Term
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Definition
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Term
| Displacement or disarrangement of the normal relationship of bones entering into the formation of a joint |
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Definition
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Term
| An incomplete luxation or dislocation; although a relationship is altered, contact between joint surfaces remains |
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Definition
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Term
| Any mechanical injury (usually caused by a blow) resulting in hemorrhage beneath unbroken skin |
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Definition
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Term
| A localized mass of extravasated blood that is relatively or completely confined within an organ or tissue, a space, or a potential space |
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Definition
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Term
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Definition
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Term
| The injuries caused by repetetive stresses and microtrauma |
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Definition
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Term
| Injury resulting from tensile force to muscle or tendon, especially skeletal muscles |
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Definition
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Term
| An injury of the ligamentous structures around a joint caused by abnormal or excessive joint motion |
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Definition
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Term
| A retrogressive pathologic change in cells or tissues; consequently their functions are often impaired or destroyed; sometimes reversible |
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Definition
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Term
| Name 6 types of soft tissue injuries |
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Definition
Strains and Sprains
Lacerations
Tendon Ruptures
Muscle injuries
Myofascial compartment syndrome
Dislocations and subluxations |
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Term
| Refer to the stretching or tearing of the musculotendinous unit; they may be partial or full tears |
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Definition
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Term
| Can be classified as mild, moderate, or severe (complete) tears or as injuries of first, second, or third degree depending on the severity of tissue damage; an alternate classification scheme uses three grades of injury (I, II, III). |
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Definition
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Term
| Describe a first degree (mild) strain/sprain |
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Definition
| Stretching or minor tearing of a few fibers without loss of integrity with only minor swelling and discomfort accompanied by no or only minimal loss of strength and restriction of movement. |
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Term
| Describe a second degree (moderate) sprain/strain |
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Definition
| Partial tearing of tissue with clear loss of function (ability to contract). Pain, moderate disability, point tenderness, swelling, localized hemorrhaging, and slightly to moderately abnormal motion are typical |
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Term
| Describe a third degree (severe) sprain/strain |
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Definition
| Complete loss of structural or biomechanical integrity extending across the entire cross section of the muscle and usually requires surgical repair. Commons ites for this type of injury include the ankle, knee, and fingers. |
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Term
| Which soft tissue structure is most vulnerable to injury? |
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Definition
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Term
| __ and __ __ __ have been reported to occur as a potential side effect of antibiotic treatment, especially with the use of fluorquinolone antibiotics (ex: drugs ending in "floxacin", such as ofloxacin, norfloxacin, levofloxacin) |
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Definition
| Tendinitis and spontaneous tendon ruptures |
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Term
| These tendon disorders are more common in people over 60 years of age, especially those who are also taking oral corticosteroids. |
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Definition
| Fluoroquinolone-associated tendon disorders |
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Term
| ___ injuries occur at a higher rate in kidney transplant recipients, possibly caused by medications. In such cases, care should be taken to avoid overloading tendons, since dramatic ruptures following even small trauma have been reported. |
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Definition
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Term
| A __ muscle is also at risk for complete rupture if the muscle is subjected to high tensile force |
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Definition
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Term
| What are the clinical manifestations of soft tissue injuries? |
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Definition
-Local pain, edema, increased local tissue temperature, ecchymosis, hypermobility or instability, and loss of function
-Muscle contusion (bruising with intact skin) is common in contact sports and incites an inflammatory response, sometimes involving hematoma formation
-Inflammatory reaction from injured soft tissue may lead to structural adaptation of tissue, scarring, weakness, and inflexibilities that can cause structural deficits or functional adaptations
-If, after an injury, the PT notes quick onset of joint effusion and the joint feels hot to the touch and movement is extremely painful and limited, the joint needs to be examined by DR to rule out hemarthrosis |
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Term
| Develops when increased interstitial pressure iwthin a closed myofascial compartment compromises the functions of the nerves, muscles, and vessels within the compartment |
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Definition
| Myofascial compartment syndromes |
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Term
| May be acute or chronic and are most likely to occur within the "envelopes" of the lower leg, forearm, thigh, and foot where the fascia cannot give or expand |
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Definition
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Term
| What can happen if myofascial compartment syndrome is left untreated? |
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Definition
| Ischemia and irreversible muscle loss can occur, resulting if functional disability (and potential limb loss) |
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Term
| What is the etiology of myofascial compartment syndrome? |
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Definition
| Many clinical conditions predispose to the development of compartment syndromes, including fractures, severe contusions, crush injuries, excessive skeletal traction, and reperfusion injuries and trauma. Other risk factors may include burns, circumferential wraps or restrictive dressings, or a cast or other unyielding immobilizer. |
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Term
| What are the clinical manifestations for myofascial compartment syndrome? |
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Definition
-The earliest clinical symptoms of impending compartment ischemia is pain out of proportion to that expected from the injury.
-The pain is described as deep, throbbing pressure
-There may be sensory deficit or parasthesia within the region distal to the area of involvement
-In severe compartment syndromes, objective signs are visible, such as swollen extremity with smooth, shiny, or red skin
-The extremity is tense on palpation, and passive stretch increases the pain |
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Term
| How should myofascial compartment syndrome be treated? |
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Definition
| Prompt surgical decompression is the standard intervention |
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Term
| Can occur in skeletally immature children and adolescents. The 3 areas include the physis (growth plate), articular cartilage of joint surfaces, and major bone-tendon attachemnts (apophyses). |
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Definition
| Injury to growth cartilage |
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Term
| The sites of growing cartilage account for a large number of sports injuries in young athletes including what? |
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Definition
-Osteochondritis dissecans (articular surface)
-Osgood-Schlatter disease (apophysis) |
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Term
| The partial disruption of the anatomic relationship within a joint |
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Definition
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Term
| What type of joints are at risk for subluxation? |
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Definition
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Term
| Name 4 joints that are at risk for subluxation |
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Definition
Glenohumeral
Acromioclavicular
Sacroiliac
Atlantoaxial |
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Term
| Once the mobile joint has been stabilized, what should rehab do? |
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Definition
| address local muscle imbalances and adjacent joint hypomobility, which could increase mechanical stresses at the joint |
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Term
| Implies complete loss of joint integrity with loss of anatomic relationships |
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Definition
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Term
| What other type of damage often occurs with a dislocation? |
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Definition
| Significant ligamentous damage |
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Term
| At what joint do dislocations most often occur? |
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Definition
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Term
| Congenital dislocations are most often seen wehre? |
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Definition
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Term
| Joint dislocation can also be a late manifestaion of chronic disease, such as what? (3) |
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Definition
Rheumatoid Arthritis
Paralysis
Neuromuscular disease |
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Term
| In the presence of a joint dislocation, the integrity of __ and __ tissue must be assessed. If compromise is suspected, timely reduction is esstnetial to prevent serious complication |
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Definition
| Nerve and vascular tissue |
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Term
| Defined as bone formation in nonosseous tissues (usually muscles and other soft tissue areas) |
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Definition
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Term
| Defined as bone formation in bruised, damaged, or inflamed muscle |
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Definition
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Term
| What are 2 causes for HO? |
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Definition
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Term
| Occurs most commonly after trauma such as fractures, surgical procedures (esp THR), SCI and TBIs, burns, and amputations. |
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Definition
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Term
| What is the most common complication of Total Hip Arthroplasty? |
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Definition
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Term
| There is an increased incidence of HO among who? |
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Definition
| Military personnel with blast injuries |
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Term
| HO in ppl with SCI is often referred to as what? |
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Definition
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Term
| Relates more to the degree of completeness of SCI than the level involved; individuals with complete transverse SCI are more likely to develop HO compared to those with incomplete SCI |
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Definition
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Term
| What are some hereditary causes of HO? |
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Definition
| Fibrodysplasia ossificans progressiva, progressive osseous heteroplasia, and Albright's hereditary osteodystrophy. These conditions are very rare |
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Term
| Name the risk factors for HO |
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Definition
-A serious traumatic injury, previous history of HO, hypertrophic osteoarthritis, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis
-Men are at higher risk than women
-Paget's dz, RA, post traumatic arthritis, neural axis and thermal injuries, and osteonecrosis
-Surgery-rlated factors. Individuals who have undergone multiple surgical interventions over a short period of time are at increased risk of HO
-HO occurs in 1-3% of the burn populaton. It relates more to the degree of thermal injury than to the location of the burn. Individuals with third-degree burns affecting more than 20% of the total body surface are at greatest risk for the development of HO |
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Term
| What is the pathogenesis of HO? |
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Definition
-Histologically, in the acute phase, the inflammatory process results in edema and degeneration of the muscle tissue. After a few weeks, the inflamed tissue is replaced with cartilage and bone, and the bone undergoes intensive turnover
-It is likely that pluripotent mesenchymal (stem) cells that could differentiate into cartilage, bone, or tendon/ligament become osteoblasts instead. Differentiation begins early after surgery and peaks at 32 hours, possibly induced by bone-inducing substances such as bone morphogenetic protein. The stimulus and mechanism that causes this to happen in soft tissues after trauma has not been determined. There may be local factors such as mechanical stress (articular disruption, muscle damage) and/or systemic factors |
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Term
| May be asymptomatic and without pain but pain and loss of motion are the most common symptoms, often within 2 weeks of the precipitating trauma, surgery, burn or neurologic insult |
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Definition
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Term
| Swelling, warmth, erythema, and tenderness mimic a low-grade infection, or in the case of surgery, the normal postoperative inflammation that is often present. |
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Definition
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Term
| What is the hallmark sign of HO? |
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Definition
| Progressive loss of joint motion at a time when posttraumatic inflammation should be resolving |
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Term
| As the ectopic ossification advances, the acute symptoms described may subside, but motion continues to decrease, even with intervention such as dynamic or static progressive splinting. What happens over the next 3-6 months? |
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Definition
| The HO matures and the individual develops a rigid or abrupt end feel with pain at the end ROM. Delayed nerve palsy is common when the elbow is affected |
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Term
| Areas of calcification and bone spurs may progress to what? |
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Definition
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Term
| What are the most common sites for HO? |
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Definition
| Hip, elbow, knee, shoulder, and TMJ |
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Term
| Where is the most common site of HO in burn pts? |
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Definition
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Term
| 1-3% of burn patients are affected, this area is involved more than 90% of the time. Typically, a bridge of ectopic bone forms across the posterolateral aspect, possibly filling in the olecranon fossa |
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Definition
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Term
| Pressure from the bone formation can result in what? |
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Definition
Pressure ulcers
-They may also interfere with skin grafts |
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Term
| Loss of motion can have serious consequences for daily function, especially for those individuals who are already what? |
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Definition
| neurologically compromised |
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Term
| What measures can be taken to prevent HO? |
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Definition
| Radiation treatment and medications such as NSAIDs and diphosphonates |
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Term
| Inhibits osteoid cells from calcifying, thus preventing HO. The effect lasts only as long as the drug is taken. GI disturbance and osteomalacia are adverse side effects of this treatment, making it less than optimal |
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Definition
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Term
| Are effective in reducing the frequency and magnitude of ectopic bone formation in some areas (ex: hip). Used during the first 3 weeks postoperatively, indomethacin inhibits precursor (undifferentiated) cells from developing into osteoblasts |
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Definition
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Term
| another preventive measure for HO is radiation, should it be low or high dose external beam? |
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Definition
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Term
| ___ is recommended for individuals at high risk of ectopic ossification, including those with neurologic injury, burns, past history of HO, and/or a previous history of other conditions previously mentioned |
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Definition
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Term
| What is the BEST prevention for HO? |
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Definition
| To avoid soft tissue trauma, especially among high-risk individuals undergoing surgery of any kind. Complete wound lavage and the removal of all bone debris may help prevent HO |
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Term
| ___ evidence with mineralization may be observed 4-6 weeks after the trauma (sometimes as early as 2 weeks after the incident event). |
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Definition
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Term
| __ show location, extent, and maturity of pathologic bone. |
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Definition
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Term
| HO must be differentiated from __ __, most often associated with hypercalcemia, and from dystrophic calcifications in tumors |
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Definition
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Term
| History and radiographic examination usually provide the tools needed to diagnose what condition? |
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Definition
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Term
| Ultrasound may prove useful in diagnosing HO around what 2 areas? |
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Definition
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Term
| May be the best to show the exact location and involvement of the articular surfaces |
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Definition
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Term
| Lab tests to measure the level of __ __ __ are used by some, but they are not consistently accurate |
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Definition
| Serum alkaline phosphatase |
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Term
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Definition
| Presence of HO but without functional ROM limitations |
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Term
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Definition
| HO with limitations in all plans of motion |
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Term
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Definition
| HO with ankylosis preventing motion |
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Term
| __ applied to the damaged limb site within a few days after the injury may respond but there is always the risk of impaired healing for those with bone fractures. |
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Definition
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Term
| __ __ is delayed until the bone matures and develops a distinct fibrous capsule in order to minimize trauma to the tissues and reduce the risk of recurrence and may only be done in cases where ADLs are compromised by loss of motion |
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Definition
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Term
| Indication for __ may not be just the presence of HO but rather the severity of functional restriction when loss of motion prevents the individual from using the extremity. |
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Definition
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Term
| A comprehensive ___ program is needed to maximize motion, restore function, and reduce the risk of developing ankylosis |
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Definition
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Term
| Once surgical removal is done, __ and __ are continued to prevent recurrence |
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Definition
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Term
| Not simply due to normal wear of articular cartilage. Regular moderate to strenuous WB activity does not appear to cause or accelerate __ |
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Definition
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Term
| Idiopathic onset. Associated with aging in nonlinear fashion, after 50 y/o exponential increases in frequency with increased age |
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Definition
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Term
| Appears at any age and is associated with previous trauma or congenital abnormality |
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Definition
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Term
| What are the risk factors for DJD? |
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Definition
| Cumulative trauma: repetitive actions associated with poor body mechanics, vibration. Repetitive exposure to high level of impact (contact sports) |
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Term
| Whats the pathophysiology for DJD? |
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Definition
-Degenerative dzs that can be associated with an inflammatory component
-Involves all of the tissues associated with the synovial joint. But, the primary affects are on the articular cartilage, subchondral bone, and formation of osteophytes
-Cartilaginous changes involve disruption/fibrillation of articular cartilage followed by degeneration of cartilage
-Bony changes involve an increase in subchondral bone and the formation of cyst-like cavities just under the subchondral bone. The cavities weaken the bone and increase the likelihood of fractures
-Osteophytes often develop at the periphery of the joint, normally around the cartilage/bone interface. Osteophytes also form at the insertion sites of the joint capsule. There is a common pattern of osteophyte formation associated with each joint
-Secondary changes involve mild to moderate inflammation of the synovial membrane and contraction of the ligaments and joint capsules. Mm can also develop contractures leading to decreased ROM |
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Term
| What are the clinical manifestations of DJD? |
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Definition
-Joint stiffness, particularly in the morning
-Decreased ROM
-Crepitus
-Joint enlargement
-Unlike RA, joint involvement is usually not symmetrical |
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Term
| Noise or vibration produced by rubbing bone or irregular cartilage surfaces together as by movement of patella against femoral condyles in arthritis and other conditions |
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Definition
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Term
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Definition
-Weight loss
-Exercise: stretching, ROM, and strengthening for mild to moderate cases of DJD
-Exercise should NOT include impact loading
-Pt education concerning proper body mechanics
-Heat for pain relief
-Supportive aids: splints, braces, canes, or crutches to decrease loading in severe cases
-Medications: analgesics as needed, NSAIDs as needed to reduce pain and inflammation, intra-articular corticosteroids used in some pts for pain relief |
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Term
| A group of diseases characterized by chronic joint inflammation that, by definition, begins before 16 y/o. Appears to be an autoimmune dz initiated by prior infection or trauma. |
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Definition
| Juvenile Rheumatoid Arthritis (JRA) |
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Term
| Name 3 major subtypes of JRA |
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Definition
Systemic
Polyarticular
Pauciarticular |
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Term
| Involves multiple systems including: joint pain, pericariditis, myocarditis and hepatosplenomegaly. This form exhibits an equal distribution in males and females |
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Definition
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Term
| Involvement of 5 or more joints (usually in an asymmetrical pattern). More common in girls; knees and ankles affected more then elbows, wrists, and fingers |
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Definition
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Term
| The most frequent subtype. Involves 4 or fewer joints. Usually observed in girls 4 y/o and younger who run a high risk of blindness due to inflammation of the iris. Also observed in males 10 y/o and older where the hip, pelvis, and spine are often affected |
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Definition
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Term
| JRA differs from adult RA in what ways? |
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Definition
-Large joints are usually affected before smaller joints
-Rheumatoid factor and rheumatoid nodules are usually absent
-Antinuclear antibodies are often present
-Systemic onset is more frequent |
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Term
| The fracture site pierces the skin surface. Used to be referred to as compound |
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Definition
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Term
| A fracture where the overlying tissue is intact. Used to be referred to as simple. |
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Definition
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Term
| Fracture due to bone weakness produced by a previous condition (tumor, osteomyeltitis, etc) |
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Definition
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Term
| Fracture due to bone fatigue from repeated loading coupled with inadequate muscular support. |
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Definition
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Term
| Correct alignment between two bone fragments |
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Definition
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Term
| All of the corticees have been broken and there are two distinct bone fragments |
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Definition
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Term
| A fracture that has more than 2 fragments |
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Definition
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Term
| Not the entire cortex has been disrupted |
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Definition
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Term
| There is no apposition between 2 fragments |
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Definition
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Term
| Partial apposition between 2 fragments |
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Definition
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Term
| The 2 fragments have complete contact with each other on both AP and lateral radiographs |
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Definition
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Term
| How is the direction of the displacement described? |
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Definition
| The relationship of the distal fragment to the proximal fragment |
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Term
| Can arise from distraction, overriding or rotation of the fracture fragments |
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Definition
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Term
| One fracture fragment is driven into another |
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Definition
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Term
| A hard surface of one fracture fragment is driven into the softer surface of another fragment |
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Definition
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Term
| Two surfaces are forced together |
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Definition
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Term
| A fracture fragment is pulled away from its normal anatomical position |
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Definition
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Term
| What are the 3 phases of fracture repair? |
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Definition
Inflammatory
Reparative
Remodeling |
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Term
| Bleeing of periosteum, bone and soft tissue. Periosteum can strip away from the bone more easily in children than adults. A large fracture hematoma can form. If the periosteal sleeve is not disrupted, the hematoma will be localized. If the periosteum is disrupted, decompression will occur and the hematoma will spread into the surrounding tissues. End of the fractured bone normally display necrosis. However, there is also proliferative activity from cells of the endosteum and internal layer of periosteum. BOne is initially replaced peripherally. If the periosteum is stripped away and/or there is a large degree of bone loss, a bone graft may be necessary. The clot of the fracture hematoma is replaced with collagen fibers and matrix elements that will eventually mineralized into woven bone |
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Definition
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Term
| Cellular reorganization occurs. Circumferential tissue acts as scaffold. Within 10-14 days in children, a fracture callus of woven bone is formed. Vascularization is essential. In areas of low oxygen tension, cartilage forms and is replaced by bone when the area becomes more vascularized. |
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Definition
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Term
| Resorption of mechanically unnecessary portions of callus and reorientation of trabecular bone alone lines of stress. Appears to be set up by piezoelectrical (electrical currents set up by pressure on crystals) properties of bone |
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Definition
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Term
| Proportional to the volume of damaged bone. Some minor fractures can heal within three weeks whereas displaced fractures may require months to years in order to heal. With good apposition the forearm bones and humerus normally heal within 3 months while the femur and tibia normally require 4-6 months to heal |
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Definition
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Term
| Fractures of the __ region can result in alterations in the lengths of long bones. For example, the blood supply to a portion of the region can be compromised, slowing growth in that region. This can result in increased varus or valgus angles. |
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Definition
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Term
| Due to infarction of bone and marrow. Can occur in the medullary region or subchondral portion of bone. The cortex is normally not severely affected due to collateral circulation |
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Definition
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Term
| Ischemia can be caused by what 5 things? |
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Definition
-Fractures (disrupt vasculature)
-Thrombosis or embolism (sickle cell anemia, clotting disorders)
-Vessel injury (vasculitis, connective tissue disorders)
-Vascular compression
-Complications of hypertension |
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Term
| The region of the lesion is pale yellow and contains dead osteocytes, adipocytes and empty lacunae. Osteoclasts remove the dead tissue and bone is gradually replaced by creeping substitution from the margins of the lesion. |
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Definition
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Term
| Infarcts that occur under articular cartilage (subchondral) can lead to osteoarthritis due to collapse of hte overlying tissue. About 10% of the approximately 500,000 total joint replacements performed in the US each year are due to complications arising from __ |
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Definition
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