Stages of Tissue Healing and Injury Flashcards
Inflammation/Acute Stage (Definition)
- Acute pain is the “typical” or predicted and time-limited response to trauma or other noxious event (i.e. ankle sprain in the last 24 hours)
- Acute pain may develop in the absence of clear local tissue injury (insidious onset) (i.e. acute flares of osteoarthritis, rheumatoid arthritis, etc.)
Sub-Acute Stage (Definition)
- This phase represents the transition following a traumatic injury to normal expected tissue healing (1-2 months or longer for some tissues (i.e. tendon))
- In the absence of a traumatic injury, it represents the phase of a disorder where symptoms usually subside as part of the natural history of the disorder
Recurrent Stage (Definition)
- Experiencing a new episode of previously experienced MSK symptoms following a period of being symptom-free
- In reality some patients may present with ongoing, mild persistent symptoms, but have recent episode of increased symptoms that are impacting on the usual activities
Chronic/Persistent Stage (Definition)
- Most commonly defined by a time frame of greater than 3-6 months duration, or pain that extends beyond the expected period of disorder resolution
- Some disorders are chronic, though episodes of pain are recurrent/episodic
Inflammation/Acute Stage (Clinical Signs)
- Pain
- Swelling
- Pain with/without tissue resistance
- Discolouration
- Decreased movement
Inflammation/Acute Stage (Timeline)
-Bleeding:
Onset - Immediate
Peak - 4-6 hours
Duration - hours
-Inflammation:
Onset - 1-3 hours
Peak - 1-3 days
Duration - weeks
Inflammation/Acute Stage (Physiological Processes)
- Bleeding
- Vasoconstriction (immediate)
-Fibrin + platelet plug
(clotting)
- Incr. vasodilation, permeability
- Incr. plasma exudate to interstitial tissues - swelling & edema
- Incr. phagocytosis: macrophages, neutrophils
Inflammation/Acute Stage (Clinical Management)
- Control effects of inflammation
- Control pain
- Prevent deleterious effects of rest
- Stimulate revascularization
- Education
- Positioning - Protection
- ROM, PROM, AAROM, AROM (painfree, midrange)
- Isometric or light midrange contractions
- Aerobic activity: light intensity
- Unaffected areas: maintain normal function
Proliferation/Sub-Acute Stage (Clinical Signs)
- Pain: mechanical vs. inflammatory
- Decr. swelling
- Decr. pain with tissue resistance
- Minor or absent edema
- Increased ROM
Proliferation/Sub-Acute Stage (Timeline)
-Proliferation:
Onset - 24-48 hours
Peak - 2-3 weeks
Duration - 4-6 months
Proliferation/Sub-Acute Stage (Physiological Processes)
- Repair
- Collagen formation - scar tissue
- Revascularization/Angiogenesis R.I. incr. blood flow
- Formation of granulation tissue with fibroblasts (produce collagen, elastin, fibronectin, glycosaminoglycans, protease)
- Epithelialization: form epithelium
Proliferation/Sub-Acute Stage (Clinical Management)
- Develop mobile scar
- Scar fragile and easily reinjured
- Education:
- PROM, AARON, AROM, joint play
- Stretching - joint or muscle
- Multiple angle isometrics
- Isotonic exercises with low resistance
- Resumption of normal low intensity functional activities
Remodelling/Late and Final Stages (Clinical Signs)
- Absence of swelling
- Absence of pain at rest
- Pain with activity that stresses scar
- Decreased function
Remodelling/Late and Final Stages (Timeline)
-Remodelling:
Onset - 2-3- weeks
Peak - months
Duration - months
Remodelling/Late and Final Stages (Physiological Processes)
- Remodelling
- Maturation of connective tissue
- Contracture of scar tissue
- Remodelling of scar
- Collagen aligns to stress
