lecture 1: tissue healing Flashcards
what is a strain
mild injury , tissue is not torn
where is a strain usually an injury at
injury to musculotendious unit
what is a sprain
more severe than strain ; tear of soft tissues usually refer to injury of a ligament
what are the different grades for a sprain
• Grade I - ligament stretched but intact
• Grade II - incomplete or partial tear
• Grade III - complete tear
what type of mm are strains most common at
biarticulate (crosses 2 joints)
what is the difference between a particular and complete muscle/ tendon rupture or tear
partial: pain and reduced strength
complete: no pain , severe weakness
what is a subluxation and what does it include
incomplete or partial dislocation and included soft tissue trauma
what is a dislocation and what does it include
complete loss of anatomical relations and included soft tissue damage , pain , spasms and inflammation
what direction is the shoulder most commonly dislocated
anterior
what is the most common dislocation for a hip
posterior
what are the posteior hip precautions and anterior
flex add and ir
extension abd and ER
what soft tissue lesion is inflammation of tendon; resulting scarring or calcium deposits
tendinitis
what soft tissue lesion is a pathology of chronic degeneration without inflammation
tendinosis
what is the MOI for tendinosis
repetitive micro trauma
what is inflammation of synovial membrane
tensoynovitis
what is inflammation with thickening of a tendon sheath
tendovagintis
what is synovitis
inflammation of a synovial membrane
for synovitis there is excessive synovial fluid where
in the joint or tendon sheath
what is a bursitis
inflammation of a bursa
what is a bursa
synovial pocket inserted between a tendon and a bony prominence
what are the common dysfunctional bursa
pre patellar
subacromnion
trochanteric
glute med
sub deltoid
olecrannon
what is a ganglion and what is it common with
Ballooning of the wall of a joint capsule
common with rheumatoid arthritis
what is Hemarthrosis and what is the MOI
bleeding into a joint from severe trauma
what is a Contusion
bruising from a direct blow
what consequences of soft tissue injury is this
• Loss of normal function of tissue or region
• Mechanical loss of normal joint play
dysfunction
what consequences of soft tissue injury is this
• Abnormal adherence of collagen fibers
• Reduce elasticity of tissue
• Immobilization, disuse, surgery
adhesion
what consequences of soft tissue injury is this
• Adaptive shortening of short tissue (skin,
fascia, muscle, capsule)
• Reduce mobility and flexibility
• Immobilization, disuse, burns, spasticity
contracture
what is the building block of tissue
collagen
what kind of end feel is pain
empty end feel
how does a contracture affect MMT grading
they still get a 5
what is reflex mm guarding
prolonged mm contraction in response to a painful stimulus
what is a Prolonged contraction of a muscle in response to the local circulatory and metabolic changes
intrinsic mm spasm
what is muscle weakness
direct insult to the mm or inactivity
what is
• Increased interstitial pressure in a closed, nonexpanding,
myofascial compartment
• Results in ischemia and causes tissue damages
myofascial compartment syndromes
• Mild pain at time of injury or within 24 hrs
• Mild swelling, local tenderness
• Pain (+) when injured tissues are stressed
what grade of tissue injury is this
1
• Moderate pain that affects daily activities
• Stress and palpation increase the pain
• Tissue is partially torn
what grade of tissue injury is this
grade 2
• Near-complete or complete tear or avulsion of the
tissue
• Severe pain
• Stress to tissue is usually painless
• Palpation may reveal the defect
what grade of tissue injury is this
3
- Microtearing of a few muscle fibers
- Local pain of smaller dimensions
- Tightness and possible cramping in the posterior thigh
- Slight pain with muscle stretching and/or activation
- Stiffness that may subside during activity but returns afterwards 6. Minimal strength loss
- Less than a 15° deficit with the AKE test
what grade of strain is this
grade 1 - mild
- Moderate tearing of muscle fibers, but the muscle is still intact 2. Local pain covering a larger area than in a grade I strain
- Greater pain with muscle stretching and/or activation
- Stiffness, weakness, and possible hemorrhaging and bruising
- Limited ability to walk, especially for 24 to 48 hours after injury
- A 16° to 25° deficit with the AKE test
what grade of strain is this
2 - moderate
- Complete tear of the muscle
- Diffuse swelling and bleeding
- A possible palpable mass of muscle tissue at the tear site
- Extreme difficulty or inability to walk
- A 26° to 35° deficit with the AKE test
what grade of strain is this
grade 2- severe
a grade 1 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel
pain - mild within 24 hours
palpation- swelling , tender
stress to tissues - some pain
joint feel - normal
a grade 2 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel
pain - mod, stops activity
palpation - painful
stress to tissues - painful
joint feel - increased mobility
a grade 3 soft tissue lesion will have what pain , palpation , stress to tissues and joint feel
pain- severe
palpation- can reveal a defect
stress to tissues - painless
joint feel- unstable
what are the 3 stages of healing
acute stage (inflammatory reaction)
subacute stage (Proliferation, repair, and healing)
chronic stage ( maturation and remodeling)
how is pain in the acute stage of healing
pain before the movement even starts
how is pain in the subacute stage of healing
pain as the movement starts
how is pain in the chronic stage of healing
pain more towards the end of ROM with over pressure
which stage of healing are neutrophils ,pro inflammatory cytokines and macrophages in
acute phase 1
what stage of healing is angiogenesis, fibroblast (collagen , GAGs , elastin) and myofibroblast in
phase 2 proliferation subacute
how long is the acute phase of healing
day of injury to 10 days
when is the subacute phase of healing
form day 2 to day 22
when is the chronic stage of healing
from day 15 to over a year
what phase of healing is The initial reaction of the body tissue to an injury
and occurs within first 48 hours (up to 4-10 days)
acute
what are the 5 cardinal signs of healing
pain
heat
redness
swelling
loss of function
what phase of healing is ROM is painful and patient usually guards against movement before end range is achieved
acute
pain and impaired movements in the acute phase are a result from what 3 things
•altered chemical state that irritated the nerves ‘
•increased tissues tension from edema
•muscle gaurding
what 3 things in the acute phase occur from the actual trauma
•cellular death
•coagulation
•phagocytosis
what 2 things move to the end of the injured sits to clean dead cells in the acute stage
Neutrophils and Monocytes
what are the 3 PT goals and interventions in the acute stage
•protection phase
•control effects of inflammation
prevent negative effects of rest
what is the control of inflammation include
RICE
rest , ice , compression and elevate
what phase of healing is The actual healing phase which extends from the inflammatory phase (48 to 72 hours to approximately 6-10 weeks)
repair and regeneration phase , subacute phase
what is the processes used for tissue repair int he subacute stage
angiogenesis
collagen formation
epithelialization
what tissue repair is x Growth of
capillary beds into area
angiogenesis
what tissue repair si fibroblasts form extracellular matrix and synthesize immature collagen
collagen formation
what tissue repair si wound surface is covered and contract
epithelialization
what is granulation tissue
dedicate connective tissue
what does granulation tissue consist of of
fibroblast , collagen and capillaries
when does the formation fo scar begin
subacute stage when granulation tissue is formed
what is the pt goals and innervation for the subacute stage
*control motion phase
* develop mobile scare
*promote healing
how do u promote healing in the subacute stage
• Nondestructive movement –
AROM
• Resistive exercise
• Open and closed chain stabilization
• Muscular endurance
• Cardiopulmonary endurance
what is the remodeling phase
new collagen continues to increase its tensile strength
how long does the remodeling phase last
up to a year
excess production of collagen by fibroblast leads to what
hypertrophy of scare formation
what are clinical signs for chronic stage
absence of inflammation and pain after tissue resistance
what is the pt goals and interventions for the chronic stage of healing
*retunr to function
*increase tensile quality of scar
*develop functional independence
what is considered the unhappy triad
ACL + MCL + medial meniscus tear
genu valgum results in laxity of which ligament
MCL
when does wound closure in skin and muscles happen
5-8 days
how long does it take for wound closure in ligament and tendons
3-6 week’s
what is the normal amount of type 1 collagen in ligament
85%
after injury what type of collagen does the ligaments have
type 3
mature repaired ligament is how much weaker then uninjuried ligaments
30-50%
for ligament healing when can it tolerate mild tension
by 3 weeks
for ligament healing when can u begin to resume to normal activity
by 6 weeks
for ligament healing when have they regained almost maximum tensile strength
by 12 weeks
partial tear or rupture of a tendon most often occurs where
at the musculotendinous junction or at the tenoperiosteal junction
if the tendon injury is > 50% diameter what will it require
surgical repair
what is tendon healing affected by
the limited blood supply in the tendons
is o2 computing lower in the tendons and ligaments or that of skeletal muscles
ligaments and tendons
when is the proliferative stage for tendon healing
48-72 hours after injury
what kind of collagen is in the proliferative stage of tendon healing
type 3 collagen
when does the remodeling phase of tendon healing start
6-8 weeks after injury and may continue for years
what type of collagen is in remoedleing phase of tendon healing
type 1 , reduces the amount of type 3
how are the type 1 collagen fibers orgazinsed in the remodeling phase of tendon healing
longitudinally along the tendon axis and responsible for mechanical strength
active tension of tendon across repair site in the first 3 weeks results in what
a poor outcome
what kind of motion should occur in the first 3 weeks of tendon healing
passive exercise
what is limited in the first 4-6 weeks following a tendon repair
no/limited active recruitment of the muscle tendon
what is necessary initially yo assist in aligning collagen fibers for tendon treatment
passive movement
how long are most tendon rehab programs
> 6 months sometimes 1-2 years
what are causes of mm injury
*mecahnical forces
*thermal stresses
*nerve injury
*myotoxic agents
*prolonged ischemia
how long are u immobilized for a mm injury
2-5 days
when during a mm injury do you balance between tissue extensibility and portoectin of fibers from re injury
weeks 2-3
what are u focusing on during weeks 4-6 for a mm injury
gentle AROM < full range and no resistance
what can causes innjury especially with 2 joint mm
eccentric contraction or overstretch
when is Warm-up period and endurance activities to prevent new or recurring injuries for a mm injury
after 6 weeks
what is the difference between osteoclast and osteoblasts
osteoclast kills the bone and osteoblast makes new bone
T/F Bone is in a constant state of construction
T
• Bone is deposited in sites
subjected to stress
• Bone cells will align in such a way as to efficiently withstand stress
• Stress in bones with weight-bearing or tension
• Lack of stress causes bony atrophy
what law is this
wolffs law
what are causes of bone fx
direct violence
indirect violence
disease of bone
repeated stresses
what kind of fx is bone fragments into 3 or more pieces and common in long bones
comminuted
what kind of fx is ragged break occurs when excessive twisting forces are applied to a bone , common sports fx
spiral
what kind of fx is bone crushed and common in porous bones ( osteoporotic bones) subjected to extreme trauma as in a fall
compression
what kind of fx is epiphysis separates from the diaphysis along the epiphyseal place and tends to occur where cartilage cells are dying and calcification of the matrix is occurring
epiphyseal
what kind of fx is broken bone portion is pressed inward and typically a skull fx
depressed
what kind of fx does a bone break incompletely , much in the water a green twig breaks . only one side of the shaft breaks and the other side bends.. common in children whose bones have more organic matrix and are more flexible than those of adults
greenstick
how long is the inflammatory phase for fx repair
last 1-2 weeks
what phase of fx repair is soft callus formation and when is it
reparative phase and one week after injury
what phase of fx repair is hard callus formation in and when is it
reparaitive phase and several weeks to months
what phase of fx repair is Fracture site is firm and no longer moves, fracture line still appears on x-ray
remodeling phase
what is the order of fx repair
hematoma formation > fibrocartilaginous callus formation > bony callus formation > bone remodeling
how long does it take children , adolescents , adults and eldrty to heal from a fx
children : 4-6 weeks
adolescents: 6-8 weeks
adults: 10-18 weeks
elderly : much longer
in adults does the UE or LE heal faster for fx , distal or proximal heal faster , and is a simple fx faster to heal or a complex fx
UE
Distal
simple
