Stages of healing, tissue in lesion

Why is knowing the stage of healing important

-helps determine:

-type of tx that will be most successful

-level of tx at which to start

-other info on condition and for prognosis

Acute stage (time)

-7-10 days

Sub-acute stage (time)

-10 days to several wks

Chronic stage (time)

-greater than several wks

Acute (behavior of pain)

-pain at rest, aggravated by activity

-chemical and mechanical

Sub-acute (behavior of pain)

-pain w/ activity only, relieved by rest

-mechanical

Chronic (behavior of pain)

-little or no pain w/ activity

-pain only at extremes of range

-pain only after activity ceases

Acute (ROM)

-pain before limitation of motion

Sub-acute (ROM)

-pain at the point of limitation

Chronic (ROM)

-pain after limitation of motion

what are the 3 types of pain

-neuroplastic (central)

-peripheral neuropathic (radicular/referred)

-nociceptive (primarily MSK pattern)

what type of pain is most common in the orthopedic setting

-nociceptive

nociceptive pain can be

-mechanically related

-temp related

-chem related (inflammation)

why is level of irritability important

-type of tx that will be most successful

-level of tx at which to start

level of irritability

-amt of activity necessary to cause symptom worsening

a condition is irritable if

-it produces constant pain w/ specific motion or posture

-increases progressively w/ mvmt or posture

-increases w/ minimal activity

-increased latent response

increased latent response

-pain lasts more than a few mins after mvmt

Why is knowing the tissue in lesion important

-different tissues are associated with different precautions and req different tx strategies

-can't be 100% certain of what tissue is in lesion but good to have a working hypothesis (can be adjusted)

What information does AROM give us

-quality of motion

-quantity of motion

-pattern of restrictions

-presence/absence of pain

-where pain occurs in the range

-compensatory movements

-NO END FEEL

What information does PROM give us

-quantity of motion

-pattern of restrictions

-presence or absence of pain

-where pain occurs in the range

-type of end feel (must do overpressure at end range)

What information does MMT give us

-strength

-presence/absence of pain

-position based on best position for muscle strength test

What information does APR give us

-strength

-presence or absence of pain

-there's a better chance that if pain occurs it's from a contractile source

APR compares

-AROM

-PROM

-resistive tests

What is noted with APR

-presence or absence of pain

-pattern in which pain occurs

-helps classify lesion as contractile/non-contractils

When doing APR you need to test AROM and PROM in ____________

-2 directions opposite one another

contractile lesions

-active and passive motions painful in opposite directions

-ex: active knee flexion and passive knee extension

non-contractile lesions

-active and passive motions painful in same direction

a contractile structure is likely to be painful when

-muscle is actively working

-muscle is passively stretched

non-contractile structure is likely to be painfu

-every time it's stressed

-it is positional so will hurt every time the pt reaches problematic position

you confirm a contarctile lesion

-with a resistive test (should be painful)

resistive test should be done in ______________(loose/closed) packed position

-loose packed (or mid range) to minimize compression of inert tissues

T/F resistive tests in fully lengthened position may ID a sub acute or chronic muscle condition that's otherwise pain free to testing

-T

Pain with _________________(compression/distraction) implicates articular tissue

-compression

Pain with ________________(compression/distraction) implicates capsular or ligamentous tissue

-distraction

Things to keep in mind during APR testing

-some non-contractile conditions may present as contractile

-some conditions are so acute that all things hurt (APR not possible)

-APR testing is one additional piece of useful info but is not pathognomonic