Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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30.2 Tissue Tolerances
abstracts and keywords

Tissue Tolerances of the Muscle-Tendon Unit

Abstract:

This monograph discusses the wide ranging variables that affect the capacity of the muscle-tendon unit to facilitate human movement. A spectrum of clinically relevant content is covered, from anatomy and biomechanical considerations of normal tissue to pathologic changes with disease or injury. Current evidence regarding contemporary physical therapy and medical management of the pathologic muscle-tendon unit is presented and evaluated. Clinical reasoning related to intervention selection is also discussed. This content is intended to be useful for clinicians, researchers, educators, students, and all other stakeholders in orthopedic and sports settings. CASE ANALYSES: Four case studies are presented to assist in the application of knowledge in clinical practice. Specific tissue tolerance considerations are highlighted and management priorities are detailed to guide the reader through patient presentations similar to those encountered every day in the clinical setting.

Keywords:​

capacity, musculotendinous injury, tendinopathy

References:

Click here.

Tissue Tolerances of the Ligament and Capsule

Abstract:

This monograph reviews the clinically-relevant basic science of ligaments and joint capsules. A brief overview is also provided of healthy ligament and capsule anatomy, physiology, and biomechanics in addition to the healing process and general management strategies. To illustrate the application of the basic science principles, common ligamentous and capsular diagnoses are presented, specifically including the background, clinical examination, and management of each condition. These diagnoses include adhesive capsulitis, distal humeral fractures and resulting joint stiffness, distal radioulnar instability, the role of a tight joint capsule in hip osteoarthritis, anterior cruciate and medial collateral ligament injuries of the knee, and mechanical versus functional instability of the ankle. Finally, future treatment ideas are introduced, followed by a brief discussion of the implications for the healing process and management of ligamentous and capsule injuries. CASE ANALYSES: The monograph culminates in 3 case studies that highlight the clinical thought process for evaluation and intervention. The first case involves a 55-year-old female daycare administrator complaining of a gradual onset of hip pain that spread to the lateral aspect of the hip. The second case describes a 60-year-old female cashier who was referred for physical therapy for pain in the left deltoid region. The third case describes a healthy 33-year-old male electrical engineer complaining of recurrent ankle sprains over the past 2 years. He plays soccer at an amateur level and the injuries have caused him to stop playing temporarily.

Keywords:​

evaluation, basic science, management

References:

Click here.

Articular Cartilage

Abstract:

This monograph discusses articular cartilage, a highly specialized connective tissue whose principal function is to provide a frictionless surface for movement while simultaneously providing a shock-absorbing structure. The highly specialized design of this simple and yet intricate structure makes it an essential feature of painfree ROM, while also allowing the human body to withstand large forces during walking, running, and athletic endeavors. Mature cartilage lacks the key elements of a ready blood supply, innervation, and lymphatics to aid in tissue repair. Articular cartilage damage is frequently encountered in former athletes and the elderly. As our youth today increasingly are encouraged to engage in highly competitive sports, a corresponding rise has been seen in the incidence of articular cartilage lesions in children and adolescents. This escalation has prompted several biomedical research teams in the past three decades to look for novel approaches to address cartilage lesions through engineering and biological research. It is important for the physical therapist to have a working knowledge of the unique properties of articular cartilage lesions and the wide variety of surgical and biological treatment options available in order to achieve optimal short- and long-term outcomes. CASE ANALYSES: Four case studies represent the orthopedic and rehabilitation challenges encountered with chondral injuries. The first case involves a 12-year-old competitive gymnast who sustained an osteochondral injury of her right elbow. The second case describes a 15-year-old basketball player with chronic pain and swelling of his right knee. The third case is a 26-year-old male referred to physical therapy with chronic knee pain who had undergone surgery 9 years earlier for a large osteochondral injury. The final case involves a 61-year-old patient with known osteoarthritis who fell and sustained a tibial plateau fracture.

Keywords:​

chondrocytes, chondral lesions, connective tissue, sports injuries

References:

Click here.

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