Inflammation and soft tissue repair

Question 1

What are the 5 cardinal signs of inflammation?

Answer 1

Pain
Heat
Redness 
Swelling
Loss of function

Question 2

Is inflammation good or bad?

Answer 2

Good providing it is controlled.

Question 3

What is inflammation?

Answer 3

• A response to cell injury
• Try’s to eliminate the cause of the injury and clean up the dead and dying cells and tissues.
• Protection (protects the area)
• healing

Question 4

What is the purpose of inflammation?

Answer 4

1. Neutralise and destroy the invading and harmful agent/pathogen.
2. Limit the spread of harmful agents to other tissues
3. Prepare any damaged tissue for repair.

Question 5

Why does pain occur with inflammation?

Answer 5

Chemical irritation/pressure on the tissues and sensory nerve endings.

Question 6

Why does redness occur?

Answer 6

Increase of blood flow to the area (underlying hyperaemia)

Question 7

Why does pain occur with inflammation?

Answer 7

Chemical irritation/pressure on the tissues and sensory nerve endings.

Question 8

Why does redness occur with inflammation?

Answer 8

Increase of blood flow to the area (underlying hyperaemia)

Question 9

Why does Heat occur with inflammation?

Answer 9

Hyperaemia - becomes warmer as more blood rushing to the area

Question 10

Why does Heat occur with inflammation?

Answer 10

Increase of permeability to blood vessels, therefore, increase of fluid into the tissues. (Contains fibrinogen and proteins)

Question 11

Why does loss of function occur with inflammation?

Answer 11

Pain and swelling can limit movement

Question 12

Why does loss of function occur with inflammation?

Answer 12

Pain and swelling can limit movement (protection)

Question 13

What are the differences between infection and inflammation?

Answer 13

Infection will commonly have an inflammatory response.

You can have inflammation but no infection.

Question 14

What is the difference between acute and chronic

Answer 14

Acute = Short in duration (1-2 weeks)

Chronic = more than 12 weeks

Question 15

What sort of response is inflammation?

Answer 15

Vascular response = Leaky vessels (aim of getting tissue odema)

Cellular response

Question 16

How long does the bleeding stage of soft tissue repair last for?

Answer 16

4-6 hrs

Question 17

What are the 4 phases of soft tissue repair?

Answer 17

• Bleeding
• Inflammation
• Proliferation
• Remodelling

Question 18

What happens during the bleeding stage of soft tissue repair.

Answer 18

• Bleeding 4-6 hr
• Vascular injury
• Soft tissues are disrupted and blood vessels are *severed, releasing blood plasma and peripheral blood cells into the wound site.

Question 19

What happens during the inflammation stage of soft tissue repair?

Answer 19

Rapid onset (few hours)
Maximal reaction 2-3 days
Resolves in a couple of weeks

Mast cells detect injury to nearby cells and release histamine, initiating an inflammatory response. (triggers dilation of blood vessels enabling more blood to reach the area transporting white blood cells to assist the healing process.

Bradykinin (help transport histamines and also initiates pain response to nerve endings). and prostaglandins are also released from the damaged cells.

Question 20

Describe the vascular response of inflammation

Answer 20

• Vasodilation & vasopermeability
• Dormant capillaries open
• Increased flow through capillaries = leaky vessels
• The above leads to increased Exudate (tissue oedma/swelling)
• Exudate - Fluid coming into the sight of bleeding which causes swelling.
• Helps dilute irritants (if infection there can help dilute).
• Helps with the clotting of a fibrin clot.
• Starts the initial reunion of intact torn tissue

Question 21

Describe the cellular response of inflammation? (pacman)

Answer 21

*Phagocytes go to the injured area - debride wound (eat up dead and dying cells, fibrin mesh, clot etc.)

Question 22

Describe the proliferation stage of soft tissue repair

Answer 22

Starts 24-48 hours after injury
Can last for 2-3 weeks

Fibroplasia - Fibroblasts lay down new collagen to begin the formation of connective tissue (scar tissue).

New collagen - grade 3 collagen will need to refine and remodel to become type 1 scar tissue.

Oxygen and nutrients are needed to build collagen

Angeogenesis - forms new blood vessels = basic scar formation

Question 23

Describe the remodelling stage

Answer 23

1-2 weeks to 1 year

Refining collagen

Initially type 3 collagen (messy spaghetti) - weak, random orientation, all over the place and stuck together.

Remodels down to type 1 collagen (dried uncooked spaghetti) organised / orientated in a line with stress

Question 24

What factors can affect healing ?

Answer 24

GENERAL
Age
proteing deficiency 
Low vit C levels 
Steroids and NSAID's (inhibits effect)
Temperature (lower rate when cooler) 

LOCAL
Poor blood supply / ischemia 
Adhesion to bone or underlying tissue 
Prolomged inflammation 
Drying of wound 
Excessive movement or mechanical stress (restarts inflammation)

Question 25

Management of soft tissue healing

Answer 25

PEACE & LOVE

P = Protection (avoid activities and movement that may increase pain)

E = Elevation (lifting limb above the level of the heart if possible)

A = Avoid anti-inflmmatories (avoid for 1st 3 days)

C = Compression (control the swelling - compression bandage - shouldn’t need after 2 weeks)

E = Education (what they should and shouldn’t be doing)

L = Load (Gradually increase load - to get back to usual activity)

O= Optimism (Can have an effect of healing)

V = Vasculatisation (Maintain fitness - helos with blood flow around the body for healing)

E = Exercise