Healing and Assessment

Question 1

stages of the healing process

Answer 1

1. inflammation generic response to tissue threat, acute inflammation is exaggerated response lasting up to 72h post inj is generated by biochem mediators such as histamines, prostaglandin, and bradykinin (vasodialates, increase vascular permeability, and increase pain sensitivity of nerve endings to cause acute hyperalgesia)
2. repair and proliferate from 2 days up to 3 weeks post inj, macrophages use phagocytosis to remove debris, fibroblasts lay down new foundation of weak and unorg collagen and build new BV to form granulation tissue; clinically feel better but pain, swelling, and alt func may occur but disappear by end
3. remodelling and maturation from 3 weeks to 2 yrs post inj simultaneously break foundation of collagen and replace with strong collagen (no net gain) and BV stabilize with no new growth; can progressively stress tissue to regain strength and endurance

Question 2

clinical presentation of inflammation

Answer 2

1. swelling, can remain after inflammation over esp if immobile or inj has poor circulation for ext period, diff types have diff name (edema is fluid leak from vessels, hematoma is collection of blood which can present as bruise, hemarthosis is bleeding into joint cavity, joint effusion is excessive synovial fluid)
2. heat due to vasodilation by biochem mediators but can depend on structure and location
3. altered func related to pain and lack of stability
4. redness due to vasodilation by biochem mediators but can depend on structure and location
5. pain due to increased nerve ending (nociceptor) sensitivity by biochem mediators

Question 3

injury assessment process overview

Answer 3

filter info to come to conclusion: take history, observe inj, note ROM, test resistance, perform special tests, palpation

Question 4

taking history

Answer 4

1. introduce self to patient and build trust
2. guide into injury story focusing on how injury happened to determine acute or chronic, find timeline to know how far into the healing process
3. clinical presentation of signs (visible diff and objective) and symptoms (feelings/exp and subjective) and functional impact of inj on daily life
4. previous health history to know ideal state to set goals and factors contributing to problem, current health, and physical activity demands

Question 5

measuring ROM

Answer 5

1. record all types of motion for specific joint actively and passively while recording instances of pain
2. measure degrees of movement with goniometer
3. compare to avg ROM values keeping in mind health history (limited, excessive, painful) and interpret (what is being pulled apart, what is contracting that could contribute to pain)
4. what structure (periosteum, tendon, ligament) is being pulled apart and is injured muscle contracting

Question 6

observation of inj

Answer 6

1. ask for consent
2. use qualitative and bilateral observations to allow for comparison of inj v. control
3. look for signs of swelling, deformity, and discolouration (look carefully on darker skin since it can make signs less visible)

Question 7

resistance testing

Answer 7

use manual strength test grading (isometric test in mid range ROM where struc strongest)
1. starting in antigravity position, zero with no contraction
2. one if some contraction but no motion
3. two in gravity pos, some motion unable to overcome gravity
4. three able to overcome and hold pos against gravity
5. four able to meet external opp force with some resistance
6. full contraction, able to work as well as other side

Question 8

special tests and palpation

Answer 8

1. id potential structures dmg, test each structure
2. reproduce mechanism of injury by applying same stress causing injury to test reproducibility of symptoms
3. use a battery of tests to confirm, no test perfect and know anatomy for palpation

Question 9

What is the problem with assessing an injury during the inflammation stage?

Answer 9

You get a lot of false positives, because nociceptors become significantly more active during an injuries inflammation stage. so everything hurts.

Question 10

When testing range of motion, why must we perform all tests bilaterally?

Answer 10

To get a sense of what normal function is.

Question 11

why is there more swelling with ligament than tendon injury

Answer 11

less blood supply in the ligaments, increase blood supply to ligaments to speed up healing process, tendons already have more blood supply thus don’t need to swell as much