Soft tissue healing Flashcards
What is a sprain
A sprain is a stretch and/ or a tear of ligaments, the fibrous band of connective tissue that join the end of one bone to another. Ligaments stabilize and support the body’s joints
Grading I-III injury for sprain- brief
posterior talofibular ligament- grade I (mild injury)- small tears normally parallel to muscle fibres, grade II injury- large (moderate), but incomplete tear, grade III injury- complete tear
What is a strain
a strain is a muscle or tendon injury- involves over contracting or lengthening a muscle causing tearing of collagen
internal and external factors for strain
internal- factors that relate to our body contraction or lengthening
external- factors outside the body, e.g. kicked
Grade 1 tear sprains and strains
ligament, tendon or muscle is overstretched with only micro- tears. Localised pain/ tenderness. no visible bruising. Minimal swelling and minimal loss of function
effects of grade I injury
Muscle- no loss of strength or ROM (<10°)
Ligament- non ligament laxity
Grade II
Partial tear of ligament, tendon, or muscle with immediate onset of all inflammatory signs. Moderate swelling, bruising, poorly localised pain, impairment and painful ROM (with deficit)
effect of grade II sprains and strains
muscle= decrease in strength and pain on contraction
Ligament- joint may be unstable
Grade III tear
complete rupture of ligament, tendon, or muscle,
both immediate acute pain, often audible pop, crack ,clock, all cardinal signs, later= symptoms may be less than grade II,
Effect of grade III tear
Sprain- joint instability
Strain- inability to contract muscle, separation may be evident
may require immobilisation and/ or surgery
British athletics muscle injury classification- muscle and tendon
grade injury 1-4, then subdivided into a,b,c
this provides more detail and information
the disadvantages of this system- is an MRI is needed within 24-48 hours, NHS cannot see patients this quickly
subcategories meaning (a,b,c)
A- denotes myofascial injury, B- musculotendinous injury, C- intratendinous injury
Factors that cause tissue damage- injury
physical- direct impact/ thermal- over heating/ cooling/ electrical/ radiatiational/ chemical
Factors that cause tissue damage- infection
viruses/ bacteria, fungi/ protozoa
Factors that cause tissue damage- infraction
myocardial infarct- where is obstruction in the blood supply ( in the heart)
Factors that cause tissue damage- immune reactions
foreign protein hypersensitivity, auto immunity
Types of body tissue- parenchymal tissue
functioning cells or organs, e.g. neuronal tissue (brain), epithelial tissue (skin), cardiac myocyte tissue (heart), hepatocyte tissue (liver)
Types of body tissue- stromal (Interstitial) tissue
supporting connective tissue, contains many cell types including fibroblasts, blood vessels, nerves and nerve endings
3 types of tissue healing- resolution
rapid healing of mild injury, epithelial cells slough and regenerate without incidents, this is where the body can remove information to restore the body to its original state
3 types of tissue healing- tissue regeneration
specialized tissue is replaced by proliferation of surrounding undamaged specialised cells, for example injured tissues are repaired with parenchyma
3 types of tissue healing- replacement
connective tissue repair- lost tissue is replaced by granulation tissue which matures to form scar tissue
types of cells: the ability to regenerate- labile cells
constant turnover, e.g. skin cells
types of cells: the ability to regenerate- stable cells
usually stop growing once growth stops, i.e. the liver, requires a supportive framework if damage occurs
types of cells: the ability to regenerate- fixed pereant non dividing cells
cannot undergo mitosis, i.e. muscle, nerve, cardiac tissue repair leaves a scar
tissue regeneration
growth factors released from damaged tissues and cells (platelet growth factors, cytokines- increased mitogenic activity (mitosis), injured tissue replaced with parenchymal cells, little evidence of injury after repair
connective tissue repair- timesclae
6-8 weeks- bleeding
2-3 weeks- inflammation, days- months- proliferation, weeks to months remodelling
these overlap
connective tissue repair- Bleeding phase
occurs following injury, relatively short lived, more vascular tissue (e.g. muscle) will bleed for longer, other tissues (e.g. ligaments) bleed less in volume and duration
connective tissue repair- the inflammatory process
changes in blood flow- exudation of protein rich fluid (oedema), leukocyte migration- WBC such as neutrophils attract macrophages, phagocytosis- removal of waste, lymphatic drainage- leads to decreased swelling, release chemicals- histamine, bradykinin
connective tissue repair- the proliferative phase 1
fibroblasts- produce and secrete collagen - they lay down type 3 collagen first (weaker), macrophages and blood vessels proliferate to form granulation tissues, angiogenesis occurs with development of capillary buds , capillary network is leaky
connective tissue repair- proliferative phase 2
WBC and plasma rich proteins leak into tissues, collagen synthesis continues a result of fibroblast proliferation, collagen type III synthesis reaches its peak between 5-7 days and lasts for several weeks, granulation tissue matures
what happens when granulation tissue matures
lymphatic development, nerve fibre in growth, mast cell invasion
connective tissue repair- remodeling/ maturation process
begins at 3 weeks and can last 2 years- no evidence suggests it starts before this, continuous remodelling of scar tissue, collagen (type 1) synthesis of fibroblasts, simultaneous lysis b collagenase enzymes
What is an important influencing factor during the remodelling/ maturation process
physical stress is an important influencing factor at this stage
phases of wound healing
1- haemostasis, 2- inflammatory, 3- proliferative, 4- remodelling
what is primary healing (wound edges are approximated)-
wound edges joined by fibrin plug, regrowth of base layer of epidermis, lysis of fibrin and re-epithelization, restoration to intact skin
what is secondary healing (wound edges are seperated)
large defect filled with blood clot, new blood vessels and fibroblasts (granulation tissue) grow from the dermis into fibrin, collagen laid down by granulation tissue, fibroblasts to restore integrity, maturation of collagen achieves structural integrity and allows regrowth of epidermis, leads to more scar formation and takes longer
factors that affect tissue healing
nature of injury- type of cell, site of injury, temperature- cold- delays healing, drugs- steroid and NSAIDs, prolonged inflammation, movement= + or - stress, malnutrition, blood flow and oxygen delivery, wound separation, infection, foreign bodies age, adhesion to bone/ tissue
complications to tissue repair- infection
invasion by microorganisms
complications to tissue repair- ulceration
circumscribed, open, crater like lesion of the skin and mucous membrane
complications to tissue repair- dehiscence
deficient scar formation, wound separates
complications to tissue repair- keloid development
hypertrophic scars, excessive collagen production
complications to tissue repair- adhesion
fibrous connections between cavities and tissues
