Soft Tissue Injury, Repair and Management
Examples of soft tissue lesions.
Strain, Sprain, Dislocation, Subluxation, Contracture, Adhesion, Muscle rupture or tear, Repetitive strain injury etc.
What is arthritis?
Inflammation of the joint.
During what stage of healing does inflammation develop?
Acute stage
What are the most common types of arthritis treated by therapists?
Rheumatoid arthritis and Osteoarthritis
Passive ROM, Low-dosage joint manipulation, Muscle setting, Massage.
These are specific interventions for what stage of tissue healing?
Acute stage.
Clinical Signs and Symptoms common to all types of arthritic conditions.
1.Patient presents with signs of joint involvement including a characteristic pattern of limitation called...? What would this impair?
2.How can joint swelling or pain Impair Muscle Performance?
3. Why do some arthritic patient's have impaired balance?
4. Limitation of the ability to carry out home, community, work related, or social activities is?
1. Capsular pattern, Impaired Mobility
2.Weakness from disused or reflex inhibition of stabilizing muscles occurs when there is joint swelling or pain. Muscle weakness or inhibition leads to imbalances in strength.
3. Altered or decreased sensory input from joint mechanoreceptors and muscle spindles. Big problem for weight bearing joints.
4. Activity limitation and participation restriction
Tissue response: Proliferation, Repair and Healing
What stage of healing is this?
When does it take place?
Fibroblasts produce what and why?
Sub acute stage.
Takes place during the second to fourth day after tissue injury.
Fibroblast produce new collagen to replace the exudate that originally formed the clot.
Helps build and repair tissues by producing the building blocks of connective tissue.
Rheumatoid Arthritis
1. Is a chronic, auto immune, inflammatory, systemic disease affecting ______ as well as ______.
2. This disease is characterized by...
1. Synovial lining of diarthrodial joints, other connective tissue.
2. Symmetric erosive synovitis with periods of exacerbation and remission. Early inflammatory changes in the synovial membrane trigger granulation tissue (Pannus) to form, covers and erodes the articular cartilage, bones, and ligaments of the joint capsule.
A clinical condition described as an abnormal adherence of collagen fibers to surrounding trauma or pathology that prevents motion
What is an adhesion?
Impairments, active limitations, and participation restrictions of RA
1. Educate the patient: Inform pt. on importance of what?
2. Relieve pain and muscle guarding and promote relaxation: What types of interventions?
3. Minimize joint stiffness and maintain available motion: What types of interventions?
4. Minimize muscle atrophy: What type of contractions?
5. Prevent deformity and protect the joint structures: What kind of devices take stress of a joint?
6. Precautions?
7. Contradictions?
1. Inform on importance of rest, joint protection, energy conservation and performance ROM. Teach HEP
2. Modalities, gentle massage, Immobilize in orthoses, Relaxation techniques, Medications
3. PROM & AAROM within limits of pain progress as tol. Grade I, II joint mobs.
4. Gentle isometrics in pain free positions
5. Use an assistive device for all pathologically active joints.
6. Respect fatigue and incr. pain. do not over stress osteoporotic bone or lax ligaments.
7. Do not stress swollen joints or apply heavy resistance training.
What is Chronic pain syndrome?
A state of pain that persists longer than 6 months and can’t be linked to a source --- physical, psychological, or emotional
Osteoarthritis: Degenerative Joint Disease
1. What does OA mainly affect?
2. How do you get OA?
3. Risk factors?
1. A chronic degenerative disorder mainly affecting the the articular cartilage of the synovial joints.
2. The etiology of OA is unknown but mechanical injury to the joint due to major stress or repetitive minor stress is likely the cause.
3. Risk factors that show a direct relationship with OA are obesity, weak quads, joint impact, most sports, and some occupational actives.
Chronic Stage (maturation & remodeling)
How long can it last?
Are there signs of inflammation?
Are there contractures/ adhesions?
Stretch pain where?
How is their endurance and neuromuscular control?
Can last 6 months to 1 year
No signs of inflammation
Sometimes contractures/adhesions
Stretch pain may be felt at end ranges
Poor endurance, neuromuscular control
Characteristics of OA
1. Why do contractures form at the joint capsule and overlying muscles?
2. What happens to the cartilage? What happens as a result?
3. How does the size of the joint change?
4. What are the most commonly involved joints?
1. OA will cause pain and decreased willingness to move. Contractures develop as the disease progresses and motion becomes more limited.
2. Cartilage splits and thins out and looses its ability to withstand stress. As a result loose bodies occur in the joint?
3. Joints become enlarged.
4. Weight bearing joints ex: hips, knees, feet, spine.
Sub-Acute Stage Management
What are some impairments they may present with?
What to educate the patient on?
How should we promote healing of injured tissue?
How should we restore mobility?
Multiple angle isometrics will help develop what?
Precautions?
Impairments
Pain at end of available ROM
Decreasing edema and joint effusion
Developing soft tissue, muscle, joint contractures
Muscle weakness from disuse
Decreased function
Patient education
Anticipated healing time/importance of following guidelines
Teach HEP and modify as needed
Promote healing of injured tissue
Monitor tissue response to exercise
Decrease intensity if inflammation occurs
Restore mobility (soft tissue, joint, muscle)
Progress from PROM→AAROM→AROM
Increase scar/soft tissue mobility/related areas
Develop neuromuscular control/endurance/strength
Multiple angle isometrics
Initiate AROM and protected W/B and stabilization exercises
As healing/ROM improves, progress to isotonic ex with emphasis on form
Maintain integrity/function of associated areas
Precautions
Too much motion/activity = resting pain, fatigue, spasm, weakness
Pain should not last longer than a few hours after a new activity