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DPT 516 > Quiz 2 > Flashcards

Quiz 2 Flashcards

pain lecture and CT lecture

1
Q

what is pain?

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage or an experience described in terms of such damage

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2
Q

is pain subjective or objective?

A

subjective

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3
Q

t/f: pain is individual

A

true!!!

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4
Q

pain is perceived ___ and influenced ____

A

cortically, peripherally

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5
Q

in chronic pain, is the pain always reflective of the damage?

A

no

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6
Q

what is usually worse, the fear of pain or the pain itself?

A

the fear of pain

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7
Q

what are the 3 categories of pain?

A

neuropathic

inflammatory

nociceptive

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8
Q

what is nociceptive pain?

A

like a pin prick

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9
Q

what is inflammatory pain?

A

tissue injury

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10
Q

what is neuropathic pain?

A

pain that can be central of peripheral

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11
Q

what are some examples of central neuropathatic pain?

A

migraine

stroke

TBI (traumatic brain injury)

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12
Q

what are some examples of peripheral neuropathic pain?

A

trigeminal neuralgia (Tic douleroux)

poorly controlled diabetes

nerve compression

herpes zoster (shingles or post-herpetic neuralgia)

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13
Q

what are the 5 sources of pain?

A

cutaneous

somatic

visceral

neurogenic(pathic)

referred

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14
Q

what is cutaneous pain?

A

pain related to the skin that can be superficial or subcutaneous

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15
Q

is cutaneous pain localized?

A

yes! the patient can point to where the pain is

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16
Q

can cutaneous pain be referred from deeper structures?

A

yes

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17
Q

cutaneous pain varies between individuals’ ____ and _____

A

gender

ethnicity

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18
Q

what is somatic pain?

A

superficial or deep pain of the neuromuscular, musculoskeletal, or neuromusculoskeletal systems

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19
Q

what is superficial somatic pain?

A

pain of the skin, superficial fasciae, or tendon sheaths like cellulitis

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20
Q

what is deep somatic pain?

A

periosteum and cancellous (spongey) bone, nerves, tendons, ligaments, blood vessels, deep fasciae, or joint capsule pain

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21
Q

is deep somatic pain well localized?

A

no, it is poorly localized

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22
Q

t/f deep somatic pain can be referred to the skin (cutaneous)

A

true

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23
Q

would you see autonomic phenomenon with deep somatic pain?

A

yes

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24
Q

what autonomic phenomenon would be seen with deep somatic pain?

A

sweating, pallor, pulse or BP changes, nausea, or faintness

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25
Q

is deep somatic pain always over the source organ?

A

no!

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26
Q

what are some examples of deep somatic pain?

A

myofascial pain, facet joint arthritis

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27
Q

what are the 5 types of somatic pain?

A

deep

superficial

somatoemotional/psychosomatic

viscerosomatic

somatovisceral

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28
Q

what is somatoemotional/psychosomatic pain?

A

emotional or psychological distress produces physical symptoms that can be brief, prolonged, or recurrent

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29
Q

what type of somatic pain is somatization categorized under?

A

psychosomatic pain

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30
Q

what is viscerosomatic pain?

A

visceral structures (chest and abdomen) affect the somatic musculature

(easier way to understand: musculoskeletal pain bc of internal organs)

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31
Q

what is somatovisceral pain?

A

myalgic pain causes functional disturbance of the viscera

(easier understood as musculoskeletal problem causing visceral issues)

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32
Q

what is visceral pain?

A

pain of the internal organs of the trunk and abdomen and the heart

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33
Q

is visceral pain well localized?

A

no!

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34
Q

why is visceral pain poorly localized?

A

because of the multisegmental innervation and few nerve receptors in these structures

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35
Q

what are the two types of visceral pain?

A

viscerogenic, psychogenic

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36
Q

what is viscerogenic pain?

A

lesions in the viscera that share innervation causing a broad distribution

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37
Q

is there a mechanism to reproduce viscerogenic pain?

A

no!

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38
Q

what are some examples of viscerogenic pain?

A

colon cancer and MI

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39
Q

what is psychogenic pain?

A

poorly defined pain that originates in the cortex unrelated to tissue damage

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40
Q

what are some examples of psychogenic pain?

A

depression and conversion disorder

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41
Q

what is kehr’s sign?

A

mostly right shoulder pain above the clavicle that is related to a spleen injury

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42
Q

what is parietal pain?

A

deep somatic pain that affects the parietal or visceral pleura

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43
Q

which pleura has a good supply of nerve endings? parietal or visceral?

A

parietal

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44
Q

why does visceral pleura injury often go unnoticed until the pressure is put on the parietal pleura?

A

the visceral pleura is insensitive to pain

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45
Q

what is the viscerocutaneous reflex?

A

hypersensitivity of the skin to touch during disease of internal organs in the acute phase of disease

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46
Q

is visceral pain usually accompanied by ANS response?

A

yes, such as changes in vital signs, unexplained sweating, and/or skin pallor

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47
Q

what is neurogenic pain?

A

damage or pathology of the CNS or PNS due to injury/destruction of a peripheral nerve, spinal cord pathway, or neurons in the brain (all NS malfunctions)

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48
Q

t/f: neurogenic pain is due to the stimulation of nociceptive fibers?

A

false, it’s due to the malfunction of the NS!

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49
Q

neurogenic pain causes disruption of ___ and ___ nerve transmission of PNS, spinal cord, or brain

A

afferent, efferent

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50
Q

neurogenic pain causes altered _____ ______ and _____ _____

A

sensory perception, motor function

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51
Q

what are 3 causes of neurogenic pain?

A

drugs, trauma, or metabolic disorder

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52
Q

how would one describe neurogenic pain as feeling?

A

burning, shooting, tingling, electric shock

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53
Q

what kind of pain is radicular pain?

A

neurogenic bc it affects the spinal nerve roots

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54
Q

what are some examples of neurogenic pain?

A

hyperalgesia

diabetic neuropathy

MS

cancer

chronic regional pain syndrome (CRPS)

trigeminal neuralgia

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55
Q

what is radicular pain?

A

pain caused by irritation of the spinal nerve root and experienced in the dermatome, scleratome, or myotome

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56
Q

radicular pain of the viscera is within the _____ ______ of the affected organ

A

segmental innervation

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57
Q

what is referred pain?

A

pain felt in an area far from the site of the lesion but supplied by the same or adjacent nerve

hyperexcitability in the dorsal horn leads to afferent input from other segmentally related tissues giving rise to pain in these tissues

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58
Q

referred pain can be ____, ____, or ____ source

A

cutaneous, somatic, visceral

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59
Q

does visceral pain often precede or come after referred musculoskeletal pain?

A

precedes!

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60
Q

does referred pain often follow normal anatomical pathways? why or why not?

A

no because the sensory paths are distorted

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61
Q

referred pain is often ____ _____ but has _____ _______ borders (smudging)

A

well localized, ill defined

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62
Q

what is diffuse pain?

A

obscure pain in the trunk, especially when felt anteriorly only

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63
Q

what is diffuse pain suggestive of

A

pain from the spinal facet joint, PNS, or viscera

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64
Q

what is pain at rest suggestive of?

A

ischemia of various tissues

vascular disease (peripheral vascular disease)

tumor growth

skin/subcutaneous edema

neoplasms

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65
Q

what are the s/s peripheral vascular disease?

A

the 5 Ps: pain, pallor, pulselessness, paresthesia, paralysis

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66
Q

how would one describe the pain from skin/subcutaneous edema feels?

A

burning or boring pain

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67
Q

what is a neoplasm?

A

night pain, difficulty sleeping, unremitting, non-mechanical pain

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68
Q

what is neurogenic claudication?

A

LE pain upon exertion that becomes better with trunk flexion and rest

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69
Q

what is neurogenic claudication suggestive of?

A

ischemia associated with peripheral or spinal vascular disease

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70
Q

what causes neurogenic claudication?

A

an accumulation of hypoxic products

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71
Q

what is the bicycle test of van gelderen used for ?

A

to distinguish b/w neurogenic and vascular claudication as the neurogenic will get better with trunk flexion, but vascular will not

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72
Q

what is vascular claudication?

A

pain with walking for a while because their is insufficient blood flow to and from the legs

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73
Q

would trunk flexion alleviate the symptoms of vascular claudication?

A

NO

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74
Q

what is joint pain suggestive of?

A

bone disease or neoplasm

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75
Q

what is joint derangement?

A

sharp pain with stress that is immediately reduced with rest and aggregated with activity

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76
Q

what is systemic joint disease?

A

deep, aching, throbbing, pain reduced by pressure and increased with stress and movement

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77
Q

what is chronic pain

A

pain lasting more than 6 months (sometimes just more than 2 months)

78
Q

what is chronic pain syndrome?

A

psychological overlay and dissociation b/w presentation and clinical findings (the reported pain often doesn’t line up with the damage) due to changes in the brain and its perception of pain

79
Q

the most effective PT diagnosis will define the ____, address the _____ __ ____ rather than just defining the source of pain

A

syndrome, causes of pain

80
Q

what are the 4 types of connective tissue?

A

bone, blood, cartilage, and connective tissue proper

81
Q

what are the 2 types of connective tissue proper?

A

dense and loose

82
Q

what are the 3 types of loose connective tissue proper?

A

areolar, reticular, and adipose

83
Q

what are the 3 types of dense connective tissue proper?

A

regular, irregular, and elastic

84
Q

what are the 3 types of cartilage?

A

fibrocartilage, elastic, and hyaline

85
Q

what are the 2 types of bone tissue?

A

spongey and compact

86
Q

what are the 2 basic components of CT?

A

ECM and cellular fibers

87
Q

what is the structure of collagen?

A

triple helix polypeptide

88
Q

what is the makeup of the ECM?

A

water and protein

89
Q

what are largely responsible for the water-binding property of cartilage and allows it to withstand pressure?

A

aggregans

90
Q

what are CT cells derived from?

A

mesenchymal cells

91
Q

what is a -blast?

A

immature cell that divides and secretes the matrix

92
Q

what is a -cyte?

A

mature cell that has a reduced capacity for cell division (determines matrix function)

93
Q

what are fibroblasts?

A

the basic cell of most CT that produces the ECM and different types of CT depending on the environment

94
Q

what is a chondroblast?

A

immature fibroblast of the cartilage

95
Q

what is a tenoblast?

A

immature fibroblast of tendons

96
Q

what is an osteoblast?

A

immature fibroblast of bone

97
Q

what is a chondrocyte?

A

mature fibroblast of cartilage

98
Q

what is a tenocyte?

A

mature fibroblast of tendons

99
Q

what is an osteocyte?

A

mature fibroblast of bone

100
Q

can CT cells de-differentiate?

A

yes! they can de-differentiate based on the environment and stimuli

101
Q

what is hyaluronan?

A

a non-sulfated GAG that doesn’t attach to the core protein and can exist as a free GAG (variable lengths in tendons and ligaments) or a core molecule (with many PGs attached to it)

102
Q

what are the 3 types of CT fibers?

A

collagen, elastic, and reticular

103
Q

what are collagen fibers?

A

fibers that resist tension and promote flexibility

104
Q

collagen fibers exist in bundles ____ to one another

A

parallel

105
Q

which type of connective tissue fiber is in most CT?

A

collagen

106
Q

what are elastic fibers?

A

strong, but stretchy fibers found in the skin, blood vessels, and lung tissue that has a smaller diameter than collagen fibers

107
Q

what are reticular fibers?

A

fibers that support the walls of blood vessels, network around fat/muscle cells, nerve fibers, and organs, and are produced by fibroblasts

108
Q

are tendons and ligaments active or passive elements of motion?

A

passive

109
Q

are tendons and ligaments dense or loose CT?

A

dense CT

110
Q

tendons and ligaments are similar in_____ but different in _____

A

structure, arrangement

111
Q

tendons transmit tensile forces from _____ to _____

A

muscle, bone

112
Q

what is one of the important roles of tendons?

A

length-tension relationship (put the muscle at an optimal length to produce optimal tension)

113
Q

what is an important role of ligaments?

A

mechanical stability to prevent excessive motions and sometimes guide motions

114
Q

what is the main component of tendons and ligaments?

A

collagen (mostly type 1)

115
Q

what is the fiber arrangement of tendons?

A

parallel

116
Q

what is the fiber arrangement of ligaments?

A

interlaced

117
Q

do tendons have high or low metabolism?

A

low

118
Q

do ligaments have high or low metabolism?

A

high

119
Q

why do ligaments have an interlaced structure while tendons have a parallel structure?

A

ligaments tend to take multidirectional forces, while tendons tend to take forces from one direction

120
Q

do tendons or ligaments have more type 1 collagen?

A

ligaments

121
Q

where would you find type 3 collagen in tendons?

A

tendon sheath (tenosynovium)

122
Q

tendon fibers form ____ covered by the ____

A

fascicles, endotendon

123
Q

what three things does the endotendon cover?

A

blood vessels, lymphatic vessels, and nerves

124
Q

what does the epitenon do?

A

encloses the entire tendon?

125
Q

what is the paratenon?

A

areolar CT that covers the epitenon

126
Q

what is the tenosynovium?

A

the tendon sheath, a form of the paratenon that is synovium filled and a source of replacement cells for an injured tendon

127
Q

are ligaments composed mostly of cells or the ECM?

A

ECM

128
Q

what is the entheses?

A

area of attachment of tendons and ligaments to bone

129
Q

t/f: the entheses is a common area of degeneration

A

true!

130
Q

direct attachments

A

via fibrocartilage

131
Q

indirect attachments

A

via fibrous attachment that blends in the periosteum which is attached to the underlying cortical bone via SHARPEYS FIBERS

132
Q

what is the role of sharpey’s fibers in indirect attachments?

A

to act as the roots for tendons and ligaments

133
Q

what is stress?

A

the load or force

134
Q

what is strain?

A

the deformation caused by the stress

135
Q

where on the stress-strain curve do length changes begin?

A

elastic region

136
Q

what is the necking area on the stress strain curve?

A

where tissues being to fail and will rupture if you don’t get out of it

137
Q

what is the region used in PT to get more range out of a muscle?

A

plastic region

138
Q

what 2 therapeutic concepts does a low load, long duration stretch make use of?

A

creep and stress-relaxation

139
Q

what is crimp?

A

I have literally no clue if anyone could help me out here

140
Q

what is viscoelasticity?

A

the viscous and elastic properties of tissue

141
Q

what is creep?

A

constant STRESS

142
Q

what is stress-relaxation?

A

reduction in stress under constant STRAIN

143
Q

what is a low load over a long time good for in therapy?

A

elongating tissues

144
Q

what is plastic deformation?

A

when tissue remains deformed and doesn’t recover to pre-stretch length due to microfailure

145
Q

is plastic deformation a bad thing?

A

not always, as this is how we gain new length of tissues in PT!

146
Q

how does the health of tissue influence injury?

A

healthier tissue can accept more load than unhealthy tissue

147
Q

how does age influence injury?

A

as you age, your tissues have a reduced capacity to cope with stress, making them more susceptible to injury

148
Q

how does collagen and proteoglycans content influence injury?

A

you have more collagen when you’re younger and it decreases as you age, making it more difficult to withstand stress

149
Q

how does the ability of tissue to adapt to change influence injury?

A

if the tissue has a greater ability to adapt to change, it is able to handle greater stresses

150
Q

how does the speed at which adaptive change occurs influence injury?

A

when a low force is applied over a long time, it is able to adapt to the change better than a large force applied quickly

151
Q

what are some ways that tissue failure occurs?

A

application of stress:
- too quickly
- exceed tissue tolerance limits
- applied repetitively w/o time to recover

dynamic overload

152
Q

what are the two types of dynamic overload?

A

acceleration injury
deceleration injury

153
Q

what is an acceleration injury?

A

usually a contact injury resulting when a body part is stationary or moving slower than an applied force and the force exceeds the tissue tolerance

154
Q

what is an example of an acceleration injury?

A

getting hit

155
Q

what is a deceleration injury?

A

typically a non-contact injury that occurs when a body part rapidly decelerates and the muscles aren’t strong enough to adapt to stress and the force exceeds the tissue tolerance

156
Q

what is an example of a deceleration injury?

A

cutting or landing

157
Q

what is the transitional/ transformational zone?

A

the zone in activity where you go from eccentric to concentric or are changing directions and you need a high volume of muscles control

common area of injury

158
Q

is acute stress macrofailure or microfailure?

A

macrofailure

159
Q

is an acceleration injury micro or macrofailure?

A

macrofailure

160
Q

what is acute stress?

A

a single force large enough to cause tissue failure

161
Q

is repetitive stress micro or macrotrauma?

A

microtrauma

162
Q

what is repetitive stress?

A

a single force insufficient to cause injury, but repeated over time can cause injury (chronic injury)

163
Q

what are the physical characteristics that predispose an individual to injury?

A

age, gender, muscle imbalances, leg length discrepencies, and anatomical anomallies

164
Q

t/f: physical/intrinsic characteristics that predispose an individual to injury are usually non-modifiable

A

true!

165
Q

t/f: extrinsic factors that predispose and individual to injury are usually non-modifiable

A

false, these tend to be more modifiable

166
Q

what are extrinsic factors that lead to injury?

A

training errors, terrain, temperature, incorrect equipment, or incorrect use of equipment

167
Q

what 3 things influence injury of ligaments?

A

aging, hormones, and inactivity

168
Q

middle age influence on ligaments

A

ligament and bone insertion sites are weakened and there is a loss in structural strength

169
Q

elderly age influence on ligaments

A

loss of mass, strength, and viscocity

170
Q

hormones influence on ligaments

A

laxity during pregnancy allows more pelvic flexibility (relaxin)

menstruation

171
Q

inactivity influence on ligaments

A

rapid deterioration in biomechanical properties, loss of ligament strength and stiffness

172
Q

if the stress is greater than the elastic range what happens?

A

tissue failure begins

173
Q

if stress is great enough, other ligaments are recruited and undergo_____

A

strain

174
Q

what tissues get strained?

A

muscles

175
Q

what tissues get sprained?

A

ligaments

176
Q

what is a sprain?

A

injury of the ligamentous structures caused by abnormal or excessive joint motion

177
Q

what is a first degree (mild tear) ligament injury?

A

stretching or minor tearing of a few fibers without loss of integrity with only minor swelling and discomfort, and no/minimal loss of strength and restriction of movement

178
Q

how long does the pain/discomfort of a first degree injury last?

A

1-2 and maybe 3 days

179
Q

what is a second degree (moderate tear) ligament injury?

A

partial tearing of tissue with clear loss of function accompanied by pain, moderate disability, point tenderness, swelling, bruising, and slightly/moderate abnormal motion

180
Q

what is a third degree (severe tear) ligament injury?

A

complete loss of structural or biomechanical integrity extending across the entire ligament usually requiring surgery or casting

181
Q

do intraarticular or extra articular ligaments heal better?

A

extra articular

182
Q

why do intraarticular ligaments not heal as well?

A

they have a limited blood supply and synovial fluid may hinder the inflammatory response

183
Q

what are the 4 phases of extraarticular healing?

A

hemorrhagic, inflammatory, proliferation, and remodeling and maturation

184
Q

what is the hemorrhagic phase of ligament healing?

A

the injury gap fills with a hematoma (blood clot) and PMN leukocytes and lymphocytes appear within hours

185
Q

what is the inflammatory phase of ligament healing?

A

macrophages arrive within 24-48 hours post-injury and clear necrotic tissue and secrete growth factors that induce neovascularization and formation of granulation tissue

186
Q

what happens by day 3 post injury in the inflammation phase of ligament healing?

A

the wound contains PMN leukocytes, lymphocytes, mesenchymal cells, growth factors, and platelets

187
Q

other than neovascularization, what do growth factors induce in the inflammatory phase?

A

fibroblast proliferation and synthesis of collagen type 1, 3, 5, and non-collagenous proteins

188
Q

what is the proliferation phase of ligament healing?

A

fibroblasts produce collagen and matrix proteins within 1 week and by week 2 the original blood supply is more organized, capillary buds begin to form, and there is a disorganized collagen matrix

189
Q

what is the remodeling and maturation phase of ligament healing?

A

decreased cellularity of healed tissue, a denser and more longitudinally arranged matrix, and collagen turnover and water-collagen ratios approaching normal.

190
Q

what is the typical timeline of healing?

A

some tensile strength by week 5

50% normal strength by 6 months

80% normal strength by one year in more severe injury

can take as long as 3 years to heal to the point of near -normal tensile strength

191
Q

what are some treatment guidelines for ligament injuries?

A

minimize immobilization

progressive stress

small cyclical loads to promote scar proliferation and remodeling (scar becomes stronger and stiffer)

RICE

heat after first 48 hours

surgical repair

growth factors

gene therapy to alter expression of cells and alter the healing environment

DPT 516 (14 decks)

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