PT 851 Musculoskeletal Assessment: Foundations of Clinical Orthopedics & Musculoskeletal Examination

Flashcards covering musculoskeletal assessment, biological tissues, injury, healing, and orthopedic pathologies from the lecture notes.

What do PTs aim to understand regarding the healing process in orthopedic evaluation?

Outline physiology/pathophysiology of the healing process and identify factors that can impede it.

What is a primary objective related to orthopedic evaluation?

Understand the principles of a comprehensive orthopedic evaluation.

What is the primary role of collagen in connective tissues?

Structural integrity and tensile forces.

What property does elastin provide to connective tissues?

Elasticity.

What two components make up fascia, tendons, and ligaments?

Collagen and Elastin.

What percentage of dry weight do tendons and ligaments represent?

70-86%.

What type of tendon is partially surrounded by a sheath?

Gliding tendons.

What term describes tendons with a sheath containing synovium?

Vascular tendons.

What is "tenosynovium"?

A sheath with synovium surrounding vascular tendons.

What is tendonitis defined as?

Inflammation of a tendon due to overuse.

What is tendinosis defined as?

A degenerative tendon with thickening.

What is paratenonitis defined as?

Inflammation of the tendon sheath due to friction.

What are the clinical signs of acute tendinitis?

Acute swelling, pain, local tenderness, warmth, dysfunction.

What characterizes tendinosis at a cellular level?

Intratendinous degeneration, cellular/tissue aging, vascular compromise, increased cellularity and neovascularization.

What is the primary characteristic of a reactive tendinopathy?

Tensile or compressive overload leading to prominent repair proteins and proteoglycans.

What indicates the start of disorganization and collagen separation in tendon pathology?

Tendon Dysrepair, with myofibroblasts present.

How do tendon cells appear in a normal tendon?

Spindle-shaped.

What characterizes the collagen in a normal tendon?

Linear, tight bundled.

What characterizes the collagen in tendinopathy?

Disrupted collagen.

What is seen regarding intratendinous nerves in tendinopathy?

Ingrowth of intratendinous nerves.

What are the general characteristics of ligaments?

Dense, thick, stiff.

How do ligaments respond to stress?

In accordance with the SAID principle.

What effect does immobilization have on ligament strength?

It decreases strength.

What degree of ligament sprain involves tearing of a few fibers with minimal loss of structural integrity?

First Degree.

What degree of ligament sprain involves significant structural weakening and some abnormal motion, but a definite end-point to stress?

Second Degree.

What clinical signs are common with a second-degree ligament sprain?

May have hemarthrosis and effusion, more bruising and swelling.

What degree of ligament sprain involves complete tearing of ligaments and marked abnormal motion?

Third Degree.

What interventions are often necessary for a third-degree ligament sprain?

Prolonged protection or surgical intervention.

Is bone highly vascular or avascular?

Highly vascular.

What forces can bone absorb and transmit?

Tensile forces.

What is the term for the ends of a bone, containing articular cartilage?

Epiphysis.

What is the physis of a bone?

The growth plate.

What part of the bone is the shaft?

Diaphysis.

What is the most important factor in fracture healing?

Blood supply.

Name one factor that can negatively affect fracture healing.

Smoking (or Diabetes, Advanced age, Poor nutrition, NSAIDS).

How does nicotine specifically affect fracture healing?

Increases time to fracture healing, increases risk of nonunion, decreases strength of the fracture callus.

What are the three main stages of fracture healing?

Inflammation, Repair, Remodeling.

What forms during the inflammation stage of fracture healing?

Hematoma.

What cells are present at the fracture site during inflammation and contribute to granulation tissue?

Fibroblasts, mesenchymal cells, and osteoprogenitor cells.

What occurs during the repair stage when bone ends are not in continuity?

Bridging (soft) callus formation.

What process replaces soft callus with woven bone?

Endochondral ossification.

What type of bone is formed during the hard callus stage?

Woven bone.

What begins during the middle of the repair phase and continues until after clinical healing, allowing bone to assume its normal configuration?

Remodeling.

What type of bone replaces woven bone during the remodeling phase?

Lamellar bone.

What type of fracture occurs when a tendon or ligament pulls off a piece of the bone?

Avulsion fracture.

What describes a fracture where the bone does not penetrate the skin?

Closed fracture.

What is a comminuted fracture?

A fracture with more than two fragments of bone broken off.

What describes a fracture where the bone has been completely fractured through its width?

Complete fracture.

What type of fracture involves severe damage to the soft tissue surrounding the bone?

Complex fracture.

What is a compound (open) fracture?

A fracture where bone fragments penetrate through soft tissue and break through the skin.

What type of fracture occurs when the bone is compressed beyond its limits of tolerance, often seen in vertebral bodies?

Compression fracture.

A fracture of the epiphysis and physis (growth plate) is known as what?

Epiphyseal fracture.

What type of incomplete fracture, commonly seen in children, only breaks one side of the bone?

Greenstick fracture.

What is the most common location for stress fractures, accounting for 49%?

Tibia.

What is the most common type of Salter-Harris epiphyseal fracture?

Type II.

Which Salter-Harris fracture type is considered the "best" prognosis?

Type I.

Which Salter-Harris fracture type is considered the "worst" prognosis?

Type V.

What are two characteristics of woven bone?

More random with more osteocytes than lamellar bone, increased turnover rate, weaker and more flexible, not stress oriented.

What bone pathology is characterized by decreased bone mass due to genetic and environmental factors?

Osteoporosis.

What pathology is characterized by decreased mineralization and "softening" of bone due to lack of vitamin D?

Osteomalacia (or rickets in children).

What is osteomyelitis?

An infectious process of bone.

How does the WHO define osteoporosis in terms of lumbar bone mass?

At least 2.5 SDs below the peak bone mass of a 25 y/o individual.

What is osteopenia defined as?

Bone mass that is 1.0-2.5 SDs below peak bone mass of a 25 y/o.

What are the two main types of osteoporosis?

Type I (Postmenopausal) and Type II (Age-related).

Name one treatment for osteoporosis.

Physical activity (or Estrogen-progesterone therapy, Calcium supplementation, Vitamin D, various other drugs).

What are three characteristics of hyaline (articular) cartilage?

Viscoelastic, aneural, avascular.

What are the cells found in cartilage?

Chondrocytes.

What type of collagen is prominent in fibrocartilage?

Type I and type II collagen.

Name one example of where fibrocartilage is found.

Menisci (or IV discs, pubic symphysis, TFCC).

What is a common macroscopic finding in osteoarthritis due to the body adapting to cartilage loss?

Bone spurs (osteophytes).