biology of injury and healing Flashcards
Tissue healing and repair lecture review
Tissue type: labile (bone), stable (muscle, tendons, ligament and cartilage), non division/permanent
Healing:
1 inflammation
2. granulation tissue formation (cell proliferation and angiogenesis, fibroblast migration)
3. remodeling
Acute vs chronic musculoskeletal pathology
Acute: hours-weeks (varies by body system), inflammation based pathology
Chronic: months or longer, degenerative pathology (failed, incomplete, interrupted completion of healing
bone fractures
Traumatic: high force exceeds normal bone strength
Pathologic: normal force exceeds damaged bone strength
Stress: repetitive submaximal forces gradually damages bone
bony healing
Bleeding (seconds to minutes) Clot formation (minutes to hours) Inflammatory stage (hours to days) Repair stage (wks to months): osteoclasts and blasts invade blood clot, soft callus, then hard callus, that callus matures, bony gaps bridged Remodeling stage (1-2 years)
bone injury
acute-known injury
Stress-overuse injury
Pathologic-normal forces to abnormal bone
Point tenderness on exam
Pain with indirect loading
chondral damage
loose body (joint mice)
Joint mice– locking
Arthritic joint damage: pain with both passive and active motion, poor healing
Ligaments, joint stability
Dislocation–complete displacement
Subluxation: transient, partial displacement
Laxity: normal variant in joint looseness
ligament healing
needs good blood supply
Needs damage section to be approximated or guided to correct area
Needs to relative rest
Cast: greater protection, nonremovable,
Acute vs chronic ligament damage
Acute: classic injury, exact time of injury, gets worse with use, inflammation, treatment: RICE (rest ice, compress, elevate)
Chronic: overuse injury, vague time of onset of pain, pain gets better after warming up for awhile, degeneration
Dislocation mechanisms
Acute: from sudden impact of large force exceeding strength of the joint restraints
Pathologic: from normal forces to weakened or anatomic variant joint capsular restraints
Joint is stabilized by muscles, capsule, bony architecture, ligaments, intracapsular negative pressure
Most common shoulder dislocation: anterior shoulder then inferior, usually due to forced extension abduction and external rotation, direct blow to posterior shoulder
Exam of anterior shoulder dislocation
arm held by opposite hand in slightly abducted away from body, alteration of contour including prominant acromion, humeral head anterior to acromion and adjacent to coracoid
Check sensation of axillary and musculocutateous nerves, positive apprehension test: feeling of instability with stress
Load and shift test: loading joint (compression loading tests joint surfaces and structures between surfaces, distraction loading tests strucutes surrounding the joint), shift stress to test various structures
Biceps brachii muscle pop
usually long head biceps brachii and treat with nothing or surgeyr
Treatment of musculotendinous ruptures: impact of absence of muscle, presence of alternative muscles, functional requirements of patients
Capsulitis
Capsular thickening (inflammation, scarring)
Idiopathic or post injury: risk factors (injury, diabetes, thyroid disease)
History: limited range of motion: pain early with decreasing ROM (freeze phase), Non painful with stable/decreased ROM (frozen phase), Non painful with improving ROM (thawing phase)
Exam: decreased ROM, gradual tightening endpoint, exam otherwise
Capsilitis treatment
Reassurance, educate and set expectations, maintenance of ROM, pain control
5th metatarsal fracture
Types
Avulsion-5th metatarsal base at peroneus brevis insertion
Jones-ttraumatic fracture metaphyseal-diaphysis junction (pseudo jones - stress fracture proximal diaphyseal)
Dancer’s-spiral fracture mid to distal diaphysis
