Week 1: Impaired ROM and Joint Mobility pt 1

osteos vs arthros

osteos-straight plane (flex/ext)

arthros-joint surfaces (roll, glide, spin)

explain joint ROM

have capsular patterns of restriction, motions can be loss in more than 1 motion, have substitue motions, assessed with accessory movement, can use beighton test for hypermobility

2 types of accessory moement

angular, translatoric

explain mm ROM

length issue (too long/short), unilateral loss of ROM in 1 direction, have substitute movements, assessed with flexibility/mm length tests, weakness could limit ROM

grade 1 mobility score

anklyosis of joint

grade 1-2 mobility score

hypomobility (stiff)

1: slight

2: considerable

grade 3 mobility

normal

grade 4-5 mobility

hypermobility, not as firm as it should be

4: slight

5: considerable

grade 6 mobility score

instability of joint, no passive restraint and empty end feel

causes of immobility

trauma, injury, surgery, repetative use, fear, neurological injury (tone, coma)

effects of immobilization of mm

fiber atrophy, functional loss is faster than mass loss, elasticity loss, increased connective tissue, increased fat

how to remobilize mm

lengthy rehab to restore mm performance especially with long immobilization

effects of immobilization on tendon

decreased size, number, thin, disorganized collagen, load tolerance, water and Gag content, increased synthesis and degradation of collagen, decreased strength/stiffness/tissue weight

remobilized tendon benefits

controlled mechanical stress with increase the tensile strength, energy absorption capacity, facilitates normal gliding and soft tissue relationships, prevents excessive scar tissue

effects of immobilization on ligaments and insertion sights

decreased total collagen,strength/stiffness of lig, load to failure, disproportionate increase in immature collagen, bony resorption and weak insertions that cause avulsion fractures

remobilization of ligaments and insertion sites

restores the structural and mechanical properties of ligaments but takes longer than the original immobilization period

effects of immobilization on articular cartilage (AC)

decreased proteoglycans, chondrocyte population, AC thickness/stiffness, more softening, collagen splinting and fibrilation, subchondral bone sclerosis, osteophyte development

remobilization of articular cartilage

time and load dependent, progressive joint deterioration may occur with inappropraite loading after immobilization

effects of immobilization on bone

decrease bone mass, synthesis, trabecular bone volume, weight bearing bone loss will exceed non weight bearing bone loss

remobilization of bone

depends upon bone quality before immobilization, may return to normal faster or bone changes may not be reversed

cycle of immobility

injury, immobility, decreased loading, progressive adaptive shortening, dereased mobility and function, disuse and substitution, pain increase, restart

what do WE do in that cycle

pt education/control of pain, start mobility, improve mm work (isometrics), mobility and dynamic exercises, add functional tasks, do motor programing and retraining

contracture def

adaptive shortening of the MTU and soft tissues that cross or surround the joint resulting in significant resistance to p/a stretch

how to name contracture

named in the opposite direction of impaired motion (what are they stuck in?)

myostatic (Myogenic) contracture

MTU shortened, ROM is decrreased, no pathology, can be treated with stretching and eccentric loading

pseudomyostatic contracture

impaired mobility and loss of ROM due to hypertonicity and spasticity, muscles are in constant stage of tension, excessive resistance to stretch, treat with neuromuscular inhibition

what things can cause pseudomyostatic contractures

mm spasms, gaurding, pain, cns lesion

arthrogenic contracture

capsular end feel, treat with mobilizations, due to pathology IN the joint (adhesions, effusion, synovial proliferation, osteophytes, irregularities)

periarticular contracture

caused when connective tissue that cross or attach to joint or the capsule lose mobility, treat those tissues

fibrotic/irreversible contractures

afet long immobilization where they are shortened or trauma, fibrous changes in elastic components of mm and periarticular fibers occur, causes adherence of tissue that replaces the normal tissues, can be stretch but never truly reach optimal length (may need surgery/manips)