soft tissue injury, repair and management Flashcards
week 2
4 phases of rehabilitation
phase I: max protection
phase II: moderate protection/controlled motion
phase III: minimum to no protection/return to function
phase IV: chronic inflammation & persisting dysfunction
macrotrauma vs microtrauma
macro - specific MOI
micro - repetitive strain overload over time ; cumulative
is acute a macro or micro trauma?
macro
is a chronic injury a macro or micro trauma?
can be either
What are the grades of soft tissue injury?
Grade 1
Grade 2
Grade 3
what is a grade 1 soft tissue injury?
- mild pain at onset or within the first 24 hrs
- mild swelling, local tenderness and pain occur when injred tissue is stressed
what is a grade 2 soft tissue injury?
- moderate pain that requies activity stoppage
- stsress and palpation of injured tissue greatly increase pain
- incomplete tearing; with ligamentous injury some fibers are torn resulting in increased joint mobility
what is a grade 3 soft tissue inury?
- near complete/ tear/ avulsion (tendon or ligament) with severe pain
- stress to injred tissue usually painless -why (nothing there, no connection)
- palpation may reveal the defect
- a torn ligament results in joint instability
stages of tissue healing
acute stage (typically first 3-5 days post onset)
inflammatory response phase
stages of tissue healing
subacute stage (day 4-21 post onset; may last up to 6 wks)
fibroblastic repair phase
stages of tissue healing
chronic stage 3 wks post onset > 1 year
maturation-remodeling phase
stages of tissue healing
characteristics & clinical signs - ACUTE: inflammation
days 3-5
vascular changes
- constriction followed by dilation
exudation of cells and chemicals
- stuff oozes out
clot formation
phagocytosis
early fibroblastic activity
stages of tissue healing
what are some clinical signs of acute: inflammation stage of tissue healing (3-5)
- inflammation
- pain before tissue resistance
ex: medial talar tilt test; will report pain before full test starts
stages of tissue healing
characteristics & clinical signs: subacute - proliferation
days 4-21
- removal of noxious stimulu
- growth of capillary beds into area
- collagen formation
- granulation tissue
- very fragile, easily injury tissue
clinical signs:
- decreasing inflammation
- pain synchronous with tissue resistance
stages of tissue healing
characteristics & clinical signs: Chronic - maturation & remodeling
3wks>1 yr
- maturation of connective tissue
- contracture and remodeling of scar
- collagen aligns to stress (type III vs type I)
clinical signs:
- absence of inflammation
- pain after tissue resistance
ex: medial talr tilt test; once resistance is placed, then pain
tissue specific healing timeframes
wound?
1-3 days: inflammation
3-7 days: proliferation
5 days to 8-18 mos: remodeing
tissue specific healing timeframes
muscle
6 hrs up to 3 wks: inflammation
7-18 days: proliferation
6 wks-6 mos: remodeling
- contraction ability is 90% normal
what does mucle have a longer inflammation period in healing?
its contractile –> still using it
tissue specific healing times
bone
immediately-4 days: inflammation
4 days- 6 wks: proliferation
6-12 wks: remodeling
- near normal strength is attained
what tissue has the shortest remodeling phase?
bone - high vasculatur and highly metabolic
tissue specific healing timeframes
articular cartilage
48hrs-5 days: inflammation
2 wks-1mos: proliferation
2-6 mos: remodeling
- type 1 and 2 collagen have near normal appearance
tissue specific healing timeframes
tendon
first 3 days -1 wk: inflammation
10-42 days: proliferation
6-50 wks: remodeling
- 40-50 wks- strenth is 85%-95% normals
soft tissue injury management
phase 1: maximum protection
impairments of body structure and function
- inflammation, joint effusion, pain, edema, muscle spasm
- impaired movement
- restricted use of associated areas
soft tissue inury management
phase 1: maximum protection
PT’s role:
goal:
PT’s role:
- control inflammation
- facilitate healing
- maintain normal function in unaffected tissues and regions
goals:
- control inflammation
- prevent deleterious effects of rest (deconditioning, lost of strength)
soft tissue injury managment
phase 1: maximum protection
precautions
condraindications
precautions:
- the properdosage of rest adn movemetn must be used during the inflammatory stage
condraindications:
- stretching and resistance exercises should not be perforemd at the site of the inflamed or swollen tissue (simply no stretch or resistance training)
