Inflammatory Process & Scars

Question 1

5 Cardinal Signs of Inflammation

Answer 1

• Redness
• Swelling
• Heat
• Pain
• Loss of Function

Question 2

Inflammation is the body reacting to initial injury by

Answer 2

an immediate attempt to minimize damage and restore homeostasis

Question 3

Ultimate goal of treating an injury it to

Answer 3

promote a strong, mobile scar, and as much as possible, full, pain-free mvmt of affected structure, and full strength and return to function

Question 4

2 Types of Healing

Answer 4

• Primary (1st intention)
• Secondary (2nd intention)

Question 5

Primary Healing

Answer 5

• wound end are approximated (tape, sutures, staples)
• some tissue loss & only small amounts of collagen are produced

Question 6

Secondary Healing

Answer 6

• extensive tissue loss or a large surface area is affected
• wound edges cannot be approximated easily
• extensive re-epithelialization & wound contraction
• large amounts of granulation tissue produced (scar tissue formation)

Question 7

Re-epithelializaiton

Answer 7

the resurfacing of a wound with new epithelium

Question 8

Wound healing

Answer 8

complex multi-step process involving overlapping stages of blood clot formation, inflammation, re-epithelialization, granulation tissue formation, and remodelling

Question 9

RICE

Answer 9

Rest
Ice
Compression
Elevation

Question 10

PRICE

Answer 10

Protect
Rest
Ice
Compression
Elevation

Question 11

POLICE

Answer 11

Protect
Optimal Loading
Ice
Compression
Elevation

Question 12

PEACE

Answer 12

Protect
Elevate
Avoid Anti-inflammatories
Compression
Educate

Question 13

Factors that Affect the Healing Process

Answer 13

• severity of injury
• age
• infection
• presence of foreign material
• nutritional support
• existing conditionings
• adequate blood supply
• wound separation
• effects of some drugs
• smoking

Question 14

4 Stages of Wound Healing

Answer 14

Acute
Sub-acute
Chronic
Chronic inflammation (possible)

Question 15

Acute Inflammation

Answer 15

• vascular, cellular & tissue repair
• 4-6 days from point of injury
• redness, heat, swelling, pain, loss of function, mm spasm, bruising is black/blue/purple
• decrease inflammation
• decrease pain/swelling
• increase relaxation
• prevent re-injury
• Tx compensations

Question 16

LOVE

Answer 16

Load
Optimism
Vascularization
Exercise

Question 17

Subacute Proliferation, Repair & Healing

Answer 17

• lasts 10-17 days (14-21 days after POI) up to 6 weeks
• decrease inflammation
• decrease mm spasm
• bruising changing to green/yellow/brown
• ROM – pain when tissue resistance is met, tissue is most susceptible to re-injury w/ overstretch, decrease ROM due to adhesions & mm weakness

Question 18

Subacute Tx Goals

Answer 18

• decrease effects of inflammation
• decrease pain, edema, spasm
• maintain ROM/strength
• tx tissue proximal to injury, not distal
• decrease adhesions - develop mobile scar & promote healing

Question 19

Chronic Maturation & Remodelling

Answer 19

• 2-3 wks up to 1-2 years
• no edema (unless chronic inflammation)
• no cardinal signs of inflammation
• decrease ROM
• pain (maybe)
• decrease adhesions/TP’s/increase mm tone
• Tx compensations
• increase ROM/strength/functional mvmt, balance, etc.
• can increase aggressiveness of tx Optimal Progressive Loading

Question 20

Scar Tissue responds to

Answer 20

Stress - only strengthens to 70-80% as strong as the tissue it replaced

Question 22

3 Phases of Scar Tissue Formation

Answer 22

1. Inflammatory (4-6 days): Vascular & cellular response to injury
2. Proliferative (6-24 days): Re-epithelialization, fibroplasia w/ neovascularization, wound contraction (granulation tissue formation)
3. Remodelling (21d to 2 yrs): Conversion of granulation tissue into collagen filled scar. Consolidation/Maturation

Question 23

Causes of Scars

Answer 23

• inflammatory response from wounds, surgery, burns, musculoskeletal trauma, inflammatory arthritides or late stage of osteoarthritis
• prolonged immobilization
• paralysis or paresis

Question 24

Scar

Answer 24

Connects 2 pieces of tissue that are meant to connect

Question 25

Contractures

Answer 25

shortening of connective tissue supporting structures over or around a jt. It cannot fully lengthen and results in reduced ROM in jt.

Question 26

Adhesions

Answer 26

Connects 2 pieces of tissue that are not meant to connect

Question 27

Fibrotic Adhesion

Answer 27

occurring with on-going chronic inflammation can cause moderate to severe restrictions in ROM.
- difficult to eradicate

Question 28

Irreversible Contractures

Answer 28

occur in fibrotic tissue or bone replaces muscle and connective tissue
- permanent loss of ROM that can only be restored w/ surgery

Question 29

Hypertrophic Scar

Answer 29

overgrowth of dermal tissue that remains within the boundary of the wound. Scar is associated w/ deep partial or full thickness burn.

Question 30

Proud Flesh

Answer 30

thick dermal granulation tissue that results from abnormal healing process.

• when wound does not re-epithelialize, there is chronic inflammation.
• granulation tissue is composed of disorganized collagen & capillaries
• raised, red structure that is susceptible to damage

Question 31

Keloid

Answer 31

dermal scar tissue that extends beyond the boundaries of original wound, in a tumor-like growth

• do not respond well to surgery and frequently recur.