Intro to MSK: PT eval and strains

PT evalutation should be

• ____ and methodical

• compare _____

• consider the _____

sequential, bilaterally, kinetic chain

eval sequence (8 parts)

patient history, observation, screen physical exam red flags, exam of movement, palpation, diagnostic imaging, assessment, PT POC

eval - pt history: review ____, ____ interview, screen for _____

intake from, subjective, red flags

eval - observation: ____, posture, ____ of movement, skin ____ and _____, edema

gait, quality, integrity, color

eval - screen physical exam red flags: ____, _____, _____

vitals, reflexes, sensation

eval - exam of movement: ____ then _____, joint ____ and ____, _____

AROM, PROM, play, overpressure, MMTs

eval - palpation: ____ changes, ____ tissue, ____ tests

temp, soft, special

eval - assessment: PT ____, ____ and ____

diagnosis, prognosis, goals

4 regions of the stress strain curve

toe region, elastic region, plastic region, mechanical failure

toe region: fibers on _____

slack

elastic region; fibers ___ but _____ after stretch is released

stretch, return to original shape

plastic region: microscopic ____ of tissue, ____ failure, ___ deformation

tearing, progressive, permanent

mechanical failure: complete ____ or ____

rupture, fracture

soft tissue strain is injury ro a ____ or ____ often at the _____

muscle, tendon, mulsculotendinous junction

MOI of soft tissue strains

overload, overstretch, acceleration, deceleration

grade I muscle strain = ____ fibers torn

few

s/s of grade I muscle strain

mild swelling, local tenderness, pain on stretch

muscle contraction with grade I muscle strain is _____ and ____

painful, strong

grade II muscle strain = ____ fibers torn

about half

s/s of grade II and III muscle strain

mod/major swelling, bruising, significant pain on stretch

muscle contraction with grade II muscle strain is _____ and ____

painful, weak

grade III muscle strain = ____ fibers torn

most or all

s/s of complete muscle strain

min to no pain on stretch, palpable defect

with complete grade III muscle strain, contraction is ____ and _____

nonpainful, weak

3 stages of tissue healing

inflammation, proliferation, maturation and remodeling

phase I of healing - inflammation: time frame = ____ after acute injury

4-6 days

phase I of healing - inflammation: whats happening

• damages tissues _____

• ____ formed

• ____ and ____ allow inflammation and bring cells to area to _____

removed, clot, prostaglandins, bradykinins, initiate healing

phase I of healing - inflammation: s/s

• ____, warmth, palpable _____, _____

• arom = _____

• prom = ____ end feel

pain, tenderness, edema, limited, empty

phase I of healing - inflammation: treatment goals

• decrease ____ and _____ with ____ and grade ____ joint mob

• maintain ____ and _____ of adjacent joints/soft tissue

• rest - use ____, ____ or ___ as needed

pain, edema, PRICE, I-II, mobility, strength, protection, bracing, AD

phase II of healing - proliferation: time = _____ after injury

4 days - 6 wks

phase II of healing - proliferation: whats happening

• ____ growth

• regeneration = replacing with _____

• repair = replacing with ____

• new collagen from ____, bit it is ____, small, _____

capillary bed, same tissue, scar tissue, fibroblasts, disorganized, deficient

phase II of healing - proliferation: s/s

• decreased ______

• pain with _____

• muscle ___ and limited _____

inflammation, tissue resistance, weakness, function

phase II of healing - proliferation: treatment goals

• develop tissue ____ (stretching, ____, WB, balance/____, endurance)

• monitor s/s

  • reactive _____

  • ____ signs

• changes become _____

  • ____ base should be established by the end of this phase

motility, ROM, proprioception, effusion, over loading, habitual, mobility

phase III of healing - remodeling and maturation: time = _____

6 wks - 2 yrs

phase III of healing - remodeling and maturation: whats happening

• maturation of _____

• ____ and ____ of scar tissue

• ____ aligns to stress

connective tissue, contracture, remodeling, collagen

phase III of healing - remodeling and maturation: s/s

• no ____ or _____

• no pain until after ______

inflammation, reactive effusion, tissue resistance

phase III of healing - remodeling and maturation: treatment goals

• minimal to no ____

• ____ loads to organize collagen

• increase ____ strength

• return to ___/____

protection, tensile, tensile, work, sport

ways to minimize effects of immobilization

• _____ or _____ to slow strength loss

• ____ at joints above and below

• ____ exercises to load ____ and prevent ______

• modified exercise to maintain ____ fitness

estim, isometrics, AROM, weight bearing, articular cartilage, degradation, cardiovascular

signs of overload

1. increased pain that ____ decrease within ____ hours and resolve after ____ hours

2. greater ___ or ___ onset of _____ than previous session

3. increased _____, decreased _____, or weaknesss over several session

4. increased ____, _____ or _____ in the injury area

5. decreased ability to use _____

does not, 4, 24, pain, earlier, pain, stiffness, rom, swelling, warmth, redness, affected area

specific adaptations to imposed demands

• includes ___ and ____ of activity

• guides ____ parameters

• ____ of healing and _____ loading parameters closely reflect the ___ of the patients functional tasks

quality, type, exercise prescription, stage, optimal, specific demands