Inflammation & Tissue Repair

Question 1

ATC’s & modalities

Answer 1

used effectively: will enhance healing

used incorrectly: can harm the individual

Question 2

therapeutics

Answer 2

• process of heeling

- must be conducive to the healing process

Question 3

modality

Answer 3

application of some sort of stress to the body

Question 4

are modalities effective?

Answer 4

conflicting evidence

- exercise if often the most important modality

Question 5

primary trauma

Answer 5

immediate cellular destruction due to injury, irreversible

EX: ACL tear

Question 6

secondary trauma

Answer 6

cell death cause by blockage of oxygen (hypoxia) supply to area
EX: swelling cuts off blood supply

Question 7

prevent secondary trauma?

Answer 7

RICE :
rest 
ice
compression 
elevation

Question 8

phases of healing

Answer 8

1. Inflammatory Response Phase: elicit local & systematic effects, cells remove debris, cells create groundwork
   0-4 days
2. Fibroblastic Repair Phase: cells restore blood vessels
   2 days - 6 weeks
3. Maturation Remodeling Phase: healed tissues adapt to functional loading
   3 weeks - 2 years

Question 9

Heling process

“inflammation can occur without healing, but healing cannot occur without inflammation”

Answer 9

• continuum
• phases over lap with no distinct beginning
• phases do not always continue forward

Question 10

1. Inflammatory Response Phase

Answer 10

• initial reaction of the body tissue to an irritant or injury 3-4 days post injury
• treatment goal: limit pain & swelling

Question 11

acute injury vascular response

Answer 11

immediate vasoconstriction, then vasodilation occurs

Question 12

cardinal signs of inflammation

Answer 12

• heat
• swelling
• redness
• pain
• loss of function

Question 13

White Blood Cells involved

Answer 13

leukocytes. margination. pavementing. adhere. chemotaxis. phagocytosis

Question 14

3 mechanisms to managing blood loss

Answer 14

1. vasoconstriction
2. plalelet plug
   - adhere to one another, mechanical plug, not permanent
3. coagulation cascade

Question 15

clotting cascade

Answer 15

permanent stop of blood loss from injured area

Question 16

fibrin patch

Answer 16

(scab) forms blood clot, cover injured tissue

Question 17

what happens to clot?

Answer 17

2nd phase: granulation tissue replaces it

3rd phase: granulation tissue will be replaced with new collagen (healing scar)

Question 18

2. Fibroblastic Repair/Proliferation Phase

Answer 18

• starts 48-72 hours after injury & may extend to 6 weeks
• two parts
  1. granulation
  2. fibroblastic/proliferative phase

Question 19

granulation phase

Answer 19

• re-epithelialization: growth of new tissue
• angiogenesis: new blood vessels form
• fibroplasia: development of fibrous tissue

Question 20

scar formation

Answer 20

as the fibrin begins to break down, connective tissue (granulation tissue) forms

• collagen matrix begins to from
• scar is pink, weak, ad immature

Question 21

3. Maturation Remodeling Phase

Answer 21

• 3 weeks after injury can last up to 2 years
• would tissue converts to scar tissue
• Davis law: soft tissue will remodel along the lines of the stress placed on it
• type 3 collagen replaced with type 1 **

Question 22

chronic inflammation

Answer 22

• subacute: inflammatory process that lasts up to one month/past
• chronic: inflammation lasting longer than a month and in some cases years

Question 23

healing of various tissues

Answer 23

• in a healthy individual, healing process will vary given the type of tissue that is injured
• higher metabolic rate (skin, muscle) should occur in 5-8 days
• lower metabolic rate: 3-5 weeks

Question 24

repair v regeneration

Answer 24

repair: tissue heals with a scar
- ligament, tendon, bone, muscle

regeneration: actual tissue is replaced
- bone

Question 25

nerve tissue

Answer 25

PNS: can't regenerate after they die, can regenerate from partial tear - closer a nerve injury is to the cell body, the less likely it will heal

Question 26

fracture healing | phase 1

Answer 26

acute phase - up to 1 week - hematoma forms - angiogenesis - begins to develop soft callus

Question 27

fracture healing | phase 2

Answer 27

repair/ regeneration - up to 8-12 weeks - soft callus to hard callus: cartilage to bone occurs starting week 3

Question 28

fracture healing | phase 3

Answer 28

remodeling phase - resorption of callus: as callus is removed trabecular bone lays down, can take several years - osteoblast and osteoclasts remodel bone

Question 29

factors that impede healing

Answer 29

extent of injury, edema, poor vascular supply, separation of tissue, muscle spasm, age, diabetes, smokers, infection