MIDTERM Flashcards
what is the ultimate goal of treating an injury
promote a strong, mobile scar
pain free ROM
5 signs of inflammation - SHARP
swelling
heat
altered function
redness
pain
what is the point of the healing process
restore integrity of the tissue
what is mature collagen repair called
scar tissue
what is primary / first intention healing
some tissue loss
wound edges are approximated
healing is efficient, only small amounts of collagen produced
what is secondary/second intention healing
extensive tissue loss/large area affected
wound edges aren’t easily approximated
healing takes longer through extensive re-epithelization
acute timeline
moment of injury –> 3-4 days
symptom picture of acute
redness
swelling
heat
pain
loss of function
muscle spasm/guarding
black, blue purple bruising
what causes swelling
fluid leaking into interstitium due to increased permeability of blood vessels
treatment goals in acute stage
limit inflamm. process
reduce pain/swelling
decrease SNS firing
prevent re injury
protective spasms are reduced but not removed
compensatory structures are addressed
early subacute stage timeframe
within 2 days of injury –> 3 weeks
symptom picture of early subacute
less signs of inflammation
decreased swelling
less pain
muscle spasm diminished
what is the primary process of early subacute stage
filling damaged area with new tissue
regeneration begins in this stage if necessary
when does re-epithelization happen
only applies if the skin is damaged
treatment goals for early subacute
decrease inflammation, pain, swelling and spasms
maintain available ROM and strength
peripheral tissue to injury can be treated
what is different from acute tx vs early subacute tx
you can start working on tissue proximal to injury site
granulation tissue is part of any tissue repair where first/second intention healing
true
what is neuroangiogenesis
new blood vessels develop from venues at the edge of an injury
what is granulation tissue
vascular CT
in acute stage:
initial vasoconstriction is followed by what
vasodilation
what happens in acute stage briefly
vasoconstriction followed by vasodilation
swelling caused by fluid leaking into interstitium
platelets cause coagulation
leukocytes go to injured site and clean
subacute time frame
within 2 days up to 3 weeks up to 6 weeks
timeline of late subacute
2-3 weeks post subacute stage
what happens in late subacute stage
blood vessels that developed w neoangiogenesis retract***
what can wound contraction result in
deformation of tissue and possible dysfunction
describe what happens in scar remodeling
reshaping, reorganizing, healing as collagen is broken down, new collagen is synthesized
cross links develop
strength increases
timeline for chronic
2-3 weeks post injury –> 1-2 years
describe reflex muscle guarding
response to pain/injury
acts to splint, reduce movement and prevent further injury
can result from referred pain
guarding stops when pain is relieved
describe intrinsic muscle spasm
self perpetuating pain spasm cycle
indirect or direct trauma
increase in SNS due to not knowing why mm is spasming
RESTRICTS MOVEMENT OF JOINT IF CROSSED BY MUSCLE
circulatory stasis, metabolite build up
what is tone
resistance of a relaxed muscle
what is tension
increase in tone in mm that tend to shorten
what causes muscle contraction
filaments move past each other, pulling on actin, repeated actions produce muscular contraction
muscle spindle and golgi tendon transmit proprioceptive info from muscles to the CNS to allow proper functioning
true
where are muscle spindles found
where are golgi tendons found
muscle belly
tendons
what do muscle spindles do\
what do they measure
major sensory organs that aid in control of movement
measure muscle stretch / speed
causes of muscle spasms (6)
pain
circulatory stasis
increased gamma firing
chilling of muscle
impaired nutritional supply
lack of vit d
symptom picture of spasms
pain within muscle due to ischemia and retention of metabolites
spasm/hypertonicity
decreased ROM of joint crossed by shortened affected muscle
antagonist/synergists muscles are affected
what does an acutely spasmodic spasm feel like
firm dense congested
what is the texture of a intrinsic spasm
hard fibrous
describe abrasion
superficial wound w ragged edges
extremely painful
how does a muscle spasm occur
an action potential stimulates release of calcium –> initates mm contraction
when action potential stops, calcium is recovered and mm contraction ceases
in a spasm, the contraction continues
define laceration
increased tissue loss w ragged edges
define incision
clean approximated edges
from sharp object
define puncture
clean edges w small entry point
define animal bite
combo of laceration, crush, puncture
what happens within a short amount of time in first intention healing, then what happens later on
thin layer of fibrin, basis for a clot of laid down
re-epithelization is complete in 2-3 days
site is closed to bacteria
over 10-14 days fibroblasts and collagen add strength
what happens in second intention healing
if dermis is affected
moisture allows better healing
describe superficial burn (1st degree)
affects epidermis
prolonged low heat or quick exposure to high heat
redness/pain
mild edema
within week epithelium sloughs off
healing is rapid, no scar tissue but discoloration may occur
describe partial thickness (2nd degree burn)
goes into dermis
blistering
increased edema, risk of infection, decreased pain due to nerve damage
new layer of skin as a barrier within 14-21 days , deeper burns in 21-35 days
good functional return, minimal scar tissue
deeper= contracture, fibrosis, joint mob restrictions
full thickness (third/fourth degree) burn
affects down to subcutaneous
down to muscles, bone, tendon
burns look waxy, dry, white or charred
painless = nevre damage
re-ep is not possible because of tissue damage
skin grafts needed
what is hypertrophic scar tissue
fibres organizing into adhesions w reduced elasticity combined w contraction of myofibroblasts causes “heaped up” tissue
AKA tissue appears heaped up
goal for working with scar tissue
mobility
return strength
improve tissue health
where is the area of a trigger point
the motor point where nerve stimulation initiates a contraction in a small, sensitive bundle of muscle fibres that in turn activates the entire muscle
what causes a trigger point
calcium and ATP on myofascial tissues that have been stressed that causes the tissue to shorten producing taut band/nodule
localized uncontrolled metabolic activity in area and localized acidic fluid environment does what
makes the nerve endings hyperirritable resulting in TP pain
3 perpetuating factors of TP development
reflexive
mechanical
systemic
reflexive perpetuating factors TP’s
skin sensitivity
joint / visceral dysfunction
vasoconstriction
nerve segment
mechanical perpetuating factors
gait distortion
immobilization
vocational stress
restrictive clothes
furniture
systemic perpetuating factors
enzyme dysfunction
metabolic / endocrine dysfunction
chronic infection
dietary insufficiencies
psychological stress
what is an active trigger point
PAINFUL ALL THE TIME / AT REST
prevents mm from fully lengthening
tender on palpation
referred pain in a specific pattern
when mm is lengthened to point of pain a protective mm spasm occurs
on an active TP what can palpation produce
a local twitch response and possible referred autonomic phenomena
what is a latent trigger point
produces pain only when palpated
more common than active can persist for years
all other characteristics of active may occur w latent
primary trigger points
activated by acute or chronic mechanical strain or overload of affected muscle
secondary trigger point
activated in the overworked synergist or antagonist muscles
satellite trigger points
found in muscles that lie within the referral pattern of another trigger point
who invented trigger points
travell
simons
what is panniculosis
thickening of subcutaneous tissue
granular feel
what is a jump sign
when pain is intense enough to cause client to jump
