Unit 2 Week 7 Flashcards
Anatomy of a LIGAMENT
Collagen fibers in longitudinal bundles with small cross links
- Epiligament layer
- Hypoceular: fibroblasts
- Hypovascular
- mechanoreceptors
- Intraarticular vs. Extraarticular
- Thickened bands in joint capsule or discrete cords
Epiligament layer
VASCULAR SUPPLY
- contains mostly fibroblasts
- Mechanoreceptors
Deeper ligament are …
Less vascularized and less cellular than superficial layers
Intra-articular ligaments
WITHIN THE JOINT CAPSULE
Ex; ACL or PCL
Extraarticular layer
OUTSIDE OF THE JOINT CAPSULE
Ex: LCL
Capsular Ligaments
They don’t present and look like a ligament it just looks like a capsule/thickened bands within the joint capsule
What are the functions of a ligament
- Structural= Holds skeleton together
- Motion Help guide joint motions/control amount of motion at a joint
- Limit joint excursion
- Restrain abnormal motions
- When on slack exhibit crimp = when the tissue is sort of scrunched up in the toe region and the slack is taken off when tension is applied to the ligament
- Viscoelastic tissue and exhibits viscoelastic properties they respond to time and history dependent mechanical behaviors or loads
How do ligaments play a passive role?
technically they are inert but have a proprioceptive role and a passive role by structural types of tension as well
Injuries to ligaments are called?
Sprains
What is the phases of Healing for LIGAMENTS
- hemorrhagic = hematoma in the gap, inflammatory recruitment
- Inflammatory= clearance of necrotic tissue, neovascularization, granulation tissue, recruitment of cells
- Proliferation= by 1st week fibroblasts arrive last, begin collagen and other protein production: by 2nd week original clot more organized capillary bundles collagen content and high but disorganized
- Remodeling= gradual decrease cells, matrix becomes dense and organized : normalize water content
- Type 1:3 ratio
Strength of a ligament @
5 weeks-
6 months-
1 year-
5th week- some strength
6 months- 50% strength
1 year- 80%
Which is less likely to heal ACL or MCL?
ACL is less likely to heal
- This is because it it encased in synovium and less likely to heal without surgery
- Intraarticular ligaments do not follow typical triphasic healing an timeframes
- Blood dissipates into synovium and a hematoma is prevented–> limiting arrival of growth factors and cytokines needed to mediate inflammation and healing
INTRAARTICULAR
Why is the MCL more likely to heal?
- Epiligament layer- highly vascular, cellular and sensory/proprioceptive nerves
- Greater likelihood of healing without surgery
- Follows triphasic healing time frames
EXTRAARTICULAR
Grade 1 Ligament Injury
Tissue damage=
- fiber stretching or tearing
Clinical signs
- point tenderness
- mild swelling
- some joint stiffness
- no abnormal motion/laxity
- Mild ecchymosis
Implications
- Minimal function loss
- early return to training with some protection
Grade 2 Ligament Injury
Tissue damage
- Some tearing, separation of fibers
Clinical Signs
- Tenderness
- effusion/hemarthrosis
- Stiffness
- Laxity and abnormal motion
- Moderate function loss
Implications
- tendency to recur
- modified immobilization
- Longer term instability - Arthritis risk
Grade 3 Ligament injury
Tissue Damage
- Total Rupture
Clinical Signs
- Initial severe pain , then min/none
- Profusion swelling and ecchymosis
- marked laxity and abnormal motion
- Moderate loss of function
Protective phase
- control swelling and pain
- relative rest versus complete immobilization
- submaximal isometrics
- pain free ROM(PROM, AAROM, AROM)
What is the neutral zone of a joint?
Little to no resistance to movement
What is an elastic zone of a joint ?
first barrier to motion encountered
What is the plastic zone of a joint
permanent deformation may lead to injury
what are normal barriers to joint movement ?
- articular shape of bone and cartilage
- restraining ligament tension
- capsular tension
- Muscle length
- synovial fluid
Hypomobile
- Internal derangement
- Arthrosis= break down of joint surfaces
- Ankylosis= bones fuse together
- Myofascial length = myofascial adhesion
- Effusion hemarthrosis= to much fluid
- Capsular
- neurodynamic tension
Management=
- manual therapy
- exercise to promote normal movement
- Medical intervention
Laxity
state of more than typical motion present at a joint, though not a problem unless associated with symptoms
Hypermobility =
Laxity + symptoms associate with inability to control joint during movement
Flexability
Function of contractile tissue length/ resistance
- Can also be function of joint passive restraints. Related to amount of motion available an the ease or quality of joint motion
Generalized Hypermobility
- Multi-joint
- Activity related, individual variability genetic disease
- Beighton scale >4 +
What is instability of a joint?
- Loss of joint congruity in response to loading
- INcreased ROM without adequate neuromotor control
- Multifactorial
- Altered arthrokinematics
- Altered physiological motion
- Functional interferes with function
What are the components of joint stability?>
- Joint integrity= articular surfaces/congruity
- Muscle= static stability and dynamic stability
- Passive restraints= ligament, capsule, skin
- motor control = activation , magnitude, timing
Hypermobility Management
- Neuromuscular control
- supporitve garments/orthotics
- treat muscular stability
- improve strength
- retrain patterns of function
DVT and what can a PT do?
Blood clot formed in deep veins commonly of the lower leg, if it breaks free it can lead to a pulmonary embolism (PE)
Risk factors=
1. age
2. bed rest
3. Immobility
4. distance traveled
5. major traumas
ecttt
PT role=
1. recognize signs and symptoms and refer out fast for medical testing and intervention
2. prevention of immobility; mobilization, exercise to promote circulation
3. monitoring anti-coagulant status; patients compliance with medications and monitoring lab values
Physis=
epiphysial plate cartilage
growth plate
Diaphysis=
Shaft
primary ossification center
Epiphysis
the ends
secondary ossification center
Metaphysis=
IN betweeen the epi and the dia- physes
part of the growth plate
Apophysis
secondary ossification center
growth plate attachment of muscle
