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DPT 516 > Quiz 3 > Flashcards

Quiz 3 Flashcards

skeleton and tendons

1
Q

what are the functions of the skeletal system?

A

support, protection, storage, assist motion, homeostasis, and hemopoiesis

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2
Q

what is hemopoiesis?

A

blood production

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3
Q

what is the diaphysis?

A

the bone shaft; main portion

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4
Q

what is the epiphysis?

A

distal and proximal end of long bones

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5
Q

what is the metaphysis?

A

where epiphysis and diaphysis join

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6
Q

where is the epiphyseal line?

A

in the metaphysis

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7
Q

what is articular cartilage?

A

cartilage that covers the epiphysis at articulations

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8
Q

what is the periosteum?

A

dense irregular CT that protects, nourishes, and allows growth

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9
Q

where is the attachment site for tendons and ligaments?

A

the periosteum

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10
Q

what is the medullary cavity?

A

the area within the diaphysis that contains the marrow for hemopoeisis

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11
Q

what is the center for hemopoeisis?

A

the medullary cavity

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12
Q

what is the endosteum?

A

lines the medullary cavity w/bone forming cells

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13
Q

what are the influences on healthy bone?

A

diet, hormones, and biomechanics

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14
Q

what is the bone matrix?

A

organic material and fluid

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15
Q

what are the benefits of increased mineral density of bones?

A

ability to withstand more stress

stiffness

mineral storage system

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16
Q

bone is a _____ _______ material

A

biphasic, composite

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17
Q

if a load is applied quickly, there is _____ stress, _____ strain

A

high, low

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18
Q

if a low force is applied over a long time, what may occur?

A

spurring

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19
Q

a low load applied will result in more _____

A

strain

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20
Q

stresses can create _____ or _______

A

growth, fractures

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21
Q

what factors affect bone response?

A

mechanical properties, geometric characteristics, loading mode applied, rate of loading, frequency of loading

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22
Q

what is the geometric characteristics of bone?

A

the way the bone is shaped

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23
Q

what is the bone’s response to tension?

A

de-bonding at the cement lines and pulling out of osteons causing avulsion/tension fractures

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24
Q

the fracture line is often _____ to the arc of tension

A

perpendicular

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25
Q

tension fractures usually occur in bones with a large portion of ______ bone

A

cancellous

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26
Q

what is Wolff’s Law?

A

changes in bone shape to match function

application of forces, changes the structure

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27
Q

application of new forces causes _____ activity to _____ bone mass

A

osteoblast, increase

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28
Q

a decrease in usual forces causes _____ activity to _______bone mass

A

osteoclast, decrease

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29
Q

bone remodeling is influenced by….

A

internal forces, nutrition, aging, metabolic and disease processes

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30
Q

long bone is the thickest at the _____ where the bending stress is the greatest

A

mid-shaft

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31
Q

bone has a higher ____ and lower ____ on the stress strain curve

A

stress, strain

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32
Q

tendon has a higher _____ and lower _____ on the stress strain curve

A

stress, strain

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33
Q

cartilage, skin and aorta have a higher ______ and lower ______ on the stress strain curve

A

strain, stress

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34
Q

a calcaneal spur can occur as a result of the pull of what 2 structures?

A

plantar fascia, Achilles tendon

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35
Q

a teardrop fracture can occur on the anterior vertebrae as a result of the pull of what?

A

anterior longitudinal ligament on the anterior spine

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36
Q

a dislocation of the patella can occur when what tendon pulls off tibial tuberosity with it?

A

patellar tendon

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37
Q

what is the bone’s response to compression?

A

structure shortens and widens

failure in response to oblique cracking of osteons

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38
Q

can bone withstand greater compressive or tension forces?

A

compressive

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39
Q

where is a common place for compression fractures to occur?

A

in the spine

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40
Q

what is the bone’s response to shear forces?

A

internal deformation in an angular manner

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41
Q

fractures due to shear are most often seen in _____ bone

A

cancellous (spongy)

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42
Q

cortical bone is stronger in ______>_______>______

A

compression, tension, shear

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43
Q

what is a common example of shear forces pathology on bone?

A

slipped capital femoral epiphysis (slip of the femoral head often seen in preadolescence)

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44
Q

______ bone is stiffer than _____ bone

A

cortical, cancellous

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45
Q

cancellous bone can withstand strains up to _____% prior to failure

A

75%

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46
Q

cortical bone fails if strain exceeds ___%

A

2%

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47
Q

bending of bone is a combo of what 2 forces?

A

tension and compression

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48
Q

the further the bending from the _____ axis, the ______ the magnitude of stress

A

neutral, greater

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49
Q

failure of bone as a result of bending occurs on what side?

A

the side subjected to tension

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50
Q

what is a greenstick fracture?

A

partial fracture of a bone like trying to break a stick the isn’t quite dead yet

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51
Q

what is torsion force?

A

twist about an axis that produces torque within bone

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52
Q

what is the bone’s response to torsion force?

A

shear forces over the entire structure with tensile and compressive forces

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53
Q

in a torsion fracture, where does the failure initially occur? what region does failure occur in next?

A

it begins in the region of shear, then to the region of tension

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54
Q

what is repetitive loading?

A

forces produced by a few reps of high load or many reps of a normal load

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55
Q

bone fatigues rapidly when approaching the _____ ______ on the stress strain curve

A

yield point

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56
Q

why does a fatigued muscle cause bone injury?

A

bc a fatigued muscle doesn’t have the same ability to store energy and neutralize stress forces so it can’t offload stress as well and the bone has to take on that stress which may cause failure of the bone

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57
Q

t/f: good cyclical stress is good for bone and creation of osteoblasts

A

true, as long as it’s not overdone

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58
Q

what is the bone’s response to repetitive loading?

A

fatigue fractures

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59
Q

what is the most commonly encountered fracture by PTs?

A

fatigue fractures

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60
Q

fatigue fractures are about ___% of all athletic injuries

A

10%

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61
Q

____% of fatigue fractures occur in the LE

A

80-90%

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62
Q

what is the most common bone affected by fatigue fractures?

A

the tibia

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63
Q

what are 2 ways to diagnose a stress fracture easily?

A

MRI or bone scan

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64
Q

what are stress fractures often thought to be in differential diagnoses?

A

soft tissue injuries, compartment syndrome, infection, or other overuse conditions

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65
Q

fractures occur when….

A

bone is taken to its failure point

load exceeds linear region of the stress-strain curve

there is microarchitectural damage

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66
Q

what is the effect of muscles on loading of bone?

A

muscles contractions alter stress distribution of bone and eliminates tensile stress on bone by producing compressive stress that serves to neutralize tension

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67
Q

bone balance requires…

A
  1. balance b/w resorption and building must be maintained
  2. activities may fluctuate depending on several factors
  3. hormones serve tor regulate this process (parathyroid hormone, vitamin D, and estrogen)
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68
Q

repair by original tissue is more _____ rather than ______

A

regeneration, repair

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69
Q

what are the 2 broad phases of bone healing?

A
  1. primary osteonal (cortical) healing
  2. secondary callus healing
70
Q

what is the primary osteonal (cortical) healing phase of bone healing?

A

phase in which the cortex of one side of the fracture must unit with the cortex of the other side

re-establishes continuity

71
Q

what is the secondary callus healing phase of bone healing?

A

the phase in which there are responses in the periosteum and surrounding soft tissues

majority of the fracture repairs

72
Q

what are the 4 phases of bone healing?

A
  1. hematoma
  2. fibrocartilagenous callus
  3. bony callus
  4. bone remodeling
73
Q

what is the hematoma phase of bone healing?

A

blood vessels at the fx site are disrupted and leaks into the site 6-8 hours post-injury

blood flow here stops causing the adjacent bone cells to die

swelling and inflammation

phagocytes remove debris (could be several weeks)

74
Q

what is the fibrocartilagenous callus stage of bone healing?

A

fibroblasts from the periosteum invade the fx site and produce collagen and fibrocartilage that makes the fibrocartilagenous callus

3 weeks post-injury

75
Q

what is the bony callus phase of bone healing?

A

osteogenic cells develop into osteoblasts and begin to produce spongy bone trabeculae that joins healthy and dead portions of the og bone fragments

fibrocartilage is converted to spongy bone to form the bony callus

76
Q

what is the bone remodeling phase of bone healing?

A

the dead portions of the og fx are reabsorbed by osteoclasts

compact bone replaces spongy bone

thickened area on the bone surface often remains

77
Q

what are some common non-operative treatment options for bone fractures?

A

casting, splinting, braces, skeletal traction to stimulate bone growth

78
Q

what is the primary approach to treating a fracture?

A

immobilization

79
Q

what are some common operative treatment options for bone fractures?

A

percutaneous pinning

external fixation

open reduction and internal fixation

locking plates

intermedullary nailing

80
Q

what are possible post surgical complications?

A

infection, venous thromboembolism (DVT or PE), poor wound healing, scars, and adhesions

81
Q

what are the implications for rehab in fractures?

A

consider the stress-strain curve

appreciate bone healing and the importance of early mobilizations

consider adjacent soft tissues

consider the importance of muscles in shock absorption

address secondary impairments

DO NO HARM

start with isometrics with casting and ORIF if deemed safe by the physician

ROM is usually allows once the fx union has been determined

LE progressive weight bearing as allowed by the physician

82
Q

what percentage of sport injuries are tendon injuries?

A

30-50%

83
Q

what percentage of the GP consultations for MSK injuries are tendon injuries?

A

30%

84
Q

when are tendons more subjected to injury?

A

high loads in eccentric and elastic conditions

85
Q

what are common LE tendons that get injured?

A

Achilles and patellar tendons

86
Q

what are common UE tendons that get injured?

A

supraspinatus, extensor carpi radialis brevis (tennis elbow/lateral elbow pain)

87
Q

what is the composition of tendons and ligaments?

A

78% H2O
20% collagen
2% GAGs

88
Q

tendons are good for sustaining _____, ______ tensile loads

A

high, unidirectional

89
Q

what is the collagen arrangement of tendons?

A

parallel along the lines of stress

90
Q

what are positional tendons?

A

tendons that allow precise movement

91
Q

what are some examples of positional tendons?

A

digital flexors

92
Q

what are energy-storing tendons?

A

typically involved in locomotion and ballistic actions

more elastic (store energy better)

93
Q

what is an example of an energy-storing tendon?

A

the Achilles tendon that stretches during the late stance phase of gait

94
Q

what percentage of strain causes uncrimping of tendons?

A

1-2%

95
Q

what percentage of strain causes incomplete tendon tearing?

A

> 6%

96
Q

what percentage of strain causes complete tendon tearing?

A

> 8-10%

97
Q

in what percentage range do tendons function in?

A

2-6%

98
Q

position tendons tend to operate in the ____ region with _____ load during use

A

linear, lower

99
Q

energy storing tendons tend to be loaded to values close to ______ _______

A

absolute failure

100
Q

tendons respond well to what kind of loading?

A

cyclical

101
Q

why do tendons respond well to cyclical loading?

A

bc it builds more collagen and tenocytes, making them stronger

102
Q

what are the effects of no cyclical loading of tendons?

A

reduced collagen fibers and weakened tendons

103
Q

what area is the weakest point in tendons where strain injuries are common?

A

the MT junction area

104
Q

t/f: the pathophysiology of tendons is fully understood

A

false!

105
Q

what are some common features of tendon injuries?

A

pain during loading, diffuse/localized swelling, and limitations in activity and performance

106
Q

what is a tendinopathy?

A

a painful disorder involving a tendon w/o implying the type of underlying pathology

107
Q

what is the best clinical term for a tendon injury?

A

tendinopathy

108
Q

what is tendinitis?

A

evidence of active intrasubstance inflammation

109
Q

what is tendinosis?

A

no intrasubstance evidence of inflammation

110
Q

which tendinopathy histology shows more degenerated/disorganized changes in collagen tissue causing pain?

A

tendinosis

111
Q

what is the common etiology of tendinosis?

A

overuse and chronic overload with repetitive trauma

112
Q

t/f: neovascularization is not normal in a tendon

A

true! it is usually the cause or result of chronic tendon irritation

113
Q

tendinopathy is the absence of ____ _____ _____

A

prostaglandin mediated inflammation

114
Q

what is likely the cause of inflammation in tendon injury?

A

PNS or CNS changes

115
Q

t/f: inflammation in tendons is the same as everywhere else in the body?

A

false!

116
Q

what are some structural changes in tendinopathy?

A

thickening

hypoechogenicity (US)

hypervascularity (Doppler US)

high signal intensity (MRI)

fiber thinning

myxoid degeneration

chondroid metaplasia

calcification

vascular infiltrates

117
Q

what is myxoid degeneration?

A

degenerative process where CT is replaced by gelatinous material

118
Q

what is chondroid metaplasia?

A

more chondrocytes in the tendon than there should be

119
Q

what is calcification of tendons?

A

calcium deposits in tendons

120
Q

what is vascular infiltrates in tendons?

A

vascularity infused into the area

121
Q

t/f: the sources of pain in tendons is not easily defined?

A

true

122
Q

what are 3 possible sources of tendon pain?

A
  1. sprouting of substance P positive nerve fibers in tendinous lesions (neurogenic/pathic cause)
  2. CNS output may/may not be related to physiological nociception
  3. changes to brain and SC excitability and cortical reorganization
123
Q

what tendinopathy is a tendon rupture?

A

tendinitis

124
Q

a tendon is most vulnerable to injury when it is ____ and attached muscle is maximally _____ or stressed

A

tense, contracted

125
Q

tendons are most vulnerable to injury when tension is applied ____ or _____

A

quickly, obliquely

126
Q

what are contributing factors to tendon injuries?

A

sports activities (most common)

work-related

drug-related

metabolic

127
Q

what are the drug-related factors that contribute to tendon injuries?

A

corticosteroids

cyclosporine

statin

fluoroquinolone antibiotics

128
Q

what are the metabolic factors that contribute to tendon injuries?

A

disturbed glucose metabolism

atherosclerosis

129
Q

____, _____or ____ loading can cause tendon injuries

A

sudden, repeated, rapid

130
Q

what is the primary force related to tendon injuries?

A

tension forces

131
Q

what are internal forces in tendon injury?

A

one fascicle/bundle against another

132
Q

what are external forces in tendon injury?

A

paratenon, retinaculum, bone

133
Q

tendon compression results in….

A

shearing and friction

134
Q

mechanical loading of tendons is a ____ process

A

anabolic

135
Q

what does mechanical loading cause?

A

increases synthesis of collagen proteins over 24 hrs post-exercise and can stay elevated for 70-80 hrs

136
Q

what is an anabolic process?

A

building up tissue

137
Q

what is a catabolic process?

A

degeneration of tissues

138
Q

why is there a net loss of collagen around the 1st 24-36 hrs post-training?

A

bc the catabolic peak is earlier than the anabolic peak so at first there is more tissue degeneration than is being built

139
Q

net ____ in collagen is followed by net ____ in collagen

A

loss, gain

140
Q

what are intrinsic factors that contribute to tendon injury?

A

biomechanics (malalignment, muscles weakness/imbalance, decreased flexibility, poor form)

age

adiposity (fat tissue in the body)

141
Q

what are extrinsic factors that contribute to tendon injury?

A

excessive volume, magnitude, or speed of loading

training errors

environmental

running surfaces

142
Q

does concentric contraction produce more force slow or fast?

A

slow

143
Q

does eccentric contraction produces more force slow or fast?

A

fast

144
Q

as velocity increases, max force in eccentrics____

A

increases

145
Q

as velocity increases, max force in concentrics _____

A

decreases

146
Q

what is the continuum of degeneration?

A

overload–>tendinopathy–> thickened/increased stiffness–>continued overload –>degenerative tendinopathy

147
Q

what is an acute tendon injury?

A

the time and method of injury is known

may be more reactive

148
Q

what is a grade I sensitivity?

A

pain after activity

no interference w/performace

generalized tenderness

gone by the next exercise

149
Q

what is a grade II sensitivity?

A

minimal pain with activity

doesn’t interfere w/intensity/distance

localized tenderness

150
Q

what is a grade III sensitivity?

A

pain interferes w/activity

usually disappears b/w sessions

definite local ttp

151
Q

what is a grade IV sensitivity?

A

pain doesn’t disappear b/w activities

serious interference w/intensity of training

significant local signs of pain, ttp, crepitus, and swelling

152
Q

what is a grade V sensitivity?

A

pain interferes w/sports and ADLs

symptoms are chronic and recurrent

signs of tissue change and altered associated muscle function

153
Q

what factors contribute to chronic tendon disorders?

A

load applied

older age

gender w/hormonal fluctuations

joint motion

tendon/muscles flexibility

fluoroquinolone use

154
Q

what are the 2 acute healing processes in tendons?

A

proliferation of tenoblasts from the cut end of the tendon

OR

vascular in-growth w/proliferation of fibroblasts from surrounding tissue which were injured at the same time (more likely)

155
Q

what are the 4 stages of healing in tendons?

A
  1. hemostasis
  2. inflammation
  3. proliferation
  4. maturation
156
Q

what is the hemostasis phase of tendon healing?

A

platelets form a clot

fibrin and fibronectin form a fragile bond

157
Q

what is the inflammation phase of tendon healing?

A

infiltration of debris removing cells (phagocytes)

chemotactic signals induce fibroblasts to start synthesizing collagen

healing tissue may be able to be subjected to low-level forces w/in days

3-5 days post

158
Q

what is the proliferation phase of tendon healing?

A

blood vessels proliferating

fibroblasts secrete type 3 collagen

in about 2 weeks collagen fibers arranging in thick bundles, randomly aligned, no cross-links, weak

2-3 weeks post

159
Q

what is the maturation phase of tendon healing?

A

about 3 weeks post

type 3 collagen replaced by type 1

type 1 begins alignment to tensile forces and continues throughout the phase

12-16 weeks to reach level to w/stand stresses

motion allowed once integrity is restored

normal strength at about 40-50 weeks post

160
Q

after healing, the new tissue is ___ and ____ than the OG

A

weaker, larger

161
Q

healed tendons have….

A

increased levels of minor collagen (III, IV, and VI)

decreased cross links

increased GAGs (more ground substance=not as strong)

162
Q

what is the general consensus on treatment of tendon injuries?

A

appropriate, carefully-graded progression of loading a tendon

initially isometric

muscles strengthening w/heavy slow resistance w/consideration of other muscles in the chain

later increase load incrementally with slow increase in speed of load application

163
Q

why has isolated eccentrics been the choice treatment since the 90s?

A

eccentrics produce a greater max force

tendons stretch more

greater mechanical stimulation

greater frequency oscillation in tendon force

164
Q

t/f: eccentric loading leads to hypertrophy and increased tensile strength of tendons?

A

true

165
Q

does eccentrics lead to lengthening or shortening of the muscle-tendon unit?

A

lengthening

166
Q

eccentrics normalizes concentration of ____ and enables normalization of _____ ______

A

GAGs, fiber arrangement

167
Q

does eccentrics lead to increased or decreased paratenon capillary blood flow?

A

decreased

168
Q

eccentrics preserve paratenon ____ saturation

A

O2

169
Q

what does new research say about treatment of tendons?

A

tendons need load to recover

the type of contraction doesn’t matter

increased loads of increased duration has a better response

tensile v. compressive loads are better

patellar and quad tendons may need to be loaded at different knee angles

tendons need proper recovery to avoid further damage

170
Q

t/f: s/s should guide intervention

A

true

171
Q

t/f: in the early stage you should avoid endurance and compressive loads and focus on eccentrics?

A

true!

DPT 516 (14 decks)

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