Principles of Tissue Healing Flashcards
Duration of pain is 0-7 days
Acute
Duration is 7 days to 7 weeks
Subacute
Duration is >7 weeks
Chronic
What are the 3 main phases of healing
- Primary
- Secondary
- Maturation
What occurs during the primary phase of healing (4)
- Mitosis in fibroblasts and endothelial cells
- Fibroblasts move into the damaged tissue
- Small capillary sprouts move into periphery of the damaged area
- Phagocytosis
What type of pain is constant pain
Chemical pain
What occurs during the secondary phase of healing (3)
- Fibroblasts and capillaries invade the area
- Fibroblasts start to produce collagen
- Collagen fibers increase in diameter
What occurs in the maturation phase of healing (3)
- Continuation of collagen synthesis (slow)
- Increase of intramolecular cross-linking of collagen fibers: increase in tensile strength
- Orientation of collagen parallel to lines of tension
How long do collagen fibers increase in diameter in the secondary phase of healing
7-14 days
How long do collagen fibers increase in tensile strength in the maturation phase
2-4 months
Which phase do fibroblasts produce collagen slowly
Maturation
What phase do fibroblasts produce collagen fastly
Secondary
What are the 2 ways tissue injury can occur
- Trauma
2. Insidious onset
What is microtrauma
Insidious onset
What is macrotrauma
Trauma
True or False:
Both macrotrauma and microtrauma result in tissue injury and a resultant imflammatory response
TRUE
Does inflammation produce constant or phasic pain
Constant
What are the 3 steps of tissue repair
- Inflammation
- Repair
- Remodeling
Do connective tissue and muscle regenerate
NO
What replaces damaged connective tissue or muscle
Inferior fibrous scar tissue
What is inflammation (3)
- Increased local blood supply
- Leaking of plasma proteins and leukocytes from the blood vessels
- Accumulation of white blood cells at the site of injury
What are the 4 cardinal signals of inflammation
- Calor
- Rubor
- Dolor
- Tumor
In optimal conditions how long does inflammation last
Less than 5 days
How long does the tissue repair stage last
3 weeks
What are the 3 steps of tissue repair
- Collagen and glycosaminoglycaans that replace the dead and damaged tissue are laid down
- Rapid increase in the amount of collagen, damaged nerve endings and capillaries “sprout” and invade the area
- Cellular activity is stimulated by physical stresses to the tissue
When inactive does collagen turn over occur
Yes
When inactive does collagen get oriented according to the line of stress
No
What does appropriate education and movement provide
The optimal climate for uncomplicated repair
What is remodeling
The process of turning weak, immature, and disorganized scar into a functional structure able to perform normal tasks
Wound repair is considered optimal if what
Remodeling of the scar occurs
What does progressively normal use and specific loading increase
Strength and flexibility of the scar tissue
What does regular application of intermittent stress or loading to bone and normal soft tissue enhance
Structural integrity
What may disrupt the repair process
Prolonged loading
What damages scar tissue
Prolonged stress
What strengthens scar tissue
Intermittent stress
What is another name for remodeling
Wolf’s Law
What does failure or inflammation, repair, or remodeling or inadequate or ineffectual repair lead to (2)
- Chronic pathological changes
2. Repeated structural failure
What does failure to remodel result in (5)
- Collagen shortening over time
- Recently formed scar tissue can stretch
- Contracture of old scar tissue may continue for years
- Cross linkage of newly synthesized collagen fibers can prevent full movement
- Nerve endings can cause the scar tissue to be sensitized like normal tissue
What does applying regular stress sufficient to provide tension without damage do to the collagen
Causes collagen to undergo chemical and structural changes that allow elongation and strengthening of the affected tissue
When does the recently formed scar tissue begin to shorten
3rd to 6 months
What effect the remodeling process (4)
- Previous trauma
- Inflammatory
- Degenerative
- Past derangement
How can we apply sufficient stress without damage
Patient response method
What is increased pain
Goes from 3 to 5
What is produced pain
Goes from 0 to some level
True or False:
You should always ask the patient if the pain has not gone away and gotten worse
True
True or False:
Chronic conditions in which symptoms remain relatively stable over time appear to get “stuck” in the repair process
True
What is degenerative tendonopathy thought to be caused by
Hypoxia and microtrauma
Failure to repair may result from a combination of what (4)
- Slow or failed healing
- Avascularity
- Degenerated tissue
- Lack of appropriate stresses
Failure to remodel leads to what
Imperfect repair
What are the effects of stress deprivation (3)
- Weakens and atrophies ligament, tendon, muscle, and bone
- Degrades surfaces and tissue interfaces
- Causes disorganized tissue to bond randomly together
True or False:
Injuries can be made to heal faster than their natural rate
False
What can happen is the tissue is still stiff and painful long after the expected period of healing
The person may become anxious and lose conidence
What are the factors restricting normal return to function (9)
- Poor blood supply or ischemia
- Lack of initial protection and reduction of swelling in acute stage
- Lack of early mobilization
- Continued inflammation
- Systemic or local steroids which decrease the tensile strength of wound, slows the rate of wound closure and vascularization
- Poor nutrition
- Diabetes
- Overabundant deposition of collagen
- Level of physical activity
What does an overabundant deposition of collagen lead to
Keloid scar
