Pain, scars, wounds, and burns Flashcards
Define cutaneous pain
- superficial tissue damage
- sharp, bright, burning and well-localized
Define Deep somatic pain
- from muscles, tendons, joints, and periosteum
- more diffuse &can refer to other areas of the body
Define Visceral pain
- arises from visceral distension or ischemia or strong, abnormal gastrointestinal contractions
- often disffuse
What is referred pain
- may come from cutaneous, deeper somatic and viseral tissue
- occurs in tissue that is remote from the original lesion or injury
- referred pain is well localized
What is functional or psychogenic pain
-believe to arise from the emotions of psyche but is experienced as though it originates from an organic disorder.
What is capsular pattern
- is the pattern of limitation of movement at an injured or affected joint
- with injury to the joint capsule or the synovial lining, a pattern or proportional limitation will be noted as the therapist takes the joint through its passive range.
- limitation is due either to fibrosing of the joint capsule to inflammation or to a joint effusion
What is non-capsular pattern
- limitation of movement of a joint but not in a capsular pattern
- restriction may be due to an intra-articular mechanical blockage from torn pieces of cartilage, menisci or intra-articular adhesions
- it may be due to extra-capsular lesions, such as muscle contracture, mysoitis ossificans or acute bursitis.
Define contracture
the shortening of connective tissue supporting structures over or around a joint
Define adhesion
occurs when reduced motion at a joint allows cross-links to form among collagen fibers, reducing ROM.
(most evident with postural dysfunction or immobilization of a limb)
What is scar tissue adhesion
occurs with an injury or an acute inflammatory process. collagen fibers during tissue repair allow adhesions and contractures to form in random patterns
Define fibrotic adhesions
occurs with ongoing chronic inflammation can cause moderate to severe restrictions in ROM.
(hard to get rid of)
What is proud flesh
refers to think dermal granulation tissue that results from an abnormal healing process. the wound does not re-epithelialize, leading to chronic inflammation.
(structure is raised and red and is susceptible to damage)
What is hypertrophic scarring
overgrowth of dermal tissue that remains within the boundaries of the wound
(associated with deep partial or full thickness burns)
What is a keloid scar
a dermal scar that extends beyond the boundaries of the original wound.
can continue to grow for many years.
do not respond well to surgical excision and frequently recur.
more prominently found in dark pigmented people.
What are CI’s for treatment of scar tissue
- frictions if client on anti-inflammatory drugs.
- frictions are not recommended for proud flesh or keloid scars.
What is a wound?
a disturbance of the continuity of the skin
what is an abrasion?
superficial wound with ragged edges
scrape or tearing causing loss of skin, can be extremely painful unless nerve endings are kept moist
What is a laceration
increased tissue loss with ragged edges
hard to clean, may need suture or have wound edges taped
What is an incision
clean, approximated wound edges resulting from a sharp-edged object
(scalpel or piece of glass)
What is a puncture
clean edges with a small entry, can penetrate deeply like a bullet wound or stepping on a nail
What is an animal bite
often a combination of a crush, laceration and puncture wound.
what is a burn
caused by an external thermal agent
what are the phases of wound healing?
- inflammatory phase (acute)
- proliferative phase (subacute)
- remodeling phase (chronic)
Describe the inflammatory phase of wound healing
-s/s = heat, redness, swelling, loss of function; pain at rest
-occurs immediately to 3-4 days
-hemostasis
-vasoconstriction
-platelet aggregation
-thromboplastin makes clot
-inflammation
-vasodilation
phagocytosis
what are the treatment and management goals for the inflammatory phase of wound healing?
decrease pain, maintain ROM, stabilize injured area, address compensation, patient education, prevent injury, control inflammation
Describe the proliferative phase of wound healing.
- s/s = pain with movement & digital pressure; localized pain
- occurs 2 days - 3 weeks
- granulation
- fibroblasts lay bed of collagen
- fills defect and produces new capillaries
- contraction
- wound edges pull together to reduce defect
- epithelialization
- crosses moist surface
- cell travel about 3cm from point of origin in all directions
what are the treatment goals for the proliferative phase of wound healing?
increase ROM, prevent atrophy, promote reorganization along lines of stress, control inflammation
Describe the remodeling phase of wound healing.
- s/s = localized pain, decreased ROM, muscle weakness, low-grade inflammation
- occurs 3 weeks - 2 years
- new collagen forms which increases tensile strength to wounds
- scar tissue is only 80% as strong as original tissue
what are the treatment and management goals for the remodeling phase of wound healing?
increase tissue strength, created functional scar tissue; improve ROM, balance & proprioception; prevent re-injury, promote muscle balance.
Describe first-degree burns
- cause erythema (redness) and swelling and may be quite painful
- skin will blanch upon pressure
- involve only the epidermis
- treatment generally involves cooling the burn with running water or application of cool cloths
- heal quickly and do not result in scarring
- most sunburns can be included as first-degree burns
Describe second-degree burns
- affect both the epidermis and the dermis to varying degrees
- depending on how much of the dermis is affected, these types of burns may result in scarring and may require skin grafting to heal
- may cause permanent disfigurement
- may also be quite painful as nerves are intact and undamaged
- manifest as erythema with superficial blistering of the skin, and involve more of less pain depending on the level of nerve involvement
Describe third-degree burns
- extend down into the hypodermis or subcutaneous tissue
- may affect underlying bone, nerves, tendons and other structures
- these burns in themselves are not generally painful, however there may be surrounding areas of partial-thickness burns that are painful
- will require surgery to close and may result in permanent disfigurement and disability
- risk for infection is very high
- can be life threatening if extensive
- burn victims will exhibit charring and extreme damage of the epidermis, and sometimes hard eschar will be present.
Describe fourth-degree burns
- damage muscle, tendon, and ligament tissue, thus result in charring and catastrophic damage of the hypodermis.
- in some instances the hypodermis tissue may be partially or completely burned away as well as this may result in a condition called compartment syndrome, which threatens both the life and the limb of the patient.
- grafting is required if the burn does not prove to be fatal
What is Radicular pain
- associated with nerve root compression
- sharp, shooting pain that can be accompanied by paresthesia corresponding to a dermatome or muscle weakness
- lancinating, bright and burning and also tends to run in the distribution of specific nerves
Define pain
-an unpleasant sensation signifying actual or possible injury
