Quiz 2 Flashcards
pain lecture and CT lecture
what is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage or an experience described in terms of such damage
is pain subjective or objective?
subjective
t/f: pain is individual
true!!!
pain is perceived ___ and influenced ____
cortically, peripherally
in chronic pain, is the pain always reflective of the damage?
no
what is usually worse, the fear of pain or the pain itself?
the fear of pain
what are the 3 categories of pain?
neuropathic
inflammatory
nociceptive
what is nociceptive pain?
like a pin prick
what is inflammatory pain?
tissue injury
what is neuropathic pain?
pain that can be central of peripheral
what are some examples of central neuropathatic pain?
migraine
stroke
TBI (traumatic brain injury)
what are some examples of peripheral neuropathic pain?
trigeminal neuralgia (Tic douleroux)
poorly controlled diabetes
nerve compression
herpes zoster (shingles or post-herpetic neuralgia)
what are the 5 sources of pain?
cutaneous
somatic
visceral
neurogenic(pathic)
referred
what is cutaneous pain?
pain related to the skin that can be superficial or subcutaneous
is cutaneous pain localized?
yes! the patient can point to where the pain is
can cutaneous pain be referred from deeper structures?
yes
cutaneous pain varies between individuals’ ____ and _____
gender
ethnicity
what is somatic pain?
superficial or deep pain of the neuromuscular, musculoskeletal, or neuromusculoskeletal systems
what is superficial somatic pain?
pain of the skin, superficial fasciae, or tendon sheaths like cellulitis
what is deep somatic pain?
periosteum and cancellous (spongey) bone, nerves, tendons, ligaments, blood vessels, deep fasciae, or joint capsule pain
is deep somatic pain well localized?
no, it is poorly localized
t/f deep somatic pain can be referred to the skin (cutaneous)
true
would you see autonomic phenomenon with deep somatic pain?
yes
what autonomic phenomenon would be seen with deep somatic pain?
sweating, pallor, pulse or BP changes, nausea, or faintness
is deep somatic pain always over the source organ?
no!
what are some examples of deep somatic pain?
myofascial pain, facet joint arthritis
what are the 5 types of somatic pain?
deep
superficial
somatoemotional/psychosomatic
viscerosomatic
somatovisceral
what is somatoemotional/psychosomatic pain?
emotional or psychological distress produces physical symptoms that can be brief, prolonged, or recurrent
what type of somatic pain is somatization categorized under?
psychosomatic pain
what is viscerosomatic pain?
visceral structures (chest and abdomen) affect the somatic musculature
(easier way to understand: musculoskeletal pain bc of internal organs)
what is somatovisceral pain?
myalgic pain causes functional disturbance of the viscera
(easier understood as musculoskeletal problem causing visceral issues)
what is visceral pain?
pain of the internal organs of the trunk and abdomen and the heart
is visceral pain well localized?
no!
why is visceral pain poorly localized?
because of the multisegmental innervation and few nerve receptors in these structures
what are the two types of visceral pain?
viscerogenic, psychogenic
what is viscerogenic pain?
lesions in the viscera that share innervation causing a broad distribution
is there a mechanism to reproduce viscerogenic pain?
no!
what are some examples of viscerogenic pain?
colon cancer and MI
what is psychogenic pain?
poorly defined pain that originates in the cortex unrelated to tissue damage
what are some examples of psychogenic pain?
depression and conversion disorder
what is kehr’s sign?
mostly right shoulder pain above the clavicle that is related to a spleen injury
what is parietal pain?
deep somatic pain that affects the parietal or visceral pleura
which pleura has a good supply of nerve endings? parietal or visceral?
parietal
why does visceral pleura injury often go unnoticed until the pressure is put on the parietal pleura?
the visceral pleura is insensitive to pain
what is the viscerocutaneous reflex?
hypersensitivity of the skin to touch during disease of internal organs in the acute phase of disease
is visceral pain usually accompanied by ANS response?
yes, such as changes in vital signs, unexplained sweating, and/or skin pallor
what is neurogenic pain?
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)
t/f: neurogenic pain is due to the stimulation of nociceptive fibers?
false, it’s due to the malfunction of the NS!
neurogenic pain causes disruption of ___ and ___ nerve transmission of PNS, spinal cord, or brain
afferent, efferent
neurogenic pain causes altered _____ ______ and _____ _____
sensory perception, motor function
what are 3 causes of neurogenic pain?
drugs, trauma, or metabolic disorder
how would one describe neurogenic pain as feeling?
burning, shooting, tingling, electric shock
what kind of pain is radicular pain?
neurogenic bc it affects the spinal nerve roots
what are some examples of neurogenic pain?
hyperalgesia
diabetic neuropathy
MS
cancer
chronic regional pain syndrome (CRPS)
trigeminal neuralgia
what is radicular pain?
pain caused by irritation of the spinal nerve root and experienced in the dermatome, scleratome, or myotome
radicular pain of the viscera is within the _____ ______ of the affected organ
segmental innervation
what is referred pain?
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
referred pain can be ____, ____, or ____ source
cutaneous, somatic, visceral
does visceral pain often precede or come after referred musculoskeletal pain?
precedes!
does referred pain often follow normal anatomical pathways? why or why not?
no because the sensory paths are distorted
referred pain is often ____ _____ but has _____ _______ borders (smudging)
well localized, ill defined
what is diffuse pain?
obscure pain in the trunk, especially when felt anteriorly only
what is diffuse pain suggestive of
pain from the spinal facet joint, PNS, or viscera
what is pain at rest suggestive of?
ischemia of various tissues
vascular disease (peripheral vascular disease)
tumor growth
skin/subcutaneous edema
neoplasms
what are the s/s peripheral vascular disease?
the 5 Ps: pain, pallor, pulselessness, paresthesia, paralysis
how would one describe the pain from skin/subcutaneous edema feels?
burning or boring pain
what is a neoplasm?
night pain, difficulty sleeping, unremitting, non-mechanical pain
what is neurogenic claudication?
LE pain upon exertion that becomes better with trunk flexion and rest
what is neurogenic claudication suggestive of?
ischemia associated with peripheral or spinal vascular disease
what causes neurogenic claudication?
an accumulation of hypoxic products
what is the bicycle test of van gelderen used for ?
to distinguish b/w neurogenic and vascular claudication as the neurogenic will get better with trunk flexion, but vascular will not
what is vascular claudication?
pain with walking for a while because their is insufficient blood flow to and from the legs
would trunk flexion alleviate the symptoms of vascular claudication?
NO
what is joint pain suggestive of?
bone disease or neoplasm
what is joint derangement?
sharp pain with stress that is immediately reduced with rest and aggregated with activity
what is systemic joint disease?
deep, aching, throbbing, pain reduced by pressure and increased with stress and movement
what is chronic pain
pain lasting more than 6 months (sometimes just more than 2 months)
what is chronic pain syndrome?
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
the most effective PT diagnosis will define the ____, address the _____ __ ____ rather than just defining the source of pain
syndrome, causes of pain
what are the 4 types of connective tissue?
bone, blood, cartilage, and connective tissue proper
what are the 2 types of connective tissue proper?
dense and loose
what are the 3 types of loose connective tissue proper?
areolar, reticular, and adipose
what are the 3 types of dense connective tissue proper?
regular, irregular, and elastic
what are the 3 types of cartilage?
fibrocartilage, elastic, and hyaline
what are the 2 types of bone tissue?
spongey and compact
what are the 2 basic components of CT?
ECM and cellular fibers
what is the structure of collagen?
triple helix polypeptide
what is the makeup of the ECM?
water and protein
what are largely responsible for the water-binding property of cartilage and allows it to withstand pressure?
aggregans
what are CT cells derived from?
mesenchymal cells
what is a -blast?
immature cell that divides and secretes the matrix
what is a -cyte?
mature cell that has a reduced capacity for cell division (determines matrix function)
what are fibroblasts?
the basic cell of most CT that produces the ECM and different types of CT depending on the environment
what is a chondroblast?
immature fibroblast of the cartilage
what is a tenoblast?
immature fibroblast of tendons
what is an osteoblast?
immature fibroblast of bone
what is a chondrocyte?
mature fibroblast of cartilage
what is a tenocyte?
mature fibroblast of tendons
what is an osteocyte?
mature fibroblast of bone
can CT cells de-differentiate?
yes! they can de-differentiate based on the environment and stimuli
what is hyaluronan?
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)
what are the 3 types of CT fibers?
collagen, elastic, and reticular
what are collagen fibers?
fibers that resist tension and promote flexibility
collagen fibers exist in bundles ____ to one another
parallel
which type of connective tissue fiber is in most CT?
collagen
what are elastic fibers?
strong, but stretchy fibers found in the skin, blood vessels, and lung tissue that has a smaller diameter than collagen fibers
what are reticular fibers?
fibers that support the walls of blood vessels, network around fat/muscle cells, nerve fibers, and organs, and are produced by fibroblasts
are tendons and ligaments active or passive elements of motion?
passive
are tendons and ligaments dense or loose CT?
dense CT
tendons and ligaments are similar in_____ but different in _____
structure, arrangement
tendons transmit tensile forces from _____ to _____
muscle, bone
what is one of the important roles of tendons?
length-tension relationship (put the muscle at an optimal length to produce optimal tension)
what is an important role of ligaments?
mechanical stability to prevent excessive motions and sometimes guide motions
what is the main component of tendons and ligaments?
collagen (mostly type 1)
what is the fiber arrangement of tendons?
parallel
what is the fiber arrangement of ligaments?
interlaced
do tendons have high or low metabolism?
low
do ligaments have high or low metabolism?
high
why do ligaments have an interlaced structure while tendons have a parallel structure?
ligaments tend to take multidirectional forces, while tendons tend to take forces from one direction
do tendons or ligaments have more type 1 collagen?
ligaments
where would you find type 3 collagen in tendons?
tendon sheath (tenosynovium)
tendon fibers form ____ covered by the ____
fascicles, endotendon
what three things does the endotendon cover?
blood vessels, lymphatic vessels, and nerves
what does the epitenon do?
encloses the entire tendon?
what is the paratenon?
areolar CT that covers the epitenon
what is the tenosynovium?
the tendon sheath, a form of the paratenon that is synovium filled and a source of replacement cells for an injured tendon
are ligaments composed mostly of cells or the ECM?
ECM
what is the entheses?
area of attachment of tendons and ligaments to bone
t/f: the entheses is a common area of degeneration
true!
direct attachments
via fibrocartilage
indirect attachments
via fibrous attachment that blends in the periosteum which is attached to the underlying cortical bone via SHARPEYS FIBERS
what is the role of sharpey’s fibers in indirect attachments?
to act as the roots for tendons and ligaments
what is stress?
the load or force
what is strain?
the deformation caused by the stress
where on the stress-strain curve do length changes begin?
elastic region
what is the necking area on the stress strain curve?
where tissues being to fail and will rupture if you don’t get out of it
what is the region used in PT to get more range out of a muscle?
plastic region
what 2 therapeutic concepts does a low load, long duration stretch make use of?
creep and stress-relaxation
what is crimp?
I have literally no clue if anyone could help me out here
what is viscoelasticity?
the viscous and elastic properties of tissue
what is creep?
constant STRESS
what is stress-relaxation?
reduction in stress under constant STRAIN
what is a low load over a long time good for in therapy?
elongating tissues
what is plastic deformation?
when tissue remains deformed and doesn’t recover to pre-stretch length due to microfailure
is plastic deformation a bad thing?
not always, as this is how we gain new length of tissues in PT!
how does the health of tissue influence injury?
healthier tissue can accept more load than unhealthy tissue
how does age influence injury?
as you age, your tissues have a reduced capacity to cope with stress, making them more susceptible to injury
how does collagen and proteoglycans content influence injury?
you have more collagen when you’re younger and it decreases as you age, making it more difficult to withstand stress
how does the ability of tissue to adapt to change influence injury?
if the tissue has a greater ability to adapt to change, it is able to handle greater stresses
how does the speed at which adaptive change occurs influence injury?
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
what are some ways that tissue failure occurs?
application of stress:
- too quickly
- exceed tissue tolerance limits
- applied repetitively w/o time to recover
dynamic overload
what are the two types of dynamic overload?
acceleration injury
deceleration injury
what is an acceleration injury?
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
what is an example of an acceleration injury?
getting hit
what is a deceleration injury?
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
what is an example of a deceleration injury?
cutting or landing
what is the transitional/ transformational zone?
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
is acute stress macrofailure or microfailure?
macrofailure
is an acceleration injury micro or macrofailure?
macrofailure
what is acute stress?
a single force large enough to cause tissue failure
is repetitive stress micro or macrotrauma?
microtrauma
what is repetitive stress?
a single force insufficient to cause injury, but repeated over time can cause injury (chronic injury)
what are the physical characteristics that predispose an individual to injury?
age, gender, muscle imbalances, leg length discrepencies, and anatomical anomallies
t/f: physical/intrinsic characteristics that predispose an individual to injury are usually non-modifiable
true!
t/f: extrinsic factors that predispose and individual to injury are usually non-modifiable
false, these tend to be more modifiable
what are extrinsic factors that lead to injury?
training errors, terrain, temperature, incorrect equipment, or incorrect use of equipment
what 3 things influence injury of ligaments?
aging, hormones, and inactivity
middle age influence on ligaments
ligament and bone insertion sites are weakened and there is a loss in structural strength
elderly age influence on ligaments
loss of mass, strength, and viscocity
hormones influence on ligaments
laxity during pregnancy allows more pelvic flexibility (relaxin)
menstruation
inactivity influence on ligaments
rapid deterioration in biomechanical properties, loss of ligament strength and stiffness
if the stress is greater than the elastic range what happens?
tissue failure begins
if stress is great enough, other ligaments are recruited and undergo_____
strain
what tissues get strained?
muscles
what tissues get sprained?
ligaments
what is a sprain?
injury of the ligamentous structures caused by abnormal or excessive joint motion
what is a first degree (mild tear) ligament injury?
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
how long does the pain/discomfort of a first degree injury last?
1-2 and maybe 3 days
what is a second degree (moderate tear) ligament injury?
partial tearing of tissue with clear loss of function accompanied by pain, moderate disability, point tenderness, swelling, bruising, and slightly/moderate abnormal motion
what is a third degree (severe tear) ligament injury?
complete loss of structural or biomechanical integrity extending across the entire ligament usually requiring surgery or casting
do intraarticular or extra articular ligaments heal better?
extra articular
why do intraarticular ligaments not heal as well?
they have a limited blood supply and synovial fluid may hinder the inflammatory response
what are the 4 phases of extraarticular healing?
hemorrhagic, inflammatory, proliferation, and remodeling and maturation
what is the hemorrhagic phase of ligament healing?
the injury gap fills with a hematoma (blood clot) and PMN leukocytes and lymphocytes appear within hours
what is the inflammatory phase of ligament healing?
macrophages arrive within 24-48 hours post-injury and clear necrotic tissue and secrete growth factors that induce neovascularization and formation of granulation tissue
what happens by day 3 post injury in the inflammation phase of ligament healing?
the wound contains PMN leukocytes, lymphocytes, mesenchymal cells, growth factors, and platelets
other than neovascularization, what do growth factors induce in the inflammatory phase?
fibroblast proliferation and synthesis of collagen type 1, 3, 5, and non-collagenous proteins
what is the proliferation phase of ligament healing?
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
what is the remodeling and maturation phase of ligament healing?
decreased cellularity of healed tissue, a denser and more longitudinally arranged matrix, and collagen turnover and water-collagen ratios approaching normal.
what is the typical timeline of healing?
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
what are some treatment guidelines for ligament injuries?
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
