Soft Tissue Healing Flashcards
What is a sprain?
Stretch and/or tear of a LIGAMENT.
What is a strain?
Muscle/tendon injury - over contracting/lengthening a muscle causing tearing of collagen.
Classification of a grade 1 strain/sprain.
- Micro-tears.
- Localised pain/tenderness.
- No visible bruising.
- Minimal swelling.
- Minimal loss of function.
- No loss of muscle strength/ROM.
- No ligament laxity.
Classification of grade 2 strain/sprain.
- Partial tear w/ immediate onset of inflammatory signs.
- Moderate swelling.
- Bruising.
- Poorly localised pain.
- Impairment and painful ROM.
- Decreased muscle strength and pain on contraction.
- Joint may be unstable.
Classification of grade 3 strain/sprain.
- Complete rupture
- Increased joint stability
- Inability to contract muscle, separation may be evident.
- Immediate acute pain, often audible.
- Later symptoms may be less than grade 2.
- May require immobilisation and/or surgery.
What are the factors that cause tissue damage?
Injury, Infection, Infarction, Immune reactions
What are 3 types of tissue healing?
Resolution, tissue regeneration, connective tissue repair (replacement).
What is resolution?
Rapid healing of mild injury
What is tissue regeneration?
Specialised tissue is replaced by proliferation of surrounding undamaged specialised cells.
What is connective tissue repair?
Lost tissue is replaced by granulation tissue which matures to form scar tissue.
What are the 3 types of cell and can they regenerate?
Labile cells (e.g. skin cells) - constant turn over. Stable cells (e.g. liver) - stop growing when growth stops, requires supportive framework if damage occurs. Fixed (permanent) cells (e.g. nerve, muscle, cardiac) - Can't undergo mitosis, usually leaves scars.
What are the 4 stages of connective tissue repair?
Bleeding, inflammation, proliferation, remodelling.
How long does the bleeding phase last?
Average 4-6hours but can continue to bleed significantly longer.
How long does the inflammatory phase last?
Rapid onset and increases 1-3 days before gradually resolving over next 2 weeks.
How long does the proliferative phase last?
24-48 hours after injury.
What happens during the proliferative phase?
Fibroblasts, macrophages & blood vessels proliferate to form granulation tissue. Angiogenesis occurs (new vessels growing into soft tissue). Capillary network is leaky and WBC and plasma proteins leak into tissue.
What is the function of fibroblasts?
They manufacture and secrete collagen to fill gaps after removal of damaged tissue because of phagocytosis. Excess collagen leads to scarring.
When does the remodelling phases occur?
Begins at 3 weeks and can last up to 2 years.
What factors affect wound healing?
Nature of injury, site of injury, temp, drugs like steroids and NSAIDs, prolonged inflammation, too little or too much movement, malnutrition, blood flow and O2 delivery, infection, wound separation, foreign bodies, age, adhesions to bone/tissues.
What are the complications of tissue repair?
- Infection
- Ulceration
- Dehiscence
- Keloid development
- Adhesions
