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Ortho 2009-10

stages of healing for connective tissue repair

4 principls of rehab endurance ex, proprioception/balance activities, coordination agility, sport/function specific/work harding
use AD until pain-free amb, minimal gait deviation, LE mmt 4/5--need to get out of pain to get out of acute phase
benefit of using crutches need to get out of pain to get out of acute stg, usng crutches shortens acute phase
PT progress as tolerated avoiding pain (muscle guarding), edema, spasm
grade 1 ligament injury some fibers torn, integ remains, jt stable, mild pain, mild edema, local tenderness
grade 2 lig injury more fibers torn w/inc in jt motion, mod pain requiring cessation of activity, stress & palpation greatly inc pain, excessive jt motion w/stress test
grade 3 lig injury near complete or complete tear, severe pain, stress to tissue is PAINLESS, palpation may reveal defect, great instability of jt, most often requires surgical repair
are ligaments vascular? yes, particularly at origin & insertion
what kind of sensory does a lig have? mechanoreceptors (proprioception), free nerve endings (pain)
what is characteristic of extraarticular ligament? example LCL. heal spontaneously & predicably - have vascular supply, fibers can come back tog b/c no synovial fluid to interfer
what is characteristic of intraarticular ligaments? example ACL. vascular response but limited by synovial fluid
what to expect in healing process of MCL grades I, II III heal well spontaneously w/protective bracing & strengthening of mm's for dynamic support
what to expect in healing process of ACL usually requires surgical interventions for healing
after healing, ligament strength is? tensile strength only 50-70% of normal
how long do lig continue to heal continue to remodel & mature for up to 1 year
what should be done to insure good healing, scar formation? PROM during healing helps insure well organized collagen formation
role of scar tissue in lig repair healing by scar tissue porliferation (not lig regeneration)
left untreated, nonsurgical, how long before lig fully healed? most are not fully healed even at 40 wks aft injury
what should PT rehab of ligamentous injuries include/involve? dec swelling, inc ROM, inc stg, normalize gain, inc aerobic, inc proprioception, pain mngmt
nutrients in articular cartilage are in? synovial fluid ( jt motion required)
articular cartilage is avascular/vascular? avascular, incapable of intrinsic repair
superficial injuries....heal well? why? no, further away from synovial
deeper injuries elicit..... inflammatory response, better healing
process of minor tendon strains? (tendonitis) spontaneous healing, inflammation, repair, remodeling
process of major repair for tendon strains (rupture)? surgical, i.e. Achilles tendon
PT rehab of tendon injury dec swelling, inc ROM, inc stg, normalize gain/function inc aerobic fitness, inc proprioception, pain mngment (same as ligament)
effects of immobilization 3 days and 1 wk greatest amt of mm atrophy occurs w/1 wk, size dec by approx 17% w/in 3 days
formation of new bone callus (cartilagenous tissue), pro callus 6 wks
bone healing .....blood's action into spaces betw bone fragments, clotting w/in 24 hrs
effects of immobilization connective tissue weaking, articular cartilage degeneration, mm atrophy, development of contracture, sluggish circulation, bone atrophy
rehab principles during immob stage isom, AROM to jts below & above, resistive ex to major mm groups, teach use of assistive device
rehab PT principles post-immob stage PROM stretching, AROM PRE's, WB'ing progression (per MD), functional trng
types of fixation cast, ORIF (rods, pins, wires, etc), external fixation traction
Created by: djbari



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