Therapeutic Exercise Chapter 10: Soft Tissue Injury, Repair, and Management (Multiple Choice and Short Answer Quiz)

How would the therapist educate the patient during the acute stage of Chronic Inflammation?

-Counsel as to the cause and the need to avoid stressing the part while it's inflamed - Adapt environment to decrease tissue stress - Implement HEP to reinforce therapeutic interventions

What causes Chronic Inflammation?

-Injured tissue continually stressed beyond its ability to repair

What are the Symptoms of Chronic Inflammation

1. Increased pain, swelling, and muscle guarding that last more than several hours after activity 2. Increased feeling of stiffness after rest 3. Loss of ROM 24 hrs after activity 4. progressively greater stiffness of tissue as long as irritation persists

Mild pain at the time of injury or within the first 24 hours. Mild swelling, local tenderness, and pain occur when the tissue is stressed. A. 1st Degree Trauma B. 2nd Degree Trauma C. 3rd Degree Trauma

1st Degree Trauma

Moderate pain that requires stopping the activity. Stress and palpation of the tissue greatly increase the pain. When the injury is to ligaments, some of the fibers are torn, resulting in some increased joint mobility. A. 1st Degree Trauma B. 2nd Degree Trauma C. 3rd Degree Trauma

2nd Degree Trauma

Near-complete or complete tear or avulsion of the tissue with severe pain. Stress is usually painless; palpation may reveal the defect. Results in instability of the joint. A. 1st Degree Trauma B. 2nd Degree Trauma C. 3rd Degree Trauma

3rd Degree Trauma

How long does the Acute Stage of Healing usually last? A 4-6 hours B 4-6 days C 4-6 weeks D 4-6 months

4-6 days

Chronic Pain Syndrome is a state that persists longer that ___ months. A 2 B 4 C 5 D 6

6

When does the Chronic Stage of Healing usually occur? A. >3 hours post injury B. >3 days post injury C. >3 weeks post injury D. >3 months post injury

>3 weeks post injury

Abnormal adherence of collagen fibers to surrounding structures during immobilization, after trauma, or as a complication of surgery, which restricts normal elasticity and gliding of the structures involved. A Muscle Weakness B Myofascial Compartment Syndrome C Contracture D Adhesion

Adhesion

Proper dosage of rest and movement must be used in progress healing. If a patient experiences and increase in pain or swelling, the therapist should: A. Stop treatment and call the physician B. Decrease movement to an appropriate level C. Increase movement to alleviate pain D. Increase resistance but decrease repetitions

B. Decrease movement to an appropriate level

What is the proper approach to stretching and resistance exercises during the acute stage? A. Proceed with caution, taking cue from patient B. Stretch and Resistance are contraindicated in this stage C. Resistance exercises before Stretch D. Stretch before Resistance

B. Stretch and Resistance are contraindicated in this stage

Inflammation of a bursa A Bursitis B Contusion C Tendinitis D Subluxation

Bursitis

Complete or continuous immobilization should: A. continue as long as there is pain B. last about 2 weeks C. stay brief to avoid loss of function and mobility D. Immobilization has no effect on healing

C. Stay brief to avoid loss of function and mobility

All of the following are soft tissue responses common to the Acute phase EXCEPT: A Swelling B Collagen Formation C Phagocytosis at trauma site D Redness

Collagen Formation- Clot formation happens in the acute stage, while collagen fiber formation begins in the subacute stage

Adaptive shortening of the skin, fascia, muscle, or joint capsule that prevents normal mobility or flexibility in that structure. A Adhesion B Joint Dysfunction C Capsulitis D Contracture

Contracture

What is the therapist's role during the Acute Stage/Protection Phase?

Control the effects of inflammation, facilitate wound healing, and maintain normal function in unaffected tissues and body regions.

Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory response. A Synovitis B Hemarthrosis C Bursitis D Contusion

Contusion

Which of the following is NOT a contributing factor to Chronic Inflammation? A. Age B. Muscle Weakness C. Bone malalignment D. Diet

D. Diet.

What is the therapist's role during the Chronic Stage/Return to Function Phase?

Design a progression of exercises that safely stresses the maturing connective tissue in terms of both flexibility and strength, so that patient can return to functional and work-related activities.

Displacement of a part, usually the boney partners in a joint, resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm. A Subluxation B Dislocation C Tendinopathy/tendinous lesion D Strain

Dislocation

Loss of normal function of a tissue or region. A Muscle Weakness B Contracture C Atrophy D Dysfunction

Dysfunction

Ballooning of the wall of a joint capsule or tendon sheath. May arise after trauma, and somtimes occur with Rheumatoid Arthritis. A Bursitis B Synovitis C Contusion D Ganglion

Ganglion

Which of the following is a common soft tissue response during the SUBACUTE phase? A. Maturation of Connective Tissue B. Early Fibroblastic Activity C. Growth of Capillary beds into the Area D. Remodeling of a Scar

Growth of Capillary Beds into the Area

Bleeding into a joint, usually due to severe trauma A Ganglion B Hemarthrosis C Contusion D Bursitis

Hemarthrosis

What is the therapist's role during the Subacute Stage/Controlled Motion Phase?

Initiate and progress NON-DESTRUCTIVE exercises and activities, such as multi-angle, submaximal isometrics and AROM exercises within the pain free range.

Prolonged muscle contraction in response to local circulatory and metabolic changes that occur when a muscle is in contraction, causing self-perpetuation regardless of whether or not the primary cause is removed. A Intrinsic Muscle Spasm B Reflex Muscle Guarding C Contracture D Adhesion

Intrinsic Muscle Spasm

Mechanical loss of normal joint play in synovial joints; commonly causes loss of function and pain. Precipitating factors may be trauma, immobilization, disuse, aging, or a serious pathological condition. A Rheumatoid Arthritis B Contracture C Joint Dysfunction D Adhesion

Joint Dysfunction

Decrease in the strength of muscle contraction. May be result of a systemic, chemical, or local lesion of a nerve of the CNS or PNS or the myoneural junction; direct insult; or inactivity. A Myofascial Compartment Syndrome B Muscle Atrophy C Dysfunction D Muscle Weakness

Muscle Weakness

If partial, pain is experienced in the region of the breach when the muscle in stretched or when it contracts against resistance. If complete, the muscle does no pull against the injury, so stretching or contraction of the muscle does not cause pain. A Muscle/Tendon Rupture/Tear B Subluxation C Strain D Sprain

Muscle/Tendon Rupture/Tear

Increased interstitial pressure in a closed, non-expanding, _________ that compromises the function of the blood vessels, muscles, and nerves. Results in ischemia and irreversible muscle loss if there is no intervention. A Myofascial Compartment Syndrome B Bone Fracture C Ganglion D Intrinsic Muscle Spasm

Myofascial Compartment Syndrome

All of the following are PT interventions/goals appropriate to the Subacute Stage EXCEPT: A. Selective Stretching B. Stabilization Exercise C. Progression from PROM>AAROM> AROM exercise within the pain free range D. Plyometrics

Plyometrics. These exercises should only be introduced in the Chronic Stage according to the patient's abilities

Which of the following is a PT goal/intervention appropriate to the ACUTE phase? A. R.I.C.E. B. AROM Exercise to Injured Muscle C. Selective Stretching D. Progressive Strengthening/Endurance Exercise

R-est I-ce C-ompression E-levation

Prolonged contraction of a muscle in response to a painful stimulus. Ceases when painful stimulus is relieved. A Contracture B Adhesion C Reflex Muscle Guarding D Intrinsic Muscle Spasm

Reflex Muscle Guarding

Which of the following is NOT a soft tissue response appropriate the the Chronic Stage of Healing? A Collagen fibers align to stress B Contracture of scare tissue C Maturation of Connective Tissue D Signs of Inflammation

Signs of Inflammation. Inflammation should have decreased to the point of absence by this stage. If inflammation has persisted, this is a sign of perpetuating injury or another underlying issue.

Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle. Frequently refers specifically to injury of a ligament and is graded as 1st, 2nd, or 3rd degree. A Subluxation B Tendinopathy/tendinous lesion C Dislocation D Sprain

Sprain

Overstretching, overexertion, or overuse of soft tissue, occurs from slight trauma or unaccustomed repetitive trauma. Often refers specifically to some degree of disruption of the musculotendinous unit. A Subluxation B Muscle/Tendon Rupture/Tear C Strain D Sprain

Strain

Incomplete/partial separation of the boney partners in a joint that often involves secondary trauma to surrounding soft tissues. A Subluxation B Dislocation C Sprain D Muscle/Tendon Rupture/Tear

Subluxation

Inflammation of a synovial membrane; an excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease. A Synovitis B Bursitis C Tenosynovitis D Contusion

Synovitis

Inflammation of a tendon A Tenosynovitis B Tendinosis C Tendinitis D Tenovaginitis

Tendinitis

Refers to generally to chronic tendon pathology A Muscle/Tendon Rupture/Tear B Strain C Sprain D Tendinopathy/tendinous lesion

Tendinopathy/tendinous lesion

Degeneration of the tendon due to repetitive microtrauma. A Tenosynovitis B Tendinosis C Tendinitis D Tenovaginitis

Tendinosis

Inflammation of the synovial membrane covering a tendon. A Tenosynovitis B Tendinosis C Tendinitis D Tenovaginitis

Tenosynovitis

Inflammation with a thickening of a tendon sheath A Tenosynovitis B Tendinosis C Tendinitis D Tenovaginitis

Tenovaginitis

How long does the Subacute Stage of Healing usually last? A. up to 3 days post injury B. Up to 3 weeks post injury C. Up to 3 months post injury D. Up to 3 years post injury

Up to 3 weeks post injury (10 - 17 days total)

Which of the following is an appropriate PT goal/intervention for the CHRONIC Stage? A. Progressive strengthening/endurance exercise B. Increase soft tissue, muscle, &/or joint mobility C. Improve cardiopulmonary endurance D. All of the above

all of the above