Soft Tissue Injury, Repair, and Mgmt Flashcards
What does injury result in?
tissue damage and initiation of healing response (inflammation can occur too)
What is the overstretching, overexertion, overuse of sift tissue?
Strain
What is severe stress, stretch, or tear of soft tissues?
sprain
What is the displacement of a part - usually boney partners in a joint that results in loss of the anatomic relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm?
dislocation
What is an incomplete or partial dislocation of boney partners in a joint that often involves secondary trauma to surrounding soft tissue?
subluxation
What is inflammation of a synovial membrane/excess synovial fluid in a joint or tendon sheath?
synovitis
What is bleeding into a joint, usually due to severe trauma?
hemarthrosis
What is ballooning of the wall of a joint capsule or tendon sheath?
ganglion
What is inflammation of a bursa?
bursitis
What is bruising from a direct blow resulting in capillary rupture, bleeding, and an inflammatory response?
contusion
What is inflammation of a joint?
arthritis
What is limitation of a joint without inflammation?
arthrosis
What is inflammation of the synovial membrane covering a tendon?
tenosynovitis
What is inflammation of a tendon?
tendinitis
What is inflammation with thickening of a tendon sheath?
tenovaginitis
What is degeneration of the tendon due to repetitive microtrauma?
tendinosis
True/False: If a rupture/tear is partial, pain is experienced. If it is complete, pain is not experienced.
True - if partial - pain is experienced in the region of breach when muscle is stretched or contracts against resistance, if complete - the muscle does not pull against the injury
Which of the following is not consistent with a grade 1 injury?
a. disruption of small percentage of total number of fibers
b. mild pain 0.24 hours after injury
c. severe swelling
d. local tenderness and local pain with stress
C - it is mild swelling
What grade is consistent with the following information?
Partial tear of structure, moderate pain, stress and palpation increases pain, joint mobility is increased if ligaments are involved
grade II
Describe a grade three injury.
near-complete to complete tear or avulsion, severe pain, stress to tissue is painless, anatomic defects are palpable, results in joint instability when ligaments are involved
What is regeneration?
the process by which lost tissue is replaced by tissue of the same morphological and functional characteristics
What is repair?
process by which lost tissue is replaced by granulation tissue that forms into a mature scar
Where does soft tissue healing not occur?
neurons, cells of the lens of the eye, cardiac muscle cells, differentiated muscle cells
What is hemostasis?
the arrest of bleeding through coagulation and vasoconstriction so that blood transforms from fluid state to solid
When does hemostasis occur and for how long?
occurs in inflammation phase, usually achieved within 6-8 hours but highly vascularized tissues/extensive damage may continue to bleed for days
What are the signs of inflammation?
redness, warmth, swelling, pain at rest, loss of function
What is the timeline of the inflammation phase?
peaks at 2-3 hours, usually lasts 4-6 days but can last a few weeks
Why are leukocytes essential to the inflammation process?
degrade and remove necrotic tissue and microbes via phagocytosis
What are the goals for controlling the effects of inflammation?
selective rest, ice, compression, elevation
What is the therapist’s role during the acute/protection phase?
control the effects of inflammation (necessary during first 24-48 hours, RICE)
facilitate wound healing,
maintain normal function in unaffected tissues and body regions,
patient education: expectations (duration of symptoms, etc), activity recommendations, precautions/contraindications, reassurance that these symptoms are usually short lived,
movement intervention: controlled passive movement, tissue specific activities, general active movement of neighboring regions
What occurs during the proliferation phase?
signs of inflammation are decreased/eventually absent, removal of noxious stimuli, growth of capillary beds, collagen formation, wound contraction (inward movement of wound edges by myofibroblasts ~ day5), the immature CT is thin and unorganized so is extremely fragile and easily re-injured
What is the timeline of the proliferation phase?
can begin at 24-48 hours, peaks at 2-3 weeks, but may last up to 6 weeks
What are therapy goals for the subacute/controled motion phase?
initiation of active movement (isometrics, AROM, muscular endurance, resistance exercises, flexibility), progression of activities within tolerance of healing tissues, management of pain and inflammation, patient education (expectations of this stage, timeframe for healing, return to activities progressively, indicated against going above tissue tolerance
What are the signs of excessive stress?
exercise or activity soreness that does not decrease after a few hours and is not resolved after 24 hours,
exercise or activity pain that comes on earlier or is increased over the previous sessions,
progressively increased feelings of stiffness and decreased ROM over several sessions,
swelling, redness, and warmth in the healing tissue,
progressive weakness,
decreased functional use of involved part
What occurs during the maturation phase?
scar retraction by myofibroblasts is usually complete by 21st day and scar stops increasing in size, so from day 21 to day 60, there is a predominance of fibroblasts that are easily remodeled, maturation and remodeling of scar tissue occurs as collagen fibers become thicker and reorient in response to stresses placed on CT.
Which of the following is true?
a. if not properly stretched, fibers adhere and form a restricting scar
b. after a few weeks, scar tissue is unresponsive to remodeling
c. at this point, treatment is unavailable
A is true. b = at week 14, c = treatment requires either adaptive lengthening in the surrounding tissue or surgical release
What is the timeline of the maturation phase?
begins a few days after injury, can last up to a year
At one week, strength of connective tissue can be back to _% normal.
3
At 3 weeks, strength of connective tissue can be back to _% normal.
30%
At 3 months, strength of connective tissue can be back to _% normal.
80
True/false: Connective tissue strength may never recover the full 100% after injury.
true
What is the therapist’s role in the maturation/return to function stage?
design a progressiion of exercises that safely stresses the maturing connective tissue in terms of both flexibility and strength, so the patient can return to functional and work-related activities, patient education about safe progression, expectations, guidelines for return to normal, movement intervention: flexibility, motor control, muscle performance, proprioception, endurance, activity specific drills, functional progression
What are the factors affecting healing?
patient, injury, tissue
What are the patient-related characteristics that can influence healing?
genetics, age, nutrition, general fitness, medical comorbidities, psychosocial status, lifestyle factors
What are the injury-related characteristics that can influence healing?
mechanism of injury, quantity of tissue involved, quality of injury site
What are the tissue characteristics that can influence healing?
healing potential due to blood supply, uniformity of injury, region
Rank the tissues in order of best outcome of healing.
muscle,tendon, extra-articular ligament, intra-articular ligament, articular cartilage, fibrocartilage
What happens to a tissue that is repetitively stressed beyond the ability to repair itself?
inflammatory response is perpetuated - proliferation of fibroblasts with increasing collagen production and degradation of mature collagen results in a predominance of new, immature collagen = overall weakening effect on tissue - progressive limitations
Cumulative trauma disorders results from what?
repeated submaximal loading or frictional wear with excess frequency and/or duration beyond adaptive capabilities which elicits a chronic inflammatory response
What may occur due to the stress imposed on tissues that are unable to respond due to repetitive or excessive nature of the stress?
prolonged or recurrent pain and functional limitations
What are the contributing factors associated with cumulative trauma disorders?
MSK impairments relative to muscle length, strength, power, and joint mobility;
NMS impairments relative to motor control and proprioception;
structural alignment;
environmental features such as poor design of work stations, activity demands
The presence of what perpetuates the inflammatory response?
continued abusive load
What is the crucial element across all stages of rehabilitation for cumulative trauma?
management of contributing factors
What are the other rehab guidelines for acute cumulative trauma?
control inflammation, non-stressful activities
What are the other rehab guidelines for subacute cumulative trauma?
controlled stresses and continual monitoring
What are the other rehab guidelines for chronic cumulative trauma?
progression of stresses and development of endurance
