Osteoporosis and Arthritis Quiz
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Questions and Answers

Which of the following best describes arthrosis?

  • Limitation of a joint without accompanying inflammation. (correct)
  • An autoimmune disease affecting the synovial lining of joints.
  • Inflammation of a joint with significant swelling.
  • A systemic disease causing low-grade fever and fatigue.
  • What is a common effect of joint swelling or pain on the surrounding muscles?

  • Disuse or reflex inhibition of stabilizing muscles. (correct)
  • Voluntary increase in range of motion.
  • Enhanced balance and coordination.
  • Increased muscle performance and strengthening.
  • Which T-score from a bone mineral density scan (BMD) indicates osteoporosis?

  • -1.0 or higher
  • -2.5 or less (correct)
  • 0 or above
  • Between -1.0 and -2.4
  • What type of exercise is recommended at least 5 days a week for someone with osteoporosis?

    <p>Aerobic exercise (C)</p> Signup and view all the answers

    Which of the following sensory inputs are impacted, leading to impaired balance due to joint disorders?

    <p>Mechanoreceptors and muscle spindles. (A)</p> Signup and view all the answers

    Which of the following is a precaution when exercising with osteoporosis?

    <p>Combining trunk flexion and rotation (C)</p> Signup and view all the answers

    What is the primary characteristic of rheumatoid arthritis (RA)?

    <p>An autoimmune disease impacting the synovial lining of joints. (B)</p> Signup and view all the answers

    Which intervention would be used to address a trigger point?

    <p>Contract-relax-passive stretch (B)</p> Signup and view all the answers

    Where does rheumatoid arthritis (RA) typically begin?

    <p>The smaller joints of the hands and feet. (B)</p> Signup and view all the answers

    What can occur as a result of joint deformation in rheumatoid arthritis?

    <p>Ankylosis or subluxation. (C)</p> Signup and view all the answers

    What is the primary mechanical effect of exercise that helps improve bone mass density?

    <p>Mechanical loading leading to osteoblastic activity (A)</p> Signup and view all the answers

    In addition to joint problems, how else does Rheumatoid Arthritis affect the body?

    <p>Low-grade fever, malaise, and fatigue. (A)</p> Signup and view all the answers

    What is a key principle of managing rheumatoid arthritis during an active inflammatory period?

    <p>Patient education on joint protection and energy conservation. (D)</p> Signup and view all the answers

    What is a typical timeframe for immobilization in adults?

    <p>10-18 weeks (D)</p> Signup and view all the answers

    Which of the following is a local tissue response to post-traumatic immobilization?

    <p>Muscle atrophy (C)</p> Signup and view all the answers

    During post-immobilization management, joint mobilization is used for what purpose?

    <p>To regain lost joint play (A)</p> Signup and view all the answers

    Why is it important to monitor the intensity of contraction during PNF stretching post-immobilization?

    <p>To avoid stress on the fracture site (A)</p> Signup and view all the answers

    What type of exercises are typically initiated to minimize secondary physiological changes that occur while immobilized?

    <p>General exercises for the uninvolved portions of the body (D)</p> Signup and view all the answers

    When can PRE (Progressive Resistive Exercise) and other intense dynamic exercises be initiated post-fracture?

    <p>When the bone is radiologically healed (C)</p> Signup and view all the answers

    What should be the focus when applying resistive force during muscle performance exercises after immobilization?

    <p>Proximal to the fracture site (D)</p> Signup and view all the answers

    What restricts tissue mobility when soft tissue damage occurred at the time of the fracture?

    <p>An inelastic scar (B)</p> Signup and view all the answers

    Which of the following is a commonly reported location of pain in individuals with fibromyalgia?

    <p>Scapula, head, neck, chest and low back (D)</p> Signup and view all the answers

    Which of the following is NOT considered a typical contributing factor to fibromyalgia flare-ups?

    <p>Consistent sleep schedule (D)</p> Signup and view all the answers

    What type of exercise is particularly emphasized in the management of fibromyalgia?

    <p>Aerobic exercise (C)</p> Signup and view all the answers

    Which of the following is a hallmark characteristic of myofascial pain syndrome?

    <p>Myofascial trigger points with a specific referred pattern of pain (B)</p> Signup and view all the answers

    What is a likely cause of trigger points in muscles according to the text?

    <p>Chronic overload of muscle with repetitive activities (D)</p> Signup and view all the answers

    Which of the following is NOT a suggested principle to manage myofascial pain syndrome?

    <p>Incorporating more high-intensity exercises (A)</p> Signup and view all the answers

    Besides medication, which other non-pharmacological intervention is recommended in the management of fibromyalgia?

    <p>Cognitive behavior therapy (D)</p> Signup and view all the answers

    What is a common feature of fibromyalgia symptoms?

    <p>Fluctuations in symptom presentation are usual (D)</p> Signup and view all the answers

    In the subacute and chronic stages of rheumatoid arthritis, which of the following treatment approaches should be prioritized?

    <p>Taking precautions due to pathological changes making tissues susceptible to damage. (D)</p> Signup and view all the answers

    What is an important aspect of joint protection and activity modification for those with rheumatoid arthritis?

    <p>Adapting the environment and modifying activities to protect joints. (B)</p> Signup and view all the answers

    Which of the following considerations should guide flexibility, strength, and endurance exercises for individuals with rheumatoid arthritis?

    <p>Ensuring all exercises are performed within the tolerance of the joints. (C)</p> Signup and view all the answers

    What type of conditioning exercises are most appropriate for individuals with rheumatoid arthritis when considering cardiopulmonary endurance?

    <p>Non-impact or low-impact exercises performed within the individual's tolerance. (A)</p> Signup and view all the answers

    Which of these statements best describe the characteristics of osteoarthritis?

    <p>Cartilage splits and thins, losing its ability to withstand stress along with capsular laxity. (B)</p> Signup and view all the answers

    What is a primary focus of patient instruction when managing osteoarthritis?

    <p>How to protect the joints, while remaining active, and manage symptoms. (B)</p> Signup and view all the answers

    Which factor is NOT used to classify fractures?

    <p>Patient's age (A)</p> Signup and view all the answers

    Which of the following is a key consideration when prescribing resistance exercise for someone with osteoarthritis?

    <p>Exercising within the tolerance of the joint. (B)</p> Signup and view all the answers

    What type of bone typically heals most rapidly due to its rich blood supply?

    <p>Cancellous bone (C)</p> Signup and view all the answers

    What is the main goal of stretching and joint mobilization exercises for individuals with osteoarthritis?

    <p>To counteract developing restrictions by moving through the full available ROM. (A)</p> Signup and view all the answers

    Which of the following is a key difference between fibromyalgia and myofascial pain syndrome?

    <p>Myofascial pain has a tight band of muscle. Fibromyalgia has no tight band of muscle. (A)</p> Signup and view all the answers

    Which of these is NOT a risk factor for fractures?

    <p>High calcium intake (A)</p> Signup and view all the answers

    What is the primary way that cancellous bone heals?

    <p>Internal callus formation (A)</p> Signup and view all the answers

    How long must chronic widespread pain persist to be classified as fibromyalgia?

    <p>More than 3 months. (A)</p> Signup and view all the answers

    In cortical bone healing, what immediately follows the inflammatory phase?

    <p>Callous formation (D)</p> Signup and view all the answers

    Which of the following factors does NOT directly influence the healing time of a fracture?

    <p>Patient's diet (B)</p> Signup and view all the answers

    What is a key concern regarding epiphyseal plate fractures in children?

    <p>Potential for growth disturbances and bony deformity (B)</p> Signup and view all the answers

    What does a 'closed' fracture indicate?

    <p>The skin is intact over the fracture site (B)</p> Signup and view all the answers

    Flashcards

    Arthritis

    Inflammation of a joint.

    Arthrosis

    Limitation of a joint's movement without inflammation.

    Rheumatoid Arthritis (RA)

    An autoimmune disease that primarily affects the synovial lining of joints, causing inflammation and potentially leading to joint damage.

    Active Inflammatory Period in RA

    A period of increased activity of the disease, characterized by symptoms like joint swelling, pain, and stiffness.

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    Joint Protection

    Strategies employed to prevent further joint damage and pain in RA.

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    Energy Conservation

    Practices that help conserve energy and reduce stress on joints, especially during periods of increased inflammation.

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    Patient Education in RA

    The process of educating the patient about RA, treatment options, and ways to manage the disease.

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    Overall Treatment Plan for RA

    The overall plan for managing RA, encompassing medication, therapies, and lifestyle modifications.

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    Osteoarthritis (OA)

    A chronic degenerative condition primarily affecting the articular cartilage of synovial joints leading to bone remodeling and overgrowth at the joint margins.

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    Joint Mobility

    The range of motion that a joint can move through.

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    Fibromyalgia

    A condition where pain, stiffness, and tenderness are experienced in multiple body regions and the axial skeleton for more than 3 months.

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    Myofascial Pain Syndrome

    A condition characterized by pain in muscles, decreased range of motion, postural stresses, and the presence of trigger points.

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    Joint Protection and Activity Modification (RA)

    Involves adapting the environment and modifying activities to protect joints in Rheumatoid Arthritis.

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    Functional Training

    Exercises that aim to improve function and ability for activities of daily living.

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    Resistance Exercise (OA)

    Exercises that involve resistance to strengthen muscles, which can help protect joints in Osteoarthritis.

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    Stretching and Joint Mobilization (OA)

    Exercises to improve flexibility and range of motion, important for all joints but especially in Osteoarthritis.

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    Cardiopulmonary Endurance

    Exercises designed to enhance cardiovascular fitness and endurance, essential for managing both Rheumatoid Arthritis and Osteoarthritis.

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    Balance Activities (OA)

    Exercises designed to improve balance and coordination, especially important for individuals with Osteoarthritis.

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    Osteoporosis

    A condition characterized by weakened bones due to decreased mineral content, primarily caused by a decrease in bone density.

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    T-score

    A measure of bone mineral density used to diagnose osteoporosis.

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    Weight-bearing Exercises for Osteoporosis

    Weight-bearing exercises, like walking, running, and jumping, are essential for bone health as they stimulate bone growth.

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    Exercise and Osteoporosis

    Regular exercise can help maintain or increase bone density, reducing the risk of fractures.

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    Fracture

    A break or disruption in the continuity of a bone.

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    Myofascial Pain Syndrome (MPS)

    Pain and discomfort caused by tight or irritated muscles that often develops after injury or overuse.

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    Fibromyalgia Flares

    Periods of increased symptoms and pain in Fibromyalgia.

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    Fibromyalgia Flare Triggers

    Factors that can trigger or worsen Fibromyalgia symptoms.

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    Myofascial Trigger Points

    Tender points in muscles that are hypersensitive to pressure and may refer pain to other areas.

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    Aerobic Exercise for Fibromyalgia

    A type of exercise that helps reduce Fibromyalgia symptoms.

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    Activity Pacing for Fibromyalgia

    Managing Fibromyalgia symptoms by pacing activities and avoiding overexertion.

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    Cognitive Behavioral Therapy (CBT) for Fibromyalgia

    A therapy that helps people manage Fibromyalgia by identifying and changing negative thoughts and behaviors.

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    Complete Fracture

    A fracture where the bone breaks completely into two or more pieces.

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    Incomplete Fracture

    A fracture where the bone cracks but doesn't break all the way through.

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    Displaced Fracture

    A bone fracture where the broken ends are out of alignment.

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    Undisplaced Fracture

    A bone fracture where the broken ends are still in their normal position.

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    Open Fracture

    A fracture where the bone breaks the skin.

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    Closed Fracture

    A fracture where the bone is broken, but the skin remains intact.

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    Inflammatory Phase of Bone Healing

    The initial stage of bone healing where bleeding occurs and inflammation sets in.

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    Reparative Phase of Bone Healing

    The stage of bone healing where a callus forms to bridge the broken bone.

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    Local Tissue Response in Posttraumatic Immobilization

    Weakening of connective tissue, cartilage degeneration, muscle atrophy, and contracture development, along with sluggish circulation. These changes occur due to prolonged immobilization and inactivity.

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    Maintaining Normal Function During Immobilization

    The goal is to maintain the affected area as close to normal as possible using exercises while ensuring the fracture site heals properly.

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    General Exercises for Uninvolved Body Parts

    Exercises for areas not affected by the fracture minimize secondary physiological changes in the body, such as muscle atrophy and cardiovascular issues.

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    Functional Adaptations During Immobilization

    Devices and gait patterns are chosen based on the fracture site, type of immobilization, and the patient's abilities, aiming to restore mobility and function as safely as possible.

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    Impairments After Immobilization

    Decreased range of motion, joint play, and muscle flexibility are common after immobilization. Weakness, fatigue, and pain with movement are also expected, but should improve with exercise.

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    Joint Mobilization After Immobilization

    Effective for restoring joint play without damaging cartilage or stressing the fracture site.

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    PNF Stretching After Immobilization

    A specific type of stretching that involves muscle contractions and controlled movements. It should avoid excessive force at the fracture site.

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    Resuming Functional Activities Post-Immobilization

    Gradual resumption of normal activities with caution. It's important to avoid stressing weakened tissues.

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    Study Notes

    Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management

    • Arthritis is inflammation of a joint
    • Arthrosis is limitation of a joint without inflammation
    • Impaired Mobility often involves a firm end-feel, decreased and possibly painful joint play, and joint swelling
    • Impaired Muscle Performance can occur due to disuse or reflex inhibition of stabilizing muscles when there is joint swelling or pain
    • Impaired Balance is often caused by altered or decreased sensory input from joint mechanoreceptors and muscle spindles
    • Activity Limitations and Participation Restrictions can range from minimally to significantly restricted.

    Rheumatoid Arthritis (RA)

    • An autoimmune, chronic, inflammatory, systemic disease of unknown etiology primarily affecting synovial lining of joints and other connective tissues
    • Characteristics:
      • Erosive synovitis with periods of exacerbation and remission
      • Inflammatory changes in tendon sheaths
      • Extra-articular pathological changes sometimes occur
      • Progressive deterioration in function often due to muscular changes and progressive muscle weakness
      • Degree of involvement varies
      • Mild symptoms result in mild lifestyle changes and medication. Significant symptoms result in major lifestyle adaptations.

    Rheumatoid Arthritis (RA) - Signs and Symptoms

    • Active Disease Periods: Often include effusion (fluid accumulation) and swelling of the joints. Onset typically in smaller joints of hands and feet, potentially leading to deformity and ankylosis (fusion) or subluxation (partial dislocation). Pain frequently spreads to muscles, potentially causing muscle atrophy and weakness. Low-grade fever, loss of appetite and weight, fatigue, and malaise can also occur.

    Rheumatoid Arthritis (RA) - Management

    • Patient Education: Includes overall treatment plan, safe activity, and joint protection techniques. Patients should be taught to recognize and respect fatigue, resting to avoid undue stress on body systems.
    • Joint Mobility & Exercise: Focus on active exercises utilizing as much range of motion (ROM) as possible, contingent on symptoms. Functional training is also emphasized, adapting Activities of Daily Living (ADLs) to protect joints.

    Rheumatoid Arthritis (RA) - Location of Erosion

    • X-rays of affected hands demonstrate areas of erosion (damage in the bone).

    Rheumatoid Arthritis (RA) - Principles of Management (Subacute and Chronic Stages)

    • Treatment Approach: Precautions are vital due to potential tissue susceptibility to further damage from pathological changes associated with the disease.
    • Joint Protection and Activity Modification: Prioritize protecting joints by adapting the environment and modifying activities to prevent further injury.
    • Flexibility and Strength: Exercises for flexibility, strength, and endurance should be within patient tolerance.
    • Cardiopulmonary Endurance: Non-impact or low-impact conditioning exercises performed within patient tolerance are critical.

    Osteoarthritis (OA)

    • A chronic degenerative disorder primarily affecting the articular cartilage of synovial joints, with eventual bony remodeling and overgrowth at the margins of the joints.
    • Characteristics:
      • Capsular laxity resulting from bone remodeling and capsule distension can lead to hypermobility or instability.
      • Cartilage can degenerate, split, and thin, losing its ability to withstand stress.
      • Affected joints may become enlarged.
      • Common sites include weight-bearing joints (hips and knees), cervical and lumbar spine, DIP joints of fingers and CM joints of the thumbs.

    Osteoarthritis (OA) - Imaging

    • X-rays demonstrate reduced joint space and the presence of osteophytes (bone spurs)

    Osteoarthritis (OA) - Management

    • Patient Instruction: Emphasize how to protect joints while remaining active and managing symptoms.
    • Pain Management: Early stages (stiffness) necessitate balance between activity, rest, and correct biomechanical stresses. Late stages emphasize activity modification, assistive devices, and orthoses.
    • Assistive Devices and Activity: Supportive devices can minimize joint stress.
    • Resistance Exercise: Within tolerance of the joint, strong muscles protect the joint.
    • Stretching and Joint Mobilization: Movement through the full available ROM prevents restrictions.
    • Balance Activities: Enhance balance to prevent falls.
    • Aerobic Conditioning: Avoid activities causing repetitive intense loading of joints.

    Fibromyalgia (FM)

    • A chronic condition characterized by widespread pain affecting multiple body regions, including the axial skeleton, lasting more than three months.
    • Prevalence: Affects approximately 2% of the adult population (18+). Women are more frequently affected than men.
    • Characteristics: Can occur at any age, often appearing during early or middle adulthood. Symptoms may develop after physical trauma or viral infections. Pain is often described as originating in muscles, commonly in the scapula, head, neck, chest, and lower back. Symptoms fluctuate. The condition is associated with other health concerns such as tendonitis, headaches, irritable bowel syndrome, temporomandibular joint dysfunction, restless legs syndrome, mitral valve prolapse, anxiety, depression, and memory problems.

    Fibromyalgia (FM) - Factors Contributing to Flare-ups

    • Environmental stresses: (e.g., weather changes)
    • Physical stresses: (e.g., repetitive activities, prolonged sitting/standing, shift work)
    • Emotional stresses: (e.g., common life stressors)

    Fibromyalgia (FM) - Management

    • Exercise: Aerobic exercise (particularly) to reduce symptoms.
    • Prescription/OTC Medications: For pain management.
    • Pacing Techniques: Instructing in and encouraging pacing activities.
    • Other Interventions: Cognitive behavior therapy, avoiding stress fractures, minimizing alcohol and caffeine consumption, diet modification, and manual therapy.

    Myofascial Pain Syndrome (MPS)

    • A chronic regional pain syndrome. The hallmark is myofascial trigger points (specific points in muscle) associated with referred pain patterns, and additional sensory, motor, and autonomic symptoms.
    • Possible Causes of Trigger Points:
      • Chronic overload of muscles due to repetitive activities.
      • Acute overload of muscles (e.g., slipping, catching oneself).
      • Poor muscle conditioning.
      • Postural stresses (e.g., prolonged sitting).
      • Poor body mechanics.

    Myofascial Pain Syndrome (MPS) - Management

    • Correct Chronic Overload: Education emphasizing the importance of intermittent mini-breaks to prevent overload.
    • Eliminate Trigger Points:
      • Contract-relax-passive stretch
      • Trigger point release
      • Spray and stretch
      • Dry needling or injection
      • Strengthen Muscle and improve Muscle Endurance

    Osteoporosis

    • A bone disease characterized by decreased mineral content and bone weakness.
    • Diagnosis: Determined by T-score from BMD (bone mineral density) scan.
      • Normal T-score = -1.0 or higher
      • Osteopenia T-score = -1.0 to -2.4
      • Osteoporosis T-score = -2.5 or less
    • Prevention:
      • Balanced diet rich in calcium and vitamin D.
      • Regular weight-bearing exercise.
      • Healthy lifestyle, including moderate alcohol consumption (2-3 drinks/day) and no smoking.
    • Physical Activity: Maintains or increases bone density to prevent fractures.
    • Effects of Exercise: Muscle contraction and mechanical loading stimulate osteoblastic activity to improve body mass density.

    Fractures

    • A structural break in the continuity of a bone, epiphyseal plate, or cartilaginous joint surface.
    • Identification:
      • Site (location of fracture).
      • Extent (complete or incomplete fracture).
      • Configuration (direction of fracture line).
      • Relationship to fragments (displaced or undisplaced).
      • Relationship to the environment (closed or open - penetratated skin).
    • Fracture Types: Transverse, Linear, Oblique, Spiral, Greenstick, Comminuted

    Fractures - Risk Factors

    • Sudden impact (e.g., trauma, accidents, abuse, assault)
    • Osteoporosis (women more than men)
    • History of Falls
    • Repetitive stress/microtrauma
    • Poor health conditions/disease

    Fractures - Bone Healing

    • Cancellous Bone healing occurs primarily through internal callus formation (endosteal callus). There is a rich blood supply leading to faster healing than dense cortical bone.
    • Epiphyseal Plate healing can cause growth disturbances and bony deformity during maturation.

    Fractures - Post-Fracture Healing Stages

    • Stages include: inflammation, soft callus, hard callus, and bone remodeling phase. The times vary depending on location, type of fracture, soft tissue involvement, and surgical intervention.

    Post-Traumatic Immobilization Management

    • Local Tissue Response during immobilization can cause weakening of connective tissues, articular cartilage degeneration, muscle atrophy, and contracture development, and sluggish circulation. It is crucial to maintain near-normal conditions.
    • Immobilization in Bed: General exercises are key for uninvolved body parts to minimize secondary physiological changes.
    • Functional Adaptations: Device choice, gait patterns, and patient functional aptitudes are all important in adapting to immobilization.

    Post-Immobilization Management (Impairments)

    • Impairments: Postimmobilization can lead to decreased ROM, joint play, muscle flexibility. Muscle atrophy and weakness are potential issues. If soft tissue damage occurred with the fracture, scar tissue can impair mobility. Pain and decrease ROM can occur with movement but the pain should decrease as movement occurs.
    • Management:
    • Joint Mobilization: Effective for regaining lost joint play without harming articular cartilage and stressing the fracture site.
    • PNF Stretching (Proprioceptive Neuromuscular Facilitation): Control contraction intensity to prevent resistance or stretch force beyond the fracture site

    Post-Immobilization Management (Functional Activities)

    • Functional Activities: Resume normal activities with caution. Avoid traumatizing weakened tissues.
    • Muscle Performance: Important to apply resistive force proximal to the fracture site until radiological healing occurs. Once healed, more intense dynamic exercises can be initiated.
    • Scar Tissue Mobilization: Manual mobilization techniques are used. Technique selection depends on the tissue involved.

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    Test your knowledge on osteoporosis and rheumatoid arthritis with this quiz. Explore key concepts such as joint swelling effects, exercise recommendations, and bone health indicators. Understand the implications of these conditions on the body and how to manage them effectively.

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