strain (3)
1.) overstretching, overexertion, overuse of soft tissue
2.) less sever than sprain, refers to tendons and muscles
3.) occurs from slight trauma or unaccustomed repeated trauma of a minor degree
sprain (3)
1.) Severe stress, stretch or tear of soft tissue
2.) Can occur in joint capsule, ligament, tendon or muscle
3.) Frequently used to refer to injury of a ligament
sprain grades (3)
1.) First degree- mild
2.) Second degree- moderate
3.) Third degree- severe
dislocation
Displacement of a bony part that results in loss the anatomical relationship
dislocation leads to...
...Leads to soft tissue damage, inflammation, pain, and muscle spasm
subluxation (2)
1.) Incomplete or partial dislocation
2.) Involves secondary trauma to surrounding soft tissue
partial muscle/tendon rupture or tear
pain in area of tear when muscle is stretched or contracts against resistance
complete muscle/tendon rupture or tear
tear-does not cause pain with stretching or resistance b/c muscle doesn't pull against the injury
tendinopathy
general term for chronic tendon pathology
tenosynovitis
inflammation of the synovial membrane covering the tendon
tendinitis
inflammation of a tendon; may result in scarring or calcium deposits
tenovaginitis
inflammation with thickening of the tendon sheath
tendinosis
degeneration of the tendon due to repetitive microtrauma
synovitis (2)
1.) Inflammation of a synovial membrane
2.) Excess synovial fluid in a joint or tendon sheath
hemarthrosis
Bleeding into a joint Usually due to severe trauma
ganglion
1.) Ballooning of the wall of a joint capsule or tendon sheath
contusion (2)
1.) Bruising from a direct blow
2.) Results in capillary rupture, bleeding, edema, and an inflammatory response
Overuse syndromes, cumulative trauma disorders, repetitive strain injury (2)
1.) Repeated submaximal overload and or friction wear to muscle or tendon resulting in inflammation and pain
2.) Occurs over time
dysfunction (3)
1.) Loss of normal function of a tissue or region
2.) May be caused by adaptive shortening of soft tissue, adhesions or muscle weakness
3.) Results in a loss of normal mobility
joint dysfunction (3)
1.) Mechanical loss of normal joint play
2.) Commonly causes loss of function and pain
3.) May be caused by trauma, immobilization, disuse, aging or pathological condition
contracture
Adaptive shortening of soft tissue around a joint that limits mobility or flexibility
synovitis caused by (2)
Caused by trauma or disease
ganglion causes (2)
May arise from trauma or associated with RA
adhesions (2)
1.) Abnormal adherence of collagen fibers to surrounding structures
2.) Restricts normal elasticity and gliding of structures
adhesion causes (3)
Can be caused by immobilization, trauma or surgery
reflex muscle guarding
prolonged contraction of a muscle in response to a painful stimulus; the contracting tissue splints the injured tissue against movement
intrinsic muscle spasm
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
causes of intrinsic muscle spasm (8)
1.) trauma
2.) pain
3.) inflammation
4.) infection
5.) stress
6.) cold
7.) immobilization
8.) emotional tension
muscle weakness caused by (2)
1.) May be caused by systemic, chemical or local lesion of a nerve (central or peripheral nervous system) or myoneural junction
2.)May also be result of direct injury or inactivity
Myofascial compartment syndromes
not a sufficient amount of blood to supply the muscles and nerves with oxygen and nutrients because of the raised pressure within the compartment such as the arm. leads to damage
Myofascial compartment syndromes causes (6)
1.) fx
2.) repetitive trauma
3.) crush injuries
4.) skeletal traction
5.) restrictive clothing
6.) wraps or casts
1st degree tissue injury (2)
1.) Mild pain at time of injury or within the first 24 hrs
2.) Mild swelling, local tenderness, pain with resistance or stretching
2nd degree tissue injury (3)
1.) Moderate pain-requires stopping of activity
2.) Palpation, movement ? pain
3.) Ligaments maybe torn leading to ? joint mobility
3rd degree tissue injury (4)
1.) Near complete or complete tear or avulsion of tissue (tendon or ligament)
2.) Severe pain at time of injury
3.) Usually painless with stretch or resistance
4.) Results in joint instability
stages of tissue inflammation and repair
1.) acute stage - inflammatory reaction
2.) subacute stage - proliferation, repair and healing, reconstruction
3.) stage 3 - maturation and remodeling
4.) chronic stage
cardinal signs of inflammation (5)
Heat (calor)
Redness (rubor)
Swelling (edema)
Pain at rest (dolor)
Loss of function (functio laesa)
heat
calor - combination of increased blood flow and release of inflammatory mediations
redness
rubor - increased vascularity
swelling
edema/tumor - exudication of fluid
pain at rest
dolor - the stretching of pain receptors and nerves by the inflammatory exudates and by the release of chemical mediations
loss of function
functio laesa
inflammatory stage responses in tissue (3)
1.) vascular
2.) cellular
3.) chemical
inflammatory stage
1.) During first 48 hours after injury...mostly vascular changes.
2.) Vasoconstriction first.
3.) Followed by vasodilation. (causes redness and heat)
4.) Increased permeability of blood vessels allowing clotting proteins, WBCs and other fluids from blood
cellular and chemical response during inflammation stage (5)
1.) Platelets are the first to arrive at the injury site and changes in thrombin/fibrinogen form clot.
2.) Chemical irritants or noxious stimuli are neutralized.
3.) Histamines and prostaglandins are released from mast cells (causes pain)
4.) Macrophages
pt education for protection phase of acute stage (3)
1.) Expected duration of symptoms (4 to 6 days).
2.) protecting the wound
3.) Precautions and contraindications.
protection of injured tissue (inflammation stage)(3)
1.) Control pain, edema, spasm.
2.) RICE
3.) Assistive devices
RICE
Rest,
Ice,
Compression,
Elevation
maintain soft tissue and joint integrity and mobility (acute stage)
1.) goal = strong mobile scar tissue
2.) organized arrangement of collagen from carefully controlled PROM
3.) movements to prevent adhesions
4.) gentle movement, no stretching/resistance at the site
5.) should not increase pain/inflammation
active movement in nearby areas during acute stage maintains...
...nearby areas during acute stage maintains integrity, circulation and lymphatic flow of uninjured tissue
PROM during acute stage
1.) Within the limit of pain to maintain mobility of joints, ligaments, tendons, muscles.
2.) Improves fluid dynamics and nutrition in joints.
3.) No stretching.
4.) Low-dosage joint mobilization
muscle setting
method of maintaining muscle strength and tone by alternately contracting and relaxing a skeletal muscle or group of skeletal muscles without moving the associated body part. avoids atrophy.
massage
Gently and cautiously to move fluid and manage edema.
interventions for associated areas in acute stage
1.) ROM - active-assistive, active or passive depending on proximity to injured area
2.) resistance exercise - not to direct muscle/tissue. prepares pt for use of assistive device
3.) functional activities - may needs supportive/adaptive devices
subacute stage
1.) Signs of inflammation decrease.
2.) Pain ? if newly developing tissue is stressed beyond tolerance.
3.) Muscles may be weak which will limit function.
4.) Usually lasts 10-17 days (14 to 21 days after onset of injury) up to 6 weeks depending on circul
fibroblastic activity (subacute)
synthesis and deposition of collagen that replaces the clot
myofibroblastic activity (subacute)
causes scar shrinkage
immature CT (subacute)
thin and unorganized, fragile and easily injured but needs stresses for proper growth and alignment and to prevent adherence to nearby tissues.
wound closure
1.) 5-8 days in muscle and skin
2.) 3-6 weeks in tendons and ligaments
protection phase
acute stage
controlled motion phase (subacute) (2)
1.) Patient feels better because pain is not constant and active movement can begin.
2.) Key is to initiate and progress non-destructive exercises and activities that are within the tolerance of the healing tissues and can respond without reinjury or infl
patient education during controlled motion phase (4)
1.) Inform pt of healing time frame and symptoms that indicate that they are pushing beyond tissue tolerance.
2.) Encourage pt to return to normal activities that do not exacerbate symptoms.
3.) Teach pt a HEP and help them adapt to work/activities that a
signs of excessive stress w exercise/activities (subacute) (6)
1.) DOMS
2.) pain that comes on earlier or is increased over the previous session
3.)Progressively increased feeling of stiffness and decreased ROM over several exercise sessions.
4.) inflammation
5.) increases weakness over several sessions
6.) decreased
management guideline (subacute)(2)
1.) Active exercise may be initiated when pain and swelling are no longer constant.
2.) Decrease intensity of exercise if pain or inflammation increase again.
initiation of active exercises (subacute)
1.) within pain-free range of injured tissue
2.) Pt response is best guide to how quickly and vigorously to progress
3.) If signs of inflammation increase or ROM decreases, intensity of exercise must decrease b/c chronic inflammation has developed and the
Multiple-angle, submaximal isometric exercise
AROM activities in pain-free ranges to develop control of motion.
Muscular endurance exercise (2)
1.) Exercises for muscle endurance emphasized during this phase b/c slow-twitch fibers are the first to atrophy when there is joint swelling, trauma, or immobilization.
2.) Initially use only AROM; later low-intensity, high repetition exercise with light
Protected weight-bearing exercise
Partial WB (PWB) within tolerance of healing tissues may be used early to load region in controlled manner and stimulate stabilizing co-contractions in the muscles.
Initiation and progression of stretching (subacute)
Initiate stretching specific to tissues involved to increase mobility and stimulate proper alignment of developing scar.
Initiation and progression of stretching includes (subacute)(6)
1.) modalities to warm tissue
2.) muscle relaxation techniques
3.) joint mobilizations
4.) stretching
5.) massage
6.) and use of the new range.
maturation and remodeling (4)
1.) no signs of inflammation
2.) May be contractures or adhesions that limit range
3.) Connective tissue continue to strengthen and remodel in response to stresses applied to it
4.) Stretch pain may be felt when tight structures are at the end of their ra
maturation and remodeling duration
6 months to 1 year
maturation begins...
...begins during the late subacute stage and continues for several months
Maturation and remodeling of the scar tissue occurs as...
...occurs as collagen fibers become thicker and reorient in response to stresses
maturation and remodeling stage see improved quality of...
...sees improved quality of the collagen and reduction of wound size
hydrogen bonds and collagen
Immature collagen molecules can be easily remodeled with gentle and persistent treatment for up to 10 weeks
stressing fibers
If not properly stressed, fibers adhere to surrounding tissue and form a restricting scar.
covalent bonds and collagen
At 14 weeks, scar tissue is unresponsive to remodeling. After this time, either need adaptive lengthening of surrounding tissue or surgical release.
PT role in return to function phase/chronic stage
to design a progression of exercises that safely stresses the maturing connective tissue in terms of flexibility and strength.
patient education (chronic stage)(3)
1.) Instruct pt in safe progression of resistance and self-stretching and how to monitor for detrimental effects and signs of excessive stress.
2.) Teach ways to avoid reinjuring the part.
3.) Teach safe body mechanics.
stretching techniques specific to tight tissue (3)
1.) Joint and selected ligaments (joint mobilization)
2.) Ligaments, tendons, and soft tissue adhesions (cross-fiber massage)
3.) Muscles (neuromuscular inhibition, passive stretch, massage, and flexibility exercises)
Improve neuromuscular control, strength, muscle endurance (3)
progress exercises ---------->>>>
1.) Submaximal to maximal resistance.
2.) Specificity of exercise using resisted concentric and eccentric, weight bearing and NWB.
3.) Safe biomechanics.
Improve cardiopulmonary endurance (chronic/return to function)
Progress aerobic exercise using safe activities.
Progress functional activities(chronic/return to function)
Continue using supportive and/or assistive devices until the ROM is functional with joint play, and strength in supporting muscles is adequate.
a state of prolonged inflammation may occur....
...If injured tissue is continually stressed beyond its ability to repair
chronic inflammation symptoms include:
increased pain, swelling, and muscle guarding lasting more than several hours after activity
chronic recurring pain
There is proliferation of fibroblasts with increased collagen production and degradation of mature collagen leads to a mostly new, immature collagen. This weakens the tissue
Chronic pain syndrome (3)
1.) A state that persists longer than 6 months.
2.) Includes pain that cannot be linked to a source of irritation or inflammation.
3.) Includes functional limitations and physical, emotional, and psychosocial disability.
Causes of chronic inflammation (6)
1.) Overuse.
2.) Cumulative trauma.
3.) Repetitive strain.
4.) Trauma
5.) Reinjury of an 'old scar'.
6.) Contractures or poor mobility.