Soft Tissue Injury Flashcards
1
Q
What 3 main factors contribute to connective tissue repair?
A
- Age
- Lifestyle
- Systemic factors
2
Q
What are the 3 microstructure components of connective tissues?
A
- Fibers (collagen and elastin)
- Ground substance (glycosaminoglycans)
- Cellular substances
3
Q
What microstructure properties have an affect on the function of connective tissues?
A
- Proportion of intracellular to extracellular components
4
Q
In what type of tissue is type I collagen found?
A
- Bone
- Ligament
- Tendon
- Fibrocartilage
- Capsules
- Synovial lining
- Skin
5
Q
In what type of tissue is type II collagen found?
A
- Cartilage
- Fibrocartilage
6
Q
In what type of tissue is type III collagen found?
A
- Blood vessels
- Synovial lining of tissues
- Skin
7
Q
In what type of tissue is type IV collagen found?
A
- Basement membranes
8
Q
What type of fibers primarily resist tensile loads?
A
- Collagen
9
Q
Beyond what degree of elongation does plastic change occur in collagen fibers? What causes the change?
A
- Past 4%
- X-links fail
10
Q
What is the yield point of a tissue?
A
- The point at which an increase in strain occurs without an increase in stress
11
Q
How do sub plastic changes result in damage over time?
A
- Microstructural damage accumulates over each loading cycle
12
Q
What is the failure caused by cyclic loading termed?
A
- Fatigue failure
13
Q
What type of fracture is caused by fatigue failure?
A
- Stress fractures.
14
Q
Describe the stress-strain curve of tissues.
A
- Stress on y-axis, strain on x-axis
- Curve rises to elastic limit (area under curve up to this point is elastic range)
- Curve rises further to the yield point (area under this part of the curve undergoes microfailure)
- Curve rises to its ultimate strength point, and then dips to the rupture strength
- The plastic region stretches from the elastic limit to the ultimate strength, past which the tissue fails.
15
Q
How is the stress-strain curve of glass or another brittle substance shaped?
A
The curve is a straight line with a combined elastic limit, ultimate strength, and rupture point.
16
Q
As load is applied faster to cortical bone, what is the effect?
A
The bone has more of an elastic property.
17
Q
What is creep?
A
- Tissue lengthens in response to a constant load.
18
Q
What is relaxation?
A
- Amount of force necessary to hold length of tissue decreases
19
Q
What do creep and relaxation allow?
A
Adaptation of connective tissues to adapt to loading conditions without being damaged.
20
Q
What type of property does creep and relaxation demonstrate?
A
Viscoelastic.
21
Q
What are the 3 characteristics of phase I of the inflammatory response?
A
- Occurs for 3 - 5 days
- Pain, tenderness, and swelling are palpable
- Prostaglandins, bradykinins and other chemical substances are being released.
22
Q
What are the 2 focuses of treatment during the acute stage of the inflammatory response?
A
- Decrease pain and inflammation
- Maintain strength and mobility of adjacent joints/ soft tissue if possible
23
Q
What is phase II of the inflammatory response?
A
Repair and regeneration.
24
Q
What are the 4 characteristics of repair and regeneration?
A
- Occurs up to 8 weeks
- New collagen forms (primarily type III)
- Edema typically resolves during this phase
- Bony callus is formed
25
What are the 4 focuses of treatment during the repair and regeneration phase?
- Regain normal tissue relationships; optimal loading (changes during this stage become habitual)
- ROM exercises
- Joint mobs
- Weight bearing
- Establish strength base
26
What is phase III of soft tissue repair?
- Remodeling and maturation.
27
What are the 2 characteristics of remodeling and maturation?
- Deposition of type I collagen
| - Decreased synthetic activity and extracellularity
28
What are the 2 focuses of treatment during remodeling and maturation?
- Tension/ resistance training (want to orient collagen(
| - Normal loading to remodel bone correctly
29
What are 4 interventions for the restoration of normal tissue relationships?
- Active muscle contraction
- Passive joint motion
- Mobilization
- Stretching
30
When does restoration of normal tissue relationships begin?
As soon as healing allows.
31
What is the most important consideration when choosing the amount of load to apply to a healing tissue?
Do not disrupt the healing process.
32
What 4 considerations must be considered when choosing a load?
- Don't over or under load tissue
- Consider biomechanical effects of daily activities
- Understand the mechanism of injury
- Individual factors (age, nutrition, fitness, etc.)
33
What are 4 signs of overload?
- Increased pain unresolved within 12 hours
- Pain increases over previous session, or presents earlier in exercise
- Swelling, warmth, or redness increase in injured area
- Decreased function
34
What is SAID?
- Specific Adaptations to Imposed Demands
- Extension of Wolff's Law
- Prescribe exercise according to optimal loading and specific demands of patient's functional tasks
35
How can the effects of immobilization be minimized while an injury is healing?
- E-stim or isometric ocntractions
- AROM above and below injury site
- WB exercises to prevent joint/ cartilage degredation
36
Describe a grade I, II, and III ligament sprain.
I: Mild, ligament stretched, no discontinuity
II: Moderate, some fibers stretched/ torn, some joint laxity
III: Severe, complete ligament disruption, with resultant laxity
37
What is a strain?
An acute injury to the muscle or tendon from an abrupt or excessive muscle contraction.
(QUICK muscle overload)
38
What is the clinical strain classification? What is the classification based on?
- Mild
- Moderate
- Severe
Based on: Pain, edema, ROM deficiency, Tenderness
39
Where can a muscle strain be palpated?
- Muscle-tendinous junction
| - Muscle belly
40
Slide 26
Slide 26
41
What are the 4 classifications of tendon injuries?
- Macrotrauma
- Microtrauma
- Tendinosis
- Tenditis
42
Where does macrotrauma typically occur?
At the musculotendinous junction.
43
Where does microtrauma typically occur?
Inflammation at the outer layer of the tendon.
44
What is tendinosis?
Degeneration without inflammatory response.
45
What is tendinitis?
- Degeneration of tendon
- With vascular disruption
- Inflammatory response
- Symptomatic
46
What subjective information is important in tendinous injuries?
- Acute or chronic?
- Localized inflammation?
- Onset?
- Predisposing factors
47
What tests should be performed for tendinous injuries?
- ROM
- MMT
- Posture
- Joint integrity
- Mobility
48
What can be palpated in tendinous injuries?
- Nodules
- Defects
- Crepitis
49
What are fundamental treatments in tendon injuries?
Restoring length and strength.
| - Eccentric activities to begin
50
What modalities should be considered for inflammation?
- Cold packs
- E-stim
- Iontophoresis
51
What are the classifications of cartilage injuries?
- Mechanical
| - Nonmechanical
52
What are some examples of non-mechanical cartilage injury?
- Infection
- Inflammation
- Joint immobilizaiton
53
What are 10 objective and subjective features that should be assessed in cartilage injury?
- Mechanism of injury
- Area of damage
- Classification/ health of cartilage
- General health
- Lifestyle factors
- Body weight
- Joint alignment
- ROM
- Muscle performance
- Joint integrity
- Mobility
54
What are 6 goals of treatment of cartilaginous injuries?
- Restore motion
- Create freedom of motion
- Distribute loads in joints equally
- Increase stability
- Increase muscle performance
- Normalize gait
55
What may occur in deeper tissues due to a contusion?
- Collection of blood (hematoma)
| - If untreated --> myositis/ ossificaitons
56
What in a history provides the best information about a contusion?
The size, location, and direction of a significant "blow".
57
What manual techniques can help assess a contusion?
- palpation
- Joint mobility
- Muscle performance
- Flexibility
- Funcitonal tests
58
What must be restored ASAP in contusion injuries?
ROM.
59
How can swelling and local inflammation be controlled in contusion injuries?
Ice.
60
What can guide the aggressiveness of treatment in contusion injuries?
- Pain
- Muscle length
- Muscle performance
61
What exercise may be used in early stages to begin treatment in contusion injuries?
Submaximal isometric contractions.
62
What are 4 classficiations of fractures?
- Open
- Closed
- Displaced
- Non displaced
63
What may be injured in addition to bone in a fracture?
Associated soft tissue.
64
What is the focus of fracture treatment?
- Recovery of initial trauma
| - Rehabilitating tissues that were immobilized
65
What is the initial intervention for recovery from fracture (after immobilization)?
- Gentle joint mobilization and stretching
| - Gentle strengthening
66
What are 7 soft tissue surgical procedures?
- Ligament reconstruction
- Tendon surgery
- Debridement
- Synovectomy
- Decompression
- Softtisue stabilization/ realignment
- Meniscal and labral tears.
67
What are 6 bony tissue surgical procedures?
- Debridement/ abrasion chondroplasty
- Osteochondral autograft transplantation (OAT/ mosaicplasty)
- Autologous chondrocyte implantation
- Open reduction and internal fixation
- Fusion
- Osteotomy
68
What is the primary goal of treatment following a joint arthroplasty?
- Pain relief
69
What are 3 categories of joint arthroplasty?
- Component design (constrained/ unconstrained)
- Fixation (cement vs biological)
- Materials (metals vs plastics)
70
What should be addressed following pain in treatment following a joint arthroplasty?
- Restore motion, strength, and function
| - Address underlying cause of surgery as awell as adjacent joints
71
What 3 conditions may lead to a TKA?
- OA
- RA
- Trauma
72
What treatments should be implemented early following a TKA?
- Continuous passive motion
| - Protected WB with an Assistive Device
73
What should be monitored throughout treatment following a TKA?
- Infection
- Effusion
- DVTs
74
What health facilities will a patient with TKA progress through?
- Acute
- SNF
- Homecare
- Outpatient
75
What are 3 common precautions for a Total Shoulder Arthroplasty?
- Avoid hyperextension/ anterior capsule stretch
- Avoid aggressive IR stretch or ER movement
- Avoid WB and lifting
76
What type of total hip arthroplasty is expected to last the longest?
- Cementless
77
What is the drawback of a cementless THA?
- Revisions are difficult
78
What type of THA is recommended for patients over 70? Why?
Cemented for immediate stability
79
What are drawbacks of cemented THA?
- Cement cracks and fragments, loosening the THA.
| - Bone resorption around the THA
80
What type of THA is recommended for active patients under the age of 60?
Resurfacing.
81
What is the advantage of a resurfaced THA?
Less risk of dislocation.
82
What are some precautions for a THA using a posterior surgical approach? How should the patient be educated?
- No hip flexion beyond 90 degrees
- No cross legs (adduction beyond neutral)
- No hip IR past neutral
- "Put a pillow between your legs if you lie on your side"
- "Sit only in elevated chairs or toilet seats"
- "Don't bend over from the hips to reach objects or tie shoes"
83
What positions should be avoided for a THA using the anterior approach?
- Hip extension and external rotation
| - Will dislocate the hip.
