Unit 2 Week 7

Question 1

Anatomy of a LIGAMENT

Answer 1

Collagen fibers in longitudinal bundles with small cross links
- Epiligament layer
- Hypoceular: fibroblasts
- Hypovascular
- mechanoreceptors
- Intraarticular vs. Extraarticular
- Thickened bands in joint capsule or discrete cords

Question 2

Epiligament layer

Answer 2

VASCULAR SUPPLY
- contains mostly fibroblasts
- Mechanoreceptors

Question 3

Deeper ligament are …

Answer 3

Less vascularized and less cellular than superficial layers

Question 4

Intra-articular ligaments

Answer 4

WITHIN THE JOINT CAPSULE
Ex; ACL or PCL

Question 5

Extraarticular layer

Answer 5

OUTSIDE OF THE JOINT CAPSULE
Ex: LCL

Question 6

Capsular Ligaments

Answer 6

They don’t present and look like a ligament it just looks like a capsule/thickened bands within the joint capsule

Question 7

What are the functions of a ligament

Answer 7

1. Structural= Holds skeleton together
2. Motion Help guide joint motions/control amount of motion at a joint
3. Limit joint excursion
4. Restrain abnormal motions
5. When on slack exhibit crimp = when the tissue is sort of scrunched up in the toe region and the slack is taken off when tension is applied to the ligament
6. Viscoelastic tissue and exhibits viscoelastic properties they respond to time and history dependent mechanical behaviors or loads

Question 8

How do ligaments play a passive role?

Answer 8

technically they are inert but have a proprioceptive role and a passive role by structural types of tension as well

Question 9

Injuries to ligaments are called?

Answer 9

Sprains

Question 10

What is the phases of Healing for LIGAMENTS

Answer 10

1. hemorrhagic = hematoma in the gap, inflammatory recruitment
2. Inflammatory= clearance of necrotic tissue, neovascularization, granulation tissue, recruitment of cells
3. Proliferation= by 1st week fibroblasts arrive last, begin collagen and other protein production: by 2nd week original clot more organized capillary bundles collagen content and high but disorganized
4. Remodeling= gradual decrease cells, matrix becomes dense and organized : normalize water content
   - Type 1:3 ratio

Question 11

Strength of a ligament @
5 weeks-
6 months-
1 year-

Answer 11

5th week- some strength
6 months- 50% strength
1 year- 80%

Question 12

Which is less likely to heal ACL or MCL?

Answer 12

ACL is less likely to heal
- This is because it it encased in synovium and less likely to heal without surgery
- Intraarticular ligaments do not follow typical triphasic healing an timeframes
- Blood dissipates into synovium and a hematoma is prevented–> limiting arrival of growth factors and cytokines needed to mediate inflammation and healing

INTRAARTICULAR

Question 13

Why is the MCL more likely to heal?

Answer 13

• Epiligament layer- highly vascular, cellular and sensory/proprioceptive nerves
• Greater likelihood of healing without surgery
• Follows triphasic healing time frames
  EXTRAARTICULAR

Question 14

Grade 1 Ligament Injury

Answer 14

Tissue damage=
- fiber stretching or tearing

Clinical signs
- point tenderness
- mild swelling
- some joint stiffness
- no abnormal motion/laxity
- Mild ecchymosis

Implications
- Minimal function loss
- early return to training with some protection

Question 15

Grade 2 Ligament Injury

Answer 15

Tissue damage
- Some tearing, separation of fibers

Clinical Signs
- Tenderness
- effusion/hemarthrosis
- Stiffness
- Laxity and abnormal motion
- Moderate function loss

Implications
- tendency to recur
- modified immobilization
- Longer term instability - Arthritis risk

Question 16

Grade 3 Ligament injury

Answer 16

Tissue Damage
- Total Rupture

Clinical Signs
- Initial severe pain , then min/none
- Profusion swelling and ecchymosis
- marked laxity and abnormal motion
- Moderate loss of function

Question 17

Protective phase

Answer 17

• control swelling and pain
• relative rest versus complete immobilization
• submaximal isometrics
• pain free ROM(PROM, AAROM, AROM)

Question 18

What is the neutral zone of a joint?

Answer 18

Little to no resistance to movement

Question 19

What is an elastic zone of a joint ?

Answer 19

first barrier to motion encountered

Question 20

What is the plastic zone of a joint

Answer 20

permanent deformation may lead to injury

Question 21

what are normal barriers to joint movement ?

Answer 21

• articular shape of bone and cartilage
• restraining ligament tension
• capsular tension
• Muscle length
• synovial fluid

Question 22

Hypomobile

Answer 22

1. Internal derangement
2. Arthrosis= break down of joint surfaces
3. Ankylosis= bones fuse together
4. Myofascial length = myofascial adhesion
5. Effusion hemarthrosis= to much fluid
6. Capsular
7. neurodynamic tension

Management=
- manual therapy
- exercise to promote normal movement
- Medical intervention

Question 23

Laxity

Answer 23

state of more than typical motion present at a joint, though not a problem unless associated with symptoms

Question 24

Hypermobility =

Answer 24

Laxity + symptoms associate with inability to control joint during movement

Question 25

Flexability

Answer 25

Function of contractile tissue length/ resistance - Can also be function of joint passive restraints. Related to amount of motion available an the ease or quality of joint motion

Question 26

Generalized Hypermobility

Answer 26

- Multi-joint - Activity related, individual variability genetic disease - Beighton scale >4 +

Question 27

What is instability of a joint?

Answer 27

- Loss of joint congruity in response to loading - INcreased ROM without adequate neuromotor control - Multifactorial - Altered arthrokinematics - Altered physiological motion - Functional interferes with function

Question 28

What are the components of joint stability?>

Answer 28

1. Joint integrity= articular surfaces/congruity 2. Muscle= static stability and dynamic stability 3. Passive restraints= ligament, capsule, skin 4. motor control = activation , magnitude, timing

Question 29

Hypermobility Management

Answer 29

- Neuromuscular control - supporitve garments/orthotics - treat muscular stability - improve strength - retrain patterns of function

Question 30

DVT and what can a PT do?

Answer 30

Blood clot formed in deep veins commonly of the lower leg, if it breaks free it can lead to a pulmonary embolism (PE) Risk factors= 1. age 2. bed rest 3. Immobility 4. distance traveled 5. major traumas ecttt PT role= 1. recognize signs and symptoms and refer out fast for medical testing and intervention 2. prevention of immobility; mobilization, exercise to promote circulation 3. monitoring anti-coagulant status; patients compliance with medications and monitoring lab values

Question 31

Physis=

Answer 31

epiphysial plate cartilage growth plate

Question 32

Diaphysis=

Answer 32

Shaft primary ossification center

Question 33

Epiphysis

Answer 33

the ends secondary ossification center

Question 34

Metaphysis=

Answer 34

IN betweeen the epi and the dia- physes part of the growth plate

Question 35

Apophysis

Answer 35

secondary ossification center growth plate attachment of muscle