Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho 1-first half > Soft tissue and post op > Flashcards

Soft tissue and post op Flashcards

1
Q

physiology of CT repair

A

affected by age, lifestyle, and systemic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

microstructure of CTs

A
  • fibers (collagen, elastin)
  • ground substance (glycosaminoglycans)
  • cellular substances (fibroblasts, fibrocytes)

function of CTs depends on portions of intracellular and extracellular components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

response to loading

A
  • Tensile loads-primarily resisted by collagen fibers
  • if tissue is elongated beyond 4%, plastic changes begin to occur (x-links begin to fail)
  • yield point is where increase in strain occurs w/o increase in stress
  • cyclic loading produces microstructural damage that accumulates with each cycling loading cycle
  • failure from cyclic loading=fatigue failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

viscoelastic properties

A

creep and relaxation allow CTs to adapt and function in a variety of loading conditions without being damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

creep

A

tissue lengthens in response to a constant load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

relaxation

A

amount of force necessary to maintain new length decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

phases of healing

A
  • needed to formulate a plan of care
  • allows for matching the loading capability to intervention
  • understanding provides the tools to treat a variety of injury and surgical conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

characteristics phase 1 healing- inflammatory response

A

3-5 days

  • palpable pain, tenderness, swelling
  • release of chemical substances (protaglandins, bradykinin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

treatment of phase 1 healing

A
  • decrease pain and inflammation

- maintain mobility and strength of adjacent joints and soft tissues if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

characteristics of phase 2 healing- repair and regeneration

A
  • up to 8 weeks
  • new collagen forming (primarily type 3)
  • edema is resolved during this phase
  • bone-callus phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment of phase 2 healing

A
  • focus on normal tissue relationships, optimal loading
  • changes become habitual in this stage!
  • ROM exercises and joint mobilization, WBing
  • end of this stage-mobility and strength base should be established
  • bone-limited activity allowed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

characteristics of phase 3 healing- remodeling and maturation

A
  • deposition of type 1 collagen (end of phase 2)

- decreased synthetic activity and extracellularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

treatment of phase 3 healing

A
  • tension/resistance becomes more important in orientation of collagen
  • normal loading is necessary for bone remodeling - Wolff’s law
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

restoration of normal tissue relationships

A

after CT injury, relationship and integrity of tissues are altered

possible interventions:

  • active muscle contractions
  • passive joint motion
  • mobilization
  • stretching
  • begin preventative interventions as early as healing process allows!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

optimal loading

A

**chose tx procedures that don’t disrupt the healing process

requires:

  • choosing a load that doesn’t under or overload the tissue
  • considering biomechanical effects of daily activities
  • understanding of mechanism of injured tissue loading
  • individual factors- age, tissue quality, nutrition, fitness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

signs of overload

A

1: increased pain that doesn’t resolve within the next 12 hours
2: pain that is increased over the previous session or comes on earlier in the exercise session
3: increased swelling, warmth or redness in the injury area
4: decreased ability to use the part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

specific adaptations to imposed demands (SAID)

A
  • includes QUANTITY and TYPE of activity
  • extension of Wolff’s low
  • guides exercise rx parameters
  • stage of healing and optimal loading parameters closely reflect the specific demands on the pt’s functional tasks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

prevention of complications

A

GOAL: minimize effects of immobilization while an injury is healing

  • e-stim or isometric contractions
  • AROM at joints above and below injury sites
  • WB exercises when feasible to load articular cartilage and prevent degradation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sprain

A

acute injury to a ligament or joint capsule without dislocation
-may resolve with short term immobilization, controlled activity and rehab exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

sprain classification

A

grade I: mild, ligament is stretched, no discontinuity

grade II: moderate, some fibers stretched/torn, some joint laxity

grade III: severe, complete ligament disruption with resultant laxity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

sprain examination and evaluation

A

-observation to assess ecchymosis and edema
-observe functional ROM, AROM and PROM
-assess joint integrity and mobility
laxity-manual/instrument
instability- apprehension/instability
-palpation to identify primary and secondary injuries- surrounding joints and soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

strain

A

musculotendinous injury
=acute injury to the muscle or tendon from an abrupt or excessive muscle contraction

-usually a result of a quick overload to the muscle-tendon unit whereby the tension generated > tissue’s capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

strain classification

A

1: mild
2: moderate
3: severe

based on clinical examination- pain, edema, loss of motion, tenderness

24
Q

contributing factors to strain

A

poor flexibility
poor warm up exercise
insufficient strength or endurance
poor coordination

25
Q

strain exam and eval

A
  • thorough history
  • palpation- ms/tendon junction, muscle belly
  • reproduce clinically through active or resisted contraction- ms may need to be put on stretch
  • localized swelling and warmth may be observed
26
Q

application of treatment principles for phase I healing

A

Principle: optimal loading; prevent secondary complications

Loading zone: balance of rest and loading

Modalities: cryotherapy w/ compression/elevation

Exercise intervention: Isometric contractions

27
Q

application of treatment principles for phase II healing

A

Principle: restore normal tissue relationships; prevent complications

Loading zone: loading is important- orientation of collagen fibers

Modalities: Joint mobs; stretching; massage; postural education

Exercise intervention: contraction of lengthened ms in shortened range

28
Q

application of treatment principles for phase III healing

A

Principle: fine tune; convert baseline strength and mobility into functional movement patterns

Loading zone: graded, progressive exercise is necessary to maintain improvements

Modalities: pt maintenance program; postural education, stretching; strengthening, etc

Exercise intervention: more whole body patterns and functional activity

29
Q

Tendinitis and tendon injuries

A
  • failure occurs due to micro- or macrotrauma
  • outcomes are lengthy BUT predictable
  • categories/classifications have evolved
30
Q

classification of tendon injuries

A

1: macrotrauma:
2: microtrauma:
3: tendinosis

31
Q

macrotrauma

A

commonly occur at musculotendinous junction

32
Q

microtrauma

A

paratendinitis (inflammation of outer layer of tendon)

33
Q

tendinosis

A

degeneration w/o inflammatory response

34
Q

tendinitis

A

symptomatic degeneration of tendon with vascular disruption and an inflammatory response

35
Q

exam and eval of tendon injuries

A
  • history and subjective symptoms are of primary importance (acute/chronic, CT/localized inflammation, onset/predisposing factors)
  • ROM, muscle performance, posture, joint integrity, mobility tests
  • observe structural or postural abnormality
  • document nodules, palpable defects, crepitus
36
Q

treatment principles and procedures for tendon injuries

A
  • tx based on specific tendon injury
  • restoring length, strength: fundamental
  • stretching (low load) if muscle length is inadequate
  • if inflammation is present- consider cold packs, estim, into
  • eccentric activities: slow/light -> fast/heavy
  • appropriate rehab activities (w/ appropriate modifications)
37
Q

classification of cartilage injuries

A

mechanical

non-mechnical: infection, inflammatory conditions, prolonged jt immobilization

38
Q

exam and eval of cartilage injuries

A
  • cause of damage
  • area of damage
  • classification/health of cartilage
  • general health
  • lifestyle factors
  • body weight
  • joint alignment
  • ROM
  • ms performance
  • joint integrity
  • mobility
39
Q

treatment principles of cartilage injuries

A
  • Primary goal= restoration of motion
  • freedom of motion
  • equitable load distribution
  • stability
  • increased muscle performance and normalization of gait
40
Q

contusion

A
  • results from a blow and can occur in any area of the body
  • blood vessels below skin become damaged
  • accumulation in deeper tissues (hematoma) may develop
  • if untreated, may progress to myositis ossifications
41
Q

exam and eval of contusions

A
  • history of “blow” provides best info
  • size, location, and direction lend a window into location and extent of soft tissue injury
  • palpation, joint mobility, ms performance, flexibility, and function tests help guide tx procedures
42
Q

treatment principles for contusions

A
  • simple contusions resolve in a timely manner
  • use & monitor measures of pain, muscle length, muscle performace to guide aggressiveness of treatment
  • ROM must be restored as quickly as possible
  • use ice to control swelling and local inflammation
  • restore muscle performance
  • submax isometrics may be initiated in early stages
43
Q

management of impairments associated with fractures

A

fracture=break in the continuity of bone

44
Q

classification of fractures

A

1: open fractures: breaks through skin surface
2: closed fractures: doesn’t break skin
3: nondisplaced: all sides of fx remain in anatomic alignment
4: displaced: the ends of the bones are not in anatomic alignment

45
Q

types of fractures

A 
transverse
spiral
oblique-transverse/butterfly
oblique
comminuted
metaphyseal compression
46
Q

application of treatment principles for fractures

A
  • consider associated soft tissues
  • healing of fx is primary
  • rehab of soft tissue may be more challenging
47
Q

fracture intervention

A
  • tx focuses on recovery of initial trauma, rehabing tissues that were immobilized
  • initially-gentle jt mobilization, stretching
  • decrease loading when indicated (stress fx)
  • gentle strengthening (isometrics)
  • NMES, SEMG-feedback for atrophy
  • as impairments improve, incorporate activities to alleviate remaining functional limitations

**keep loads w/in optimal zone!

48
Q

soft tissue procedures

A
  • ligament reconstruction
  • tendon surgery
  • debridement
  • synovectomy
  • decompression
  • soft tissue stabilization and realignment
  • meniscal and labral repairs
49
Q

bony procedures

A
  • debridement/abrasion chondroplasty
  • osteochondral autograft transplantation (OAT) or (mosaicplasty)
  • autologous chondrocyte implantation
  • open reduction and internal fixation
  • fusion
  • osteotomy
50
Q

primary goal of joint arthroplasty

A

PAIN RELIEF

-generally, any increase in ROM, strength, function is secondary to pain relief

51
Q

joint arthroplasty is categorized by..

A
  • component design- constrained/unconstrained
  • fixation: cement vs biological (cementless)
  • materials: metals vs plastics (hybrids)
52
Q

rehab considerations for joint arthroplasty

A
  • rehab is joint and prosthesis specific
  • restore motion, strength, function
  • address underlying cause of surgery as well as adjacent joints
53
Q

total knee arthroplasty (TKA)

A

unicompartmental (partial) arthroplasty (UKA)

-replaces WB surface secondary to OA, RA, trauma

rehab considerations:

  • CPM
  • early protected WB w. ADs
  • monitor for infection, effusion, DVT post op
  • acute-> SNF ->home care -> OP
54
Q

total shoulder arthroplasty (TSA)

A

common precautions:

  • avoid hyperextension/anterior capsule stretch
  • avoid aggressive IR stretch of ER movement
  • avoid WB and lifting
55
Q

total hip arthroplasty (THA)

A

Cementless: believed to last longer; revisions difficulty

Cemented: immediate stability (>70 y/o)

  • loosening via cracked, fragmented cement
  • bone resorption around implant

Resurfacing: less risk of dislocation
-younger, active patients (<60 y.o)

56
Q

THA rehab considerations

A

Posterior surgical approach:

  • no hip flexion beyond 90
  • no crossing the legs (hip ADD beyond neutral)
  • no hip IR past neutral

Pt education:

  • put a pillow between legs if you lie on your side
  • sit only on elevated chairs or toilet seats
  • don’t bend over from the hips to reach or tie shoes

anterior hip approach:
-positions that involve extreme hip extension and ER will dislocate the hip

57
Q

summary

A
  • composition and structure of CTs provide info regarding mechanical properties and function
  • unique viscoelastic characteristics are the result of fluid and solid constituent materials
  • when CTs are loaded, the stress of change per unit length gives info about the tissue’s ability to withstand loads
  • stages of healing & knowledge of injury give clinical guidelines for intervention throughout care
  • restoration of tissue relationships, SAID principle, prevention of secondary complications-guide treatment
  • acute soft tissue injuries necessitate early intervention to avoid secondary complications
  • management of tendon injuries and prognosis varies according to injury classification
  • interventions used in tx of bony or surgical procedures should have foundations in basic science and require an understanding in anatomy and kinesiology of the area

Ortho 1-first half (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions