Inflammation/ Pain Quiz Flashcards
To be therapeutic something must be..
conducive to the healing process
Modality
Application of some form of stress to the body for the purpose to eliciting an adaptive response
Primary Trauma
Immediate cellular destruction due to the trauma. Irreversible.
Secondary Trauma
Cell death caused by blockage of oxygen supply to the injured area
Phases of Healing: Phase 1: Inflammatory Response
Chemical messengers elicit local and systemic effects, cells remove debris and cells create groundwork for repair/ regeneration.
0-4 days
Phases of Healing: Phase 2: Fibroblastic Repair Phase
Cells restore vascular and structural integrity of injured structures
2 days-6 weeks
Phases of Healing: Phase 3: Maturation Remodeling Phase
Healed tissue adapt to functional loading
3 weeks to 2 years
The Healing Process
One big continuum; the phases overlap with no distinct beginning or end points
Immediate Response to Injury
Vasoconstriction. Norepinephrin limits blood loss
Vasodilation
Occurs due to release of chemical mediators (histamine and leukotaxin)
Cardinal Signs
heat, redness, swelling, pain, loss of function
Leukocytes
Neutrophils, eosinophil, basophils and lymphocytes
Jobs of Leukocytes
move to the endothelial lining, line to endothelium in a tight formation, leukocytes adhere around cell walls, draw to injured sites, begin process of phagocytosis
Platelets
Adhere to one another; a mechanical plug
Clotting Cascade
Permanent stop of blood from injured area
Fibrin Patch
Forms the blood clot of scab; covered injured tissue
Fibroblastic Repair
Starts around 48-72 hours post injury and can last for 6 weeks
Fibroblastic Repair: Granulation Phase
growth of new tissue, development of new blood vessels, and development of fibrous tissues
Fibroblastic Repair: Fibroblastic Phase
As the fibrin clot begins to break down, a connective tissue matrix forms. Acceleration of laying down collagen. The wound contracts and begins to form the collagen matrix. The scar that is formed during this phase is pink, weak and immature
Maturation Remodeling Phase
Begins 3 weeks after injury and can last for up to 2 years. Scarred, smoother skin. Type III collagen is replaced with stronger Type I collagen
Chronic Inflammation
Inflammatory process lasting longer than a month
What can cause chronic inflammation?
Autoimmune causes and extended acute inflammation from repetitive trauma
In tissue with a higher metabolic activity wound closure would occur in..
5-8 days
Repair
Tissue heals with a scar
Regeneration
Actual tissue is replaced
Hyaline Cartilage healing
Little capacity to heal
Peripheral Nerves
Cannot regenerate after they have died. Cannot regenerate from partial tearing.
The closer a nerve injury is to the cell body….
the less likely it will heal
Fracture Healing: 1. Acute Phase
Up to one week
Hematoma –> platelets
begin to develop a soft callus
Fracture Healing: 2. Repair/ Regeneration
Up to 8-12 weeks
soft callus to hard callus; cartilage to bone occurs starting week 3
Fracture Healing: 3. Remodeling Phase
Reabsorption of callus; trabecular bone takes over
Osteoblasts and osteoclasts remodel the bone based on mechanical loading
Factors that impede healing
extent of injury, edema, poor vascular supply, smoking, age, diabetes
What is pain?
An unpleasant physical and emotional experience which signifies tissue damage or when tissue damage is imminent
Pain
Signals when tissue damage is about to occur or has already occured
Somatic Pain
Originates in the skin and other internal structures
A trauma that has recently occured
Referred Pain
Pain from internal organs
Do not feel pain at the sight of injury, but in other parts of the body
Psychogenic Pain
No apparent physical cause but sensation of pain is felt
How many spinal nerves are there?
31
Grey Matter
Unmyelinated tissue; cell bodies
White Matter
Myelinated axons
Myelin Sheath
insulation around some nerves
produced by Shwann cells
fatty material
speeds transmission of APs
Neurotransmitters
Chemical substances that allow nerve impulses to move from one neuron to another
Substance P
found in synapses; transmission of pain producing impulses
brain and spinal cord
Acetycholine
responsible for transmitting motor nerve impulses
PNS and CNS
Norepinephrin
causes vasoconstriction under the flight or fight response
Enkephalin
Reduce pain perception by bonding to pain receptor sites
Endorphins
Morphine like neurohormone; thought to increase pain threshold by bonding to pain receptor sites
Serotonin
Substance that causes local vasodilation and increase permeability of capillaries
Dorsal Nerve Root
Generally transmits sensory/ afferent information
Ventral Nerve Root
Carry motor/ efferent information
Afferent Nerves
Transmits impulses from the periphery to the brain
Afferent Nerves: First Order Neuron
Connects to peripheral sensory receptor (sight of injury) and project information to DRG in spinal cord. Synapses with cell body of second order neuron in DRG
Afferent Nerves: Second Order Neuron
Cell body located in DRG; crosses the middling and ascends to the thalamus
Afferent Nerves: Third Order Neuron
Cell body in the thalamus and projects to the cortex
Efferent Nerves
Transmit impulses from the brain to periphery
a alpha
large diameter
thick myelin
fastest!
a beta
large diameter
thick myelin
fast
a delta
small diameter
thin myelin
slow
C fibers
small diameter
no myelin
slowest!
a alpha is associated with
Reflexes; GTO and muscle spindles
Nociceptors
A delta and C fibers
Mechanoreceptors
Meissner’s and Pacinian Corpuscles, Ruffini’s Endings
Mechanoreceptors function
pressure, skin, stretch, and touch
Thermoreceptors
Cold and hot receptors
Thermoreceptors function
temperature and temperature change
Nociceptors
free nerve endingss
Nociceptors function
Pain
Deep sensory receptors
PROPRIOCEPTORS
Thalamus
Area of the brain where pain is identified and sorted out.
Pain perception is influenced by these factors
physical, chemical, social and psychological
