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S2 PTA 104 disease > Injury, inflammation, and healing > Flashcards

Injury, inflammation, and healing Flashcards

1
Q

Mechanisms of cellular injury

A
  • ischemia
  • infectious
  • immune
  • genetics
  • nutritional
  • physical
  • chemical
  • psychosocial
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2
Q

Reversible vs irreversible

A
  • cell death (unable to adapt)
  • adaptation (small damage, no injury. Acute or chronic)
  • repair (scar tissue)
  • regeneration
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3
Q

Issues that affect tissue healing

A
  • physiological
  • general health
  • comorbidities
  • substance use / abuse
  • infection / foreign bodies
  • tissue type
  • medical treatment
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4
Q

Phases of normal healing for all tissue types

A
  1. Hemostasis and degeneration
  2. Inflammation
  3. Proliferation and migration
  4. Remodeling and maturation
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5
Q

Regeneration vs repair pic

A

Pic

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6
Q
  1. Hemostasis and degeneration
A
  • immediately after injry body tries to stop bleeding via platelets, hematoma, necrosis
  • abnormal: low platelets or blood thinner meds
  • cytokines are released
  • causes inflammation (growth factos and fibroblasts
  • ** do not confuse with homeostasis
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7
Q
  1. Inflammation
A
  • protective and curative
  • replaces injured tissue
  • begins with formation of blood clot (vasodilation)
  • leukocytes, macrophage, and proteases
  • growth factors, chemokines, and cytokines
  • about 5 days: fibroblasts
  • chronic disease stall the healing at this phase, failing to progress to the next phase
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8
Q

CSI

A
  • erythema - pain - heat - edema - loss of function
  • *abnormal presentation: pts with diabetes may not “mount” a normal inflammatory response, so these signs may not be obvious
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9
Q

Acute inflammation

A

Normal

  • protective
  • proteins and fluid build up
  • slower in older adults
  • subsides in presence of small amount of necrosis
  • will heal on its own
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10
Q

Chronic inflammation

A

Pathological

  • large / prolonged injury
  • delays healing
  • common in older adults
  • occurs with larger amount of necrosis or lack of intervention
  • requires skilled care
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11
Q
  1. Proliferation and migration
A
  • starts 2 days after injury (overlaps with inflammation)
  • endothelial cells proliferate to establish vascular network for O2 and nutrients (angiogenesis)
  • new vessels are leaky (edema)
  • fibroblasts synthesize collagen
  • lasts for several weeks
  • healing can also stall at this phase, due to poor control of a comorbity
  • abnormal form: hypergranulation
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12
Q
  1. Remodeling and maturation
A
  • scar tissue reduced and remodeled
  • reorientation of collagen and strength regained
  • mature scar 3-4 months
  • lasts for 1-2 years
  • abnormal form: keloid formation (different than hypergranulation)
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13
Q

Healing timeline pic

A

Pic

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14
Q

Muscle injury etiology

A

Contusion (blunt force) - laceration (open wound) - strain - sprain

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15
Q

Strain

A

An injury to a muscle, typically occurring at the myoteninous junction

  • overstraining of the myofibrils likely during eccentric contraction
  • may have signification bleeding
  • etiology: a tensil, mechanical stress / trauma
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16
Q

Grades of strains

A

I: Minor discomfort and swelling, few torn muscle fibers, minimal loss of strength and movement
II: moderate to sever pain, pain with muscle contraction that limits activity, measurable loss of strength
III: severe pain, complete rupture of muscle belly or muscle tendon complex (mm pull or tear), severe loss of función

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17
Q

Muscle healing phases

A
  • hematoma formation and inflammation overlap (24-48 hrs)
  • phagocytosis (6-8 weeks)
  • remodeling: muscle regeneration reorganization of scar tissue takes up to 1 year!
  • 1/3 injuries re-occurs within 1 year
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18
Q

Treatment strains pic

A

Pic

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19
Q

Treatment considerations

A
  1. Inflammatory response depends on extent of damage and degree of vascularization
  2. Active contraction prior to 3 weeks s/p injry can cause further damage
  3. Passive ROM: no increase in tensile strength of tendon/muscle
  4. Mechanical stress of tendons / mm stimulates repair and functional remodeling
  5. Low intensity pulsed ultrasound
  6. Kinesiotaping
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20
Q

Mm stiffness

A

Causes

  • microfibrinous adhesions
  • increased collagen fibers
  • electrolyte changes
  • release of mm enzymes
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21
Q

Sprains

A

Injury to a ligament

  • etiology: the ligament is mechanically stressed
  • 80-85% of ankle sprains inversion, AFTL, calcaneal fibular, PTFL
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22
Q

Grades of sprains

A

I: Minimal pain and no significant instability
II: severe pain, minimal-moderate joint instability but definite joint end feel, and partial tear of ligs
III: severe pain during injury with less pain after, very unstable joint—no joint end feel, and ligament has been completely torn

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23
Q

Treatment sprains pic

A

Pic

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24
Q

Ligament treatment considerations

A
  • healed lig will be 30-50% weaker in tensile strength than before injury
  • treatments that stabilize th joint put lig i optimal length and position can reduce scarring
  • early controlled mobilization and loading lig can promote healing and improve post-injury tensile strength
  • proprioception is slower than strength to return, which contributes to reinjury
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25
Q

Immobilization

A

Aid early healing and repair/protection from further injury

  • decreased force generation ability (muscle
  • decreased tensile strength (ligs and tendons)
26
Q

Mobilization (with pain-free tolerance)

A
  • earlier return to force generation (muscle)
    • mm fibers reorient in functional patterns
    • decreased scar tissue formation
  • earlier gains in tensile strength (ligs and tendon)
    • collagen fibers orient along lines of stress
27
Q

Cartilage

A

4 types:
- articular - fibrocartilage - elastic - fibroelastic

Healing challenges
- avasular - aneural - alymphatic

28
Q

Compact bone

A

Dense, composed of concentric rings

29
Q

Spongy bone

A

Composed of small needle like or flat pieces of bone (trabeculae)

30
Q

Trabeculae

A

Form an open network which is filled with bone marrow

31
Q

Signs

A

Objective/measureable

  • visual/palpable change in anatomy (deformity)
  • radiographic changes
  • inflammation
  • crepitus (noise)
32
Q

Symptoms

A

Subjective

  • severe, persistent pain
  • point tenderness
  • inability to bear weight (because they feel it)
33
Q

Types of fractures

A
  1. Open vs closed
  2. Complete vs incomplete
  3. Simple vs comminuted
  4. Compression fracture of spine
  5. Impacted
  6. Pathological
  7. Stress
  8. Epiphyseal
  9. Avulsion
34
Q

Open vs closed fracture

A

Open

  • results when the skin is broken and the bone is exposed
  • very high risk of infection
  • total disruption of the bone

Closed
- the bone is broken, but the skin remains intact

35
Q

Complete vs incomplete fracture

A

Complete

  • the bone fragments are separated completely
  • the bone is broken to form 2+ pieces

Incomplete

  • the bone is only partially broken
  • the bone fragments are still partially joined
  • greenstick fracture
36
Q

Simple vs comminuted fracture

A

Simple: a single break in the bone. Bone ends maintain their alignment and position

Comminuted: multiple fracture lines and bone fragments

37
Q

Compression fracture

A
  • common in the vertebrae
  • occurs when a bone is crushed
  • common with osteoporosis
  • results in significant pain and disability
38
Q

Impacted fracture

A
  • similar to a compression fracture
  • one end of the bone is forced into the adjacent bone
  • closed fracture
  • common in car accidents and falls
  • the neck of the femur is crushed against the pelvis
39
Q

Pathological fracture

A
  • results from weakness in bone structure due to conditions such as a tumor, hormonal imbalance, or osteoporosis
  • the break occurs spontaneously or with very little stress on the bone
40
Q

Stress fracture

A
  • results from repeated, excessive stress
  • common overuse injury, most often seen in athletes who run and jump on hard surfaces
  • common in the tibia, femur, and metatarsals
41
Q

Epiphyseal fracture

A

If the plate is separated from the epiphysis or diaphysis without proper treatment, growth will not be normal

42
Q

Epiphyseal pic

A

Pic

43
Q

Avulsion fracture

A
  • fragment of bone at the insertion of a muscle, tendon, or ligament becomes detached as a result of excessive tension
  • piece of bone is pulled free (usually occurs near the joint line)
44
Q

Classification by direction of fracture line

A
  1. Transverse
  2. Linear
  3. Oblique
  4. Spiral
45
Q

Transverse fracture

A

Fracture is at the right angle to the bone’s long axis

46
Q

Linear fracture

A

Fracture is parallel to the bone’s long axis

47
Q

Oblique fracture

A
  • the fracture is at an angle to the diaphysis of the bone

- the fragments tend to override as a result of muscle contraction, unless stability is maintained by fixation

48
Q

Spiral fracture

A
  • a break that angles around the bone
  • usually due to a twisting injury
  • usually requires fixation
49
Q
  1. Hematoma phase of bone healing
A

Fracture, blood clot, fibrin, and platelets

50
Q
  1. Inflammation phase of bone healing
A

Lasts 24-48 hrs to 2 weeks

  • vasoactive (heat, redness, swelling, pain)
  • fibrin meshwork, fibroblasts
  • phagocyte cells to area of inflammation to remove hematoma
  • chondroblasts brought to the site of injury
51
Q
  1. Reparative phase
A
  • soft callus formation 2 weeks
  • soft callus replaced by hard callus 6-12 weeks
  • fracture is not stable at end of this phase
52
Q
  1. Bone remodeling
A
  • bone restructures itself over a period of 1 year, medullary canal is restored
  • callus is reabsorbed and the anatomical contour of the bone is regained
  • wolff’s law: the bone forms and remodels in the direction of forces (mechanical stresses acting on it)
  • from disorganized to mature organized bone tissue
53
Q

Fracture management

A

Fragment reduction: re-alignment fragments

  • maintenance of alignment: stabilize, immobilize, ORIF, OREF, traction, non-weight bearing
  • preservation and restoration of function: AROM exercises for the rest of the body and strengthening exercises
54
Q

ORIF

A

Open reduction internal fixation

  • surgical repair of fracture
  • use of pins, plates and/or rods to position bones in anatomical alignment
55
Q

OREF

A

Open reduction external fixation

  • painful af
  • high risk of infection
56
Q

Complications during fracture healing

A
  1. Infections
  2. Ischemia
  3. Nerve damage
  4. Slowed healing
    - DM - elderly - poor circulation - nutritional deficits - medication such a glucocorticoids
57
Q

Delayed union

A

Factors that could cause a delayed union are poor health, poor circulation, and infection

58
Q

Non-union

A

A fracture that does not heal. Causes may include poor health, poor circulation, infection and I fracture mismanagement

59
Q

Mal-union

A

The fracture heals in a an acceptable position and could cause a significant impairment

60
Q

Therapy considerations

A

Preservation and restoration of funciton

  • AROM exercises for rest of body
  • strengthening exercises
  • we do not treat the fracture
  • immobilization is bad!

S2 PTA 104 disease (15 decks)

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