Inflammation and tissue repair Flashcards
minor damage (often with overuse)
microtrauma
significant destructions (often with acute trauma)
macrotrauma
4 causes of tissue damage:
- direct trauma
- surgery
- pathology and disease processes
- problematic healing and/or presence of infection
A non-specific immune response that occurs in reaction to any type of bodily injury regardless of cause; stereotyped response that is identical and predictable regardless of causative factor
inflammation
inflammation of rapid onset and rapid resolution. The majority of the response is usually over within 12-24 hours
Acute inflammation
inflammation that is less intense but sustained over a prolonged period of time. It may be characterized by chronically elevated WBC count, low grade fever and pain
chronic
inflammation that can last for months to years, is pathological, delays healing
chronic
a local or generalized condition in which the body tissues contain an excessive amount of fluid (interstitial tissue)
edema
the presence of a microorganism that produces tissue damage.
infection
Signs and symptoms of this are similar to that of inflammation, so be aware of any acute changes in symptoms such as:
- low grade fever
- pus/drainage with foul odor
- flu-like symptoms
infection
The 4 cardinal signs of inflammation:
- heat
- erythema (redness or rubor)
- swelling
- pain
____ may be seen with extensive inflammation or in the presence of infection
fever
timeframes are ______ and will not be the same for all patients and/or injuries
general
3 stages of tissue repair:
- inflammatory response phase (0-4 days, peaking 24-72 hours post injury)
- proliferation phase (fibro-blastic repair, day 2 to 6 weeks)
- maturation (remodeling) phase (3 weeks to 2 years)
_____: one year post injury- 50-70% of normal tensile strength
ligament
_____ can take 6 months to heal
muscle
_____ can take year to years to heal
bone
Stage S&S:
- cardinal signs of inflammation are present
- pain to touch with muscle guarding
- pain with motion
- decreased strength
Stage 1: inflammation phase
Stage 1 inflammation phase 4 actions:
- vasoconstriction
- vasodilation
- clot formation
- phagocytosis
3 treatment principles of inflammation phase:
- Control the formation of excess inflammation
- Control pain
- (P)RICE
PRICE
P - protection R - rest I - ice C - compression E - elevation
Stage S&S:
- swelling persists
- cardinal signs are resolving (post 72 hr window)
- pain to touch and pain with motion
Stage 2: proliferation phase
Stage 2:
- growth of endothelial capillary buds into the wound is stimulated by lack of oxygen
- the wound becomes capable of healing aerobically
- increased oxygen delivery
- increased blood flow
revascularization
Stage 2:
- formation of granulation tissue
- granular mass of connective tissue that fills in the gaps during the healing process
- capillaries grow
- fibroblasts arrange parallel to them
- fibroblastic cells synthesize an extracellular matrix
- fibroblasts produce collegen fibers
formation of scar
Treatment goals of the proliferation phase:
- Facilitate healing by increasing:
- enzyme activity
- circulation
- oxygenation - Prevent re-injury
Stage S&S:
- mild swelling, but should be resolving
- all symptoms should continue to be resolving
- ROM and strength will gradually become comparable to unaffected side
- patient should be returning to functional activities
Stage 3 maturation phase
As long as the scar appears redder than surrounding tissue, ____ ____ is still occurring
scar remodeling
Usually by the end of week #, the scar is firm, strong, and nonvascular
3
during maturation phase ____ is in continual synthesis and break down
collagen
scar tissue orientation based on stresses placed on it
Stage 3 Maturation phase:
Collagen fiber orientation
Treatment goals of the maturation phase
- increase: ROM, strength, scar mobility
2. Return patient to prior level of function
4 Outcomes of tissue healing:
- normal, full healing of like tissue
- scar tissue formation
- impaired healing/abscess formation
- chronic inflammation/non-healing
Pharmacological management for inflammation involves (3):
- NSAIDS (Ibuprofen, Naproxen, celebrex)
- Steroid medications (cortisone, prednisone, dexamethasone)
- Aspirin
4 physical agents/interventions for treatment of inflammation:
- PRICE (initially)
- E-stim, Ionto, non-thermal US, cryotherapy (initially)
- Manual techniques
- Therapeutic exercise/activities
