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Soft Tissue Repair Healing Process Flashcards

1
Q

What is soft tissue ?

A

Term used to describe various body tissues including:
- skin
- tendon
- ligament
- cartilage
- skeletal muscles
- peripheral nerves
- fat
- lymph
- blood vessels

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2
Q

True or false
Bone is a soft tissue

A

False

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3
Q

Which soft tissues are most commonly injured ?

A

Muscles
Tendons
Ligaments

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4
Q

True or false
Soft tissue injuries only occurs during sports and exercise activities

A

False

It can happen as a result of simple everyday activities

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5
Q

What are common soft tissue injuries

A

Sprains
Strains
Contusion
Tendinitis
Bursitis

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6
Q

What are sprains

A

Ligament injuries resulting from tugging or twisting a joint

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7
Q

What are strains

A

Injuries to a muscle or tendon often caused by overuse, force, stretching

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8
Q

What are contusions

A

Medical term for bruises where blood capillaries have ruptured due to a direct blow to the body that can cause damage to the skin and/or deeper tissues depending on the severity

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9
Q

What is tendinitis

A

Inflammation of tendons (which attach muscle to bone)

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10
Q

What are bursae and what is bursitis

A

Bursae are small fluid-filled sacs that reduce friction between moving parts in your body’s joints (specifically between tendon and bone because prolonged friction can cut the tendon)

Bursitis is the inflammation or irritation of a bursa.

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11
Q

Importance of therapeutic interventions

A
  • promote tissue repair in case of injury or pathology
  • expedite patient’s recovery
  • improve quality of life
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12
Q

Therapeutic interventions include

A
  • medication
  • surgery
  • therapeutic exercises
  • application of EPAs
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13
Q

True or false
EPA modalities are useful tools used in rehabilitation phases of injured patients

A

True

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14
Q

The effectiveness of EPAs is limited by what

A

The theoretical knowledge, skills and clinical experience of the practitioner

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15
Q

Clinical decision and reasoning should be based on what?

A

The practitioner’s clinical experience and theoretical knowledge

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16
Q

Rehabilitation protocol and progression of the medical status of the patient is based on:

A

Understanding of the:
- anatomy
- pathology
- physiology
- phases of tissue repair

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17
Q

What is meant by the “cookie cutter” management approach?

A

The same approach or style is always used and not enough attention is paid to individual differences

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18
Q

What are the 4 physiologic phases of the healing process?8

A

inflammation
Re-repithelialization
Proliferation
Remodeling

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19
Q

Phases of the soft tissue healing process ?

A

Hemostasis
Inflammatory
Proliferative
Remodeling/Maturation

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20
Q

How long does that hemostasis phase last?

A

Seconds - minutes

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21
Q

How long does the inflammatory phase last?

A

Hours - days/weeks

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22
Q

How long does the proliferative phase last?

A

Weeks - months

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23
Q

How long does the remodeling/maturation phase last?

A

Months - year

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24
Q

What is hemostasis

A

The body’s urgent response to prevent hemorrhage (bleeding) in case of injury or pathology.

Characterized by: arrest of bleeding at injury site

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25
What is the initial hemostatic mechanism that occurs within seconds after blood vessel trauma
Vasoconstriction
26
During bleeding, vasoconstriction is followed by _____________________.
temporary hemostatic plug
27
What is the secondary hemostatic mechanism where platelets plug in the injured vessel and hematoma is made ?
Coagulation (blood clotting):
28
Steps of hemostasis
1. vascular spasm (vasoconstriction) 2. platelet plug formation 3. blood clotting
29
Do platelets normally adhere to vessel walls?
NO. That could cause serious medical issues such as a stroke. HOWEVER, in case of bleeding, the platelets should adhere to the vessel wall to stop the bleeding
30
During the hemostasis phase, what is the purpose of the plug ?
To block lymph drainage and localize the injury response
31
During the hemostasis phase, what do the damaged cells release and why
They release a protein that helps form a fibrin clot that shuts off blood supply to the injured area
32
During the hemostasis phase, when does clot formation begin and end?
12 hours after injury and is completed by 48 hours≥
33
When does the inflammatory phase start?
2 - 4 days after injury
34
What is the aim of the inflammation phase?
-It is a protective reaction - serves to localize and dispose of injury by-products (blood, damaged cells) through phagocytosis -cleans the wound of the cellular debris as a preparation for the deposition of the new regenerated tissue
35
What is inflammation?
Process where leukocytes, other phagocytes, and exudate are delivered to the injured tissue
36
What is leukocyte
White blood cell Scavengers and infection fighters
37
What is phagocyte
A cell that engulfs and absorbs waste material, harmful microorganisms, or other foreign bodies in the bloodstream and tissues.
38
What is phagocytosis
The process by which certain cells (leukocytes and phagocytes) engulf and destroy microorganisms and cellular debris
39
What is anemia
Reduction of blood components
40
What is hyperemia
Excess of blood in a certain body part
41
What are chemical mediators?
Chemicals that limit the amount of exudate and swelling following injury
42
Examples of chemical mediators
histamine leucotaxin necrosin
43
What is meant by secondary hypoxic injury
Disruption of blood flow to the injury site and surrounding uninjured tissue that causes hypoxia and can lead to further tissue damage
44
What is exudate
The fluid that leaks out of blood vessels into nearby tissue, usually as a result of inflammation. It is made of cells, proteins and solid materials.
45
Exudate fluid contains high ___________ and ______________
Protein Cellular debris
46
True or false The inflammation phase sets the stage for repair of damaged tissue
True
47
What are the signs associated with inflammation
Erythema (skin redness) Hyperthermia Edema (tumor/swelling) Pain Loss of function
48
What causes erythema (rubor)
Enlargement (dilation) of capillaries results in more blood flow to the injured area causing skin redness
49
True or false Erythema occurs as a result of increased vascularity
True
50
What is meant by hyperthermia and what causes it
Heat (high temperature) that occurs as a result of erythema, in which the blood vessels are dilated and thus the blood runs closer to the surface of the skin releasing more heat.
51
What causes edema
-Accumulation of fluid in the interstitial space -Occurs due to the blockage of lymphatic drainage by platelets -Release of histamine, leucotaxin and necrosin
52
What causes pain during inflammation
- Activation of nociceptors caused by damaged tissues - physical pressure on nerve endings
53
What causes loss of function during inflammation
Pain and swelling
54
Role of histamine
- vasodilation - increased cell permeability
55
Role of leucotaxin
Assists fluid and WBC to move through cell walls to form exudate
56
Role of necrosin
Responsible for phagocytic activity
57
Why is swelling good
-The exudate brings cells to the inured area to help eliminate dead cells, tissues, etc - helps to immobilize the injured area to limit movement
58
Why is swelling bad
- painful - limited ROM - limited blood flow - can cause secondary hypoxic injury -hypoxia NOTE: - Secondary hypoxic injury occurs as a result of disrupted blood flow to the injured AND surrounding healthy tissue causing hypoxia, which is the lack of oxygen -hypoxia can cause pain, spasm, and more tissue damage
59
Another name for the proliferative phase
Fibroblastic-repair phase
60
Explain what goes on during the proliferative phase
61
What is the proliferative phase
The formation and proliferation of the new tissues to repair the damaged one , and this production and regeneration of tissues leads to scar formation and repair of injured tissue
62
What is fibroplasia
The formation of fibrous tissue
63
When does fibroplasia begin and how long does it last for?
Begins within the first few HOURS following injury Lasts for 4-6 weeks or months depending on severity of injury/pathology and the type of tissue
64
What are the key processes of the proliferative phase
Fibroplasia and angiogenesis
65
What is angiogenesis and which phase is it involved in
Formation of new blood vessels This occurs during the proliferative phase
66
The duration of the proliferative phase depends on two things
- severity of injury/pathology - type of tissue
67
How do patients feel during the proliferative phase
Many of the signs and symptoms associated with the inflammatory response SUBSIDES (lessen/go away) HOWEVER patients still report tenderness and pain with stressful movements
68
True or false As scar formation progresses , tenderness and pain gradually subside
True
69
Scar tissue causes skin tightness which can limit the ROM. What do we do as physical therapists?
We try to soften the tissue adhesions (i,e using US/laser) to promote functional ROM
70
What is the final phase of tissue healing
Remodeling/maturation phase
71
How long does the remodeling/maturation phase last
For months sometimes years
72
The duration of the remodeling phase depends on
- severity of injury/pathology - type of tissue
73
What is meant by remodeling
Re-alignment
74
What is meant by maturation
Increase of mechanical strength of the new tissue to become more functional
75
What occurs in the remodeling phase
76
What does Wolff’s Law state about the role of progressive mobility during maturation phase
77
Factors that delay tissue healing
78
True or false Oxygen promotes healing
True
79
What modalities are used for the initial injury phase (hemostasis phase)
80
What modalities are used during the inflammation phase ?
81
What modalities are used during the fibroblast-repair phase (proliferative phase)
82
What modalities are used during the remodeling/maturation phase
83
Modality aimed to limited swelling and reduce pain
-Resting 2-3 days (48-72 hours) - Compression - Cryotherapy - Ultrasound - Laser
84
What is used in cryotherapy and what is the purpose of using cold
Ice bags Cold packs Ice massages Purpose: - reduce swelling and pain - produce analgesia - better outcome when used with elevation
85
True or false Cold baths and cold whirlpools are used in cryotherapy
False
86
What produces the best results when using cryotherapy
(The triad ) - compression - cryotherapy - elevation
87
Effects of electrical stimulation
- used to address pain - elicit muscle contraction for muscle pumping action to aid in lymphatic flow and reduce pain - MUST AVOID intensities that cause muscle contraction as it may increase clotting time (I think during the hemostatic phase?)
88
Effects of ultrasound
-facilitates healing immediately after injury through the early 48 hours - lower intensities produce non-thermal effects that alter cell membrane permeability to ions which aid in healing
89
Effects of low-power laser
- effective in pain modulation - used to avoid tissue death - can be used as early as day 1 of injury to 6 days post injury
90
An injury is classified acute or chronic according to the ______ and __________ and not how old the injury is.
Signs and symptoms
91
If signs and symptoms of active inflammation is present , this injury is considered
Acute
92
If sings and symptoms are no longer presents, this injury is
Chronic
93
We treat the injury as if it is in the inflammatory response phase if
The classic signs and symptoms of inflammation are present
94
When should AROM and PROM be introduced
After initial acute injury phase
95
Progression is determined by
Injury’s response to exercise
96
What to do if the signs and symptoms of inflammation increase with exercise?
reduce the intensity of the exercise Aggressive rehab is desirable BUT SHOULD NOT jeopardize the healing process
97
Treatments may switch from cold to heat using what as an indicator?
Swelling
98
What does Thermotherapy include and what is the purpose
Hot packs Paraffin wax Warm whirlpool Purpose: - increases blood circulation - promotes healing - reduces pain
99
Purpose of intermittent compression
Facilitates removal of products from injured area
100
How are collagen fibers realigned ?
According to tensile stresses and strains placed on them
101
Most to all modalities are safe to use in what phase?
Remodeling phase (final phase)
102
During the final phase, the main goal is to
Return to activity
103
Therapeutic massage is effective in the remodeling phase. Why?
Assist in scar remodeling
104
What does deep heating include and what is the purpose
Ultrasound Shortwave Microwave diathermy Purpose: - increased blood and lymphatic flow
105
True or false Electrical stimulation can be used to increase ROM and strength by eliciting muscle contractions
True

Electrotherapy (6 decks)

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