Week 1 - Anatomy PPT PDF

ORTHOPEDICS DISABILITIES AND TREATMENT THE PACE OF CHANGE IN ORTHOPEDIC SURGERY AND RESEARCH HAS BEEN QUICK AND STEADY  ATHLETES COME IN ALL AGES AND SIZES AND THEY COMPETE AT DIFFERENT LEVELS  WORKMAN’S COMPENSATION GERIATRIC TRAUMATIC INJURIES ANATOMY OVERVIEW ...

ORTHOPEDICS DISABILITIES AND TREATMENT THE PACE OF CHANGE IN ORTHOPEDIC SURGERY AND RESEARCH HAS BEEN QUICK AND STEADY  ATHLETES COME IN ALL AGES AND SIZES AND THEY COMPETE AT DIFFERENT LEVELS  WORKMAN’S COMPENSATION GERIATRIC TRAUMATIC INJURIES ANATOMY OVERVIEW  SYNOVIAL JOINT CLASSIFICATION STABILITY JOINTS MOBILITY JOINTS STABILITY JOINTS ARTICULAR SURFACES ARE CONGRUENT DENSE, THICK JOINT CAPSULE MANY LIGAMENTS FOR SUPPORT MOBILITY JOINTS ARTICULAR SURFACES ARE INCONGRUENT LOOSE CAPSULE VERY FEW LIGAMENTS  SYNOVIAL JOINT CHARACTERISTICS Most common joint in the human body No direct union between articulating bones Surrounded by strong fibrous capsule  Free motion of the joint Has a synovial membrane that secretes synovial fluid Hyaline cartilage that covers the surfaces of the enclosed articular bones SYNOVIAL JOINT COMPONENTS STRATUM FIBROSUM: (outer layer) COMPOSED OF DENSE FIBROUS TISSUE POORLY VASCULARIZED  RICHLY INNERVATED BY JOINT RECEPTORS THAT DETECT: Compression or tension Pain Movement (rate and direction) Vibration STRATUM SYNOVIUM: (inner layer) HIGHLY VASCULARIZED POORLY INNERVATED PURPOSE IS TO PRODUCE SYNOVIAL FLUID  PURPOSE OF SYNOVIAL FLUID PROVIDE LUBRICATION TO THE JOINT ACT AS A SHOCK ABSORBER PROVIDE NOURISHMENT TO THE ARTICULAR CARTILAGE  EFFECTS OF IMMOBILIZATION SYNOVIAL FLUID NO NO NOURISHMENT SYNOVIAL TO THE FLUID HYALINE PRODUCED CARTILAGE HYALINE CARTILAGE NO NOURISHMENT TO THE HYALINE CARTILAGE OSTEOARTHRITIS JOINT CAPSULE AND SUPPORTING TISSUE JOINT/MUSCLE CONTRACTURES ADAPTIVE SHORTENING MUSCLE/ DISUSE LIGAMENT ATROPHY WEAKNESS  LIGAMENTS/TENDONS/ STRATUM FIBROSUM MAKEUP OF CONNECTIVE TISSUE: 1. COLLAGEN 2. ELASTIN 3. COLLAGEN/ELASTIN MIX COLLAGEN:  1° COMPONENT OF DENSE FIBROUS TISSUE  MOST ABUNDANT PROTEIN IN THE HUMAN BODY  HAS A VERY HIGH TENSILE STRENGTH  RESPONSIBLE FOR THE FUNCTIONAL INTEGRITY OF CONNECTIVE TISSUE STRUCTURES  NONELASTIC ELASTIN HAS ELASTIC PROPERTIES THAT ALLOW FIBERS TO DEFORM UNDER AN APPLIED FORCE AND THEN RETURN TO THEIR ORIGINAL STATE FOLLOWING REMOVAL OF THAT FORCE COLLAGEN/ELASTIN MIX: In synovial joints most connective tissue is a mix Collage n Proportion of elastin to collagen fibers varies, but in general, elastin Elastin fibers make up a much smaller portion of the fibrous component  FUNCTION OF CONNECTIVE TISSUE MAINTAIN THE STABILITY OF THE JOINT  SUSCEPTIBILITY TO INJURY DEPENDS ON THE AMOUNT OF ELASTIN AND THE ARRANGEMENT OF THE COLLAGEN FIBERS LIGAMENTS LIGAMENTS HAVE A SLIGHTLY HIGHER ELASTIN CONTENT COLLAGEN ARRANGEMENT IS VARIED, ENABLING THE LIGAMENT TO RESIST FORCES FROM MORE THAN ONE DIRECTION TENDONS HAVE A HIGHER COLLAGEN CONTENT AS THE MOVEMENT IS MORE IN THE MUSCLE COLLAGEN HAS A PARALLEL ARRANGEMENT TO HANDLE HIGH UNIDIRECTIONAL TENSILE FORCES JOINT CAPSULE VARY CONSIDERABLY IN COMPOSITION COMPOSITION MAY CHANGE BASED ON STRESSES IMPOSED IN GENERAL, THOSE CAPSULES WHOSE JOINT FUNCTION IS STABILITY WILL HAVE MORE COLLAGEN THAN THOSE BUILT FOR MOBILITY CARTILAGE SOLID TYPE OF CONNECTIVE TISSUE AVASCULAR – SO IF INJURED IT HAS LIMITED ABILITY FOR REPAIR PURPOSE: PROVIDE MORE SUPPORT FOR A JOINT SHOCK ABSORPTION CARTILAGE IS DIVIDED INTO TWO TYPES: 1. FIBROCARTILAGE A) WHITE FIBROCARTILAGE FORMS THE BONDING CEMENT IN JOINTS THAT PERMIT VERY LITTLE MOTION. ALSO FORMS THE INTERVERTEBRAL DISCS. B) YELLOW FIBROCARTILAGE - HAS A HIGHER RATIO OF ELASTIN TO COLLAGEN THAN THE WHITE AND IS FOUND IN THE EARS AND EPIGLOTTIS 2. HYALINE CARTILAGE (ARTICULAR CARTILAGE) MOST ABUNDANT CARTILAGE FORMS THIN COVERING ON THE ENDS OF MANY BONES PROVIDES A SMOOTH, RESILIENT, LOW FRICTION SURFACE FOR THE ARTICULATION OF ONE BONE WITH ANOTHER THERE ARE THREE DISTINCT LAYERS OR ZONES OF ARTICULAR CARTILAGE FOUND ON THE ENDS OF BONEY COMPONENTS OF SYNOVIAL JOINTS  BONE TISSUE CHARACTERISTICS HARDEST FORM OF CONNECTIVE TISSUE COMPOSED OF FIBROUS CONNECTIVE TISSUE IN A MATRIX OF INORGANIC SUBSTANCES BONE TISSUE IS RIGID BUT ALSO SOMEWHAT ELASTIC WOLFF’S LAW: BONE IS DEPOSITED IN SITES OF STRESS AND RESORBED IN AREAS OF LEAST STRESS  BONE MODELS AND REMODELS ITSELF OVER AND OVER ALL THROUGH LIFE, IN RESPONSE TO STRESS.  BONE RECEIVES NOURISHMENT FROM CAPILLARIES INSIDE THE BONE, NOT FROM THE HYALINE CARTILAGE. FUNCTION: PROVIDE RIGID FRAMEWORK FOR THE TRUNK AND EXTREMITIES  SERVE AS LEVERS FOR MOVEMENT AND ATTACHMENTS FOR SKELETAL MUSCLE  PROTECTION FOR VULNERABLE VISCERA  CONTAIN SITES FOR THE DEVELOPMENT OF RED BLOOD CELLS ORGAN OF STORAGE OR RESERVOIR FOR MINERALS FOR THE BODY - STORING AND RELEASING CALCIUM, SODIUM, PHOSPHORUS AND MAGNESIUM AS THE NEED ARISES STRUCTURE BONE TERMS: EPIPHYSIS: DISTAL END OF BONE DIAPHYSIS: SHAFT OF THE BONE, HOLLOW TUBE OF COMPACT BONE SURROUNDING THE MEDULLARY CAVITY METAPHYSIS: REGION IN A MATURE BONE WHERE THE DIAPHYSIS JOINS THE EPIPHYSIS BONE CELLS: OSTEOBLASTS: PRODUCE BONE OSTEOCLASTS: RESORB BONE OSTEOCYTE: OSTEOBLAST THAT HAS SURROUNDED ITSELF IN A MATRIX AND IS NOW JUST A LIVING PART OF THE BONE. NONFUNCTIONING 15yo football injury 4 months later…  TISSUE RESPONSE TO INJURY SOFT TISSUE INJURY TO SOFT TISSUE INITIATES A SERIES OF RESPONSES COLLECTIVELY KNOWN AS: INFLAMMATION AND REPAIR TIMETABLE FOR THE INFLAMMATION AND REPAIR PROCESS VARIES WITH EACH PATIENT AND IS BASED ON: EXTENT OF INJURY DISEASE PROCESS HEALTH OF INDIVIDUAL MEDICATIONS  INJURED SOFT TISSUE DOES NOT REGENERATE ITSELF HEALING IS NONSPECIFIC HEALING PROCESS TAKES PLACE THROUGH CONNECTIVE TISSUE REPAIR IN WHICH SCAR TISSUE IS SUBSTITUTED FOR NONREGENERATED SOFT TISSUE  SCAR TISSUE IS COMPOSED OF MAINLY COLLAGEN, WHICH IS HARD, STIFF, AND ADHERES TO SURROUNDING TISSUE LIMITING MOTION. EPITHELIALIZATION: NONSPECIFIC REPAIR MECHANISM OF SCAR FORMATION COMPONENTS OF THE INFLAMMATION AND REPAIR PROCESS: 1. INFLAMMATION – AREA SWELLS AND BECOMES WARM - SERVES TO RID THE AREA OF MICRO- ORGANISMS, FOREIGN MATERIAL, AND DEAD TISSUE IN PREPARATION FOR THE REPAIR PROCESS. 2. FIBROPLASIA – FORMATION OF NEW FIBROUS CONNECTIVE TISSUE 3. SCAR MATURATION – REMODELING OF THE CONNECTIVE TISSUE TAKES PLACE INFLAMMATION PHASE VASCULAR RESPONSE HEMOSTATIC RESPONSE CELLULAR RESPONSE IMMUNE RESPONSE INFLAMMATION: PROCESS WHICH ELIMINATES DEAD TISSUE IN PREPARATION FOR TISSUE REPAIR. IT IS ACTIVATED BY THE RELEASE OF HISTAMINE 1ST STAGE: = IMMEDIATE VASOCONSTRICTION (VASCULAR RESPONSE) = PLATELETS AGGREGATE AND DEPOSIT FIBRIN, CREATING A CLOT (HEMOSTATIC RESPONSE) = VASODILATION FOLLOWS VASOCONSTRICTION (VASCULAR RESPONSE) CLINICAL MANIFESTATIONS OF INFLAMMATION REDNESS WARMTH SWELLING PAIN LOSS OF FUNCTION 2ND STAGE = LEUKOCYTES COME IN WITH FRESH BLOOD SUPPLY TO BEGIN PHAGOCYTOSIS = PHAGOCYTOSIS – NEUTROPHILS, MONOCYTES, AND MACROPHAGES RECOGNIZE, ENGULF AND DIGEST DEBRIS, NECROTIC TISSUE, RED BLOOD CELLS, PROTEINS, TO PREPARE THE AREA FOR REPAIR AND GROWTH OF NEW TISSUE. 3RD STAGE = MACROPHAGES ALSO FUNCTION TO RELEASE GROWTH FACTORS THAT STIMULATE EPITHELIAL CELL GROWTH, ANGIOGENESIS, AND ATTRACTION OF FIBROBLASTS  TREATMENT FOR ACUTE STAGE OF INJURY (MAXIMUM PROTECTION PHASE) PRICE: PROTECTION REST ICE COMPRESSION ELEVATON  GENTLE MUSCLE SETTING EXER (SUB MAX ISOMETRICS) GRADE I OCCILATIONS FOR PAIN MODALITIES (US, E-STIM) PROM>AAROM>AROM IN PAIN- FREE RANGE FIBROPLASIA (PROLIFERATIVE) PHASE = FIBROBLASTS MIGRATE TO THE INFLAMMED AREA = FIBROBLASTS BEGIN PRODUCING SCAR TISSUE = SYNTHESIS, ORIENTATION, AND DEPOSITION OF NEW COLLAGEN IS RANDOM = USE OF GENTLE STRETCH TO STRESS THE SCAR WILL CAUSE FIBROBLASTS TO ORIENT PARALLEL TO THE LINES OF TENSION = FIBROBLASTS DISAPPEAR WHEN ENOUGH SCAR TISSUE IS LAID DOWN THIS MARKS THE BEGINNING OF THE REMODELING PHASE  SUBACUTE PHASE (MODERATE PROTECTION PHASE) CONTINUE WITH AROM STRETCHING BEGIN STRENGTHENING EXER AND PROGRESS ISOMETRICS YELLOW THERABAND STABILIZATION EXER SCAR MATURATION (REMODELING) PHASE = NEW COLLAGEN AND CONNECTIVE TISSUE GRADUALLY REORIENT ALONG THE LINES OF PHYSICAL STRESS IMPOSED ON THE INJURED SITE. UNSTRESSED WOUND COLLAGEN STRESSED WOUND COLLAGEN ACTIVE STRESS, OR MUSCULAR CONTRACTIONS WITH PROGRESSIVE JOINT MOTION (PROM>AAROM>AROM), PROMOTE LONGITUDINALLY ORGANIZED, STRONGER, MORE FUNCTIONAL COLLAGEN ARRANGEMENTS.  REMODELING PHASE (RETURN TO ACTIVITY) AGGRESSIVE WITH ROM AND STRENGTHENING REGAIN ACTIVITY- SPECIFIC SKILLS PHYSICAL THERAPY IS THE KEY TO CORRECT SCAR TISSUE REMODELING. THE MORE OF AN ORGANIZED PATTERN THE COLLAGEN FIBERS ACQUIRE, THE STRONGER THE TENSILE STRENGTH. HOW STRONG AND EXTENSIBLE THE FINAL SCAR IS, WILL IN LARGE PART BE DUE TO HOW DILIGENT THE PATIENT WAS WITH HOME EXERCISE PROGRAM (HEP). DESPITE REMODELING, SCAR TISSUE IS NEVER AS STRONG AS THE TISSUE IT REPLACES. AT MAXIMAL STRENGTH, SCAR TISSUE IS ONLY ABOUT 70% AS STRONG AS INTACT TISSUE. SPECIALIZED TISSUE REPAIR STRIATED MUSCLE * LIMITED ABILITY TO REGENERATE MYOFIBRILS * EDGES MUST BE CLOSELY APPROXIMATED * SCAR FORMATION WILL OCCUR TO HEAL WOUND * RESULT IS LESS FUNCTIONAL MUSCLE  STRAINS GRADE I STRAIN GRADE II STRAIN GRADE III STRAIN  TENDONS * REQUIRES UNION OF SEVERED ENDS * MUST RESTORE GLIDING FUNCTION (PREVENT ADHESIONS IN TENDON SHEATH) TERMS: TENDINITIS TENDINOSIS TENOSYNOVITIS LIGAMENT INJURIES  LIGAMENTS * DEPEND ON IF INJURY IS A RUPTURE OR AVULSION * RUPTURE: SAME REPAIR PROCESS AS TENDON * AVULSION: FIXATION OF LIGAMENT WITH A SCREW  SPRAINS GRADE I SPRAIN GRADE II SPRAIN GRADE III SPRAIN  CARTILAGE (FIBRO AND HYALINE) * MATURE CARTILAGE INCAPABLE OF REGENERATING * WILL LOSE ANATOMICAL CHARACTERISTICS (CUSHION) * IF BLOOD SUPPLY AVAILABLE AND EDGES CLOSELY APPROXIMATED SOME REGENERATION WILL OCCUR  NERVE IF INJURY DOES NOT AFFECT THE CELL BODY AND THE AXON ENDS ARE CLOSE TOGETHER MAY HEAL HEALING VERY SLOW 3-4 mm PER DAY. 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 AS PTAs YOU MUST UNDERSTAND THE HEALING PROCESS TO EFFECTIVELY SUPERVISE THE REHAB PROCESS  REFERENCES 1. PRENTICE W, VOIGHT M. TECHNIQUES IN MUSCULOSKELTAL REHABILITATION. MCGRAW-HILL, 2001 2. LEVANGIE P, NORKIN C. JOINT STRUCTURE AND FUNCTION. 3RD ED. PHILADELPHIA, F.A. DAVIS CO., 2001 3. DUTTON M. ORTHOPEDIC EXAMINATION, EVALUATION, AND INTERVENTION. MCGRAW- HILL, 2004 4. BAHR R, MAEHLUM S. CLINICAL GUIDE TO SPORTS INJURIES. OSLO, GAZETTE BOK, 2004.