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Pathophysiology PH1002 > Soft tissue healing > Flashcards

Soft tissue healing Flashcards

1
Q

What is a sprain

A

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

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2
Q

Grading I-III injury for sprain- brief

A

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

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3
Q

What is a strain

A

a strain is a muscle or tendon injury- involves over contracting or lengthening a muscle causing tearing of collagen

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4
Q

internal and external factors for strain

A

internal- factors that relate to our body contraction or lengthening
external- factors outside the body, e.g. kicked

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5
Q

Grade 1 tear sprains and strains

A

ligament, tendon or muscle is overstretched with only micro- tears. Localised pain/ tenderness. no visible bruising. Minimal swelling and minimal loss of function

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6
Q

effects of grade I injury

A

Muscle- no loss of strength or ROM (<10°)

Ligament- non ligament laxity

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7
Q

Grade II

A

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)

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8
Q

effect of grade II sprains and strains

A

muscle= decrease in strength and pain on contraction

Ligament- joint may be unstable

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9
Q

Grade III tear

A

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,

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10
Q

Effect of grade III tear

A

Sprain- joint instability
Strain- inability to contract muscle, separation may be evident
may require immobilisation and/ or surgery

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11
Q

British athletics muscle injury classification- muscle and tendon

A

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

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12
Q

subcategories meaning (a,b,c)

A

A- denotes myofascial injury, B- musculotendinous injury, C- intratendinous injury

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13
Q

Factors that cause tissue damage- injury

A

physical- direct impact/ thermal- over heating/ cooling/ electrical/ radiatiational/ chemical

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14
Q

Factors that cause tissue damage- infection

A

viruses/ bacteria, fungi/ protozoa

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15
Q

Factors that cause tissue damage- infraction

A

myocardial infarct- where is obstruction in the blood supply ( in the heart)

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16
Q

Factors that cause tissue damage- immune reactions

A

foreign protein hypersensitivity, auto immunity

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17
Q

Types of body tissue- parenchymal tissue

A

functioning cells or organs, e.g. neuronal tissue (brain), epithelial tissue (skin), cardiac myocyte tissue (heart), hepatocyte tissue (liver)

18
Q

Types of body tissue- stromal (Interstitial) tissue

A

supporting connective tissue, contains many cell types including fibroblasts, blood vessels, nerves and nerve endings

19
Q

3 types of tissue healing- resolution

A

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

20
Q

3 types of tissue healing- tissue regeneration

A

specialized tissue is replaced by proliferation of surrounding undamaged specialised cells, for example injured tissues are repaired with parenchyma

21
Q

3 types of tissue healing- replacement

A

connective tissue repair- lost tissue is replaced by granulation tissue which matures to form scar tissue

22
Q

types of cells: the ability to regenerate- labile cells

A

constant turnover, e.g. skin cells

23
Q

types of cells: the ability to regenerate- stable cells

A

usually stop growing once growth stops, i.e. the liver, requires a supportive framework if damage occurs

24
Q

types of cells: the ability to regenerate- fixed pereant non dividing cells

A

cannot undergo mitosis, i.e. muscle, nerve, cardiac tissue repair leaves a scar

25
Q

tissue regeneration

A

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

26
Q

connective tissue repair- timesclae

A

6-8 weeks- bleeding
2-3 weeks- inflammation, days- months- proliferation, weeks to months remodelling
these overlap

27
Q

connective tissue repair- Bleeding phase

A

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

28
Q

connective tissue repair- the inflammatory process

A

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

29
Q

connective tissue repair- the proliferative phase 1

A

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

30
Q

connective tissue repair- proliferative phase 2

A

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

31
Q

what happens when granulation tissue matures

A

lymphatic development, nerve fibre in growth, mast cell invasion

32
Q

connective tissue repair- remodeling/ maturation process

A

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

33
Q

What is an important influencing factor during the remodelling/ maturation process

A

physical stress is an important influencing factor at this stage

34
Q

phases of wound healing

A

1- haemostasis, 2- inflammatory, 3- proliferative, 4- remodelling

35
Q

what is primary healing (wound edges are approximated)-

A

wound edges joined by fibrin plug, regrowth of base layer of epidermis, lysis of fibrin and re-epithelization, restoration to intact skin

36
Q

what is secondary healing (wound edges are seperated)

A

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

37
Q

factors that affect tissue healing

A

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

38
Q

complications to tissue repair- infection

A

invasion by microorganisms

39
Q

complications to tissue repair- ulceration

A

circumscribed, open, crater like lesion of the skin and mucous membrane

40
Q

complications to tissue repair- dehiscence

A

deficient scar formation, wound separates

41
Q

complications to tissue repair- keloid development

A

hypertrophic scars, excessive collagen production

42
Q

complications to tissue repair- adhesion

A

fibrous connections between cavities and tissues

Pathophysiology PH1002 (22 decks)

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