KIN 240 > midterm > Flashcards

midterm Flashcards

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1
Q

what are the 3 phases of tissue response to injury and approx time

A

inflammatory response phase (4 days)
fibroblastic repair phase (4 days to 6 weeks)
maturation-remodeling phase (couple weeks to 2-3 yrs)

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2
Q

What are the 5 signs of inflammation (SHARP)

A

Swelling
Heat
altered function
redness
pain

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3
Q

What are the 4 goals of the inflammatory response phase

A

protect
localize
decrease injurious agents
prepare for healing and repair

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4
Q

What are the 3 Key stages of Phase 1 Inflammatory Response Phase

A

Vasoconstriction: occurs upon tissue disruption to seal blood vessels
Vasodilation: occurs within minutes after initial vasoconstriction (increase blood flow and leads to swelling)
Clot formation: important to avoid disruption

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5
Q

How long does vasodilation and clot formation last in phase 1 inflammatory response phase

A

vasodilation: 24-36 hours
clot formation: 12-28hours post injury

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6
Q

What was the old steps for first 28 hours post injury in acute management (RICE)

A

Rest, Ice, Compression: keeps fluid in vessels, elevation: reduces pressure in vessel and allows for fluid to drain

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7
Q

What is the new acronym for first 48 hours in acute management (POLICE)

A

Protection
Optimal Loading
Ice
Compression
Elevation

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8
Q

How to ice in acute management (kinds of ice to use) 4 things

A

frozen water, crushed ice/smaller cubes better

cold water immersion
reusuable gel and instant cold

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9
Q

What are the optimal time frames of ice application and location of the ice

A

20 min on 1 hour off
multiple applications if possible
apply directly to skin, unless there is allergy

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10
Q

What are 4 sensation explanations of icing you can explain for the first time

A

1st: Cold/pain
2nd: Burning
3rd: Aching-throbbing
4th: Numbness

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11
Q

What are 5 contraindications to ice

A

Reynaud’s syndrome: ice allergy change colors in cold anf stuff
Diabetes
Recent surgery
Sensitive skin
Altered sensation

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12
Q

What is the use for ice practically and how should it be prioritized compared to protection and optimal loading

A

Ice is best for short term relief, prioritize protection and optimal loading

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13
Q

What does fibroblastic repair phase also referred to as and main process

A

fibroplasia: pain and tenderness subsides during this period as healing occurs
formation of delicate connective tissue; consists of substances that develop collagen or scar tissue

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14
Q

What happens in the fibroblastic repair phase phase 2 (2 things + barrier to recovery)

A

tensile strength increases with proliferation collagen

normal sequence= minimal scarring

prolonged scar tissue formation can create barriers to injury recovery
- pain
-adhesion of non effective scar tissue

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15
Q

What are 3 things to know Phase 3, Maturation and Remodeling

A

Long term process
realignment of collagen is relative to applied tensile forces
continued breakdown and synthesis of collagen, more strength
tissue gradually assumes normal appearances

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16
Q

How does Chronic inflammation impede healing

3 things to know

A

Result of failed acute inflammation response
subacute inflammation represents prolonged inflammatory response phase
may be caused by further disruption to injured tissue in early fibroplastic phase

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17
Q

What are the 4 types of soft tissue + other tissue

A

Epithelial tissue
Connective tissue: tendons and ligaments
Muscle tissue
nerve tissue

bone

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18
Q

How do ligaments healing

A

follow conventional healing sequence through acute repair and remodeling phases

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19
Q

What happens in the repair phase for ligaments (and the kind of stability its integral for)

A

laying down of collagen, matures and realign in reaction to stresses

integral in regaining static stability of a joint

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20
Q

In ligaments, with intraarticular tears ______ will dilute hematoma and ________ clotting

A

synovial fluid; prevent clotting

delays healing

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21
Q

Why must muscles be strengthened to reinforce the joint

A

dynamic stability makes up for the reduction of static stability provided by the ligament

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22
Q

What happens after there is bleeding in skeletal muscle (2 things)

A

bleeding is followed by proliferation of fibroblasts
- bruising

collagen will mature and orient along lines of tensile force

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23
Q

What is the main way skeletal muscles heal, and the time frame

A

Myoblastic cells from=regeneration of new myofibrils

Healing could last 6-8 weeks depending on injury and severity (primary vs accessory)

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24
Q

What are the two general things to know about tendon healing

A

requires dense fibrous union of injured tissue in order to regain function

Abundance of collagen is required for good tensile strength

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25
What are the 3 stages of tendon healing
Stage 1: injured tendon will adhere to surrounding tissues Stage 2: tendon will gradually separate bceoming more mobile stage 3: tensile strength gradually returns, tendon can be loaded normally
26
What are the 5 stages of acute fractures of bone
Hemoatoma formation Cellular proliferation callus formation ossification remodeling
27
In the first 48 hours of bone tissue healing what happens
Hematoma within the medullary cavity and the surrounding tissue develops
28
How does blood supply get disrupted in bone healing, after hematoma, and how calluses get filled
blood supply gets disrupted by clotting vessels and cellular debris, osteoblasts fill the internal and external calluses to immobilize the site
29
How are calluses formed in bone healing
calluses are formed by bone fragments that bridge the fracture gap
30
What is associated with hard callus in bone healing
hard callus becomes more well formed as osteoblasts lay down cancellous bone replacing the cartilage
31
What to know about Wolff's Law (3 things)
Bone continually adapts to applied stresses Balance between osteoblast and osteoclast activity Time ranges from 3-8 weeks based on severity and site of fracture
32
What to know about acute fracture management (2 things)
Must be immobilized until X ray reveal hard callus clinicians must identify poor blood supply or poor immobilization that can interfere with healing
33
What are factors that impede bone healing and what it may lead to (2 things + condition)
poor immobilization: bone deformity allowing motion Poor blood supply - bone may die and healing will not occur avascular necrosis: bone dies cuz of no blood
34
What are common sites of poor blood supply in bone healing
femur head, navicular talus scaphoid, isolated fragments
35
What are the two phases of normal gait
Stance: initial contact of heal and ground and ends with toe-off Swing:time between toe off and subsequent initial contact
36
How much of the gait cycle does the stance phase account for, and where does it involve weight bearing and what is the period of swing phase
stance: 60% of gait cycle, involves weight bearing in closed kinetic chain swing: period of non weight bearing
37
What are take home points about gait weight transition, motion patter, and kinetic chain
Heel absorbs shock and transitions weight, to toes motion pattern: slight supination to pronation at midstance kinetic chain: hip/knee movements influence pronation-supination and vie verse
38
What to know in history and observation for foot
history: questions specific to foot, pain and footwear observations: gait, arch, alignment and deformities
39
what are 6 things to palpate on the foot
medial malleolus navicular tubercle lateral malleolus cuboid bone styloid process of 5th metatarsal plantar fascia
40
What are the mechanims of injury and signs and symptoms of pes planus foot (flatfoot)
Etiology: associated with excessive pronation, weak structures symptoms: pain and weakness or fatigue in medial longitudinal arch, bulging navicular
41
what to know about excessive pronation (3 things)
cause of stress injury results in loose foot, allows more midfoot motion will not allow foot to resupinate to provide rigid lever for toe off
42
Whats the management for pes planus (3 things)
orthoics can support medial longtitudinal arch taping of arch can also be used strengthening posterior lower leg and intrinsic muscle of the foot
43
What is the mechanism of injury and signs of Pes cavus (high arch foot) 3 signs
Etiology: higher arch than normal, excessive supination signs: high medial longitudinal arch and heavy callus development on ball and heel of foot, lower leg pain
44
What should you know about excessive supination (3 things)
causes foot to remain rigid, decreased mobility and limits tibia internal rotation
45
What is the management of pes cavus (high arch foot) 4 things
orthoics can aid absoroption of force through foot release achiilles and gastro complex and planar fascia
46
what is plantar fascia and what does it work on
dense broad connective tissue attaching proximally to medial surface of calcaneus, fans over plantar surface of foot works in maintaining stablity of the foot and bracing the longtitudinal arch
47
What are the etiology (3 things), sign and symptoms (2 things) and management of plantar fasciitis (4 things)
etiology: increased tension and stress of fascia during toe off phase of running, change from supportive to flexible footwear, excessive pronation signs:pain in morning and first teps, pain in anterior medial heel management: conservative, soft orthotic, simple arch taping and achilles and extension/flexion exercises
48
What are the etiology (2 things), signs (2 things) and management of metatarsal stress fractures (3 things)
etiology: second metatarsal fracture, change in running patterns signs: dull ache during weight bearing, progresses from diffuses to localized pain management: medical management, immobilization until full weight bearing without pain, return to running slowly
49
What is great toe hyperflexion (turf toe) etiology, signs, and management (3)
etiology: hyperextension injury in sprain of first metatarsophalangeal joint signs: pain and swelling increases during push off when moving management: increase rigity of forefoot in shoe, taping toe to prevent dorsiflexion and rest
50
What is the etiology, signs,(2 things) management (3 things) of apophysitis of the calcaneus- sever's disease
etiology: traction injury at apophysis of calcaneus where achilles attaches signs: children and adolsescent, occurs at posterior heel below achilles management: POLICE, heel lift and soft tissue restrictions
51
how is medial or lateral displacement of ankle prevented by
malleoli
52
what are the most and least stable position of the ankle
stable- dorsiflexion least stable: plantar flexion
53
normal gait requires minimum ___ degrees of dorsiflexion and _____ degrees of plantar flexion
10 degrees dorsiflexion 20 degrees of plantar flexion
54
what are main observations of leg and ankle
difficulty in walking, range of motion normal
55
What should you know inversion sprains (4 things)
Most common and results in injury to lateral ligaments anterior talofibular ligament most common lateral ligament injured posterior talofibular and calcaneofibular ligaments can be injured with increased force avulsion fractures may occur at lateral malleolus or 5th metatarsal
56
What are the ottawa ankle rules (2 things)
Field assesment for x rays inability to bear weight for four steps at time of injury and examination tenderness along base of fifth metatarsal or either malleoli
57
What are the signs (3 things) and management (3 things) of a grade 1 inversion ankle sprain return to play
mild pain and disability, minimally impaired weight beating and tenderness over ligaments POLICE one to two days, limited weight bearing, tape/bracing and RTP in 7 to 21 days
58
What are signs (4 things) and management (3 things) of grade 2 inversion ankle sprains
pop or snap, moderate pain, tenderness and edema POLICE for 72 hrs, air cast until weight bearing pain free, taping/brace
59
What is the mechanism of injury for a grade 3 inversion ankle sprain and what does it cause damage to
extremely disabling caused by significant force anterior talofibular, posterior talofibular and calcaneofibular ligaments are damaged
60
What are signs (3 things) and management (3 things) of a grade 3 inversion ankle sprains
signs- severe pain, swelling, discolorations and unable to bear weight management- POLICE, immobilized for 4 to 6 wks, non weight bearing until no pain
61
Eversion ankle sprains represent what proportion of all ankle sprains, and why is that so
5-10% bony protextion and ligament strength lessen occurences
62
what kind of damage can happen with an eversion ankle sprain
deltoid ligament and fibula fractures (shearing) tibia (avulsion)
63
What are signs (2 things) and management of eversion ankle sprain and something to note about grade 2 or higher sprains
signs: medial pain, same inversion sprain symptoms management: follows same course of treatment as inversion grade 2 or higher will have considerable instability
64
What's the MOI (2 things) and signs (4 things) of a high ankle sprain (syndesmotic sprain)
etiology: injury to distal tibiofibular joint, forced rotation often in dorsiflexion signs: severe pain, pain worsens with weight bearing and dorsiflexion, multiple ROM elicit symptoms
65
What's the management for a high ankle sprain ( 3 things)
Diffiicult to treat and may need months immobilization, potential surgery
66
What to know about chronic ankle instability (3 things)
common in recurrent sprains or poorly rehabbed first time injury structural instability: no static stability functional instability: loss of dynamic stability
67
what is etiology and MOI of achilles tendinopathy (4 things)
inflammatory condition involving tendon and sheath fibrosis tendon is overloaded due to consistent stress
68
What are the signs of achilles tendinopathy (2 things and pain pattern)
palpable pain proximal to calcaneal insertion crepitus with plantar and dorsiflexion pain pattern is worse in morning until tissue warms up, increase in soreness after activity
69
What is the management of achilles tendinopathy ( 4 things)
reduce stress on tendon NSAIDS strengthenening must progress slowly eccentric and isometric optimal
70
Etiology of achilles tendon rupture
forceful dorsiflexion with knee moving into full extension
71
what are signs of achilles tendo rupture (4 things)
sudden snap, tenderness and stuff obvious indentation positive squeeze test
72
management of achilles tendon rupture?
common management involves surgical repair rehab 6 months
73
What is etiology of medial tibial stress syndrome (shin spllints) (4 things)
pain in anterior shin caused by repetitve microtrauma weak muscles, improper footwear and training contribute
74
what are the signs of MTSS/Shin Splints (4 grades of pain), and what to note in 3rd and 4th grade
Four grades of pain Pain after activity Pain before and after activity, not affecting performance Pain before during and after activity, affecting performance Pain so severe performance is impossible tibial stress fracture risk at 3rd and 4th phase
75
What is the management of MTSS/Shin splints (4 things)
x ray, fixing biomechanics, therapy and taping/orthoics entire IST
76
What is etiology of stress fracture of tibia (3 things)
common overuse condition, change in environment, biomechanical insuffiences
77
what are signs of a stress fracture (2 things)
pain more intense after exercise than before point tenderness
78
what is the management for stress fracture (4 things)
discontinue stress-inducing activity partial weight bearing cycling before running pain free for 2 weeks can return to running slowly
KIN 240
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