Orthopedics: Disabilities and Treatment
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Questions and Answers

What are the two types of synovial joints?

  • Cartilagenous joints and Fibrous joints
  • Synovial joints and Cartilagenous joints
  • Rigid joints and Freely movable joints
  • Stability joints and Mobility joints (correct)

    • What are three characteristics of synovial joints in the human body?

  • Most common joint in the human body, a direct union between bones, and surrounded by a fibrous capsule
  • Most common joint in the human body, no direct union between articulating bones, and surrounded by a strong fibrous capsule (correct)
  • Least common joint in the human body, a direct union between bones, and surrounded by cartilage.
  • Least common joint in the human body, no direct union between articulating bones, and surrounded by a strong fibrous capsule

    • What is the main purpose of synovial fluid?

    Synovial fluid provides lubrication to the joint, acts as a shock absorber, and provides nourishment to the articular cartilage.

    Immobility of a joint can lead to a decrease in synovial fluid production.

    <p>True</p> Signup and view all the answers

    What is the outer layer of the synovial joint capsule composed of?

    <p>Dense fibrous tissue</p> Signup and view all the answers

    What are the three main components of connective tissue?

    <p>Collagen, elastin, and collagen/elastin mix</p> Signup and view all the answers

    What is the most abundant protein in the human body?

    <p>Collagen is the most abundant protein in the human body.</p> Signup and view all the answers

    What is the primary function of elastin?

    <p>Elastin possesses elastic properties that allow fibers to deform under applied force and then return to their original state following the removal of that force.</p> Signup and view all the answers

    What is the primary function of connective tissue?

    <p>Connective tissue is primarily responsible for maintaining the stability of a joint.</p> Signup and view all the answers

    What two factors primarily influence the susceptibility of connective tissue to injury?

    <p>The amount of elastin and the arrangement of collagen fibers</p> Signup and view all the answers

    Ligaments have a higher collagen content than tendons.

    <p>False</p> Signup and view all the answers

    What is the primary function of tendons?

    <p>To connect muscles to bones</p> Signup and view all the answers

    The composition of the joint capsule may change depending on the stresses imposed upon it.

    <p>True</p> Signup and view all the answers

    Cartilage is a vascular tissue, meaning it has a good blood supply.

    <p>False</p> Signup and view all the answers

    What are the two main types of cartilage?

    <p>Fibrocartilage and Hyaline cartilage</p> Signup and view all the answers

    The white fibrocartilage found in joints is often called bonding cement.

    <p>True</p> Signup and view all the answers

    Describe three characteristics of hyaline cartilage.

    <p>Hyaline cartilage is the most abundant type of cartilage. It forms a thin covering over the ends of bones, providing a smooth and resilient surface, which reduces friction during movement.</p> Signup and view all the answers

    Bone tissue can be described as rigid but also somewhat elastic.

    <p>True</p> Signup and view all the answers

    What is Wolff's Law?

    <p>Wolff's Law states that bone tissue is deposited in areas of stress and resorbed in areas of least stress.</p> Signup and view all the answers

    Bone receives its nourishment from the capillaries within the bone itself, not from the hyaline cartilage.

    <p>True</p> Signup and view all the answers

    What are three functions of bone tissue?

    <p>Provide rigid framework for the trunk and extremities, serve as levers for movement, and protect vulnerable viscera</p> Signup and view all the answers

    Besides its structural roles, what other important functions does bone perform?

    <p>Bone tissue contains sites for red blood cell development and acts as a reservoir for essential minerals like calcium, sodium, phosphorus, and magnesium. These minerals can be released into the bloodstream as needed by the body.</p> Signup and view all the answers

    Which of these is NOT a part of the bone?

    <p>Capillary</p> Signup and view all the answers

    What is the name of the shaft of the bone?

    <p>Diaphysis</p> Signup and view all the answers

    Match the bone cell types with their functions:

    <p>Osteoblasts = Produce bone Osteoclasts = Resorb bone Osteocytes = Living part of the bone, nonfunctioning</p> Signup and view all the answers

    The process of inflammation and repair is a specific response, meaning it always proceeds in the same way.

    <p>False</p> Signup and view all the answers

    What are four factors that influence the timetable for the inflammation and repair process?

    <p>Extent of injury, disease process, health of the individual, and medications</p> Signup and view all the answers

    What is the result of injury to soft tissue?

    <p>Injury to soft tissue initiates a series of responses known as inflammation and repair.</p> Signup and view all the answers

    Why does injured soft tissue not regenerate itself?

    <p>Because healing is nonspecific and involves scar tissue formation</p> Signup and view all the answers

    Scar tissue is composed mainly of collagen.

    <p>True</p> Signup and view all the answers

    What is the nonspecific repair mechanism of scar formation?

    <p>Epithelialization is the nonspecific repair mechanism of scar formation.</p> Signup and view all the answers

    What are the three phases of the inflammation and repair process?

    <p>Inflammation, Fibroplasia, and Scar Maturation</p> Signup and view all the answers

    During the inflammation phase, the injured area swells and becomes warm.

    <p>True</p> Signup and view all the answers

    The inflammation phase is initiated by the release of histamine.

    <p>True</p> Signup and view all the answers

    What is the primary function of leukocytes during the second stage of inflammation?

    <p>Leukocytes, including neutrophils, monocytes, and macrophages, come in with the fresh blood supply to begin phagocytosis.</p> Signup and view all the answers

    What are the four main clinical manifestations of inflammation?

    <p>The four clinical manifestations of inflammation are: redness, warmth, swelling, and pain.</p> Signup and view all the answers

    What is the treatment protocol for the acute stage of injury, often referred to as the maximum protection phase?

    <p>PRICE</p> Signup and view all the answers

    Describe the role of fibroblasts during the fibroplasia phase of tissue repair.

    <p>The fibroblasts migrate to the inflamed area and begin producing scar tissue.</p> Signup and view all the answers

    The synthesis, orientation, and deposition of new collagen during the fibroplasia phase is initially random.

    <p>True</p> Signup and view all the answers

    Fibroblasts disappear when enough scar tissue is laid down, marking the beginning of the remodeling phase.

    <p>True</p> Signup and view all the answers

    What is the treatment protocol commonly used during the subacute phase of injury?

    <p>Gentle stretching and isometric exercises</p> Signup and view all the answers

    What happens during the scar maturation phase?

    <p>During the scar maturation phase, new collagen and connective tissue gradually realign along the lines of physical stress imposed on the injured site.</p> Signup and view all the answers

    Physical therapy plays a pivotal role in promoting correct scar tissue remodeling.

    <p>True</p> Signup and view all the answers

    The strength and extensibility of the final scar tissue are largely determined by the patient's diligence with their home exercise program.

    <p>True</p> Signup and view all the answers

    Despite the remodeling process, scar tissue is never as strong as the tissue it replaces.

    <p>True</p> Signup and view all the answers

    Striated muscles are capable of regenerating myofibrils to restore full function after injury.

    <p>False</p> Signup and view all the answers

    What are the three grades of muscle strains?

    <p>Grade I, Grade II, and Grade III</p> Signup and view all the answers

    Tendons require that the injured ends are brought together and the gliding function restored.

    <p>True</p> Signup and view all the answers

    What are the three terms used to describe tendon injuries?

    <p>Tendonitis, Tendinosis, and Tenosynovitis</p> Signup and view all the answers

    What are the three grades of ligament sprains?

    <p>Grade I, Grade II, and Grade III</p> Signup and view all the answers

    Mature cartilage is capable of regenerating itself.

    <p>False</p> Signup and view all the answers

    Nerve injuries may heal if the cell body is not affected and the ends of the axon are close together.

    <p>True</p> Signup and view all the answers

    Physical therapy interventions and progressions must be based on the physiologic responses of the tissues to injury and on an understanding of how various tissues heal.

    <p>True</p> Signup and view all the answers

    As PTAs, it's important to understand the healing process to effectively supervise the rehab process.

    <p>True</p> Signup and view all the answers

    Study Notes

    Orthopedics: Disabilities and Treatment

    • Orthopedic surgery and research are constantly evolving.
    • Athletes of all ages and sizes compete at various levels.
    • Workman's compensation is relevant to workplace injuries.
    • Geriatric considerations relate to older adults' health.
    • Traumatic injuries are a significant concern.
    • The anatomy of the body's various components is crucial to orthopedic practices.

    Synovial Joint Classification

    • Stability Joints:
      • Articulating surfaces are congruent.
      • Have a dense, thick capsule.
      • Supported with numerous ligaments.
    • Mobility Joints:
      • Articulating surfaces are incongruent.
      • Have a loose capsule.
      • Supported with very few ligaments.
    • Synovial Joint Characteristics:
      • The most common joint type.
      • No direct connection between bones,
      • Surrounded by a strong fibrous capsule.
      • Allows for free motion of the joint.
      • A synovial membrane secretes synovial fluid.
      • Hyaline cartilage covers articular surfaces, decreasing friction.

    Synovial Joint Components

    • Includes stratum fibrosum (outer layer)
      • Dense fibrous tissue
      • Poorly vascularized
      • Richly innervated by joint receptors that detect:
        • Compression or tension
        • Pain
        • Movement (rate and direction)
        • Vibration
    • Includes stratum synovium (inner layer)
      • Highly vascularized
      • Poorly innervated
      • Purpose is to produce synovial fluid.

    Purpose of Synovial Fluid

    • Lubricates the joint.
    • Acts as a shock absorber.
    • Nourishes articular cartilage.

    Effects of Immobilization (on Synovial Fluid)

    • No synovial fluid is produced when a joint is immobilized.
    • This leads to lack of nourishment for the hyaline cartilage.
    • This will result in osteoarthritis.

    Hyaline Cartilage

    • Crucial for joint movement and health.
    • Is avascular, causing slow or limited repair capabilities.

    Joint Capsule and Supporting Tissue

    • Adaptive shortening occurs due to disuse atrophy.
    • Disuse atrophy causes muscle and ligament weakness.
    • Diseases or injuries can cause joint/muscle contractures.

    Ligaments / Tendons / Stratum Fibrosum

    • Makeup of connective tissue.
      • Collagen
      • Elastin
      • Collagen/Elastin Mix

    Collagen

    • A main component of fibrous connective tissue.
    • The most abundant protein.
    • High tensile strength.

    Elastin

    • Provides elastic properties.
    • Allows fibers to deform and return to their original shape.

    Collagen/Elastin Mix

    • Synovial joints primarily consist of both collagen and elastin.
    • Proportion of elastin to collagen varies depending on the joint.
    • Elastin is a smaller portion of the fibrous component.

    Function of Connective Tissue

    • Maintains the joint's stability.

    Susceptibility to Injury (of Joints)

    • Susceptibility depends on the elastin amount and arrangement of collagen fibers.
    • Ligaments have more elastin than tendons.

    Tendons

    • Higher collagen content.
    • Collagen has a parallel arrangement suitable for high unidirectional tensile forces to be withstood.

    Joint Capsule

    • Varies greatly in composition.
    • The composition changes depending on stresses imposed.
    • Joints designed for stability have more collagen than joints designed for mobility.

    Cartilage (Overview)

    • Solid type of connective tissue.
    • Avascular (no blood supply) limits its repair capability.

    Cartilage Types

    • Fibrocartilage:
      • Forms joints that permit little motion.
      • Forms intervertebral discs.
      • White fibrocartilage.
      • Yellow fibrocartilage.
    • Hyaline Cartilage (Articular):
      • Most abundant cartilage type.
      • Forms a thin covering on many bones.
      • Resilient, smooth, and low friction.
      • Crucial for articulation between bones.
      • Consists of three distinct layers or zones.

    Bone Tissue Characteristics

    • Hardest form of connective tissue.
    • Composed of fibrous connective tissue and inorganic substances.
    • Somewhat elastic despite its rigidity.

    Wolff's Law

    • Bone deposition occurs in areas of stress.
    • Bone resorption occurs in areas of reduced stress.
    • Bone models and remodels throughout life in response to stress.

    Bone Nourishment

    • Bone receives nourishment from capillaries within the bone, not from hyaline cartilage.

    Bone Function

    • Provides a rigid framework.
    • Serves as levers.
    • Protects vulnerable internal organs
    • Contains sites for blood cell development.
    • Acts as a mineral reservoir for the body.

    Bone Terms

    • Epiphysis: The distal end of a bone.
    • Diaphysis: The shaft of a bone; a hollow tube of compact bone surrounding the medullary cavity.
    • Metaphysis: The region where the diaphysis and epiphysis meet in mature bones.

    Bone Cells

    • Osteoblasts: Produce bone tissue.
    • Osteoclasts: Resorb bone tissue.
    • Osteocytes: Mature osteoblasts embedded within the bone matrix.

    Tissue Response to Injury

    • Injury to soft tissue initiates a series of responses collectively known as inflammation and repair.

    Timeline for Tissue Healing

    • The timetable is variable for each patient.
    • Factors like injury extent, disease, and medications impact the healing process.

    Healing Process (Soft Tissue)

    • Injured soft tissue does not regenerate; repair occurs instead.
    • Healing is nonspecific, with scar tissue replacing the damaged tissues.
    • Scar tissue is mainly collagen, which is rigid and limits motion.

    Components of Inflammation and Repair

    • Inflammation Phase: Area swells and becomes warm.
      • Rid the area of microorganisms, foreign matter, and debris.
      • Preparing the area for repair.
      • Characterized by four symptoms: pain, redness, warmth, and swelling.
    • Fibroplasia Phase: Formation of new fibrous connective tissue.
    • Scar Maturation Phase: Remodeling of connective tissue.

    Inflammation Phase (Stages)

    • 1st stage: immediate vasoconstriction followed by vasodilation, platelet aggregation and clot formation.
    • 2nd stage: infiltration of leukocytes, like neutrophils, monocytes, and macrophages, to phagocytose debris.
    • 3rd stage: Release of growth factors by macrophages to stimulate epithelial cell growth, angiogenesis, and fibroblast attraction.

    Treatment for Acute Stage (of Injury)

    • PRICE: Protection, Rest, Ice, Compression, Elevation.

    Subacute Phase (Treatment Stages)

    • Continuing with ROM (range of motion) exercises, stretching.
    • Beginning strengthening exercises (like isometrics, using therabands, and stabilization exercises).
    • Exercise programs progress gradually.

    Scar Maturation (Remodeling) Phase

    • New collagen and connective tissue gradually reorganize along the lines of physical stress.
    • Active stress or muscular contractions, with progressive joint motion (PROM > AAROM > AROM), promote organized, stronger, more functional collagen arrangements.

    Remodeling Phase (Return to Activity)

    • Aggressive ROM and strengthening exercises.
    • Regaining activity-specific skills.

    Physical Therapy Role

    • Physical therapy is crucial for scar tissue remodeling and improving tensile strength.
    • The more organized collagen fibers, the stronger the tensile strength.

    Additional Notes

    • The final scar strength and extensibility depend greatly on the patient's diligence in home exercises.
    • Despite remodeling, scar tissue is never as strong as the original tissue.

    Specialized Tissue Repair

    • Striated muscle. -Limited ability to regenerate myofibrils. -Edges must be closely approximated for repair. -Scar formation will occur to heal wound tissue.
    • Nerves.
      • If the cell body and axon ends are close together, the nerve may heal.
      • Healing is very slow (3-4 mm per day).
    • Some cartilages have some regeneration abilities. -Mature cartilage cannot regenerate.
      • Will often lose anatomical characteristics.
      • Will lose cushion abilities.

    Sprains

    • Grade I, II, and III sprains

    Strains

    • Grade I, II, and III strains

    Ligaments

    • Treatment of ruptures and avulsions (rupture has same repair process as tendons)
    • Fixation with screws for avulsions

    Tendons

    • Repair treatment.
    • Union of severed ends required.
    • Prevent tendon sheath adhesions.
    • Tendinitis
    • Tendinosis
    • Tenosynovitis

    Orthopaedic Considerations in Various Populations (general concepts)

    • Athletes: Injury prevention and rehabilitation programs required.
    • Workers: Workman's compensation and injury prevention.
    • Geriatric patients: Special considerations in treatment and care.

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    Explore the latest advancements in orthopedic surgery and treatments for disabilities. This quiz covers important aspects such as traumatic injuries, geriatrics, and workplace health considerations. Test your knowledge on synovial joint classifications and their characteristics.

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