Chapter 10: Exam 1 Flashcards
Why is it important for an ATC to know healing process?
Because the ATC helps rehab the injury from diagnosis to healing (short and long term)
What must the ATC know about the healing process?
- understand the phases
- know the time frames physiological changes associated with each phase
Signs of inflammation (5)
- redness
- swelling
- tenderness
- increased temperature
- loss of function
3 phases of the inflammatory response
- inflammatory response phase
- Fibroblastic repair phase
- maturation and remodeling phase
Phase 1: Inflammatory Response
Healing process begins immediately after the injury occurs
Goal of phase 1 (4)
- protect
- localize
- decrease injurious agents
- prepare for healing and repair
Phase 1 vascular response
- vasoconstriction
- vasodilation
Vasoconstriction
- first 5-10 minutes post injury
- seal the blood vessels
- damage control
- everything constricts
Vasodilation
- 5-10 post injury
- initial effusion of blood and plasma (lasts 24-36 hours)
- goal is to bring reinforcements
Histamine
Vasodilation
Cytokines
Attract phagocytes
Leukotrienes
Allow helper cells to adhere (margination)
Exudate
Protein layer at site of injury, doesn’t permeate so too much for too long is a problem
Vasoconstriction
Everything constricts for damage control
Clot formation
Contains damage
***do not disrupt the clot (heat and massage)
How long is damage control?
First 2-3 days
Phase 2: Fibroplastic repair
Rebuilding
Scar formation (phase 2)
Disorganized scar tissue
Phase 3: Maturation and remodeling
Reorganization of scar tissue
Wolff’s law
Collagen realigns along the stress lines so rehab in the range of motion you want back
Articular cartilage
Shiny white at the end of bones (protection)
Miniscis
Cushion between 2 bones
Cartilage characteristics
Little to no blood supply so it won’t heal itself
Meniscectomy
Tear on medial surface will continue to tear so surgically shave around the tear—> shorter recovery time
Meniscus repair
Red zone edge tear can heal itself with sutures (8 weeks no weight bearing)
Microfracture
Drill holes into the bone to generate tissue repair process
Isometric muscle contractions
Causing muscle contractions but not moving through range of motion
Nerve healing
Very slow and nerves cannot regenerate but axons can
Callus formation
Soft callus—> bony callus (able to see old fracture later in life)
Avasular Necrosis
If bones aren’t aligned correctly, the bone will lose blood supply and begin to die
Pain
Influenced by different factors (psychological)
Clot formation
- platelets adhere to collagen
- blood coagulation—> clot formation
- clots wall off damage
How long does the inflammatory phase last?
2-4 days after the injury
Chronic inflammation
- insufficient inflammatory response results in tissue not being restored to normal physiologic state
- granulation and fibrotic tissue develops (thick scar)
- typically associated with overuse, overload, cumulative micro trauma
Phase II
Fibroplastic repair
Phase II: Fibroplastic repair
- begins within first few days
- lasts 4-6 weeks
- formation of delicate connective tissue (granulation tissue)
Which phase is a temporary scaffold?
Phase II
Fibroplasia
Scar formation
Scar formation
- Gradual replacement of weak fibrin plug with stronger collagen
- formation of disorganized scar tissue
Phase III
maturation and remodeling
Phase III: maturation and remodeling
- realignment of collagen along stress lines
- continued breakdown and synthesis of collagen–> increased strength
- Tissue will gradually assume normal appearance
Length of time of Phase III
- long term process
- may require several years to complete
- lasts approximately 3 weeks for a strong scar
Factors that impede healing
- extent of injury
- Edema
- hemorrhage
- poor vascular supply
- muscle spasm
- atrophy
- keloids and hypertrophic scars
- infection
- humidity, climate, oxygen tension
- health, age, nutrition
Wolff’s Law (power point)
Bone and soft tissue will respond to the physical demands placed upon them
Negative manifestation of Wolff’s Law
Osgood Schlatters and myositis ossification
healing of articular cartilage
If it fails to clot or has no cell response heals very slowly
Cartilage that involves subcontractors bone
(Enhanced blood supply) healing will proceed normally
Cartilage healing
Usually requires surgical intervention
Ligament repair phase
As scar forms collagen will mature and realign in reaction to joint stress and strain
Ligament healing failure
Failure to produce enough scar and failure to reconnect end of ligaments to proper location on bones
Healing length of ligaments
Full 12 months
Non surgically repaired ligaments
Prone to joint instability
Reason intra-articular ligaments fail to heal spontaneously
They can’t form a good clot within the synovial joint fluid (ACL)
Ligament rehabilitation
- balance between exercising and immobilization
- surrounding muscles must be strengthened to reinforce joint
- preventative
Length of healing of skeletal muscles
6-8 weeks depending on injured muscle
Skeltal muscles following inflammation phase
Myoblastic cells form—>regeneration of new muscle fibers
Skeletal muscle re-injury risk
Prone to reinjury and chronic strain cycle (hamstring)
Tendon healing
-abundance of collagen is required for good tensile strength, but too much can result in adhesion and thickening which will interfere with gliding tendon motion
Tendon healing time
Tissue not strong enough until week 4-5 to withstand force of muscle contraction
Nerve healing scar formation
-scar formation can block approximation
CNS and peripheral nerves
Don’t regenerate
Bone healing acute fractures 5 stages
- hematoma formation
- cellular proliferation
- callus formation
- ossification
- remodeling
Bone healing
-hard callus becomes more well-formed as osteoblasts lay down cancellous bone replacing cartilage
Complete ossification time
Years
Bone immobilization time
3-8 weeks depending on size and location of bone
Less than ideal immobilization
Produces cartilaginous Union instead of bony callus
Acute fracture management
-must be appropriately immobilized until x-Ray reveals the presence of a hard callus
What areas must not interfere with bone healing
- poor blood supply
- poor immobilization
- infection
stress fracture cause
-constant stress can impact bone resorption, leading to micro fracture
Stress fracture healing
- early recognition to prevent complete fracture
- decreased activity and elimination of factors causing excess stress
Osteoclastic activity>osteoblastic activity
Bone becomes more prone to fractures
Pain
- inhibit healing by limiting motivation and willingness
- goal of clinician is to manage patients perception of pain
