Week 3 Flashcards
(357 cards)
1
Q
All adaptations of the human movement system are defined according to the ___ principle
A
All adaptations of the human movement system are defined according to the SAID principle
2
Q
What does the SAID principle state?
A
Specific Adaptations can occur only in response to Imposed Demands
3
Q
What is physical stress?
A
Adaptations imposed by mechanical loading
4
Q
What are the ways to observe physical stress?
A
- Structural, functional, local and systemic changes
5
Q
All adaptation begins at the ___ level
A
All adaptation begins at the cellular level
6
Q
What is mechanotransduction?
A
The process by which the body converts physical stress into cellular responses
7
Q
What do the the cellular responses from mechanotransduction promote?
A
Structural and functional adaptive change
8
Q
What are the general steps of mechanotransduction?
A
- Mechano-coupling
- Cell to cell communication
- Effector response
9
Q
What is mechano-coupling?
A
The mechanical trigger that initiates the process of mechanotransduction
10
Q
What is the key to mechano-coupling?
A
The direct or indirect physical perturbation of the cell which is transformed into a variety of chemical signals both within and among cells
11
Q
What is the critical point of understanding cell to cell communication?
A
The stimulus in one location, can lead to a distant cell registering a new signal, even though the distant cell did not receive a mechanical stimulus
12
Q
What is the effector response?
A
The reaction to the mechanical stimulus to produce and assemble the necessary materials in the correct alignment for successful adaptation
13
Q
What are the two pathways ignited by integrin proteins with movement in a tendon?
A
- Involves the cytoskeleton in direct physical communication with the nucleus( tension on the cytoskeleton sends a physical signal to the cell nucleus)
- Integrin acting on a series of biochemical signaling agents which after a series of intermediate steps, influence gene expression in the nucleus
14
Q
What happens in the effector response once the cell nucleus receives the biochemical signals?
A
Normal cellular responses are engaged. mRNAs are transcribed and shuttled to the ER in the cell cytoplasm where is it translated into protein.
15
Q
What happens to the protein in the effector response?
A
It is secreted and incorporated into extracellular matrix, hence the mechanical stimulus on the outside of the cell, promotes intra-cellular processes, leading to matrix remodeling
16
Q
What are the characteristic responses of tissue to changes in the levels of physical stress?
A
- Maintenance of physical stress tolerance
- Increased physical stress tolerance
- Decreased physical stress tolerance
- Injury
- Death
17
Q
When does the maintenance of physical stress tolerance occur?
A
When the physical loading is maintained in typical ranges and results in no apparent tissue change
18
Q
When does the increase of physical stress tolerance occur?
A
When physical loading levels exceed maintenance range, but are still within adaptive capacity
19
Q
What mechanism does increase muscle toleance to an increase of physical stress tolerance occur?
A
Hypertrophy
20
Q
When does the decrease of physical stress tolerance occur?
A
When physical loading levels fall below maintenance range, resulting in decreased muscle tolerance in subsequent loading
21
Q
What mechanism does increase muscle tolerance to an decrease of physical stress tolerance occur?
A
Atrophy
22
Q
When does injury to tissues occur?
A
When physical loading levels exceed tissue tolerance beyond adaptive capacities
23
Q
What are the things that can lead to injury of tissues?
A
- High magnitude loads of brief durations
- Low magnitude loads of long duration
- Moderate magnitude loads of excessive frequency or duration
24
Q
Tissue injury results in ___ and initiation of the ___
A
Tissue injury results in tissue damage and initiation of the healing response
25
Tissue strain results in a structure with ____ and inflammation occurs, rendering tissue ____
Tissue strain results in *a structure with lower load tolerance and inflammation occurs, rendering tissue even less tolerant to loading*
26
Tissue death involves ___ exceeding the adult ultimate adaptive capacity of tissue in which there is a complete loss of tissue ___, ___, and ____
Tissue death involves *extreme physical loading levels* exceeding the adult ultimate adaptive capacity of tissue in which there is a complete loss of *tissue vitality, function and recovery ability*
27
What are the factors influencing the level of physical stress?
- Frequency
- Rate
- Duration
- Magnitude
- Type
28
What are the general effects fo prolonged stress deprivation/ immobilization?
- Loss of glycosaminoglycans (GAGs)
- Increased quantity collagen cross-links
- Randomized orientation of newly deposited collagen fibers
- Fatty fibrous infiltrations of edematous areas
- Pannus formation inside joints
- Generalized tissue atrophy
29
How do muscles adapt to immobilization in a shortened position?
- Decrease in number of sarcomeres with a compensatory increase in sarcomere length
- Increase in the amount of perimysium
- Thickening of endomysium
- Collagen fibril orientation becomes more circumferential
- Increase in ratio of connective tissue to muscle fiber tissue
- Loss of weight and muscle atrophy
30
How else do muscles adapt to immobilization in a shortened position?
- Adjusts sarcomeres to a length at which muscles is capable of developing maximal tension in immobilized position
- Displaces the length-tension relationship of the muscle so that maximum tension generated corresponds to immobilized position
- Muscle is able to generate maximal tension in the shortened position
- Muscle will not be able function effectively at joint it crosses immediately after cessation of the immobilization
31
How do muscles adapt to immobilization in a lengthened position?
- Fewer structural and functional changes than if immobilized in shortened position
- Increase in the number of sarcomeres resulting in a decrease in sarcomere length at the lengthened position
- Increased endomyseal and perimyseal connective tissue
- Muscle hypertrophy that may be followed by atrophy
- Increase in maximum tension-generating capacity
- Displacement of the length- tension curve to the longer immobilized position
32
What happens to tissues following prolonged immobilization and stress deprivation?
There is a decrease in adaptive abilities, with lower threshold for subsequent adaptation and injury due to prolonged low physical stress
33
What are the general effects of repeated stress exposure/ exercise?
- Tissues appear to respond favorably to gradual progressive loading by adapting to meet mechanical demands
- Responses vary among tissues and depends on nature of the stimulus
34
____ alters tissue structure and physiological function and has a direct effect on matrix alignment
*Exercise* alters tissue structure and physiological function and has a direct effect on matrix alignment
35
What does exercise lead to in tissues?
- Increased quantity of glycosaminoglycans
- Reduction of collagen cross links
- Functional orientation of collaged fibers in the connective tissues align accordingly to tissue stress
- Generalized tissue hypertrophy
- Increased load bearing capacity
36
What do glycosaminoglycans do?
Provide lubrication and maintain critical inner fiber distance between tissues
37
Exercise/ increased adaptive ability leads to ____ thresholds for subsequent adaptation an injury due to repeated stress exposure
Exercise/ increased adaptive ability leads to *elevated/increased* thresholds for subsequent adaptation an injury due to repeated stress exposure
38
____ forms the foundation for therapeutic preventative and restoration of exercise interventions
*Elevated/increased thresholds for subsequent adaptation an injury due to repeated stress exposure* forms the foundation for therapeutic preventative and restoration of exercise interventions
39
What is the response of bone to low, normal, high, and excessive physical stress?
- Low: Decreased bone mineral density and strength
- Normal: No change
- High: Increased bone mineral density and strength
- Excessive: Fracture
40
What is the response of cartilage to low, normal, high, and excessive physical stress?
- Low: Decreased proteoglycan content, thickness, and stiffness
- Normal: No change
- High: Increased proteoglycan content, thickness, and stiffness
- Excessive: Tear or degeneration
41
What is the response of ligament to low, normal, high, and excessive physical stress?
- Low: decreased cross sectional are, stiffness, and strength
- Normal: No change
- High: increased cross sectional are, stiffness, and strength
- Excessive: Sprain
42
What is the response of tendon to low, normal, high, and excessive physical stress?
- Low: decreased cross sectional are, stiffness, and strength
- Normal: No change
- High: increased cross sectional are, stiffness, and strength
- Excessive: Strain
43
What is the response of muscle to low, normal, high, and excessive physical stress?
- Low: decreased contractile protein, fiber diameter, peak tension, and peak power
- Normal: No change
- High: Increased contractile protein, fiber diameter, peak tension, and peak power
- Excessive: Strain
44
What is the response of neurons to low, normal, high, and excessive physical stress?
- Low: Decreased maximum discharge rate, increased recruitment threshold, decreased activation with maximum voluntary contraction, loss of neurons
- Normal: No change
- High: Inc maximum discharge rate, dec recruitment threshold, inc activation with maximum voluntary contraction, inc motor unit synchronization, inc dendritic arborization, inc serotonergic neural activity, inc synaptic transmission, and neurogenesis
- Excessive: Axonal demyelination and degeneration
45
What is the response of the heart to low, normal, high, and excessive physical stress?
- Low: dec cardiac muscle mass, capillary density, and stroke volume
- Normal: no change
- High: Inc cardiac muscle mass, capillary density, metabolic capacity, and stroke volume
- Excessive: Fibrosis, aneurysm, ventricular hypertrophy
46
What is the response of the blood vessels to low, normal, high, and excessive physical stress?
- Low: Dec vascular diameter and arterial compliance
- Normal: no change
- High: Inc vascular diameter and arterial compliance
- Excessive: Fibrosis, and aneurysm
47
What is the response of the skin to low, normal, high, and excessive physical stress?
- Low: Dec collagen content, collagen fiber diameter, strength, and thickness
- Normal: No change
- High: Inc collagen content, collagen fiber diameter, strength, and thickness
- Excessive: Abrasion or wound
48
What are the movement factors influencing tissue tolerance for physical stress?
- Muscle performance (force generation, muscle length)
- Motor control
- Postural alignment
- Physical activity
- Occupational, leisure and self care activities
49
What are the physiological factors influencing tissue tolerance for physical stress?
- Medication
- Systemic pathology
- Obesity
- Age
50
What are the psychological factors influencing tissue tolerance for physical stress?
- Depression
- Anxiety
- PTSD
51
What are the extrinsic factors influencing tissue tolerance for physical stress?
- Orthotic devices, taping, and AD
- Footwear
- Ergonomic environment
52
What are the age related changes in bone?
- Progressive loss of bone density
- Reduction in collagen cross linking
- Decrease in overall amount of bone tissue
- Slight decrease in size
- Decrease in strength and stiffness
- Increased brittleness
- Reduction of bone toughness
- Increased fragility
53
What are the age related changes in cartilage?
- Water content decreases
- Decrease in size of hydrodynamic aggrecan
- Changes in proteoglycan population that could be considered part of accumulated tissue damage
- Can contribute to vicious cycle of degenration
54
What are the age related changes in ligament and tendon?
- Number and quality of cross links increase beyond ideal level resulting in reduced tensile strength and stiffness
- Overall decrease in collagen fibril diameter
- Increased collagen fibril concentration through reduced water content
- Changes in active differentiated fibrocytes
- Reduced ability of growth factors to induce fibroblastic activity necessary to maintain tissue health and recover from injury
55
What do the changes in active differentiated fibrocytes include?
Including reduction in quantities, and alteration in their structure, reduction in inter-cellular communication and a reduced capacity for the mechanotransduction needed for collagen production and maturation
56
With age, fiber ___ and ____ changes
With age, fiber *number and type* changes
57
____ which is a loss of muscle mass results with aging
*Sarcopenia* which is a loss of muscle mass results with aging
58
Sarcopenia occurs through ___
Sarcopenia occurs through * a decrease in the size of the existing muscle fibers and the loss of muscle fibers
59
There is a ____ of proportion of fiber types with inactivity with age
There is a *alteration* of proportion of fiber types with inactivity with age
60
There is a gradual decrease in the number of type ___ fibers and a relative increase with type __ fibers with age
There is a gradual decrease in the number of type *2* fibers and a relative increase with type *1* fibers with age
61
The quantity of ___ decreases and the remaining ones have a higher number of fibers
The quantity of *motor units* decreases and the remaining ones have a higher number of fibers
62
The amount of connective tissue within extracellular matrix ___ with aging
The amount of connective tissue within extracellular matrix *increases* with aging
63
The increase in the amount of connective tissue within extracellular matrix with aging, may contribute to ___
- Contribute to decreased ROM
| - Contribute to increased muscle stiffness
64
How does aging change muscle function?
- Decreased muscle strength
| - Decreased muscle power which may ultimately contribute to falls
65
Tissue injury results in ___
Tissue injury results in *tissue damage and initiation of healing process*
66
What are the types of soft tissue injury?
- Strain
- Sprain
- Subluxation
- Dislocation
- Synovitis
- Hemarthrosis
- Ganglion
- Bursitis
- Contusion
67
What is a strain?
An over stretching, over exertion, or over use of soft tissue
68
The term strain is mostly used to refer specifically to ___
The term strain is mostly used to refer specifically to *some degree of disruption to the muscular tendinous unit*
69
What is a sprain?
A more severe stress, stretch or tear of soft tissues
70
The term sprain is most frequently used specifically to refer to ____
The term sprain is most frequently used specifically to refer to *an injury of a ligament*
71
What is a subluxation?
An incomplete or partial dislocation of the bony points of a joint that often involves secondary trauma to their surrounding soft tissue
72
What is a dislocation?
Usually in the bony points of a joint results in a loss of the normal anatomic relationships and leads to soft tissue damage, inflammation, pain, and muscle spasm
73
What is a synovitis?
A condition that involves inflammation of a synovial membrane, leading to an excess of normal synovial fluid in a joint or tendon sheath
74
What are the possible causes of synovitis?
Trauma or disease
75
What is hemarthrosis?
A condition that involves bleeding into a joint which is usually due to severe trauma
76
What is a ganglion?
A condition that involves the ballooning of the wall of the joint capsule or tendon sheath that may arise after trauma and sometimes occur with rheumatoid arthritis
77
What is a bursitis?
Inflammation of a bursa
78
What is a contusion?
A condition that involves bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory process
79
What is an arthropathy?
A general term that refers to joint pathology
80
Arthritis involves ___
Arthritis involves *inflammation of a joint*
81
Arthrosis involves ___
Arthrosis involves *degeneration of the cartilage of a joint often due to repetitive micro-trauma*
82
What are the two types of arthropathy?
- Arthritis
| - Arthrosis
83
What is a tendinopathy?
The general term that refers to tendon pathology
84
What are the types of tendinopathy?
- Tenosynovitis
- Tendinitis
- Tenovaginitis
- Tendinosis
85
What is tenosynovitis?
Inflammation of the synovial membrane covering a tendon
86
What is tenovaginitis?
Inflammation with thickening of a tendon sheath
87
What is tendinitis?
A condition involving inflammation of a tendon
88
What is tendinosis?
Degeneration of the tendon due to repetitive micro-trauma
89
When does a rupture/tear cause pain?
When the muscle undergoes a partial rupture or tear
90
Grade 1 (first degree) injury of a soft tissue injury occurs with...?
Disruption of small percentage of total number of fibers
91
What are the presentations of a grade 1 (first degree) soft tissue injury?
- Mild pain 0-24 hours after injury
- Mild swelling may occur
- Local tenderness and local pain with stress
92
What are the presentations of a grade 2 (second degree) soft tissue injury?
- Partial tear of structure
- Moderate pain leading to halt of activity
- Stress and palpation elicits increased pain
- When ligaments involved, results in some increased joint mobility
93
What are the presentations of a grade 3 (third degree) soft tissue injury?
* Near-complete to complete tear or avulsion
* Severe pain
* Stress to tissue is painless
* Anatomic defects palpable
* When ligaments involved, results in joint instability
94
What is hemostasis?
Arrest of bleeding primarily through physiological processes of vasoconstriction and coagulation so that blood is transformed from fluid to solid state
95
What are the two processes of soft tissue healing?
- Regeneration
| - Repair
96
What is regeneration?
Process by which lost tissue is replaced by tissue of same morphological and functional characteristics
97
What is repair?
Process by which lost tissue is replaced by granulation tissue that forms into a mature scar
98
What are the cardinal signs of inflammation?
- Redness
- Warmth
- Swelling
- Pain at rest
- Loss of function
99
Where does regeneration of soft tissue occur?
In the cells of the epidermis, gastro-intestinal, gastro-urinary, respiratory tracts, and bone marrow
100
In ideal conditions, regeneration can occur in cells of the ___, ___, ___ and pancreas as well as with fibroblast, osteocytes, and endothelial cells and chndrocytes
In ideal conditions, regeneration can occur in cells of the *endocrine glands, the liver, kidney* and pancreas as well as with fibroblast, osteocytes, and endothelial cells and chndrocytes
101
Where does regeneration not occur?
Neurons, cells of the lens of the eye, cardiac muscle cells, and differentiated skeletal muscle cells
102
____ is the predominant healing process through which soft tissue in the MSK system undergo recovery
*Repair* is the predominant healing process through which soft tissue in the MSK system undergo recovery
103
What are the 3 phases of the repair process?
- Inflammatory
- Proliferative
- Maturation
104
What phase of healing is hemostasis?
The inflammation phase
105
___is crucial in precipitating the inflammatory response
*Hemostasis* is crucial in precipitating the inflammatory response
106
Damage to blood vessels and connective tissue cause ___ and ___ which releases endothelial cells, prostoglandins, and coagulation factor: thrombin
Damage to blood vessels and connective tissue cause *bleeding and exposure collagen endothelium* which releases endothelial cells, prostoglandins, and coagulation factor: thrombin
107
What does thrombin and the exposed collagen endothelium do?
They stimulate platelet activation
108
What do platelets do?
They bind to expose collagen and release fibronectin, which further stimulates platelet aggregation
109
Platelets release ___
Platelets release *growth factors that facilitate cell proliferation, attraction of white blood cells and stem cells, cell differentiation and angioneogenesis*
110
____ growth factor recruits fibroblast to the injured tissue and activates the production of collagen and glycoseminoglycans that are crucial for the repair of extra-cellular matrix
*Platelet derived* growth factor recruits fibroblast to the injured tissue and activates the production of collagen and glycoseminoglycans that are crucial for the repair of extra-cellular matrix
111
Platelets release non growth factor, ____ that increase capillary permeability, attract and activate microphages, induce tissue modulation and regeneration, and facilitate vasoconstriction
Platelets release non growth factor, *cytokines* that increase capillary permeability, attract and activate microphages, induce tissue modulation and regeneration, and facilitate vasoconstriction
112
Thrombin also converts coagulation factor ____ into fibrin with forms an inter-lacing lattice at the site of bleeding to promote clot formation
Thrombin also converts coagulation factor *fibronigen* into fibrin with forms an inter-lacing lattice at the site of bleeding to promote clot formation
113
Hemostasis is usually achieved under what time?
6-8 hours
114
Tissues that are highly vascularized or has sustained extensive damage may continue to bleed for how long following the onset injury?
1-2 days
115
Cytokines and growth factors released during the achievement of hemostasis facilitate the initiation of the ___
Cytokines and growth factors released during the achievement of hemostasis facilitate the initiation of the *inflammatory response*
116
___ stimulate vasodilation and increase permeability of capillaries, promote leakage of intra-vascular fluid, and cell migration into the area of injury and facilitate the local delivery of chemical mediators of the inflammatory process
*Cytokines* stimulate vasodilation and increase permeability of capillaries, promote leakage of intra-vascular fluid, and cell migration into the area of injury and facilitate the local delivery of chemical mediators of the inflammatory process
117
What do leukocytes do in the healing process?
They infiltrate the area and activate with the response, peaking within 2-3 hrs following the injury and lasting up to 2weeks.
118
Leukocyctes include ____ and ____
Leukocyctes include *neutrophils and microphages*
119
Why are leukocytes recruited to the area of injury?
In order to degrade and remove neucrotic tissue and microbes that might have invaded it
120
The process of degradation of that is done by leukocytes is called _____
The process of degradation of that is done by leukocytes is called *phagocytosis*
121
___ plays a significant role in the repair of damaged tissue, by releasing anti-inflammatory properties
*Macrophages* plays a significant role in the repair of damaged tissue, by releasing anti-inflammatory properties
122
How long does the inflammation phase usually last?
4-6 days
123
The inflammation response peaks in ___ hrs and lasts up to __ weeks following the initial injury
The inflammation response peaks in *2-3hrs and lasts up to 2 weeks* following the initial injury
124
What are the primary goals for intervention in the inflammatory/acute phase of healing?
* Control effects of inflammation
* Facilitate wound healing
* Maintain normal function in unaffected tissues and body regions
125
What are the patient education actions that should be taken during the inflammatory/acute phase of healing?
* Expectations for the inflammation phase of healing
* Activity recommendations
* Precautions and contraindications
* Reassurance that the phase is necessary
126
How should the site of injury be protected during the inflammatory/ acute phase of healing?
* Relative rest
* Possible supportive or adaptive devices
* Reduction of swelling
127
What are the movement interventions that should be done during the inflammatory/ acute phase of healing?
* Controlled passive movement
* Tissue-specific activities
* General active movement of neighboring regions
128
What are the primary goals for intervention in the proliferation/subacute phase of healing?
• Initiation of active movement
• Progression of activities within
tolerance of healing tissues
• Management of pain and inflammation
129
Controlled passive movements may be used to promote ___ while preventing
Controlled passive movements may be used to promote *the development of organized scar while preventing *disruption of tissue fibrils forming at the site of healing*
130
Tissue specific activities may be appropriate with ___
Tissue specific activities may be appropriate with *general joint motion when articular structures are involved and general muscle setting when musculo-tendinous structures are involved*
131
General active movement of neighboring regions is appropriate to maintain the ___ as well to aid in circulation an lymphatic flow
General active movement of neighboring regions is appropriate to maintain the integrity of *uninjured tissues as well to aid in circulation an lymphatic flow*
132
The proliferation phase overlaps into the inflammation phase due to the dual role of the ____ as they act first in phagocytosis and then in the release of anti-inflammatory mediators
The proliferation phase overlaps into the inflammation phase due to the dual role of the *macrophages* as they act first in phagocytosis and then in the release of anti-inflammatory mediators
133
At the proliferation phase noxious stimuli are ___ and ____ begin to grow into the are
At the proliferation phase noxious stimuli are *removed and capillary beds* begin to grow into the are
134
____ is a hallmark of the proliferation phase
*Fibroblast* is a hallmark of the proliferation phase
135
Fibroblast are initially brought to the area of injury by ___
Fibroblast are initially brought to the area of injury by *platelets*
136
_____ and ____ release growth factors to perpetuate the migration of further fibroblast into the injured area
*Macrophages and fibroblast themselves* release growth factors to perpetuate the migration of further fibroblast into the injured area
137
Through the proliferation of fibroblast, large amounts of ____ are produced with a laying down of the collagen fibers and the development of ____ tissue
Through the proliferation of fibroblast, large amounts of *extra-cellular matrix* are produced with a laying down of the collagen fibers and the development of *granulation* tissue
138
During the proliferation phase, the immature connective tissue that is produced is ___ and _____. It is extremely fragile and easily _____ if stressed excessively
During the proliferation phase, the immature connective tissue that is produced is *thin and unorganized.* It is extremely fragile and easily *injured* if stressed excessively
139
How can proper growth and alignment of connective tissue be stimulated in the proliferation phase?
It can be stimulated by appropriate tensile loading in the line of normal stress for the tissue
140
_____ is characteristic of the proliferation phase
*Contraction* is characteristic of the proliferation phase
141
Contraction of the wound involves inward movement of wound edges by the action of ____
Contraction of the wound involves inward movement of wound edges by the action of *myo-fibroblast*
142
_____ appear at the wound site at about 5 days after the injury and becomes prominent over the next few days.
*Myo-fibroblast* appear at the wound site at about 5 days after the injury and becomes prominent over the next few days.
143
What does the process of contraction do?
It reduces the size of the wound by as much as 70%
144
Wound closure usually takes up to 5-8days in ___ and ___, and 3-6 weeks in ___ and ___
Wound closure usually takes up to 5-8days in *muscle and skin, and 3-6 weeks in tendons and ligaments*
145
When does the proliferation phase usually begin?
Within 24-48 hours of injury
146
When does the proliferation phase hit its peak?
Between 2 and 3 weeks following injury
147
The proliferation phase may last up to ___
The proliferation phase may last up to *6 weeks*
148
During the proliferation phase, tissues are gaining ___, but remain fragile
During the proliferation phase, tissues are gaining *integrity*, but remain fragile
149
Intervention provided during the proliferation phase should include patient education, which include ____
- Expectations
- Progression of activities
- Indications of excessive tissue stress
150
What are signs of excessive tissue stress?
* Exercise or activity soreness that does not decrease after a few hours and is not resolved after 24 hours
* Exercise or activity pain that comes on earlier or is increased over the previous session
* Progressively increased feelings of stiffness and decreased ROM over several exercise sessions
* Swelling, redness, and warmth in the healing tissue
* Progressive weakness over several exercise sessions
* Decreased functional use of the involved part
151
What are the movement interventions for the proliferation phase?
* Initiation of active exercise
* Isometrics
* AROM
* Muscular endurance
* Resistive exercise
* Flexibility
* Continuous monitoring of patient response
152
___ and ___ cleave and degrade early collagen fibers comprised primarily of Type III collagen, the newly deposited collagen fibers comprise of ___ collagen
*Collagenases and proteases* cleave and degrade early collagen fibers comprised primarily of Type III collagen, the newly deposited collagen fibers comprise of *Type I* collagen
153
Maturation of a wound occurs as ____
Maturation of a wound occurs as *collagen fibers become thicker and re-orient in response to stresses placed on the connective tissue*
154
Remodeling time is affected by factors that affect the ____
Remodeling time is affected by factors that affect the *density, and activity levels of fibroblast, including the amount of time to be mobilized, stress placed on the tissue, location of the lesion, and vascular supply*
155
An old scar has a poor response to ___
An old scar has a poor response to *stretch*
156
If the tissue is not appropriately stressed during healing, what happens to it?
The tissue becomes disorganized, doesnt get remodeled properly and as a result forms a scar that can only be addressed with active stretching or surgery
157
When does the maturation phase begin and how long does it last?
Begins within days after injury and lasts for more than a year, depending on the tissue involved and the amount of tissue damage
158
What is the percentage of tissue strength 1 week following injury?
3% of normal tissue
159
What is the percentage of tissue strength 3 week following injury?
30% of normal tissue
160
What is the percentage of tissue strength 3 months following injury?
80% of normal tissue
161
True or false
Injured tissue can go back to the quality of uninjured tissue
False.
Ultimately, injured tissue can never go back to the quality of uninjured tissue
162
The ability to closely approximate uninjured tissue is dependent upon ____
The type of tissues involved, the size, location, and type of injury, the healing environment provided, and the patient's overall health including their nutritional status
163
What are the primary goals for intervention during the maturation phase?
* Design progression of exercise to safely stress healing tissues
* Facilitate return to functional activities
164
Intervention provided during the maturation phase should include patient education, which include ____
* Expectations
* Progression of activities
* Guidelines for return to functional activities
165
What are the movement interventions for the maturation phase?
* Progression of exercise
* Flexibility
* Motor control
* Muscle performance
* Proprioception
* Endurance
* Functional progression
* Activity-specific drills
166
What are the factors that affect healing?
- Injury
- TIssue type
- Patient
167
Factors that affect the healing process act as either ____ or ____ of the healing process
Factors that affect the healing process act as either *facilitators or inhibitors* of the healing process
168
What are the patient characteristics that may affect healing?
```
Genetics
Age
Nutrition
General fitness
Medical comorbidities
Psychosocial status
Lifestyle factors
```
169
Muscle and tendon exhibit ____ healing potential and ______ of injury for healing
Muscle and tendon exhibit *excellent* healing potential and *uniformity* of injury
170
Extra-articular ligament exhibits ____ healing potential primarily due to their ____ blood supply, and ____ environment for healing
Extra-articular ligament exhibits *excellent* healing potential, primarily due to their *excellent* blood supply, and *good* environment for healing
171
Intra-articular ligament exhibits ____ healing potential primarily due to their ____ blood supply, and ____ environment for healing that exist within ___ joints
Intra-articular ligament exhibits *lower* healing potential, primarily due to their *poor* blood supply, and *hostile* environment for healing that exist within *synovial* joints
172
Articular cartilage exhibit ___ blood supply, so healing potential is _____ and heals as ____
Articular cartilage exhibit *no* blood supply, so healing potential is *particularly limited* and heals as *fibrocartilage*
173
The blood supply for fibrocartilage is ____ and it repair is ___
The blood supply for fibrocartilage is *varied based on the location* and it repair is *technically difficult*
174
Which exhibits greater healing, articular cartilage or fibrocartilage?
Fibrocartilage
175
What are the injury characteristics that may affect healing?
- Mechanism of injury
- Quantity of tissue involved
- Quality of injury site
176
What are the modulators of injury progression?
- Tissue healing
- Functional abilities
- Patient goals
- Patient behaviors
177
Who is responsible for monitoring the status and responding appropriately during the uphill climb of recovery?
The patient and the provider
178
What happens to tissue that is repetitively stressed beyond the ability to repair itself?
The inflammatory process is perpetuated. {chronic inflammation}
179
Proliferation of fibroblast with increased collagen production and degradation of mature collagen leads to a ____ which has an overall ____ effect on the tissue
Proliferation of fibroblast with increased collagen production and degradation of mature collagen leads to a *predominance of new immature collagen* which has an overall *weakening* effect on the tissue
180
During chronic inflammation, mybo-fibroblast of the activity continues, which may lead to ____
During chronic inflammation, mybo-fibroblast of the activity continues, which may lead to *progressive limitations in tissue mobility*
181
Efforts to stretch inflammed tissue _____
Efforts to stretch inflammed tissue *perpetuate irritation and progressive limitation*
182
Cumulative trauma disorder/ overuse syndromes/ repetitive strain injury result from ____ occurring from ___ and eliciting a _____
Cumulative trauma disorder/ overuse syndromes/ repetitive strain injury result from *repeated submaximal loading and or frictional wear occurring from frequency and/or duration beyond adaptive capabilities eliciting a chronic inflammatory response*
183
Prolonged or recurrent pain and functional limitations may occur as a result of ____
Prolonged or recurrent pain and functional limitations may occur as a result of *stress, being imposed on tissues that are unable to respond to the repetitive or prolonged nature of the stress*
184
What are the contributing factors to cumulative trauma disorders?
- Musculoskeletal impairments
- Neuromuscular impairments
- Structural alignment
- Environmental features
- Activity demands
185
The musculoskeletal impairments that contribute to cumulative trauma disorders are
- Muscle length
- Muscle strength
- Muscle power
- Joint mobility
186
The neuromuscular impairments that contribute to cumulative trauma disorders are
- Motor control
| - Proprioception
187
_____ can be particularly relevant to the occurrence of cumulative trauma disorders, such that they involve changes in the usual intensity or demands of an activity such as an increase of change in an exercise training routine or change in job demands.
*Activity demands* can be particularly relevant to the occurrence of cumulative trauma disorders, such that they involve changes in the usual intensity or demands of an activity such as an increase of change in an exercise training routine or change in job demands.
188
Activity demands may also include training errors such as ____ which lead to abnormal stresses.
Activity demands may also include training errors such as using *improper methods, intensity, amount or equipment or the condition of the participant* which lead to abnormal stresses
189
Activity demands could also involve returning to an activity too soon after an injury when the injured tissues are ____ and not ready for the stress of the activity or sustained awkward postures or motions placing the body at a _____ leading to postural fatigue or injury. Often there is a combination of several factors
Activity demands could also involve returning to an activity too soon after an injury when the injured tissues are *weakened* and not ready for the stress of the activity or sustained awkward postures or motions placing the body at a *mechanical disadvantage* leading to postural fatigue or injury. Often there is a combination of several factors
190
What are the guidelines for rehabilitation of cumulative trauma syndromes in the acute stage?
* Manage contributing factors
* Control inflammation
* Non-stressful activities
191
What are the guidelines for rehabilitation of cumulative trauma syndromes in the subacute stage?
* Manage contributing factors
* Controlled stresses
* Continual monitoring to access for excessive tissue loading
192
What are the guidelines for rehabilitation of cumulative trauma syndromes in the chronic stage?
* Manage contributing factors
* Progression of stresses
* Development of endurance
193
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
194
What is a fracture?
A structural break in the continuity of bone,
| epiphyseal plate, or cartilaginous joint surface
195
When there is a fracture, some degree of injury also occurs to the ____
When there is a fracture, some degree of injury also occurs to the *soft tissue surrounding the bone*
196
Depending on the side of the fracture, the damage could be serious there there is damage of any _____ or _____ involved
Depending on the side of the fracture, the damage could be serious there there is damage of any *vein or artery* involved
197
What are the things that could be involved in a fracture of the skull, spine, ribs or pelvis?
The brain, spinal cord or viscera
198
Osteoporosis is a disease process that involves __
Osteoporosis is a disease process that involves *a loss of bone mass*
199
What are the risk factors for a fracture?
- Osteoporosis
- Sudden impact
- History of falls
200
In what gender do osteoporosis occur more commonly?
Females
201
History of falls is a risk factor for a fracture especially with ____
- Increased age
| - Low body mass of physical activity
202
What are the fracture sites in a bone?
- Diaphyseal
- Metaphyseal
- Epiphyseal
- Intra-articular
203
A diaphyseal fracture involves the ____
A diaphyseal fracture involves the *shaft or diaphyses of a long bone*
204
A metaphyseal fracture involves the ____ which contains the ____ of the bone
A metaphyseal fracture involves the *metaphysis, which contains the *growth plate* of the bone
205
An epiphyseal fracture involves the ____
An epiphyseal fracture involves the *epiphysis or rounded end of a long bone*
206
An intra-articular fracture involves the ____
An intra-articular fracture involves the *surface of a bone within a joint*
207
What are the orientations in reference to the long axis of bone in which fractures can be defined?
- Transverse
- Longitudinal
- Oblique
- Spiral
208
What are the positions of a fracture fragment in which a fracture can be described?
- Non displaced
- Medial displacement
- Lateral displacement
- Distracted
- Overriding with posterior and superior displacement
- Distracted and rotated laterally
209
Fractures are described by how the ___ fragment displaces on the ___ fragment
Fractures are described by how the *distal* fragment displaces in the *proximal* fragment
210
Fractures can be described as comminuted when ___
Fractures can be described as comminuted when *two or more fragments result*
211
What are some frequently comminuted fractures?
- Wedge shaped
| - Butterfly pattern
212
What are some additional fracture identifiers?
- Extent
- Relationship to environment
- Complications
213
How is the extent a fracture identifier?
Whether it is complete or incomplete
214
How is the relationship to the environment a fracture identifier?
Whether it is closed whee the skin is intact or open where the skin is penetrated
215
How is the complications a fracture identifier?
- Local
- Systemic
- Related to injury
216
What is an avulsion fracture?
When a fragment of bone tears away from
| the larger mass of bone through the pull of ligament or tendon upon the bone
217
A compression fracture most commonly occurs in ____ bone and is a result of ____ or ____ force
A compression fracture most commonly occurs in *cancellous/spongy* bone and is a result of *crushing or compressive force*
218
What is the characteristic of a compression fracture in the vertebral body?
A loss of height
219
A stress/fatigue fracture can result in ____
A stress/fatigue fracture can result in *bone unaccustomed to repetitive stress leading to cumulative trauma*
220
A pathological fracture occurs when ___
A pathological fracture occurs when *abnormal bone is subject to a normal force*
221
A weakened bone can result from ____
A weakened bone can result from *osteoporosis, bony tumor or other diseases affecting the integrity of bone*
222
What are the clinical presentations of a fracture?
- History of trauma
- Localized pain aggravated by movement or weight bearing
- Muscle guarding with passive movement
- Decreased function of the involved body part
- Swelling
- Possible deformity
- Abnormal movement
- Sharp, localized tenderness with palpation
223
Repetitive micro trauma can lead to fracture via ____ and in such cases, clinician should listen for history involving ____
Repetitive micro trauma can lead to fracture via *fatigue* and in such cases, clinician should listen for history involving *a rapid increase in a repetitive rapid activity occurring over a very short time frame*
224
In the inflammatory phase of fracture healing, there is ____ formation and ___ proliferation
In the inflammatory phase of fracture healing, there is *hematoma formation and cellular proliferation*
225
What happens when the dense cortical bone of the shaft of the long bone is fractured?
The tiny blood vessels are torn at the site of fracture resulting in internal bleeding followed by normal clotting
226
The amount of bleeding depends on the _____ and ____
The amount of bleeding depends on the *degree of fracture displacement and the amount of soft tissue in the region*
227
The inflammatory phase of fracture healing is followed by the _____ phase, which there is ____ formation uniting the breach and ossification
The inflammatory phase of fracture healing is followed by the *reparative* phase, which there is *callous* formation uniting the breach and ossification
228
The early stages of healing takes place in the _____
The early stages of healing takes place in the hematoma
229
Osteogenic cells proliferate from the ___ and _____ to form a thick callous which envelops the fracture site
Osteogenic cells proliferate from the *periosteum and endiosteum* to form a thick callous which envelops the fracture site
230
At the reparative phase, the callous formed does not contain ____ and is therefore radiolucent
At the reparative phase, the callous formed does not contain *bone* and is therefore radiolucent
231
As the callous starts to mature, the osteogenic cells differentiate into ____ and _____
As the callous starts to mature, the osteogenic cells differentiate into *osteoblast and chondroblast*
232
Initially the chondroblast form ____ near the fracture site and the osteoblast forms ____
Initially the chondroblast form *cartilage* near the fracture site and the osteoblast forms *primary woven bone*
233
What is the final phase of fracture healing?
The remodeling phase
234
In the remodeling phase, there is ___ and remodeling of the bone
In the remodeling phase, there is *consolidation* and remodeling of the bone
235
When the fracture site is strong enough to where it no longer moves, it is ____
When the fracture site is strong enough to where it no longer moves, it is *clinically united/clinical union*
236
Clinical union occurs when ___
Clinical union occurs when *the temporary callous consisting of the primary woven bone and cartilage surrounds the fracture site, the callous gradually hardens as cartilage ossifies*
237
Is mobilization required in the remodeling phase?
No
238
A stage of radiological union occurs when ___
A stage of radiological union occurs when *bone considered to be radiographically healed or consolidated when the temporary callous has been replaced with mature lamellar bone*
239
When sponge like lattice of trabeculae of cancellous bone fractures, as in the metaphyses of long bones and bodies of short and flat bones, healing occurs primarily through the ____
When sponge like lattice of trabeculae of cancellous bone fractures, as in the metaphyses of long bones and bodies of short and flat bones, healing occurs primarily through the *formation of an internal callous*
240
Why is union more rapid in cancellous bone than in dense cortical bone?
There is rich blood supply and a large area of bony contact
241
If a fracture involves the ____ of a skeletally immature individual, there may be growth disturbances and bony deformity as the skeleton continues to mature
If a fracture involves the epiphyseal plate of a skeletally immature individual, there may be growth disturbances and bony deformity as the skeleton continues to mature
242
The prognosis for growth disturbance depends on the what factors?
- Type of injury
- Age
- Blood supply to the epiphysis
- Method of reduction
- Whether or not the injury is open or closed
243
What does healing time depend on?
- Age
- Location of fracture
- Type of fracture
- Blood supply to fragment
- Whether the bone was displaced
244
What is the general bone healing time for children?
4-6 weeks
245
What is the general bone healing time for adolescents?
6-8 weeks
246
What is the general bone healing time for adults?
10-18 weeks
247
____ typically necessary for bone healing
*Mobilization* typically necessary for bone healing
248
The choice of device and gait pattern for a fracture depends on the ____
The choice of device and gait pattern for a fracture depends on the *fracture site, type of mobilization, and the functional capabilities of the patient*
249
Peripheral nerve injury may result in ___
Peripheral nerve injury may result in *motor, sensory, and or sympathetic function impairment*
250
____may be a symptom associated with nerve injury
*Pain* may be a symptom associated with nerve injury
251
What are the two primary mechanism as to why pain will be associated with a nerve injury?
- Involvement of the connective tissue and vascular structures surrounding and in the peripheral nerves
- Alterations in impulse conduction brought about by excess mechanical loading in the presence of inflammation can contribute to symptoms such as burning, tingling and shock like continuous pain
252
What are the mechanisms of nerve injury?
- Compression (external or internal)
- Laceration
- Stretch
- Radiation
- Electricity
253
Bio-mechanical injury to the peripheral nervous system most commonly occurs as a result of ___ and ____
Bio-mechanical injury to the peripheral nervous system most commonly occurs as a result of *compression and stretch*
254
What is an intra-neural pathology?
An injury that affects the conducting tissues or connective tissues that make up the nervous cell
255
What is an extra-neural pathology?
An injury that affects the nerve bed, adhesions of epineurium to another tissue, and swelling of adjacent tissue that may result in restricted gross movement of the nervous system in relation to surrounding tissues
256
What are the classification systems of nerve injury?
- Seddon classification
| - Sunderland classification
257
The two classification systems of nerve injury are based on ___
The two classification systems of nerve injury are based on *structural and functional changes that occur in the nerve with various degrees of damage*
258
The two classification systems of nerve injury are describe the ___
The two classification systems of nerve injury are describe the *degree of injury to nerve sub- structures and their effect on prognosis*
259
What are the 3 levels of pathology in the seddon classification?
- Neuropraxia
- Axonotmesis
- Neurotmesis
260
Neuropraxia results from ___
Neuropraxia results from *mild ischemia from compression or traction*
261
Axonotmesis results from ___
Axonotmesis results from *prolonged compression or stretch causing infarction and necrosis*
262
Neurotmesis results from ___
Neurotmesis results from *laceration, avulsion, or rupture*
263
Neuropraxia results in ____
Neuropraxia results in *segmental demyelination with action potentials slowed or blocked at the point of demyelination although they are normal above and below the point of compression*
264
In neuropraxia, muscles do not ____, sensory symptoms are ___ and recovery is usually ___
In neuropraxia, muscles do not *atrophy*, sensory symptoms are *temporary* and recovery is usually *complete*
265
Axonotmesis results in ____
Axonotmesis results in *a loss of axonal continuity, the connective tissue coverings remain intact*
266
What is wallerian degeneration?
Degeneration of the axon within the myelin sheath
267
Wallerian degeneration occurs ___ to the axonotmesis lesion
Wallerian degeneration occurs *distal* to the axonotmesis lesion
268
In axonotmesis, muscles ____, and sensory ___ occur and recovery is ____ and surgical intervention may be required
In axonotmesis, muscles *atrophy*, and sensory *loss* occur and recovery is *incomplete* and surgical intervention may be required
269
Neurotmesis results in ____
Neurotmesis results in *complete severance of nerve fiber occurs along with a disruption of connective tissue coverings*
270
Wallerian degeneration occurs ___ to the neurotmesis lesion
Wallerian degeneration occurs *distal* to the neurotmesis lesion
271
In neurotmesis, muscles ____, and sensory ___ occur and recovery is ____
In neurotmesis, muscles *atrophy*, and sensory *loss* occur and recovery is*non-existent without surgery*
272
What are the levels of injury in the sunderland classification?
1-5 degrees of injury
273
What is expected in the 1st degree of injury in the sunderland classification and what does it parallel with in the seddon classification?
Involves minimal structural disruption with complete recovery expected
Parallels Neuropraxia
274
What is expected in the 2nd degree of injury in the sunderland classification and what does it parallel with in the seddon classification?
Involves complete axonal disruption with wallerian degeneration. Complete recovery is expected
Parallels with Axonotmesis
275
What is expected in the 3rd degree of injury in the sunderland classification and what does it parallel with in the seddon classification?
Involves disruption of the axon and endoneurium and there is a poor prognosis without surgery
Parallels with with Axonotmesis or Neurotmesis
276
What is expected in the 4th degree of injury in the sunderland classification and what does it parallel with in the seddon classification?
Involves disruption of axon, endoneurium and perineurium and there is a poor prognosis without surgery
Parallels with Neurotmesis
277
What is expected in the 5th degree of injury in the sunderland classification and what does it parallel with in the seddon classification?
Involves complete structural disruption of the nerve and is associated with poor prognosis without micro-surgery
Parallels with Neurotmesis
278
What are the factors that the recovery of a nerve is dependent upon?
- Nature of injury
- Level of injury
- Timing and technique of surgical repair
- Regenerative potential of nerve involved
- Age and motivation of patient
279
Regeneration of nerve occurs at a rate of ___
Regeneration of nerve occurs at a rate of *1 inch/ month, 0.5-9mm/day*
280
The regeneration of nerve is based on ___
- Nature and severity of injury
- Duration of denervation
- Condition of the tissues
- Whether surgery is required
281
What nerves typically exhibit excellent regenerative potential?
- Radial
- Muscular
- Cutaneous
- Femoral
282
What nerves typically exhibit moderate regenerative potential?
- Median
- Ulna
- Tibial
283
The common fibular nerve and its branches exhibit ___ regenerative potential
The common fibular nerve and its branches exhibit *poor* regenerative potential
284
What are the outcomes of nerve regeneration?
- Exact reinnervation of its native target organ with return of function
- Exact reinnervation of its native target organ but no return of function due to degeneration of the end organ
- Wrong receptor reinnervated in the proper territory; therefore, improper input results
- Receptor reinnervation in wrong territory causing false localization of input
- No connection with an end organ
285
What are the 3 phases of nerve injury recovery?
- Acute phase
- Recovery phase
- Chronic phase
286
What is the main emphasis on in the acute phase of nerve injury recovery?
Healing and prevention of complications
287
Why might there be a period of immobilization in the acute phase of nerve injury recovery?
To protect the nerve, minimize inflammation, and minimize tension at the injured site
288
What are the things that occur in the acute phase of nerve injury recovery?
- Immobilization
- Movement
- Splinting or bracing
- Patient education
289
What are the goals of movement in the acute phase of nerve injury recovery?
To minimize joint connective tissue contractions and adhesions
290
Why is splinting and bracing necessary in the acute phase of nerve injury recovery?
To prevent deformities due to strength imbalances and to prevent undue stress on the healing nerve tissue
291
What are the things that occur in the recovery phase of nerve injury recovery?
- Motor retraining
- Desensitization
- Discriminative sensory re-education
- Patient education
292
The recovery phase is when ____ occurs, often resulting in hypersensivity and the recovery of volitional muscle contraction
The recovery phase is when *reinnervation* occurs, often resulting in hypersensivity and the recovery of volitional muscle contraction
293
Emphasis in the recovery phase is on __
Emphasis in the recovery phase is on *motor retraining and sensory re-education*
294
In the recovery phase, a progression of motor retraining is likely to begin with ___
In the recovery phase, a progression of motor retraining is likely to begin with *isometric contractions as signs of volitional muscle contraction begin*
295
What is discriminative sensory re-education?
The process of retraining the brain to recognize a stimulus as hypersensitivity diminishes
296
The chronic phase of nerve injury recovery is reached when ___
The chronic phase of nerve injury recovery is reached when *the potential for reinnervation is peaked, as minimal or no signs of reinnervation exist and significant deficits remain*
297
What is the emphasis in the chronic phase of nerve injury recovery?
Training and compensatory function
298
While training and compensatory function is minimized during the recovery phase, it is emphasized when _____
While training and compensatory function is minimized during the recovery phase, it is emphasized when *full neurological recovery does not occur*
299
What are the things that occur in the chronic phase of nerve injury recovery?
Compensatory function
| Preventative care
300
Should there be any barefoot walking without a full neurological recovery?
No
301
What are the potential indications of surgery?
• Failed conservative management
• Gross instability of a joint or boney segments
• Profound neurological compromise
• Marked limitation of active or passive
motion
• Joint deformity or abnormal joint
alignment
• Significant structural degeneration
• Chronic joint swelling
• Significant loss of function leading to
disability as the result of any of the preceding factors
302
What are the elements of preoperative management?
- Examination and evaluation
- Patient education
- Movement intervention
303
What are the benefits of preoperative PT?
- Examination and evaluation of a patient's pre-op impairments and functional status to establish a baseline for measuring post-op improvement
- The opportunity to identify and prioritize a patient's needs
- Understand the patient's goals and functional expectations after surgery
- Basis for establishing rapport for enhanced continuity of care after surgery
- Mechanism for patient education about the scheduled surgery and the components of post op rehabilitation
- Method for improving overall fitness, which could improve post-op recovery abilities
304
What are the things fundamental to a patient's post-op care?
A well planned post op program composed of a carefully progressed sequence of therapeutic exercise interventions, functional training and on going patient education
305
Post-op rehab planning should include considerations of.....?
- The extent of tissue pathology or damage
- The size or severity of the lesion
- The type and unique characteristics of the surgical procedure
- The stage of healing of the involved tissues
- The characteristics of types of tissues involved
- The integrity of structures adjacent to the involved tissues
- The philosophy of the surgeon
- Patient related factors
306
What are the patient related factors that post-op rehab planning should include considerations for...?
- Age
- Health history
- Lifestyle history
- Needs and motivation
307
Determining a patient's readiness to advance from one phase of post-op rehab to the next should not be based solely on time, but also on ___
Determining a patient's readiness to advance from one phase of post-op rehab to the next should not be based solely on time, but also on *the patients attainment of pre-determined criteria*
308
What are the phases of post-op rehab?
- Maximum protection phase
- Moderate protection phase
- Minimum protection phase
309
How are the phases of post op rehab identified?
- Overlapping phases of tissue healing
- The level of difficulty of activities
- The degree of protection of healing tissues
310
What are the characteristics of the maximum phase of post-op rehab?
- Protection of tissues is paramount in the presence of inflammation and pain.
- Mobilization to some degree is necessary after a particular type of surgery
- Timeframe ranges from a few days to 6 weeks depending on the type of surgery and the type of tissues involved
311
What are the characteristics of the moderate phase of post-op rehab?
- Inflammation has subsided, pain and tenderness are minimal, and tissues are able to withstand gradually increasing levels of stress.
- Restoring ROM while tissues continue to heal and remodel
- Improving neuromuscular control and stability
- Gradually increasing strength
- May begin within days up to 6 weeks post up and continues for an additional 4-6 weeks
312
What is the criteria of progression to the moderate phase?
- Absence of pain at rest
| - Availability of pain free movement of the operated extremity
313
The minimum protection phase is also know as the _____
The minimum protection phase is also know as the *return to function phase*
314
What are the characteristics of the minimum phase of post-op rehab?
- Little to no protection required
- Rehab focuses on restoring functional strength and participating in gradually progressed functional activities
- Begins from 6-12 weeks and may continue until 6 months or beyond post op
315
What is the criteria of progression to the minimum phase?
- Full or almost full AROM should be available
| - Joint capsule if involved should be clinically stable
316
What are some potential post-op complications?
- DVT
- Infection
- Delayed wound healing
- Muscle function deficits secondary to turnica compression and resulting in ischemia or nerve compression
- Failure, loosening or displacement of internal fixation devices or joint implants
- Delayed union of bone after fracture, osteotomy, or joint fusion
- Rupture of incompletely healed soft tissue after repair or reconstruction
- Subluxation or dislocation of joint surfaces or implants
- Nerve entrapment from scar tissue formation resulting in pain or sensory changes
- Adhesions and scarring leading to contractions of soft tissue
- Hypermobility
317
What are the categories that orthopedic surgeries can be divided into...?
- Repair
- Re-attachment
- Reconstruction
- Stabilization
- Replacement
- Realignment
- Transfer
- Release
- Reception
- Fixation
- Fusion
318
What are the surgical approaches used in performing a procedure?
- Open
- Arthroscopic
- Arthroscopically assisted
319
What does an open surgical procedure involve?
An incision of adequate length and depth through superficial and deep layer of skin, fascia, muscles, and joint capsule so the operative field can be fully visualized during the procedure
320
Open approaches are necessary for surgeries such as ____
Open approaches are necessary for surgeries such as *joint replacement, arthrodesis, internal fixation of fractures, tendon or ligament tears*
321
An open procedure requires a ____ period of rehab. Why?
*An open procedure requires a lengthy period of rehab, because there is an extensive disturbance of soft tissues*
322
Arthroscopy is used as a ____
Arthroscopy is used as a *diagnostic tool and as a means of treating a variety of intra-articular disorders*
323
What is involved in arthroscopy?
Several very tiny incisions called portals in the skin, muscle, and joint capsule for insertion of an endoscope to visualize the joint by means of a camera
324
Miniature motorized surgical tools are inserted into the portals and are used to ____
Miniature motorized surgical tools are inserted into the portals and are used to *repair tissues in or around the joint, remove lose bodies, or debried joint surfaces*
325
Arthroscopic procedures include...?
- Ligament, tendon and capsule repairs or reconstruction
- Debridement of the joints
- Meniscectomy
- Articular cartilage repair
326
There is ____ disturbance of soft tissue during arthroscopic procedures
There is *minimal* disturbance of soft tissue during arthroscopic procedures
327
An arthroscopic assisted procedure uses arthroscopy for a portion of the procedure but also requires ____
An arthroscopic assisted procedure uses arthroscopy for a portion of the procedure but also requires *an open surgical field for selected aspects of the procedure*
328
The arthroscopic assisted procedure is sometimes referred to as a ___
The arthroscopic assisted procedure is sometimes referred to as a *mini-open procedure*
329
In what procedures are tissue grafts used?
Procedures to replace tissue structures like in ligaments in the knee or ankle, in articular cartilage repair procedures and many bony procedures
330
What are the categories of tissue grafts?
- Auto-grafts
- Aligrafts
- Synthetic grafts
331
An auto graft uses ____
An auto graft uses *a patients's own tissue, harvested from a donor site in the body*
332
An aligraft uses ___
An aligraft uses *fresh or cryo- preserved tissue that comes from a source other than the patient, typically from a cadaver*
333
A synthetic graft is made from ___
A synthetic graft is *made from material such as gortech and dachron offer an alternative to human tissue, and they've had a high rate of failure over time*
334
Why would the transfer of a muscle tendon unit be required?
To improve stability of an unstable joint or to enhance neuromuscular control and function
335
Soft tissues may be incised or sectioned to improve ___, prevent or minimize ____, or relieve pain
Soft tissues may be incised or sectioned to improve *ROM, prevent or minimize progressive deformity, or relieve pain*
336
What are the procedures included in the incision or sectioning of soft tissue?
- Myotomy
- Tenotomy
- Fasciatomy
337
In what patients is a surgical release of soft tissue indicated?
- In young patients to whom joint replacement is not advised
- As a preliminary procedure for adults prior to joint replacement
- Patients with myopathic or neuropathic diseases to improve functional mobility
- Patients with an impingement or compartmental syndrome
338
Joint procedures is performed most frequently for ____
Joint procedures is performed most frequently for *management of pain and dysfunction associated with arthritis and injury such as labral tear and hip or shoulder joint*
339
What are the surgical interventions for arthritis?
- Arthroscopic debridement and lavage of the joint
- Repair of the chondral lesion
- Total joint replacement
- Arthroplasty
- Joint fusion
340
Debridement or lavage of the joint involves ____
Debridement or lavage of the joint involves *arthroscopic removal of fibrulated cartilage, unstable chondroflaps and loose bodies with are fragments of bone in the joint*
341
Synovectomy involves the removal of the ____ in the presence of _____ and is typically performed in patients who have rheumatoid arthritis with chronic proliferative synovitis with minimal articular changes
Synovectomy involves the removal of the *synovium in the presence of chronic joint inflammation* and is typically performed in patients who have rheumatoid arthritis with chronic proliferative synovitis with minimal articular changes
342
When is a synovectomy indicated?
If medical management has failed to alleviate joint inflammation for 4-6 months
343
Surgical intervention for the repair of articular cartilage defects is proven to be particularly challenging because of the limited capacity of the type of connective tissue to heal. However, several procedures such as _____ for a symptomatic extremity joint has been developed
Surgical intervention for the repair of articular cartilage defects is proven to be particularly challenging because of the limited capacity of the type of connective tissue to heal. However, several procedures such as *abrasion arthroplasty, subchondral drilling and micro-fracture, chondrocyte transportation, and osteochrondral autografts and aligrafts* for a symptomatic extremity joint has been developed
344
What is the selection criteria for one procedure over the other based on for a symptomatic extremity joint based on?
- The size of the chondral lesion
| - Patient related factors such as: age, and the ability to participate in the rehab process
345
What is arthroplasty?
Any reconstructive joint procedure with or without joint implant, designed to relieve pain and improve function
346
Joint replacement arthroplasty, which is among the most commonly performed and involves post-op management by a PT, includes _____
Joint replacement arthroplasty, which is among the most commonly performed and involves post-op management by a PT, includes *total joint replacement arthroplasty and hemi- replacement arthroplasty*
347
Total joint replacement is a ____
Total joint replacement is a *reconstructive procedure to relieve pain and improve function in patients with severe joint degeneration associated with late stage arthritis*
348
Total joint replacement procedure involves ___
Total joint replacement procedure involves *resecting both affected articulating surfaces of a joint, replacing them with artificial components*
349
Hemi- replacement arthroplasty involves _____
Hemi- replacement arthroplasty involves *resecting one of the affected articulating surfaces of a joint, replacing them with artificial components*
350
What is arthrodesis?
A surgical fusion of the surfaces of a joint
351
When is arthrodesis indicated?
As a primary surgical intervention in cases of severe joint pain associated with late stage arthritis and joint instability, in which mobility of the joint is of lesser concern*
352
Arthrodesis of the extremity joints is reserved for patients with _____
Arthrodesis of the extremity joints is reserved for patients with *significant weakness of muscles surrounding a joint as the result of neurological abnormalities*
353
Arthrodesis might be the only salvage procedure available for a patient with failed ______
Arthrodesis might be the only salvage procedure available for a patient with failed *total joint arthroplasty, when revision arthroplasty is not an option*
354
In what areas is arthrodesis most frequently used?
LUmber and cervical spine, Wrist, thumb, and ankle and selective instances in the shoulder and hip
355
What is osteotomy?
The surgical cutting and realignment of bone
356
Osteotomy is most commonly performed in the ___
Osteotomy is most commonly performed in the *hip*
357
Osteotomy is used to __
Osteotomy is used to *reduce pain and correct deformity in selected patients, correct angular or rotational deformities of bone occurring in congenital and development disorders*
