Lecture Phases of Healing and Swelling Flashcards
Name the 3 phases of healing
- inflammatory (acute phase, protection phase) - proliferative (subacute, controled motion phase) - remodeling (chronic, return-to-function phase)
when does each phase of healing occur?
- inflammatory (first 2-3 days - 10 days) - proliferative (day 3 - week 3-6) - remodeling (day 9 - week 6-month12)
describe the repair process for most vascularized soft tissues
- similar process as described in lecture - time courses may vary - based on different tissue types
what are satellite cells?
-Satellite cells are precursors to skeletal muscle cells, able to give rise to satellite cells or differentiated skeletal muscle cells
what are schwann cells?
-any of the cells in the peripheral nervous system that produce the myelin sheath around neuronal axons.
describe the chart for post-injury strength
what are the 5 cardinal signs of inflamation?
what does the inflammatory response depend on?
–Size of injury
–Type of injury
–Tissue involved
–Vascularity of tissue involved
what is the physiological role of the inflammatory response? - describe beginning middle and end (4 processes involved)
describe the hemostatic response (inflam. phase)
Role:
–Control blood loss when vessels are ruptured
Process:
–Small blood vessels retract to seal themselves
–Fibrin clot formation
–Platelets aggregate and deposit fibrin to trap red blood cells and form a blood clot
describe the vascular response
describe the cellular response of the inflamatory phase
Initial response: Migration of leukocytes (white blood cells) to site of injury
Early inflammation: Neutrophils are dominant: removal of contaminating bacteria and debris (phagocytosis)
Late inflammation (within a few hours after injury):
–Macrophages (from monocytes) are dominant: phagocytosis and promotion of fibroblastic activity
–Lymphocytes: supply antibodies for specific antigens
what are leukocytes?
white blood cells
what are neutrophils?
a type of white blood cell - remove contaminating bacteria and debris (phagocytosis)
what are Macrophages
a type of white blood cell that engulfs and digests cellular debris
what are fibroblasts?
A fibroblast is a type of cell that is responsible for making the extracellular matrix and collagen.
Together, this extracellular matrix and collagen form the structural framework of tissues in animals and plays an important role in tissue repair.
what are lymphocytes
a type of white blood cell found in lymph
what are endothelial cells
lines the interior surface of blood vessels and lymphatic vessels, forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall.
describe the immune response of the inflammatory phase
chemotactic = movement of an organism in response to a chemical stimulus
describe rehabilitation in the inflammatory phase
goal to educate: protect, prevent immobilization effects, control/reduce pain inflammation and edema
trearment: education, price, pain free rom, Muscle re-education, motor control and isometric strength, pain free Conditioning, modalities (ultrasound, electrical stim)
controlled early mobilization**
when does pain generally appear in the inflammatory phase?
–Pain generally appears before completion of ROM
what does the duration of the proliferative phase depend on?
- type of tissue
- extent of injury
what is the role of the proliferative phase?
–Proliferation of new blood vessels
–Formation of new connective tissue
–Re-establishment of tensile strength
–Preparation for remodeling
what types of tissue does the proliferative phase involve?
–Epithelial tissue
–Connective tissue
describe characteristics of the proliferative phase and when it ends
note: mast cells involved with wound healing, granulation tissue = new vascular tissue in granular form on an ulcer or the healing surface of a wound
describe the clinical presentation of the proliferative phase
–Pain when the new tissue is overstressed
Generally beginning of tissue resistance during ROM assessment
–Active effusion and local redness no longer present
Residual edema may still be present
–Resumption of normal ADL and beginning of some activities
describe the goals and treatment during the rehabilitation phase
Goals (controlled motion):
–Re-establish normal ROM and flexibility
–Start recovering strength and proprioception without damaging healing tissues
describe what determines success in the remodeling phase and what signifies the end phase
–Type of tissue
–Extent of injury
–Location of injury
–Age of patient
–Etc.
end phase is unclear
what is the the role and characteristics of the remodeling phase?
describe the clinical presentation of the remodeling phase
•Corresponds to beginning of functional activities
–+/- pain at end of tissue resistance during ROM assessment
- Pt has generally regained ROM and flexibility
- Pt has improved strength and endurance
describe the goals and treatment in the rehabilitation phase
Goals (return to function):
–Improve strength, function, proprioception (+/- agility, power, plyometrics)
–Activity/sport-specific training s̅ damaging healing tissues
describe rehabilitation during all phases of healing
describe the 2 types of chronic inflammatory responses
what are the consequences and tx of chronic inflammatory responses?
–Resistance to both physical and pharmacological interventions
–Failure to remodel adequately
–Imperfect repair
–Persistence of symptoms
–Adhesions can be formed in and around the tissue involved
treatment: Initially, treat as acute condition
what is a sprain? include degrees
- notes
what is a strain? include degrees
- notes
describe the PRICE principle
notes
what is the onset of swelling in terms of blood vs synovial?
blood = 0-4 hours (ie acl = lots of blood involved)
synovial = 8-24 hours (miniscus, not asmuch right away)
how to do a swelling measurement in general
* At a fixed, constant distance from a bony landmark
explain how to do a swelling assessment volume measure
explain swelling assessment palpations
BONY: hard
SYNOVIAL: boggy, spongy
FLUID: softer, mobile, fluctuating feeling
BLOOD: harder, thicker, warmer, gel like
PUS: thick, warm skin, body temperature increased
PITTING: thicker, slow-moving, imprint of fingers on body segment
define swelling (and 2 types of swelling)
Any abnormal enlargement or increase in volume of a body part (generic term)
1) edema
2) effusion
define edema
An abnormal excess accumulation of fluid in the intercellular spaces of connective tissue
define effusion
Abnormal accumulation of fluid inside an anatomical space such as a joint space or a pleural, pericardial, peritoneal cavity
define localized swelling and types
swelling confined to a localized anatomical area
– Encapsulated (e.g. cyst, ganglion)
– Intra-capsular (intra-synovial – e.g. RA; extra-synovial – e.g. ACL injury)
– Extra-capsular (e.g. pre-patellar bursitis)
define generalized swelling and types
swelling that appears at multiple sites or over a large area
1) peripheral (eg Edema, bilaterally, in the lower limbs as a result of congestive heart (right ventricular) failure)
2) central (e.g. Pulmonary edema; an accumulation of fluid in the lungs (throughout the lungs, as opposed to a localized inflammatory process))
Symptoms (Sx) can include: Dyspnea (shortness of breath (SOB)), Orthopnea (SOB when lying flat), Nocturia (need to get up at night to urinate)
describe 5 types of swelling
1) Synovial (due to increased production of synovial exudate, possibly as a result of synovitis)
2) Bony or hard (e.g. osteophytes, myositis ossificans)
3) Blood (bruising, haemarthrosis, etc.)
4) Pus / Abscess
5) Cutaneous edema (often “pitting”) – Seen in chronic ankle swelling, congestive heart failure, cirrhosis, etc.
