Soft Tissue Healing

Question 1

What is a sprain?

Answer 1

Stretch and/or tear of a LIGAMENT.

Question 2

What is a strain?

Answer 2

Muscle/tendon injury - over contracting/lengthening a muscle causing tearing of collagen.

Question 3

Classification of a grade 1 strain/sprain.

Answer 3

• Micro-tears.
• Localised pain/tenderness.
• No visible bruising.
• Minimal swelling.
• Minimal loss of function.
• No loss of muscle strength/ROM.
• No ligament laxity.

Question 4

Classification of grade 2 strain/sprain.

Answer 4

• 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.

Question 5

Classification of grade 3 strain/sprain.

Answer 5

• 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.

Question 6

What are the factors that cause tissue damage?

Answer 6

Injury, Infection, Infarction, Immune reactions

Question 7

What are 3 types of tissue healing?

Answer 7

Resolution, tissue regeneration, connective tissue repair (replacement).

Question 8

What is resolution?

Answer 8

Rapid healing of mild injury

Question 9

What is tissue regeneration?

Answer 9

Specialised tissue is replaced by proliferation of surrounding undamaged specialised cells.

Question 10

What is connective tissue repair?

Answer 10

Lost tissue is replaced by granulation tissue which matures to form scar tissue.

Question 11

What are the 3 types of cell and can they regenerate?

Answer 11

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.

Question 12

What are the 4 stages of connective tissue repair?

Answer 12

Bleeding, inflammation, proliferation, remodelling.

Question 13

How long does the bleeding phase last?

Answer 13

Average 4-6hours but can continue to bleed significantly longer.

Question 14

How long does the inflammatory phase last?

Answer 14

Rapid onset and increases 1-3 days before gradually resolving over next 2 weeks.

Question 15

How long does the proliferative phase last?

Answer 15

24-48 hours after injury.

Question 16

What happens during the proliferative phase?

Answer 16

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.

Question 17

What is the function of fibroblasts?

Answer 17

They manufacture and secrete collagen to fill gaps after removal of damaged tissue because of phagocytosis. Excess collagen leads to scarring.

Question 18

When does the remodelling phases occur?

Answer 18

Begins at 3 weeks and can last up to 2 years.

Question 19

What factors affect wound healing?

Answer 19

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.

Question 20

What are the complications of tissue repair?

Answer 20

• Infection
• Ulceration
• Dehiscence
• Keloid development
• Adhesions