MSK2 1ST SHIFT REVIEW

Good luck sa shifting mga kapwa tanga

• Overstretching, overexertion, overuse of soft tissue

• Less severe than a sprain

• Some degree of disruption in the musculotendinous unit.

Strain

Sever stress, stretch or tear (jt. capsule, ligament, tendon or muscle)

If a ligament is injured it is categorized into: (enumerate)

• Sprain

  • First (mild) degree

  • Second (moderate) degree

  • Third (severe) degree

Displacement of bony partners in a joint

Dislocation

Incomplete or partial dislocation

Accompanied with ____ degree of soft tissue damage of surrounding tissue

• Subluxation

  • 2nd degree

Pain on region of the muscle/tendon tear when the muscle is stretched or contracted against resistance

Partial rupture/tear

Type of muscle tear which causes no pain when contracted against resistance

Complete tear/rupture

General term for tendon injury affected by mechanical loading

Tendinopathy

Inflammation of the synovial membrane covering a tendon

Tenosynovitis

Inflammation of tendon

• May be caused by scarring or calcium deposits

Tendinitis

Inflammation and thickening of tendon sheath

Tenovaginitis

Degeneration of a tendon due to repetitive stress

Tendinosis

Inflammation of the synovial membrane d/t excess synovial fluid in a jt. or tendon sheath due to severe trauma or disease

Synovitis

Bleeding into joint dt severe trauma

Hemarthosis

Ballooning of a wall of jt. capsule or tendon sheath

Ganglion

Inflammation of a bursa

Bursitis

Bruising from a direct blow = capillary rupture, bleeding edema, inflammatory response

Contusion

Repeated submaximal overload and/or frictional wear to a muscle or tendon ( + inflammation and pain)

Overuse syndromes

Loss of normal function of tissue or region

Dysfunction

Mechanical loss of normal joint play

Joint dysfunction

Adaptive shortening of the skin fascia and muscle which prevents normal mobility and flexibility

Contracture

Abnormal adherence of collagen fibers to surrounding structures during immobilization, after trauma or surgical complication which restricts normal elasticity and gliding

Adhesions

Prolonged contraction of a muscle in response to painful stimulus, contracting muscle functionally splints injured tissue against the movement, ceases when painful stimulus is relieved.

Reflex muscle guarding

Prolonged muscle contraction of a muscle in response to local circulatory and metabolic changes that occur in continuous contraction

Intrinsic muscle spasm

Decrease in muscle strength (caused by well… everything u can think of)

Muscle weakness

Increased interstitial pressure in a closed, non-expanding myofascial compartment that compromises function of blood vessels, muscles and nerves.

Myofascial compartment syndrome

Determine the severity of injury:

Mild pain at the time of injury or within the first 24 hours

First Degree / Grade 1

Determine the severity of injury:
Near complete or complete tear or avulsion of tissue, initially pain is severe but stress to the area becomes painless; if the ligament is affected there is instability

Third degree / Grade 3

Determine the severity of injury:

Moderate pain which requires stopping of activity; aggravated by stress or palpation

Second degree / Grade 2

Identify the stage of healing:

• Vascular changes

Acute

Identify the stage of healing:

• Collagen aligns to stress

Chronic

Identify the stage of healing:

• Remodeling of scar

Chronic

Identify the stage of healing:

• Exudation of chemicals and cells

Acute

Identify the stage of healing:

• Growth of capillary beds in the area

Subacute

Identify the stage of healing:

• Removal of noxious stimuli

Subacute

Identify the stage of healing:

• Early fibroblastic activity

Acute

Identify the stage of healing:

• Collagen formation

Subacute

Identify the stage of healing:

• Maturation of connective tissue

Chronic

Identify the stage of healing:

• Contracture of scar tissue

Chronic

Identify the stage of healing:

• Clot formation

Acute

Identify the stage of healing:

• Granulation tissue

Subacute

Identify the stage of healing:

• Very fragile, easily injured tissue

Subacute

Identify the stage of healing:

• Phagocytosis, neutralization of irritants

Acute

Identify the stage of healing:

• Inflammation and pain BEFORE tissue resistance

Acute

Identify the stage of healing:

• No inflammation and pain AFTER tissue resistance

Chronic

Identify the stage of healing:

• Decreasing inflammation and pain SYNCHRONOUS with tissue resistance

Subacute

Identify the stage of rehab (goals):

• Increase tensile quality of scar

  • progressive strengthening and endurance exercises

Minimum protection

Identify the stage of rehab (goals):

• Prevent deleterious effects of rest

  • non-destructive movement: PROM, massage, muscle sets

Maximum protection

Identify the stage of rehab (goals):

• Control effects of inflammation

  • P.R.I.C.E

Maximum protection

Identify the stage of rehab (goals):

• Develop mobile scar

  • Selective stretching, mob/manipulation of restrictions

Moderate protection

Identify the stage of rehab (goals):

• Promote healing

  • non-destructive active, resistive, open and closed chain stabilization, muscular endurance, and cardiopulmonary exercises, carefully progressed intensity and range

Moderate protection

Identify the stage of rehab (goals):

• Develop functional independence

  • functional exercises and specificity drills

Maximum protection

Timeframe of acute phase

4-6 days

Timeframe of subacute phase

• Lasts longer in tissues with limited circulation, how long?

10-17 days (14-21 days after injury)

• 6 weeks

Timeframe of chronic stage

6 months to 1 year

Wound closure takes how long for muscle and skin?

5-8 days depending on size of injury

Timeframe for wound closure in tendons and ligaments

3-6 weeks

Prolonged inflammation if injured tissue is continually stressed beyond its ability to repair

Chronic inflammation

Pain than can not be linked to a source of irritation or inflammation, lasts for more than 6 months.

Chronic pain syndrome

This movement is useful immediately after joint surgery

Continuous passive movement

True or False:

AROM is a CI during an active pathological process unless its chronic like RA

True

Muscle must be kept in what position for muscle setting in the acute phase?

Shortened position / active insufficiency

When does inflammation decrease, clot starts to resolve and repair begins?

2nd to 4th day after injury

This process may last for up to 6 weeks

When are fibroblasts tremendous in number?

4th day until 21st day after injury

Myofibroblastic activity begins at which day

5th day

Scar retraction is usually complete when?

21st day after injury

Which days is there predominance of fibroblasts that are easily remodelled?

21st to 60th day

How long until there is maturation of tissue?

12-18 months

Bonding of immature collagen; easy to remodel with gentle and persistent treatment; if collagen is not properly stressed during this, the scar can be restricting.

• after how many weeks does this phenomenon occur?

Hydrogen bonding

• 10 weeks

Collagen thickens, becomes stronger, and becomes resistant to remodeling

• after how many weeks does this phenomenon occur?

Covalent bonding

• 14 weeks

Which muscle grade is needed to discontinue ADs for amb

Grade 4-5 muscle strength on LE

Which part of the muscle is at highest risk for injury?

Myotendinous junction

Identify the healing phase (muscle):

• After a few days or a few weeks

Repair phase

Identify the healing phase (muscle):

• Necrosis of contractile elements

Destruction phase

Identify the healing phase (muscle):

• Hematoma formation and inflammation

Destruction phase

Identify the healing phase (muscle):

• Reorganization of tissue integrity and functional maturation

Remodeling phase

Identify the healing phase (muscle):

• 4-6 weeks

Remodeling phase

Identify the healing phase (muscle):

• Phagocytosis

Repair phase

Identify the healing phase (muscle):

• Regeneration of contractile elements

Repair phase

Identify the healing phase (muscle):

• Stimulation of myofiber and scar formation

Repair phase

Identify the healing phase (muscle):

• Fibrin and fibronectin form early linkages to provide support against contraction

Destruction phase

In muscle injuries, small injuries heal with ______ while large injuries heal with ______

• Muscle

• Scar tissue

Active stretching should be postponed for how many days following muscle injury?

3-7 days

Identify the healing phase (tendon):

• Involves induction of fibrous repair

Remodeling phase

Identify the healing phase (tendon):

• Involves collagen synthesis

Proliferative repair phase

Identify the healing phase (tendon):

• Shows decline of tendon metabolism and vascularity

Scar formation phase

Identify the healing phase (tendon):

• Characterized by signs of inflammation

Inflammatory phase

Identify the healing phase (tendon):

• Acutely following injury for several days to weeks

Inflammatory phase

Identify the healing phase (tendon):

• After a few days to few weeks, continues up to 6 weeks

Proliferative repair phase

Identify the healing phase (tendon):

• About 6 weeks

Remodeling phase

Identify the healing phase (tendon):

• About 10 weeks to 1 year

Scar formation phase

Identify the healing phase (tendon):

• Correct faulty biomechanics and compensatory posture

Proliferative repair phase

Identify the healing phase (tendon):

• Strengthening in the tissue CONTINUES

Scar formation phase

Identify the healing phase (tendon):

• Collagen fibers align based on the direction of stress placed on the healing tendon

Remodeling phase

Identify the healing phase (tendon):

• Strengthening of the tissue BEGINS

Remodeling phase

Strengthening and stretching exercises are carefully designed particularly during which phase?

Remodeling phase

Identify the grade of ligament injury:

• Complete ligament rupture or tissue failure associated with significant joint laxity

Grade 3

Identify the grade of ligament injury:

• Ligament is stretched; microfailure, a few fibers in part of the plastic range are ruptured; no excessive motion

Grade 1

Identify the grade of ligament injury:

• ligament is stretched with more fibers torn, resulting in partial tear; associated with moderate joint laxity

Grade 2

Identify the healing process (ligament):

• 6 weeks post-injury up to 1 year

Remodeling phase

Identify the healing process (ligament):

• Deposition of ground substance and disorganized collagen fibers

Inflammatory phase