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Clinical Practice > Injury and Tissue Repair > Flashcards

Injury and Tissue Repair Flashcards

1
Q

What do you need to know to determine whether to start with exercise or modalities?

A

You need to know the severity, irritability, nature, and stage of the injury (SINS)

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2
Q

What are three considerations when looking at the severity of the injury?

A
  1. Tissue disruption
  2. Pain
  3. Function
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3
Q

Describe a Grade I (first degree) sprain.

A
  1. Microscopic tissue disruption
  2. Mild pain within first 24 hours and when tissue is stressed
  3. Mild swelling and local tenderness
  4. Little or no loss of function
  5. Not super unstable
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4
Q

Describe a Grade II (second-degree) sprain.

A
  1. Incomplete tissue tears
  2. Moderate pain and swelling that requires stopping activity
  3. Stress and palpation greatly increase pain. A lot of pain with tension tests because you are straining an injured ligament.
  4. With ligamentous injury there will be increased joint mobility. There will be some instability.
  5. Mild to moderate loss of function
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5
Q

Describe a Grade III (third-degree) sprain.

A
  1. Near complete or complete tear of tissue (ligament/tendon). This will result in a lot of instability.
  2. Severe pain and swelling
  3. Tests to apply tension to injured tissue may be painless because the tendon isn’t connected, but not palpation.
  4. With ligamentous injury, joint effusion and instability is likely
  5. Severe or complete loss of function
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6
Q

What do we mean by the “nature of an injury”?

A

Nature just means what is the injury, or what kind of injury is it.

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7
Q

A strain is…

A

Overstretching, overexertion, overuse of soft tissue, usually used regarding muscle/tendon and is graded (I, II, III)

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8
Q

This is the definition of what?

Severe stress, stretch or tear of soft tissues, usually used regarding ligaments and is graded (I, II, III)

A

This is the definition of a sprain.

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9
Q

A contusion is…

A

Bruising

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10
Q

Inflammation of the bursa is…

A

Bursitis

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11
Q

Synovitis is…

A

Inflammation of the synovial membrane

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12
Q

Bleeding into a joint, usually due to trauma describes what?

A

Hemarthrosis

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13
Q

What are three types of nerve injuries?

A
  1. Neurapraxia
  2. Axonotmesis
  3. Neurotmesis
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14
Q

Neurapraxia is…

A

numbness and tingling. Mild injury to the nerve.

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15
Q

Axonotmesis is…

A

Damage to the axon.

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16
Q

Neurotmesis is…

A

Complete severing of the nerve.

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17
Q

What is tendinopathy?

A

Tendinopathy just means a disease of the tendon.

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18
Q

Inflammation of the tendon is called?

A

Tendinitis

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19
Q

Tendinosis is…

A

Degeneration of the tendon due to repetitive microtrauma.

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20
Q

Inflammation of a tendon and its synovial sheath is…

A

Tenosynovitis

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21
Q

Tenovaginitis is…

A

Inflammation (often with thickening) of the tendon sheath

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22
Q

Dislocation is…

A

Displacement of a part of a joint

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23
Q

Incomplete or partial dislocation of bony parts describes what?

A

Subluxation

24
Q

Fractures are…

A

Structural breaks in the continuity of a bone, an epiphyseal plate, or a cartilaginous joint surface

25
Q

Why is it important to know if the bone break is at the epiphyseal plate or not?

A

If the cartilage is affected, weight bearing will be affected. This will change how you educate a patient on healing. The epiphyseal plate is a plate of cartilage in between the epiphysis and the metaphysis. Growth of the long bones occurs here, so growth will be affected if a break occurs at the epiphyseal plate.

26
Q

List the determining factors of repair and healing.

A
  1. Severity of injury (grade I, II, or III)
  2. Tissue involved (muscle, tendon, ligament etc.)
  3. Location of injury (highly used area/segment?)
  4. Onset and duration of immobilization
  5. Co-morbidities
  6. Surgical treatment
27
Q

What are the three stages of inflammation and repair?

A
  1. Acute stage (inflammatory response)
  2. Subacute stage (repair and healing)
  3. Chronic stage (maturation and remodeling)
28
Q

Approximately how long does the acute inflammation phase last?

A

The acute inflammatory phase usually lasts 4-6 days (unless injury/irritation persists). The acute inflammation phase can vary widely depending on the injury.

29
Q

How long does the reparative phase last?

A

The reparative phase could last from day 3 or 4 to week 6 or 8. However, the reparative phase might depend on the tissues and the comorbidities.

30
Q

Approximately how long does the remodeling phase last?

A

The remodeling phase could last from day 14 to a year or several years. This is why lifestyle modifications are so important. The longest stage is remodeling, and it could last several years.

31
Q

When rehabbing someone, what phase do you want to spend the most time in?

A

You want to spend as little time as possible in the acute inflammatory stage, so that you can spend time in the repair phase. The repair phase is where you are going to have the largest impact. However, you don’t necessarily want to eliminate the acute inflammatory stage because it is an important part of repair.

32
Q

What is happening during the acute inflammatory stage with chemical changes?

A

Cellular, vascular, chemical responses in the tissue. Cells and solutes from blood vessels to injured tissue and clot formation.

33
Q

What is happening during the acute inflammatory stage with phagocytosis?

A

Phagocytosis, early fibroblastic activity, and formation of new capillary beds begin. Stimulate subsequent healing and repair processes.

34
Q

What is the goal in treating the acute stage?

A

We might help modulate some of this stage. We want this healing stage to happen, but we don’t want it to limit their mobility because we don’t want them to be immobilized for too long.

35
Q

What are the signs of inflammation?

A
  1. Swelling
  2. Redness
  3. Heat
  4. Pain (at rest)
  5. Loss of function
36
Q

What does pain result from during the acute stage?

A

Pain is result of irritated nerve endings, increased tissue tension due to edema or jt. effusion, and muscle guarding.

37
Q

During a PT exam, how will the acute stage present?

A

ROM will be painful, increase in muscle guarding. In the acute phase, they will have pain before they even hit any sort of tissue stretch and resistance. There is pain either in resting or at R1.

38
Q

Patient education during the acute stage might include…

A
  • symptoms
  • precautions/contraindications
  • what they are allowed to do
39
Q

What are ways to protect the injured tissue during the acute stage?

A
  • Protect the tissue in the first 24-48 hours
  • Rest, Ice, Compression, Elevation
  • Pain and edema control - modalities, massage, gentle oscillations (grade I)
  • Prescription of assistive devices
40
Q

How can you help prevent the adverse effects of immobility during the acute stage?

A
  • Continuous immobilization should be avoided
  • Careful and controlled passive movement in a pain free range
  • Goals are to protect the injury, facilitate progression to the proliferative phase of healing, and if feasible, maintain ROM
41
Q

What are some interventions to use during the acute stage?

A
  • PROM
  • Grade I and II joint oscillations
  • Muscle setting (non-contractile injuries)
  • Massage
42
Q

How would you use PROM in the acute stage of injury?

A
  • Use pain as a limit
  • Maintain mobility of joints, ligaments, tendons, muscles
  • Maintain joint nutrition, fluid dynamics
43
Q

How would you use Grade I and II joint oscillations during acute injury?

A

Improve fluid dynamics, maintain cartilage health

44
Q

How is muscle setting used in the acute stage?

A
  • Gentle isometric contractions at submaximal intensity
  • Assists circulation
  • Facilitate early neuromuscular control
  • Use pain as a limit and to dictate position of exercise
45
Q

In areas surrounding the injured joint, what interventions can you perform?

A
  • Range of motion
  • Muscle performance
  • Functional activities (adaptive devices, assistive devices)
46
Q

What is the goal of performing interventions on the joint above and below the injury?

A

Make sure they are still using the limb. Get the joints surrounding the injured joint moving.

47
Q

What are the precautions during the acute stage?

A
  • Proper amounts of rest and movement are important
  • Too much movement can cause increase in pain, inflammation, or re-injury
  • Take into account how much pain medication they are taking. You can advise them if they feel like they don’t need it, and you can educate them on addiction and using more natural pain management routes.
48
Q

If someone is through the acute stage, should they have pain at rest?

A

No. Pain can be an indicator of when to stop doing something. Pain medication may dull this or negate it, so they may overdo it on the tissues. You can also tell patients that you will talk to their doctor.

49
Q

What are contraindications during the acute stage?

A
  • Stretching of injured tissues

- Resistance exercise for injured tissues

50
Q

During the subacute phase, what is going on with the collagen?

A
  • Collagen synthesis and deposition - fibroblast activity increases producing immature collagen replacing original clot
  • Collagen produced is thin and unorganized - very fragile, easily torn. P
51
Q

How do you achieve proper growth and alignment achieved during the subacute stage?

A

Proper growth and alignment can be achieved with appropriate stress and loading of the tissue.

52
Q

How far in ROM should we be able to get in the subacute stage without pain?

A

You should reach R1 without any pain. There is usually pain at end range.

53
Q

What are some clinical presentations of the subacute stage of injury?

A
  • Signs of inflammation progressively decrease

- Muscles will test weak with decrease in function as a result

54
Q

How long does the subacute stage last?

A

Usually lasts 10-17 days. May be as much as 6 weeks depending on tissue type and blood supply

55
Q

What should you educate the patient on in the subacute stage?

A
  • Signs and symptoms of too much. What to expect.
  • Pain and inflammation management.
  • Pain should decrease over time.
  • At any time, if an activity causes increase in pain or inflammation, it needs to be modified.
    Pain is all about tissue tension. When the tissues start to be stretched and have tension, they will have pain.

Clinical Practice (19 decks)

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