Therex II Midterm

Strain

Overstretching, overexertion, or overuse of soft tissue

• tends to be less severe than a sprain,

Sprain

Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle

Dislocation

Displacement of a part, usually the bony partners in a joint, resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm.

Subluxation

An incomplete or partial dislocation of the bony partners in a joint that often involves secondary trauma to surrounding soft tissue

In what degree of tear/rupture is pain felt the most

a partial tear causes the most pain compared to a complete tear that does not cause anypain

Tenopathy

is the general term that refers to tendon injury affected by mechanical loading

Tenosynovitis

is inflammation of the synovial membrane covering a tendon

Tendinitis

IsT inflammation of a tendon; there may be resulting synovitis, scarring, or calcium deposits.

Tenovaginitis

is inflammation with thickening of a tendon sheath

Tendinitis

is degeneration of the tendon caused by repetitive microtrauma

Synovitis

Inflammation of a synovial membrane; an excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease

Hemarthrosis

Bleeding into a joint, usually caused by severe trauma

Ganglion

Ballooning of the wall of a joint capsule or tendon sheath.

• Ganglia may arise after trauma, and they sometimes occur with rheumatoid arthritis

Bursitis

inflammation of the bursa

Contusion

Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory response.

dysfunction

Loss of normal function of a tissue or region.

• The dysfunction may be caused by adaptive shortening of the soft tissues, adhesions, muscle weakness, or any condition resulting in loss of normal mobility.

contracture

Adaptive shortening

adhesion

Abnormal adherence of collagen fibers to surrounding structures

reflex muscle guarding

Prolonged contraction of a muscle in response to a painful stimulus.

intrinsic muscle spams

Prolonged contraction of a muscle in response to the local circulatory and

metabolic changes that occur when a muscle is in a continued state of contraction

Myofascial compartment syndromes

Increased interstitial pressure in a closed, nonexpanding, myofascial compartment that compromises the function of the blood vessels, muscles, and nerves.It results in ischemia and irreversible muscle loss if there is no intervention.

acute stage

The signs of inflammation develop; they are swelling, redness, heat, pain at rest, and loss of function.

phase I aka max protection

protect the part by controlling the effects of the inflammation, facilitating wound healing, and maintaining normal functioning in unaffected tissues and body regions

At what phase is stretching contraindicated

acute

what joint mob grade to use at acute phase

I or II

Are muscle-setting activities (isometrics) acceptable during the acute phase

yes, gentle submax isometrics are appropriate

At what phase should a pta initiate active exercises

phase II aka mod protection

what is used to guide how quickly a patient should progress

patient tissue response

at what phase should stretching be initiated

phase II mod protection

In phase III the pta should initiate

flexibility and strength, challenge coordination, balance, and movement strategies

what is necessary to avoid joint trauma

Free joint play within a useful (or functional) ROM

What is the minimum LE MMT grade a pt must have to stop using an AD

4/5

Arthritis

inflammation of the joint

What are the most commonly treated forms of arthritis

Rheumatoid arthritis and osteoarthritis

arthrosis

is degeneration of a joint with inflammation

Rheumatoid arthritis (RA)

• autoimmune inflammatory systemic disease affecting the synovial lining of the joint and tissues

• has active and remissions stages

What kind of tissues forms, covers, and erodes the joint capsule during RA

granulation tissue (pannus)

what are some progressions of RA

• fibrosis

• ossific ankylosis

• subluxation

• tenosynovitis

Can loss of joint function be reversed in RA

NOPE

In RA, when is joint stiffness at its peak

morning

Where do RA flare ups primarily occur

smaller joints of the hands and feet

What is an important piece of patient education for patients in a RA flare up

joint safety/rest and energy conservation once a flare-up recedes

what is not performed when joints are swollen

stretching

oesteoarthritis (OA)

Chronic degenerative disorder affecting the articular cartilage can lead to spurs and lipping

what is the cause of OA

Not known for certain, but can be via mechanical injury, repeated stress, or poor movement of synovial fluid

should the patient be immobilized when they have OA

NO it cuases rapid destruction of articular cartilage

what are some risk factors of RA

genetics, obesity, quad weakness, joint impact, repetitive sports, heavy lifting, and kneeling

At what point/phase of OA is pain most prominent

later stages, due to the avascular cartilage

Heberden’s nodes

enlargement of the DIP joints

Bouchard’s nodes

enlargement of the PIP joints

what are the most commonly involved joints in OA

weightbearing joints such as hips and knees

should a patient with OA praticipate in CKC or OKC activities

OKC

Are resistive exercises okay for a patient with OA

yes! strong muscles protect the joint

What activities should be avoided by a pt with OA

repetitive intense loading of the joints; jogging and jumping

Osteoporosis

disease of the bone that leads to decreased mineral content and weakening of the bone

What are the most common fractures via osteoporosis

spine, hip, and wrist

What scale is used to determine an osteoporosis diagnosis

T-score, bone mineral density (BMD) scan

what is a normal T-sore

-1.0 or higher

What T-score does osteopenia have

-1.0 to -2.4

What T-score does osteoporosis have

-2.5 or less

What are some risk factors for osteoporosis

• postmenopausal

• low body weight

• low physical activity

• low calcium intake

• smoking/drinking

According to the NOF what are 4 ways to prevent osteoporosis

1. eat fruits and veggies

2. intake calcium and vitamin D

3. perform weight-bearing exercises

4. limit drinking and no smoking

osteoclasts

resorb bone, calcium goes into blood stream

osteoblast

builds bone with calcium

why are women at risk for osteoporosis becuase of menopause

Bone resorption is accelerated during menopause

what can stimulate osteoblastic activity?

The stress from muscle contraction and WB exercises

What activities should be avoided with a pt who has osteoporosis

flexion activities, and combined FLX and rotation

fracture

a structural break in the continuity of a bone

What are the 3 phases of bone healing

• inflammatory phase

• reparative phase

• remodeling phase

what do chindroblasts form

cartilage

osteoblasts form what kind of bone mainly

woven bone

What is the general fracture healing time for adults

10 to 18 weeks

Malunion

the fracture heals in an unsatisfactory position resulting in a bony deformity

Delayed union

the fracutre takes longer than normal to heal

nonunion

The fracture fails to unite with a bony union

fibromyalgia (FM)

Chronic condition characterized by widespread pain that affects multiple body regions (noninflammatory, nondegenerative, nonprogressive)

what chronic condition can appear after a physical trauma

fibromyalgia

Myofascial Pain Syndrome (MPS)

a chronic regional pain syndrome that has trigger points (TrPs)

trigger points (TrP)

hyperirritable area in a tight band of muscle

What are the 3 main compenents of MPS treatment (aka triggerpoints)

1. correct chronic overload

2. eliminate the trigger point

3. strengthen surrounding muscles

What are some common indications for surgery

• incapaitating pain

• limited ROM/function

• joint instability

• deformity

• trauma/significant damage

Emergency surgery

Performed immediately to prevent death of disability

Urgent surgery

should be performed within hours or days due to likelyhood of worsening if waiting

Elective surgery

a medically necessary or beneficial procedure that poses no threat if postponed

what are some benefits of pre-op management

include the ability to assess their pre-op functional status, to discuss their goals and

expectations following surgery, to establish rapport, to minimize patient anxiety, and to educate the patient regarding post-op rehab

What are components to keep in mind when treating a patient with a surgical site

1. Check signs if redness or necrosis

2. Note signs of tenderness and edema

3. Evidence of increased heat

4. Signs of drainage

5. incision integrity

6. scar mobility

what is one reason a pt may not go through all phases of rehab

limited number of justifiable therapy sessions via insurance

what is a thrombosis

a bolus of coagulated blood in the circulatory system

Which is more serious a thrombus in a superficial vein or a deep vein

deep vein

what is a embolus

when a clot breaks away from the wall of a vein and travels proximally

Pulmonary embolism

When an embolus affects the pulmonary circulation, it is life-threatening

What can put a patient at risk for a LE DVT

prolonged immobilization after surgery

What are some clinical manifestations of a DVT

dull aching, severe pain, swelling, skin temp and color changes

What is the tool used to determine DVT likeleyhood

Wells Criteria

what are the hallmark signs and symptoms of a pulmonary embolism

Dyspnea, tachypnea, and chest pain at the lateral aspect increased with deep breathing and coughing

• swelling

• anxiety

• fever

• diaphoresis

what are good exercises for reducing DVT risk

ankle pumps, quad sets, glute sets

Open surgical procedure

an incision big and deep enough to have a fully visualized area during surgery

• joint replacement

• arthrodesis

• internal fixation

• reconstruction

What surgical approach causes the most disturbance to soft tissues

open procedures

Arthroscopy

is used as a diagnostic tool and to treat intra-articular disorders, and can be done under local anesthesia

• multiple small incisions where a endoscope can be placed

an arthroscopically assisted procedure uses

uses arthroscopy and a open surgical feild aka a mini open