CH 1: Tissue Response to Injury Flashcards
Describe what pain is
A negative sensory and emotional experience associated with potential or actual tissue damage.
Perception of pain is influenced by physical, psychological, chemical and social factors.
Pain is SUBJECTIVE
Pain Sources
Somatic - Originates in the skin and internal structures of MSK system
Visceral - Of the viscera (internal organs)
Psychogenic - No apparent cause of pain, although the sensation of pain is felt.
Pain Categories: Fast v Slow
Fast pain:
-Felt within 0.1s after stimulus
-Bright, sharp, electric descriptors
-Mainly felt superficially or within the skin
Slow Pain:
-Felt after 1s of stimulus and increases gradually over time
-Achy or throbby descriptors
-Can occur in both the skin or deeper within joint, or area
Pain Categories: Acute v Chronic
Acute:
-Caused by an event
-Serves a purpose (warning the body of damage)
-Lasts very briefly
-Localized
-Mechanically provoked
Chronic:
-May not be associated with an injury
-Persists beyond normal healing time
-Pain is persistent and multidimensional
-Not mechanically provoked
-Pain will be widespread
What is Referred Pain, and what are the 3 subtypes?
Perceived at a location that is remote from the site actually causing pain.
The nerves carry pain signals split into several branches within the spinal cord
Myofascial:
- Tender
- Accompanied by tight bands of tissue
- Referred pain could be steady, deep and aching
- Could be acute or chronic
Sclerotomic:
- Area of bone or fascia that is supplied by a single nerve root
- Deep, aching and poorly localized
- Could result in ^BP and sweating
Dermatomic:
- Sharp, well localized
- In the area of skin that is supplied via a single nerve root
- Usually skips autonomic responses
Technique’s to assess pain
Self reporting is the best way to measure (from the person that is experiencing pain)
Use both uni and multi-dimensional questionnaires
Assessment techniques include:
-Visual analog scales (0-10)
-Pain Charts (w/ descriptions)
-McGill pain questionnaire
What are the 3 phases of healing and how long do they last?
Inflammatory Response: day 0 - 6
Fibroblastic Repair: day 3 - 21
Maturation & Remodeling:
Indefinite
Characteristics/goals of the Inflammatory Response & Cardinal signs of inflammation
Goals:
- Protect
- Localize
- Decrease injurious agents
- Prep for repair and remodeling - acts as a defense mechanism
Cardinal Signs of Inflammation:
- Pain
- Heat
- Redness
- Swelling
- Loss of Function
What does Chronic Inflammation signify?
Failure to heal.
- The acute inflammatory response does not eliminate the injuring agent.
- As inflammation persists necrosis and fibrosis will prolong the healing process
- Associated with overuse/cumulative micro trauma and over time can shift it from acute to chronic
Pain Receptors
Specialized afferent nerve endings called Nociceptors.
Sensitive to mechanical, thermal and chemical energy.
Factors that impede healing
- Extent of Injury
- Edema
- Hemorrhage
- Poor vascular supply
- Separation of tissue
- Muscle spasm
- Atrophy
- Foreign bodies
- Corticosteroids
- Keloid & Hypertrophic scars
- Infection
- Humidity, climate & O2 tension
- Health, age & Nutrition
- Inappropriate care
Characteristics of Cartilage healing
- Limited capacity to heal
- Little to no direct blood supply, therefore materials needed for repair are limited or absent
- Depends heavily if subchondral bone is disrupted
- Course of healing becomes varied if chondrocytes are destroyed
What is Myositis Ossificans?
The formation of bone inside muscle or other soft tissue.
Usually develops after traumatic injury
Most often occurs in large muscles
The bony lump that develops may be:
-Fast-growing
-Painful
-Swollen
-Tender
-Warm to touch
Characteristics of Nerve healing
Nerve fibers can regenerate but varies on:
-Proximity of injury to nerve cell
- Environment
- Peripheral vs central
Usually regens at 3-4mm/day
Roles of Osteoblasts v Osteoclasts
Osteoclasts remove old bone so Osteoblasts can lay down new bone.
An ongoing process.
