rehab ch. 1 and 2
Terms
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- 3 phases of healing process
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1. inflammation
2. fibroplastic repair
3. maturation remodeling - hypoxia
- deficiency of tissues receiving oxygen
- macroscopic characteristics of inflammatory response phase
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swelling
redness
tenderness
increased temperature - responses of inflammatory phase
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1. leukocytes, phagoctic cells, and exudate are delivered to injured tissue for the localization and removal of injury by-products
2. blood clot and fibrous tissue growth
3. blood flow slows - chemical mediators of inflammatory response
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1. histamine- vasodilation, increased cell permeability
2. leukotaxin- margination, increased cell permeability
3. necrosin- phagocytic activity - Clot Formation
- blood vessel spasm-platelet plug formation-clotting mechanism-prothrombin activator-(prothrombin)-thrombin-(fibrinogen)-fibrin-blood clot
- responses of fibroplastic-repair stage
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1. active scar formation
2. increased blood flow for nutrient delivery
3. granulation tissue composed of fibroblasts, collagen and capillaries forms
4. collagen is deposited - responses of maturation-remodeling phase
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realignment of collagen
firm scar present - wolff's law
- bone and soft tissue will respond to physical demands placed upon them
- controlled mobilization enhances
- scar formation, revascularization, muscle regeneration and fiber reorientation, tensile properties - smrft
- factors that impede healing
- extent of injury, edema, hemorrhage, poor vascular supply, muscle spasm, atrophy, keloids and hypertrophic scars, infection, and health, age, and nutrition
- 4 types of connective tissue
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1. fibrous- dense (tendon, ligaments) and loose (adipose)
2. cartilage- hyaline, fibrocartilage, and elastic
3.reticular CT- composed of collagen, lines organs
4. elastic CT- composed of elastic fibers, in bllod vesels, airways, and hollow organs - define: epithelial tissue, bone, and blood
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1. covers internal and external surfaces to protect and form structure for other tissues; absorption and secretion
2. cancelllous (spongy) or cortical (solid) for support, movement, and protection
3. contains RBCs, WBCs, and platelets for nutrition, cleansing and physiology - extra-articular ligament sprain versus intra-articular ligament sprain
- e-a: bleeding in subcutaneous space vs. i-a: bleeding within capsule
- stress fracture: possible causes, signs/symptoms, tx
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causes: overload due to muscle contraction, altered stress distribution due to muscle fatigue, changes in suface, and rhythmic repetitive stress vibrations
s/s: focal tenderness and pain, pain w/ activity, pn becomes more constant and more intense, not on x-ray until callus formation
tx: removal from activity for 2 weeks - healing of bone
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1. fibrous collagen network serves as framework for chondroblasts
2. cartilage infiltrates callus
3. osteoblasts form cancellous and trabeulae
-callus crystalizes
4. osteoclasts resorb bone fragments and clean debris - healing of bone depends on:
- type of injury and bone, severity, location, patient age and nutrition
- define these types of cartilage damages: osteoarthritis, arthrosis, fibrillation, osteophytosis, and chondromalacia
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osteoarthritis- inflammatory condition with secondary destruction
arthrosis-degenerative proces w/ cartilage destruction, bone remodeling, and secondary inflammation
fibrillation-degenerative process of cartilage assoc. w/ poor nutrition and disuse
osteophytosis-increasing surface area to decrease contact force
chondromalacia- non-progressive cartilage transformation with areas of irregulatiry and softening - cartiskeletral muscle's 4 traits
- elasticity, extensibility, irritability, and contractility
- muscle strains occur when? and where?
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-when overstretched or forced to contract against too great a resistance
-muscle, tendon, musculotendinous junction, ad tendone-bone interface - healing of muscle
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1.fibroblasts and ground substance produce a gel-like matrix leading to fibrosis and scarring
2.myoblastic cells cause myofibril regeneration
3.collagen matures - define: tendinitis, paratenonitis, tendinosis, chronic tendinitis, and tenosynovitis
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tendinitis- inflammation of tendon
paratenonitis- inflammation of tendon outer layer, friction injury
tendinosis- degenerative tendon changes
chronic tend- tendon degeneration with no inflammatory cellular response
tenosynovitis- inflammation of and stick adhensions within the synovial tendon sheath - healing of tendon
- collagen synthesis and scar tissue formation
- cns nerve healing vs. pns
- peripheral nerves can regenerate if injury does not impact cell body; cns nerves regenerate poorly due to lack of connective tissue support
- goal of rehabiliation during each healing phase
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1. pre-surgical phase: maintaining/increasing strenght, rom, cardio, nm control
2. acute injury phase: swelling management and pain control
3. repair phase: increase cardio, full ROM, restore/increase strength, nm control; modalilties use for pn and swl
4. remodeling phase: return to play: sport-specific skills, functional testing, heating modalities, and manual therapy - primary goals of healing process in sports medicine
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1. positively influence inflammation and repair process
2. expedite recovery of function
3. minimize early effects of inflammatory process
4. prevent recurrence of injury - medications used during healing process
- aspirin, ibuprofen, acetaminophen, naproxen sodium, ketoprofen (usually as an analgesic, anti-inflammatory, and antipyretic); oral muscle relaxants