Pain, scars, wounds, and burns

Question 1

Define cutaneous pain

Answer 1

• superficial tissue damage

- sharp, bright, burning and well-localized

Question 2

Define Deep somatic pain

Answer 2

• from muscles, tendons, joints, and periosteum

- more diffuse &can refer to other areas of the body

Question 3

Define Visceral pain

Answer 3

• arises from visceral distension or ischemia or strong, abnormal gastrointestinal contractions
• often disffuse

Question 4

What is referred pain

Answer 4

• 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

Question 5

What is functional or psychogenic pain

Answer 5

-believe to arise from the emotions of psyche but is experienced as though it originates from an organic disorder.

Question 6

What is capsular pattern

Answer 6

• 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

Question 7

What is non-capsular pattern

Answer 7

• 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.

Question 8

Define contracture

Answer 8

the shortening of connective tissue supporting structures over or around a joint

Question 9

Define adhesion

Answer 9

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)

Question 10

What is scar tissue adhesion

Answer 10

occurs with an injury or an acute inflammatory process. collagen fibers during tissue repair allow adhesions and contractures to form in random patterns

Question 11

Define fibrotic adhesions

Answer 11

occurs with ongoing chronic inflammation can cause moderate to severe restrictions in ROM.
(hard to get rid of)

Question 12

What is proud flesh

Answer 12

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)

Question 13

What is hypertrophic scarring

Answer 13

overgrowth of dermal tissue that remains within the boundaries of the wound
(associated with deep partial or full thickness burns)

Question 14

What is a keloid scar

Answer 14

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.

Question 15

What are CI’s for treatment of scar tissue

Answer 15

• frictions if client on anti-inflammatory drugs.

- frictions are not recommended for proud flesh or keloid scars.

Question 16

What is a wound?

Answer 16

a disturbance of the continuity of the skin

Question 17

what is an abrasion?

Answer 17

superficial wound with ragged edges

scrape or tearing causing loss of skin, can be extremely painful unless nerve endings are kept moist

Question 18

What is a laceration

Answer 18

increased tissue loss with ragged edges

hard to clean, may need suture or have wound edges taped

Question 19

What is an incision

Answer 19

clean, approximated wound edges resulting from a sharp-edged object
(scalpel or piece of glass)

Question 20

What is a puncture

Answer 20

clean edges with a small entry, can penetrate deeply like a bullet wound or stepping on a nail

Question 21

What is an animal bite

Answer 21

often a combination of a crush, laceration and puncture wound.

Question 22

what is a burn

Answer 22

caused by an external thermal agent

Question 23

what are the phases of wound healing?

Answer 23

• inflammatory phase (acute)
• proliferative phase (subacute)
• remodeling phase (chronic)

Question 24

Describe the inflammatory phase of wound healing

Answer 24

-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

Question 25

what are the treatment and management goals for the inflammatory phase of wound healing?

Answer 25

decrease pain, maintain ROM, stabilize injured area, address compensation, patient education, prevent injury, control inflammation

Question 26

Describe the proliferative phase of wound healing.

Answer 26

• 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

Question 27

what are the treatment goals for the proliferative phase of wound healing?

Answer 27

increase ROM, prevent atrophy, promote reorganization along lines of stress, control inflammation

Question 28

Describe the remodeling phase of wound healing.

Answer 28

• 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

Question 29

what are the treatment and management goals for the remodeling phase of wound healing?

Answer 29

increase tissue strength, created functional scar tissue; improve ROM, balance & proprioception; prevent re-injury, promote muscle balance.

Question 30

Describe first-degree burns

Answer 30

• 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

Question 31

Describe second-degree burns

Answer 31

• 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

Question 32

Describe third-degree burns

Answer 32

• 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.

Question 33

Describe fourth-degree burns

Answer 33

• 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

Question 34

What is Radicular pain

Answer 34

• 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

Question 35

Define pain

Answer 35

-an unpleasant sensation signifying actual or possible injury