Scars + Contusions + Bruises

Question 1

Define ‘contracture’

Answer 1

anatomical shortening of connective tissue supporting structures over/around a joint (muscles, tendons, jint capsules)

Question 2

Define ‘adhesion’

Answer 2

union of two opposing surfaces

Question 3

What causes fibrotic adhesions?

Answer 3

ongoing chronic inflammation

Question 4

What is ‘proud flesh’?

Answer 4

thick, raised, red dermal granulation tissue that results from an abnormal healing process

Question 5

What is hypertrophic scarring?

Answer 5

overgrowth of dermal tissue that remains within the boundaries of the wound

Question 6

Hypertrophic scarring is most often associated with…

Answer 6

deep, partial or full-thickness burns that have healed through 2nd intention, or at the healing edges of skin grafts

Question 7

What is keloid scarring?

Answer 7

dermal scar tissue that extends beyond the boundaries of the original wound, in a tumour-like growth (do not respond well to surgical excision & frequently recur - steroids are more effective)

Question 8

Which type of scarring has collagen fibres arranged in nodular or whirl patterns?

Answer 8

hypertrophic

Question 9

What is essential to follow up scar massage with?

Answer 9

stretching of the scar

Question 10

What is a contusion compared to a bruise?

Answer 10

contusions involve a crush injury to the underlying muscle

bruises are a type of hematoma where blood escapes from ruptured capillaries and is dispersed in the surrounding tissue - this does not necessitate a contusion

Question 11

What is a hematoma?

Answer 11

large area of local hemorrhage following a trauma

Question 12

A hematoma contained in a fascial compartment may lead to…

Answer 12

compartment syndrome

Question 13

What is myositis ossificans?

Answer 13

an occasional complication after a hematoma, where the blood within muscle calcifies

Question 14

Scar tissue is only about ___ as strong as the tissue it replaces

Answer 14

80%

Question 15

What are the 3 causes of scar tissue?

Answer 15

inflammatory response
prolonged immobilization
paralysis or paresis of a structure due to PNS or CNS lesion (basically also prolonged immobilization…)

Question 16

What are the 5 types of scar tissue?

Answer 16

contracture
adhesions
proud flesh
hypertrophic scars
keloid scars

Question 17

When does proud flesh occur?

Answer 17

when a wound does not re-epithelialize, so chronic inflammation ensues

Question 18

Differentiate the typical appearance of hypertrophic vs. keloid scars other than the wound boundaries

Answer 18

hypertrophic: red, raised, can regress with time
keloid: shiny, round protuberances ranging from pink to purple, do not regress with time

Question 19

Keloid scarring is more common in…

Answer 19

Blacks, Asians, and younger people

Question 20

Keloid scars are most likely to occur where?

Answer 20

ear level to waist, shoulder to elbow

Question 21

How can massage prevent excessive scar tissue formation?

Answer 21

by decreasing edema

Question 22

How many sessions does it usually take for frictions to cause noticeable changes?

Answer 22

6-10

Question 23

What is the protocol for frictions (depth and timing)?

Answer 23

place tissue in a slight stretch to provide tension

light-to-moderate for 2-3min
(pause for circulatory techniques)
moderate-to-deep for 2-3min
(pause for circulatory techniques)
deep for 2-3min

discontinue at any point if pain does not decrease - first level should create analgesic effect

then, stretch, ice, and move through pROM

Question 24

What are the contraindications to cross-fibre frictions?

Answer 24

• patient is taking anti-inflammatories

* do not use on proud flesh, keloid scars, or with inflammatory arthritic conditions

Question 25

You explain frictions as homecare for your patient. What FID do you provide?

Answer 25

apply up to 6 times a day for up to 10-15 minutes
2-3 mins light
2-3 mins moderate
2-3 mins deep

Question 26

What would you want to strengthen to prevent contracture in a healing muscle?

Answer 26

its antagonist

Question 27

Define ‘hemorrhage’

Answer 27

active or ongoing bleeding

Question 28

Define ‘hematoma’

Answer 28

pathological collection of blood in body tissues

Question 29

What is the cause of myositis ossificans?

Answer 29

it’s idiopathic

Question 30

What is Dupuytren’s contracture?

Answer 30

a contracture of the tendons that flex the fingers

Question 31

What is the most effective treatment for keloids?

Answer 31

steroids

Question 32

Which type of scarring does not regress with time?

Answer 32

keloids

Question 33

Which type of scarring promotes scar contractures?

Answer 33

hypertrophic scarring

Question 34

Scar tissue is…

Answer 34

a collagen based tissue that develops as a result of the inflammatory process

Question 35

Irreversible contracture occurs when…

Answer 35

fibrotic tissue or bone replaces muscle and CT (permanent loss of ROM that can only be restored by surgery)

Question 36

Adhesions occur when…

Answer 36

Reduced motion at a joint allows cross-links to form among collagen fibres = reduced ROM

Question 37

In what 3 tissue situations would adhesion and their mechanism of cross-link formation be most likely to occur?

Answer 37

Tissue is left in a shortened position for long periods of time

Persistent postural dysfunctions

Immobilization

Question 38

When do scar tissue adhesions vs fibrotic adhesions occur?

Answer 38

scar tissue adhesions occur with acute inflammatory process

fibrotic adhesion occur with ongoing chronic inflammation leading to moderate to severe restrictions in ROM (difficult to eradicate)

Question 39

Scar tissue adhesions can usually be reduced with what 4 techniques?

Answer 39

myofascial release
cross-fiber frictions
joint play
stretching

Question 40

What areas of the body are keloid scars more likely to develop?

Answer 40

ear level to waist and shoulder to elbow

Question 41

What areas of the body are hypertrophic scars more likely to develop?

Answer 41

sternum, upper back, shoulder area, buttock and dorsal surface of foot.