Inflammation & Spasms Flashcards
Define orthopaedics:
correction of deformities/function impairments of the skeletal system - including associated structures such as muscle, tendon and ligaments.
define inflammation:
an immediate, local response to injury and tissue damage
What are the three main stages of inflammation?
- acute
- early/late subacute
- chronic
define edema:
local or general accumulation of the fluid in interstitial space (swelling caused by fluid leaking into the interstitium due to increased bv permeability)
What chemical mediator helps increase permeability in response to inflammation?
histamine - produced by basophils and mast cells in nearby CT
What is advantageous about increased bv permeability in response to inflammation?
allows for the flow of WBC and some proteins into wound area allowing immune response to address infection
What is the purpose of the healing process?
restore integrity of tissues! (redevelopment of structure via scar tissue creation)
What are 3 components of the repair process?
- re-epithelialization (superficial healing - no scar tissue)
- exudate
- synthesis of new tissue
Define exudate:
mass of cells and fluid that has seeped out of bv’s or an organ (category of edema characterized by protein content)
What could happen if exudate is excessive?
some fibrosis in tissues will occur
Define primary/first intention wound healing:
occurs when there is SOME tissue loss and wound edges are approximated
Define secondary/second intention wound healing:
occurs with excessive tissue loss, edges cannot be easily brought together, healing will be longer through extensive re-epithelialization
What is granulation tissue?
new CT and microscopic bv’s that form on the surface of a wound during healing - main component of fibroblasts.
What are 2 jobs of platelets during the repair process?
- coagulation to reduce blood loss
2. isolate and prevent/reduce bacterial infiltration
What is the role of leukocytes during the repair process?
WBC’s involved in protecting the body against infectious disease and foreign invaders.
What cell functions to stimulate proliferation of fibroblasts and regulate collagen synthesis?
leukocytes
What happens during neoangiogenesis?
New bv’s develop from venules at edge of injury and provide nutrients during cellular activity and then retract during late sub-acute phase
What is the main structural and most abundant protein in the body?
collagen
define endomysium:
areolar CT that covers each individual muscle fiber/cell that helps provide chemical exchange of calcium, sodium and potassium.
define areolar tissues composition:
loose CT that consists of a meshwork of collagen, elastic tissue, and reticular fibers - with many CT cells in between the meshwork of fibers
What are 3 effects of fibroblasts in the repair process?
- synthesizes new collagen fibers
- forms loose CT matrix in the area of tissue loss to replace the clot after the acute phase
- can result in excess scar tissue development
What is the purpose of wound contraction?
To speed the healing process by reducing the need for more scar tissue by reducing wound space (myofibroblasts contain contractile fibers)
When does the wound contraction process peak?
2 weeks after injury but continue into late subacute phase
What happens during the scar remodeling process of healing?
strength of site increases with existing collagen broken down and new collagen made = cross links - adhesions may begin to form and ROM will reduce (chronic phase)
What is the time frame an injury is considered in the acute phase of inflammation?
3-4 days post (4-6days)
What is the time frame an injury is considered in the sub-acute phase of inflammation?
early: 2 days- 3 weeks
Late: 2-3 weeks (possibly longer)
What is the time frame an injury is considered in the chronic phase of inflammation?
Overlaps with sub-acute; 3 weeks- 2 + years
What are the cardinal signs of inflammation associated with the acute phase of healing?
Heat, Edema, LOF, Pain, Redness (4-6 days)
Does chronic inflammation present with the cardinal signs of inflammation?
NO, but flare-ups may instigate reoccurrence of them
Describe the presentation of a 1st degree injury:
mild pain at time of injury- first 24 hours post - may have mild swelling, local tenderness, or pain with tissue stress
describe the presentation of a 2nd degree injury:
moderate pain = stoppage of activity - stress and palpation to area = increased pain and joint mobility may increase with lig. injury
describe the presentation of a 3rd degree injury:
near complete/complete avulsion of tissues with severe pain, therefore stress to tissues maybe painless and joint instability more present.
What are 3 main goals for management of acute inflammation?
- manage effects of inflammation
- facilitate wound healing
- maintain normal function in un-affected tissues and regions
what are 4 ways that you can educate your client during the acute inflammation phase?
- expectations of symptoms (4-6 days)
- what they can/can’t do
- Precautions/CI’s
- what to expect as they move into subacute phase
What is muscle setting techniques in the acute phase of inflammation?
gentle isometrics to help fluid dynamics (if muscle injury, perform in shortened position; if joint injury, use pain free/resting position)
What position should you keep mm and tendons in when working on them in the acute inflammation phase, respectively?
mm lesions are kept in a shortened position to avoid breaching healing tissues
tendon kept taut
What may ROM testing show during the sub-acute phase of inflammation?
may show pain with tissue resistance
Why is function limited during the sub-acute phase of inflammation?
function is limited as a result of weakened tissues
How long may the sub-acute phase of inflammation last in tissue with adequate circulation and tissue with limited circulation, respectively?
last 10-17 days (14-21 days after onset of injury); may last >6 weeks in tissues with limited circulation (ex tendons)
What are 3 criteria for exercise during the sub-acute phase of inflammation?
- decreased swelling
- pain no longer constant
- pain not exacerbated by motion in available range
What are 4 signs that a client is exceeding tissue tolerance with exercise?
- exercise/activity soreness doesn’t decrease in less than 4 hours
- exercise soreness onset is earlier than before
- progressive stiffness or weakness over several sessions
- decreased functional usage of involved part
What type of cell is there a predominance of by day 21-60, post injury?
fibroblasts
Maturation and remodeling during the chronic phase of inflammation are occurring as the collagen fibers do what?
thicken and re-orientate in response to stress placed on the tissues
At what week, post injury, is scar tissue considered unresponsive to remodelling?
14 weeks
What are muscle fibers/ cells made up of?
thousands of fine strands called myofibrils
Action potentials reaching the NMJ stimulate the release of what substance in the muscle?
calcium = initiation of muscle contraction (spasmodic muscle= contraction continues)
What do muscle spindles measure?
degree and speed of muscle movements - will reflexively stimulate a contraction to avoid over stretching
What do gamma fibers react to?
react strongly to any degree of stretch
What are gamma fibers responsible for?
deep tendon reflexes, spasticity and rigidity (not the degree of contractile response)
What do GTO inhibit?
contraction of muscle to protect from OVER-STRETCH
What symptoms can hypertonicity result in? Secondary to what occurring in the muscle?
can result in pain and tenderness
secondary to ischemia and/or formation of active TrPs and mm. spasm
define hypertonus:
abnormally increased/excessive muscle tone often with increased resistance to stretch, but possibly with a normal resting length
define spasm:
involuntary, sustained contraction of a muscle
define cramp:
common term for a painful, prolonged muscle spasm (caused by decreased circulation, overuse, injury or dehydration/ electrolyte imbalance)
define extrinsic spasm (aka reflex muscle guarding):
protective mechanism to immobilize a part of the body that has sustained an injury
define spacticity:
state of sustained, involuntary hypertonicity, secondary to CNS pathology, resistant to stretch
define muscle tone:
resistance of a relaxed muscle to passive stretch or elongation
define muscle tension:
a muscle held in a sustained contraction
what is a neurologist definition of hypertonicity?
abnormally high tone usually seen with upper motor neuron disorders (forms of hypertonia: spasticity, rigidity, and spasm)
What is a PT’s definition of hypertonicity?
an increase in tone that is present with painful, dysfunctional muscles (no neural component mentioned - spasticity and rigidity are now used for describing neuronal disorders)
What leads to an INTRINSIC muscle spasm?
part of the self-perpetuating pain-muscle cycle - pain resulting from trauma = initiation of reflex muscle action = restricted movement = tissue ischemia = irritated nerves = pain = body staying is spasm (intrinsic spasm remains even when tissue injury heals)
What are 7 causes of muscle spasm?
- pain / intermittent claudication
- circulatory stasis
- increased gamma neuron firing (d/t stress, anxiety, fatigue)
- chilling of mm. (reflex muscle contraction)
- impaired nutritional supply/lack of vitamin D (decreased calcium or loss of sodium)
- DVT
- Lx DDD
What are 3 goals of treatment for acute and subacute spasm?
- break the pain cycle
- reduce spasm
- increase ROM
How could you break the pain cycle when treating acute vs. subacute spasm?
acute: DB and hydro application (depending on whether intrinsic or extrinsic)
subacute: relaxation massage
What are 3 different techniques you can use to reduce muscle spasm when treating acute or subacute?
GTO release/ O&I / muscle approximation
Vibrations
Petrissage
What are 4 precautions/CI’s when treating spasms?
- if mm. guarding is splinting an acute injury, do not eliminate a reflex mm. guard
- avoid passively stretching an acutely spasmodic mm.
- No HOT hydro with ACUTE mm. spasm IF inflammation is present
- no local massage with a DVT
What is a hydro homecare you can give for an extrinsic spasm?
ice for analgesic effects - no more than 20 min at a time
What is a hydro homecare you can give for an intrinsic spasm?
deep moist heat or contrast (after reduction of spasm use pain free AROM and finish with a slow, complete stretch)
