Inflammatory Process & Scars Flashcards
5 Cardinal Signs of Inflammation
- Redness
- Swelling
- Heat
- Pain
- Loss of Function
Inflammation is the body reacting to initial injury by
an immediate attempt to minimize damage and restore homeostasis
Ultimate goal of treating an injury it to
promote a strong, mobile scar, and as much as possible, full, pain-free mvmt of affected structure, and full strength and return to function
2 Types of Healing
- Primary (1st intention)
- Secondary (2nd intention)
Primary Healing
- wound end are approximated (tape, sutures, staples)
- some tissue loss & only small amounts of collagen are produced
Secondary Healing
- 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)
Re-epithelializaiton
the resurfacing of a wound with new epithelium
Wound healing
complex multi-step process involving overlapping stages of blood clot formation, inflammation, re-epithelialization, granulation tissue formation, and remodelling
RICE
Rest
Ice
Compression
Elevation
PRICE
Protect
Rest
Ice
Compression
Elevation
POLICE
Protect
Optimal Loading
Ice
Compression
Elevation
PEACE
Protect
Elevate
Avoid Anti-inflammatories
Compression
Educate
Factors that Affect the Healing Process
- severity of injury
- age
- infection
- presence of foreign material
- nutritional support
- existing conditionings
- adequate blood supply
- wound separation
- effects of some drugs
- smoking
4 Stages of Wound Healing
Acute
Sub-acute
Chronic
Chronic inflammation (possible)
Acute Inflammation
- 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
LOVE
Load
Optimism
Vascularization
Exercise
Subacute Proliferation, Repair & Healing
- 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
Subacute Tx Goals
- 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
Chronic Maturation & Remodelling
- 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
Scar Tissue responds to
Stress - only strengthens to 70-80% as strong as the tissue it replaced
3 Phases of Scar Tissue Formation
- Inflammatory (4-6 days): Vascular & cellular response to injury
- Proliferative (6-24 days): Re-epithelialization, fibroplasia w/ neovascularization, wound contraction (granulation tissue formation)
- Remodelling (21d to 2 yrs): Conversion of granulation tissue into collagen filled scar. Consolidation/Maturation
Causes of Scars
- inflammatory response from wounds, surgery, burns, musculoskeletal trauma, inflammatory arthritides or late stage of osteoarthritis
- prolonged immobilization
- paralysis or paresis
Scar
Connects 2 pieces of tissue that are meant to connect
Contractures
shortening of connective tissue supporting structures over or around a jt. It cannot fully lengthen and results in reduced ROM in jt.
Adhesions
Connects 2 pieces of tissue that are not meant to connect
Fibrotic Adhesion
occurring with on-going chronic inflammation can cause moderate to severe restrictions in ROM.
- difficult to eradicate
Irreversible Contractures
occur in fibrotic tissue or bone replaces muscle and connective tissue
- permanent loss of ROM that can only be restored w/ surgery
Hypertrophic Scar
overgrowth of dermal tissue that remains within the boundary of the wound. Scar is associated w/ deep partial or full thickness burn.
Proud Flesh
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
Keloid
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.
