stages of healing for connective tissue repair
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| 4 principls of rehab | endurance ex, proprioception/balance activities, coordination agility, sport/function specific/work harding
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| 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
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| benefit of using crutches | need to get out of pain to get out of acute stg, usng crutches shortens acute phase
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| PT progress as tolerated avoiding | pain (muscle guarding), edema, spasm
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| grade 1 ligament injury | some fibers torn, integ remains, jt stable, mild pain, mild edema, local tenderness
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| 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
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| 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
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| are ligaments vascular? | yes, particularly at origin & insertion
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| what kind of sensory does a lig have? | mechanoreceptors (proprioception), free nerve endings (pain)
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| 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
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| what is characteristic of intraarticular ligaments? | example ACL. vascular response but limited by synovial fluid
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| 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
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| what to expect in healing process of ACL | usually requires surgical interventions for healing
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| after healing, ligament strength is? | tensile strength only 50-70% of normal
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| how long do lig continue to heal | continue to remodel & mature for up to 1 year
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| what should be done to insure good healing, scar formation? | PROM during healing helps insure well organized collagen formation
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| role of scar tissue in lig repair | healing by scar tissue porliferation (not lig regeneration)
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| left untreated, nonsurgical, how long before lig fully healed? | most are not fully healed even at 40 wks aft injury
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| what should PT rehab of ligamentous injuries include/involve? | dec swelling, inc ROM, inc stg, normalize gain, inc aerobic, inc proprioception, pain mngmt
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| nutrients in articular cartilage are in? | synovial fluid ( jt motion required)
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| articular cartilage is avascular/vascular? | avascular, incapable of intrinsic repair
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| superficial injuries....heal well? why? | no, further away from synovial
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| deeper injuries elicit..... | inflammatory response, better healing
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| process of minor tendon strains? (tendonitis) | spontaneous healing, inflammation, repair, remodeling
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| process of major repair for tendon strains (rupture)? | surgical, i.e. Achilles tendon
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| PT rehab of tendon injury | dec swelling, inc ROM, inc stg, normalize gain/function inc aerobic fitness, inc proprioception, pain mngment (same as ligament)
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| 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
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| formation of new bone | callus (cartilagenous tissue), pro callus 6 wks
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| bone healing .....blood's action | into spaces betw bone fragments, clotting w/in 24 hrs
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| effects of immobilization | connective tissue weaking, articular cartilage degeneration, mm atrophy, development of contracture, sluggish circulation, bone atrophy
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| rehab principles during immob stage | isom, AROM to jts below & above, resistive ex to major mm groups, teach use of assistive device
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| rehab PT principles post-immob stage | PROM stretching, AROM PRE's, WB'ing progression (per MD), functional trng
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| types of fixation | cast, ORIF (rods, pins, wires, etc), external fixation traction
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