scar tissue, burns, wounds, inflammatory Flashcards
what is scar tissue
collagen based tissue that develops from inflammatory process
what are the types of scars (8)
contracture
adhesion
scar tissue adhesion
fibrotic adhesion
irreversible contracture
proud flesh
hypertrophic scarring
keloid
describe contracture
shortening of CT structures over a joint
describe adhesion
reduced ROM at a joint allows cross links to form among collagen fibres
when tissue is left in a shorted position for a long time
describe fibrotic adhesion
occuring w ongoing chronic inflammation
difficult to eradicate
describe scar tissue adhesion
occurs w an injury or acute inflaamm. process
describe irreversible contracture
when fibrotic tissue or bone replaces muscle or CT
permanent loss of ROM
describe proud flesh
thick dermal granulation tissue from an abnormal healing process
happens when wound doesn’t re-epithelialize
results in disorganized collagen and capillaries susceptible to damage
describe hypertrophic scarring
overgrowth of dermal tissue that remains within boundaries of the wound
describe keloid scar
dermal scar tissues that extends beyond the boundaries of OG wound
can continue to grow for many years
effects of massage on scar tissue
decrease edema before scar tissue develops
stretching the scar tissue after massage is essential to realign collagen fibres
helps desensitize the area through tactile stimulation
prevent hypertrophic scarring
increase circulation
CI’s w scar tissue
frictions if taking anti inflammatory meds
frictions not recommended for proud flesh/keloid
what is a spasm
an involuntary sustained contraction of a muscle
describe reflex muscle guarding
painful muscle spasm is response to pain
it acts to functionally splint the injury preventing further movement / injury
describe intrinsic muscle spasm
part of self perpetuating pain spasm cycle
result from direct or indirect trauma
increase in SNS firing
what is tone
resistance of relaxed muscle and CT to palpation
continuous contraction of a muscle in response to the stimulation of the nervous system
what is tension
increase in tone palpated in muscle fibres that tend to shorten
what causes a muscle contraction
myosin filaments and actin moving past each other, pulling on actin
releasing and rebonding
repeated actions cause muscle contraction
fascicles, muscle fibres, made up of myofibrils
sarcomeres
what do the mm spindles and golgi tendon organs do together
transmit proprioceptive info from muscle to the CNS to allow proper functioning
what are muscle spindles
major sensory organs that aid in control of movements
measure stretch *
what do muscle spindles measure and where are they located
stretch and speed
located in the muscle belly
what are golgi tendon organs
nerve receptors located int tendons near their attachments
protect muscle from overstretch injury
causes of mm spasms (6)
pain
circulatory stasis
increased gamma neuron firing
chilling of the muscle
lack of vit d
impaired nutrition
CI’s with spams
do not remove spasm reflexive spasm in acute/subacute stages that is splinting an injury
massage is locally CI’d w deep vein thrombosis
hot hydro w acute injury spasm
passively stretching acute injury spasm
what is reciprocal inhibition
when one muscle contracts another lengthens
reflex action for a muscle to relax
some tx goals for spasm
break the pain spasm cycle and decrease spasm
decrease pain and SNS firing
increase local circulation
increase ROM
decrease hypertonicity
what indirect techniques would be used first for a spasm
GTO release
muscle approximation
types of healing
re-epithelization
granulation tissue
scar tissue
what is re-epithelization
applies only if skin is damaged
superficial damage
no scar tissue, normal tissue structure results
regeneration is possible
what is granulation tissue
part of any tissue repair when there is 1st or 2nd intention healing
new blood vessels develop from venues at the edge of an injury called neoangiogenesis (coordinated growth of blood vessels & nerves)
fibroblasts are important , they form loose CT matrix
result is vascular CT
when does scar tissue occur
when there is increased loss of epidermal and dermal tissue layers
mature collagen repair
what is first intention healing
some tissue loss and wound edges are approximated
healing is efficient w small amounts of collagen produced to repair
what is second intention healing
when extensive tissue damage or a large area is affected
penetration of dermis
wound edges cannot be brought together easily
healing takes longer
describe early subacute stage
2-3 days post injury -continue up to 3 weeks
diminishing sign of inflammation
muscle spasm diminishes
what is the primary process of the early subacute stage
filling damaged area w new tissue
describe subacute stage
within 2 days - 3 weeks -6 weeks
wound closure takes 5-8 days,
tendon/muscle takes 3-5 wks
gradual restoration of damaged structure
describe late subacute
2-3 weeks after subacute stage
pocket of residual swelling
potential loss of ROM, min discomfort
p is experienced w overpressure of tissue
what is scar remodelling
reshaping of healing area as existing collagen is broken down, new collagen is synthesized
cross links develop among fibres
strength of site increases
tx goals at late subacute
decrease remaining edema
reduce trigger points
decrease pain and adhesions
improve ROM/ strength
tx goals for early subacute/subacute
decrease inflammation, pain, swelling and spasm
maintain ROM/strength
now can treat peripheral but not distal to injury site
tx goals for acute stage
limit inflammatory process
reduce pain/swelling
decrease SNS firing
protective spasms are reduced but not removed
compensatory structures are treated
describe chronic stage
2-3 weeks continue up to 2-3 years
inflamm. process is resolved
likely no edema but loss of ROM w decrease in function
tx for chronic
reduce restrictive adhesions and trigger points and restore ROM and strength to affected areas
what does the dermis contain
sebaceous and sweat glands
hair follicles
nerve receptors
blood vessels
lymphatic vessels
what does the subcutaneous contain
adipose tissue, larger blood vessles
deep hair follicles
functions of skin
excretion/absorption
vit d synthesis
thermoregulation
fat storage
gas exchange
protection
wound definition
a disruption of the continuity of the skin
what is an abrasion
superficial wound w ragged edges
what is a laceration
increased tissue loss w ragged wound edges
incision
clean approximated edges
puncture
clean edges w small entry point
risk of wound closing over before damage is healed, increase in infection
animal bite
combo of crush, laceration, puncture wound
how can healing occur
simple generation or 1st or 2nd intention healing
superficial burn
affects epidermis
1st degree burn
healing is rapid without scar tissue
partial thickness burn
second degree
affects epidermis and dermis
BLISTERS
full thickness burn
third degree
damage to all skin layers
burns appear dry, inelastic, white, waxy, charred
re-epithelization is not possible
4th degree damages all layers plus muscle and bone
rule of nines
used to explain the % of the body surface damaged by the burn
complications of burns
breathing
inhalation injuries
GI
renal
heterotrophic calcification
burned skin
thermoregulation
peripheral nerve damage
sensory impairment or loss
subluxation & discoloration
amputation
what is hypertrophic scar tissue
as scars develop there is ongoing deposition and destruction of collagen
tissue appears heaped up
