulative trauma, repetitive strain - Trauma - Re-injury of an old scar - Contractures or poor mobility
How should you manage a patient with chronic recurring pain during the acute stage?
MUST control and avoid inflammation and pain
How should you manage a patient with chronic recurring pain during the subacute and chronic stage?
Slowly progress exercises so tissue develops ability to withstand stresses of functional activities
What is arthritis?
Inflammation of a joint
What is arthrosis?
Limitation of a joint without inflammation
4 Clinical signs and symptoms of arthritis and arthrosis
- Impaired mobility
- Impaired muscle performance
- Impaired balance
- Functional limitations
Describe Rheumatoid arthritis
Periods of exacerbation and remission
In order for someone to be diagnosed with RA what must they exhibit?
They must exhibit 4 of the 7 symptoms
7 Criteria for diagnosis of RA
1) Morning stiffness in and around the joints lasting at least 1 hr before maximal improvement
2) At least 3 joint areas with simultaneous soft tissue swelling or fluid observed by a MD
3) Swelling in the wrist, MCP, or PIP joints
4) Symmetrical arthritis
5) Rheumatoid nodules
6) Serum rheumatoid factor
7) Radiographic changes including erosions or periarticular osteopenia in hand/wrist joints
7 signs and symptoms of RA during periods of exacerbation
- Tenderness and warmth over the involved joints with joint swelling
- Muscle guarding and pain on motion
- Joint stiffness and limited motion
- Muscle weakness and atrophy
- Potential deformity and ankylosis from the degenerative process and asymmetric muscle pull
- Fatigue, malaise, sleep disorders
- Restricted ADLs and IADLs
How to treat a pt with RA during the acute stage?
Joint protection Energy conservation Joint mobility Exercise Functional training
How to treat a pt with RA during the subacute and chronic stage?
Exercise should be aimed at: - improving flexibility - muscle performance - cardiopulmonary endurance Nonimpact or low-impact conditioning exercises should be used such as swimming/bicycling
What is osteoarthritis?
Chronic degenerative disorder mainly affecting articular cartilage of synovial joints
7 Characteristics of OA
- Pain with mechanical stress or excessive activity
- Pain at rest in the advanced stages
- Stiffness after inactivity
- Limitation of motion
- Muscle weakness
- Decreased proprioception and balance
- Functional limitations in ADLs and IADLs
Which type of arthritis (RA or OA) do joint replacement patients typically have?
Osteoarthritis
What is Fibromyalgia?
A chronic condition characterized by widespread pain that covers half the body and lasts for more than 3 months
Someone with fibromyalgia demonstrates what symptoms?
They have 11 of the 18 tender points Poor sleep Morning stiffness No referred patterns of pain Fatigue
Fibromyalgia is non_____, non_____, and non_____
Inflammatory
Degenerative
Progressive
What tender spots are most common among fibromyalgia patients?
Upper Neck and Trap area
Fibromyalgia patients experience flareups do to what types of things?
Physical stresses (barometric pressure changes, cold, dampness, fog, rain, fluorescent lights)
Environmental stresses
Emotional stresses
How do you treat a patient with fibromyalgia?
Aerobic exercise is the most beneficial, but it is also the most painful.
They should also avoid stress factors, drinking alcohol and caffeine, and eating unhealthy foods.
Medication (OTC meds) can also be prescribed
What is Myofascial Pain Syndrome?
Chronic, regional pain syndrome
3 Characteristics of Myofascial pain syndrome
1) Trigger points in muscle
2) Referred patterns of pain
3) Tight band of muscles
6 possible causes of trigger points for those with myofacial pain syndrome
- Chronic overload of muscle in a shortened position with repetitive activities
- Acute overload of muscle
- Poorly conditioned muscles
- Postural stresses
- Poor body mechanics
What types of techniques can be used to eliminate the trigger points associated with myofacial pain syndrome?
1) Contract-relax
2) Trigger point release
3) Spray and stretch
4) Dry needling or injection (not done by PTs)
5) Modalities such as IFC, US, lasers, heat
What is osteoporosis?
Disease of the bone that leads to decreased mineral content and weakening of the bone
Approximately how many Americans have osteoporosis?
10 million
What percentage of Americans with osteoporosis are females?
80%
How is osteoporosis diagnosed?
a T score of a bone mineral scan
A T score of ___ or higher is normal
-1.0
A T score of ___ to ___ is called osteopenia
-1.1 to -2.4
A T score of ___ or less is called osteoporosis
-2.5
Primary vs. Secondary Osteoporosis
Primary is due to postmenopausal, Caucasian or Asian descent, family history, low body weight, little physical activity, or smoking
Secondary is due to other medical conditions and the use of certain medications
What types of exercise precautions are associated with osteoporosis?
- Flexion activities
- Supine curl-ups or sit-ups
- Sitting abdominal machines
- Combining flexion and rotation of the trunk
- Use caution when increasing resistance
What is a fracture?
a structural break in the continuity of a bone, epiphyseal plate, or a cartilaginous joint surface
6 Ways fractures are identified
1) Site
2) Extent
3) Configuration
4) Relationship of the fragments
5) Relationship to the environment
6) Complications
Following a fracture what is the bone healing process?
Inflammation –> Soft callus –> Hard callus –> Remodeling
