1
Q
What are the seven forms of GAG?
A
- chondrotin-4 sulfate
- chondrotin-6 sulfate
- dermatan sulfate
- keratan sulfate (i, II)
- heparan sulfate
- hyluronic acid
2
Q
What impact does vitamin A have on wound healing?
A
- improves healing
- increases synthesis of GAG in granulation tissue
- defecencies are associated with bone loss, decreased glycoprotein production, decreased adhesion of chondrocytes and fibroblasts in ECM, decreased quality of wound strength
3
Q
What impact does zinc have on wound healing
A
- promotes faster wound healing
- essential for enzymatic activities that promote protein synthesis, collagen synthesis, and cell growth
- deficiencies of zinc result in impaired wound healing, reduced collagen synthesis and immune deficiencies
4
Q
How does copper impact wound healing?
A
deficiencies effect neutrophil function
5
Q
How doe oral corticosteriods effect healing?
A
- osteoporis, myopathy, bone osteonecrosis, psycologic complication
- faciliates catabolism of musculoskeletal tissue
- fibroblast, lymphocytes and adiposites DNA synthesis and cellular proliferation are inhibited
- blocked glucose uptake
- increased protien breakdown
- decreased protein synthesis for muscles and connective tissues
- stops collagen synthesis
- stops fibroblastic function and inhibits scar formation
6
Q
How do NSAIDs effect tissue healing?
A
- 30% of users have GI complications
- inhibits macrophage function leaving necrotic tissue behind
- inhibits synthesis of type II collagen and GAG
- faciilates boney destruction with OA
- delays tendon healing
7
Q
What is the healing pathway for muscles?
A
- Activation of mononucleated satellite cells or mononuclated by degeneration of muscle fibers within the basal lamina to create myoblasts
- fusion of myoblasts produces myotubes that regenerate into mature muscle fibers
- mature fibers assume charateristics of fast or slow muscles depending on what nerve innervates it
8
Q
What is granulation tissue?
A
- formed during repair phase
- contains myofibroblasts, fibroblasts, ECM
- rich vascular supply
9
Q
What is glycoprotein?
A
- protein which binds carbohydrates
- plays a role in the interaction b/w adjacent connective tissue cells and the adhesion of these cells to collagen
- fibronectin and laminin are examples
10
Q
What are Gray’s classifications of joints?
A
- plane joint
- hinge (modified sellar)- uniaxial with concave/convex
- pivot or trochoid- cylinder inside cylinder
- condylar (modified ovoid)- primarily uniaxial
- ellipsoid (modified ovoid)- MCPs
- spheroidal (ball and socket)
11
Q
How does Macanail classify joints?
A
- Ovoid- convex or concave in all directions, egg shaped so constant change in radii
- modified- ellipsoid or biaxial
- unmodified- ball and socket, 3 axis of motion - sellar- saddle shapped with conjunct rotation and movement in perpindicular planes
- modified- uniaxial hinge joint
- unmodified- mulit axial
12
Q
What are the categories of synarthrotic joints?
A
- fibrous- fibrous tissue bone to bone
- suture- then layer of fibrous tissue with bone overlay
- gomphsis- peg in hole (tooth)
- cartilaginous
13
Q
What are the different type of cartilaginous synarthrotic joints?
A
- symphysis- the boney componets joined by a disc or plates of fibrocartilage
- synchondrosis- hyaline cartilage connects the boney components
14
Q
What are proteoglycans?
A
- noncollagenous macromolecule interwoven with collage fiber and elastin
- contain a protein core and GAG chain
15
Q
What are satellite cells?
A
- reserve cell with myogenic regenerating capacity
- lie between a muscle fiber and its basal lamina
- can differentiate into myblasts that fuse into myotubules
16
Q
What two mechanisms are responsible for local tissue edema after trauma?
A
- venous stasis- local dilation with distal non-dilation
2. tissue edema- reversal of osmotic pressure gradients
17
Q
What is the manual therapy lesion?
A
- collagen trauma
- receptor damage
- reduce tonic muscle recuritement
- tonic fiber atrophy
- reduced antigravity stability
- mation around a non-physiologic axis
- trauma/acute locking
- pain/guarding
- back to 1
18
Q
Who started to educate PTs in joint manipulation?
A
James McMenell in England
His son John brought to the world
19
Q
Who developed the first clinical differential?
A
Cyriax
20
Q
What the difference between adjunction and conjunct rotation?
A
- adjunct- voluntary rotation and is considered a osteokinematic motion
- conjunct is involuntary spin accompaning an arcuate swing
21
Q
How does cryotherapy effect tissues?
A
- increased stiffness
- decreased inflamation
- decreased metabolic rate
- decreased circulation
- decreased muscle spasm
- decreased pain
22
Q
What impact does vitamin C have on healing?
A
- required for collagen production
2. deficencies are associated with poor wound healing, poor vascularization, reduced collagen production
23
Q
What is the difference between cardinal and arcuate swing?
A
- cardinal- shortest distance b/w two points with no roation
- arcuate- follows a curved path due to shape of joint surfaces
24
Q
What is the cyriax differential evaluation?
A
active and passive motion are restricted
- same direction arthogenic
- opposite directions non-contractile
25
How do intramuscular adhesions change the cyriax differentials?
pain and limitation are present with active and passive motion in opposite direction as well as motion in the same direction
26
What some options to NSAIDs?
1. tylenol
| 2. omega-3 fatty acids, eicosapentaenoic acid and docosaherxaenic acid found in cold water fish nuts and oils
27
what are the vascular events of wound healing?
1. hemorage
2. fibrin clot
3. vasoconstriction
4. vasodialation
5. increased permeability due to prostaglandins, brady kinins and histamine
28
What are the cellular events of wound healing?
1. neutrophisl phagocytize pathogens
2. macrophages phagocytize cellular debride and pathogens while stimulating neoangeogenisis
3. fibroblasts work to increase density of granulation tissue by producing collage and GAG
29
What is the number one factor that effects speed and intensity of tissue repair?
the degree of capillary growth in the wound bed
30
What are the categories of joints?
1. synarthrotic- non-synovial
| 2. diarthortic- synovial
31
What is the basal lamina?
membrane surrounding individual muscle fibers
32
What is the function of cytokine?
chemicial messenger that regulates immune response and calls in WBCs as needed
33
What is elastin?
fibrous protein in connective tissue
34
What is fibronectin?
glycoprotein with an important role in adhesion of connective tissue
35
What are mast cells?
1. a connective cell important in the defense mechanism during injury or infection
2. faciliates blood coagulation
3. releases histamine
36
What are polymorpheonuclear leucocytes
1. WBC also know as neutrophil
2. often the first to reach the injury site
3. ingests necrotic tisseue, debris and pathogens
4. releases "powerful enzymes"
37
what are myotubes?
1formed by cytoplasmic fusion of myoblasts
| 2.precursor to newly formed muscle
38
what are myofibroblasts?
1. contain contractile element that causes the scar tissue to contract
2. most active 5-21 days
39
what are myoblasts?
1. mononucleated muscle precursor
| 2. can differentiate into new skeletal muscle
40
What is the mechanism for changes in capillary fluid pressures with trauma?
1. localized vasodialation with distal vaso-nondialtion increased pressure
2. permeability causes loss of fluids and other molecules into tissue to alter colloid osmotic balance
3. causes the pressure balance to change form negative to positive
41
What should clinical treatment in acute stage look like?
1. decrease the hydorstatic pressure via elevation to minimize edema
2. ince ot inhibit pain response and local muscle guarding
3. movement to decrease circulatory stasis
4. pain avoided at all times
42
What are the adverse effects of heat during the settled stage of healing?
1. increases fluid in the extra capillary space
2. creates chemical changes in muscle which do not occur with guarding
3. causes muscles to go into metabolic rigor adn respond in a nuerophsiologic manner
43
What should treatment in the settled stage look like?
1. faciliate neoangiogensis through active motion utilizing minimal tension on muscles
2. apply OSR
3. avoid chronic inflamation
44
what region of the brain has the greatest influence on tonic/slow twitch/stabilizing muscles?
basal ganglia cortex
45
Explain how prolonged postures or immobilization can lead into the manual therapy lesion?
1. injury with tonic muscle guarding
2. secondary hyermobility to compensate for the hypo
3. collagen structures adapt and their is a loss of elasticity
4. loss of elasity leads to decreases sensitivity to stretch
5. decreased afferent stimulus
6. loss of tonic muscle stability (MTL)
46
How does increased tissue temperature effect collagen?
1. at a temperature of 42C or 112F you get inhibition of GAG production from fibroblasts
2. 40-42C collagen partially metls and tissue becomes fragile
3. 45C tendon rupture with only 25% of the normal tearing force
47
What effect does arachidonic acid have on pain and what food do you find it in?
1. since it is a major precursor to inflammation in faciliates the inflammation casscade
2. red meat, shell fish, dairy products
48
What are normal vascular and tissue pressues
1. vascular- mean fluid pressure of 17 mmHg and colloid OS of 28mmHg
2. tissue: tissue osmotic -5.3 -> total tissue pressue -17 -> total colliod pressure 28.3
49
How do tissue pressures change with trauma?
1. vascular mean fluid and colloid osmotic pressure increases to 18-40 mmHg
2. tissue pressures decease to less than 7 mmHg for total tissue pressure and colloid osmotic
50
What are the differentials for spine capsule involvement?
1. stretching of the capsule is painful
2. palpation tenderness
3. resisted motion of the the multifidus that ties into it
