Healing Soft Tissue Flashcards
Define a sprain and strain
> Sprain
- Stretch or tear of a ligament
> Strain
- Muscle or tendon injury (Over contracting/stretching either from internal or external forces)
What is a grade 1 strain/sprain
Micro-tears
- localised pain/tenderness
- minimal swelling/bruising/loss of function
strain = no loss of strength, <10 degrees loss of RoM
sprain = no laxity
What is a grade 2 strain/sprain
Partial tear - moderate swelling/ bruising - poorly localised pain/ tenderness - impairment with painful RoM strain = decreased strength, painful contraction sprain = joint may be unstable
What is a grade 3 strain/sprain
Complete rupture - immediate acute pain - audible pop/crack/click - symptoms may then die down Strain - inability to contract, possible gap visible Sprain - expect joint to be v. unstable
What is the british athletics grading system of strains/sprains
0 - normal a) myofascial tear
- < 10% effected b) musculotendinous tear
- <50% effected c) Intratendinous tear
- > 50% effected
- Complete tear
* Requires MRI within 48 hours - unreasonable for NHS
What are the factors that cause tissue damage?
> Injury - physical/thermal/radiation/electrical/chemical
Infection - virus/bacteria/fungi/protozoa
Infarction - obstruction to blood supply
Immune response - protein hypersensitivity/ autoimmunity
Name the two types of body tissue
Parenchymal
- functioning cells of an organ e.g neuronal (brain)/ cardiac myocyte (heart)/ hepatocyte (liver)
Stomal (interstitial)
- Supporting connective tissues
- many cell types e.g fibroblasts
- blood vessels
- nerves + nerve endings
What are the three types of tissue healing
- Resolution
- Regeneration
- Repair (Replacement)
Describe the resolution phase of tissue healing
- Rapid healing of minor injury (e.g insect bite)
- Epithelial cells regenerate without incident
Describe the regeneration phase of tissue healing
- Specialise tissue = replaced by proliferation of nearby undamaged cells (like for like replacement)
> growth factors are released from damaged cells (increase mitosis)
> injured tissue is replaced by parenchymal tissue
> little evidence of injury after repair
Describe the stages of the repair phase of tissue healing
Bleeding phase (lasts ~6-8 hours) Inflammatory phase (from 2 hours - 2/3 weeks) Proliferative phase (from 24 hours - days/months) Remodelling phase (from weeks/2 years)
Describe the bleeding and inflammation stages of the repair phase of tissue healing
Bleeding
- Following injury
- Short lived - time depends on vascularisation
Inflammation
- Changes in blood flow (exudation of protein rich fluid = oedema)
- Leukocyte emigration (neutrophils + macrophages)
- Phagocytosis
- Lymphatic drainage
- Caused by bradykinin/histamine/prostaglandin which create blood flow changes + chemotaxis
Describe the Proliferative phase of tissue healing
- peaks at 5-7 days (type 3 synthesis)
- fibroblasts, macrophages, blood vessels proliferate to form Granulation tissue
- Angiogenesis - formation of new blood vessels
- Capillary network allows leakage of WBC’s and plasma proteins
- fibroblasts synthesise collagen to fill gaps (type 3 which is weaker than type 1)
- Granulation tissue matures (lymphatic development, nerve cell in growth, immune cell invasion)
Describe the Remodelling phase of tissue healing
- Continuous remodelling of scar tissue
- Collagen type 1 synthesis of fibroblasts
- Lysis by collagenase enzymes
- Physical stress aligns new collagen fibres with old ones = stronger tissue
What are the types of cells according to regeneration ability
- Labile Cells
- constant turn over e.g skin cells - Stable Cells
- Stop growing when growth stops e.g liver cells
- Can regenerate if damaged (need supportive framework) - Fixed Cells
- Cannot undergo mitosis (e.g cardiac tissue)
- tissue repair leaves scar
