Scars + Contusions + Bruises Flashcards
Define ‘contracture’
anatomical shortening of connective tissue supporting structures over/around a joint (muscles, tendons, jint capsules)
Define ‘adhesion’
union of two opposing surfaces
What causes fibrotic adhesions?
ongoing chronic inflammation
What is ‘proud flesh’?
thick, raised, red dermal granulation tissue that results from an abnormal healing process
What is hypertrophic scarring?
overgrowth of dermal tissue that remains within the boundaries of the wound
Hypertrophic scarring is most often associated with…
deep, partial or full-thickness burns that have healed through 2nd intention, or at the healing edges of skin grafts
What is keloid scarring?
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)
Which type of scarring has collagen fibres arranged in nodular or whirl patterns?
hypertrophic
What is essential to follow up scar massage with?
stretching of the scar
What is a contusion compared to a bruise?
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
What is a hematoma?
large area of local hemorrhage following a trauma
A hematoma contained in a fascial compartment may lead to…
compartment syndrome
What is myositis ossificans?
an occasional complication after a hematoma, where the blood within muscle calcifies
Scar tissue is only about ___ as strong as the tissue it replaces
80%
What are the 3 causes of scar tissue?
inflammatory response
prolonged immobilization
paralysis or paresis of a structure due to PNS or CNS lesion (basically also prolonged immobilization…)
What are the 5 types of scar tissue?
contracture adhesions proud flesh hypertrophic scars keloid scars
When does proud flesh occur?
when a wound does not re-epithelialize, so chronic inflammation ensues
Differentiate the typical appearance of hypertrophic vs. keloid scars other than the wound boundaries
hypertrophic: red, raised, can regress with time
keloid: shiny, round protuberances ranging from pink to purple, do not regress with time
Keloid scarring is more common in…
Blacks, Asians, and younger people
Keloid scars are most likely to occur where?
ear level to waist, shoulder to elbow
How can massage prevent excessive scar tissue formation?
by decreasing edema
How many sessions does it usually take for frictions to cause noticeable changes?
6-10
What is the protocol for frictions (depth and timing)?
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
What are the contraindications to cross-fibre frictions?
- patient is taking anti-inflammatories
* do not use on proud flesh, keloid scars, or with inflammatory arthritic conditions
You explain frictions as homecare for your patient. What FID do you provide?
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
What would you want to strengthen to prevent contracture in a healing muscle?
its antagonist
Define ‘hemorrhage’
active or ongoing bleeding
Define ‘hematoma’
pathological collection of blood in body tissues
What is the cause of myositis ossificans?
it’s idiopathic
What is Dupuytren’s contracture?
a contracture of the tendons that flex the fingers
What is the most effective treatment for keloids?
steroids
Which type of scarring does not regress with time?
keloids
Which type of scarring promotes scar contractures?
hypertrophic scarring
Scar tissue is…
a collagen based tissue that develops as a result of the inflammatory process
Irreversible contracture occurs when…
fibrotic tissue or bone replaces muscle and CT (permanent loss of ROM that can only be restored by surgery)
Adhesions occur when…
Reduced motion at a joint allows cross-links to form among collagen fibres = reduced ROM
In what 3 tissue situations would adhesion and their mechanism of cross-link formation be most likely to occur?
Tissue is left in a shortened position for long periods of time
Persistent postural dysfunctions
Immobilization
When do scar tissue adhesions vs fibrotic adhesions occur?
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)
Scar tissue adhesions can usually be reduced with what 4 techniques?
myofascial release
cross-fiber frictions
joint play
stretching
What areas of the body are keloid scars more likely to develop?
ear level to waist and shoulder to elbow
What areas of the body are hypertrophic scars more likely to develop?
sternum, upper back, shoulder area, buttock and dorsal surface of foot.
