Tissue healing

Question 1

Sprain

Answer 1

• severe stress, stretch or tear of a ligament or capsule
• Grade 1: 6-8% stretch and tenderness to palpation
• Grade 2: increase in laxity
• Grade 3: complete tear

Question 2

Strain

Answer 2

• severe stress, stretch or tear of a muscle or a tendon
• Grade 1: point tenderness
• Grade 2: more severe stretch
• Grade 3: rupture

Question 3

Dislocation

Answer 3

• displacement of a part, usually the bony partners in a joint leading to loss of anatomical relationship

Question 4

subluxation

Answer 4

• incomplete or partial dislocation
• Usually states that they felt it go out and then go back in

Question 5

Tendonious lesions/tendopathy

Answer 5

• Tendinitis: inflammation
• Tenosynovitis: inflammation of sheath that surrounds tendon (usually common in digits and toes flexors and extensors)
• Tendinosis: degeneration

Question 6

Synovitis

Answer 6

inflammation of the synovium around a diarthrodial joint

Question 7

Hemarthrosis

Answer 7

• bleeding into the joint (ACL)

Question 8

Bursitis

Answer 8

inflammation in bursa

Question 9

contusion

Answer 9

• bruising from direct trauma

Question 10

Scar tissue (describe)

Answer 10

• What the body uses to heal ourselves however it is not as strong as the original tissue
• Made of collagen
• Fibroblast
• Triple helix (tropocollagen)
• Tropocollagen come together to form collagen filaments → fibrils → collagen fibers that close the breach
• Ground substance: Made up of GAGs and water and solutes

Question 11

When should the clotting phase/hemostasis phase occur

Answer 11

• 5 minutes to 24 hours

Question 12

• clotting/hemostasis phase

Answer 12

• Slow down the bleed
• Tissue damage, blood/lymph vessel rupture
• Swelling and vasospasm leads to anoxia (decreased oxygen)
• Platelets and RBCs die
• Blood congeals and forms a clot
• Prothrombinase and thromboplastin convert prothrombin to thrombin
• Thrombin turns fibrinogen in presences of fibronectin to fibrin
• Fibrin, platelets, and cellular debris form a clot
  stops the bleeding
• This process depends on what tissue is affected
• We can apply pressure and elevate to stop the bleed

Question 13

Acute inflammation phase when does it occur

Answer 13

• 4-6 days after onset of injury

Question 14

What occurs during the acute inflammation stage

Answer 14

• Vascular and cellular response: Increase in blood flow to bring things to the area to aide in healing
• Damaged platelets leukocytes and mast cells release bradykinin, histamine, and prostaglandin
• Collagen/ground substance are in the area at the end of week 1
• Scar intercellular attachments are fragile
• Pain and guarding before end range
• Injury in a joint often causes muscle inhibition tp muscles that cross it

Question 15

What do Bradykinins, histamine, and prostaglandin do?

Answer 15

• Increase vascular permeability
• Cause vasodilation
• Attract leukocytes (neutrophils and macrophages)
• Attract fibroblasts for scar tissue formation
• Responsible for cardinal signs of inflammation
• Prostaglandin will sensitize nociceptors

Question 16

cardinal signs of inflammation

Answer 16

• Swelling
• Heat
• Redness
• Loss of function

Question 17

What can we do during the acute inflammation phase

Answer 17

• Protective phase:
• PRICE
• Selectiv rest of excessive activity/motions likely to cause injury
• Some immobilization
• Promote healing and prevent adverse effects of immobilization
• PROM → within limits of pain
• Sub-max isometrics
• Grade 1-2 joint mobilizations

Question 18

What does the subacute/repair and regeneration phase begin

Answer 18

• 72 hour to 6-8 weeks

Question 19

What occurs during the subacute/repair and regeneration phase

Answer 19

• Reducing inflammation/pain
• Week 2: breech filled with granulation tissue but still fragile (peaks at week 3)
• Fibroblasts predominant/extracellular matrix
• Increase tensile strength
• Scar stops increasing size (day 21 - peaks collagen lay down)
• pain with end range

Question 20

how long does muscle and skin take for scar formation in subacute phase vs tendon and ligaments

Answer 20

• Muscle/skin - 5-8 days
• Tendon/ligament 3-8 weeks

Question 21

How is the scar different during week 3 and under vs as the scar heals

Answer 21

• Type 3 (primary held together by H+ bonds (at first) → type 1 later (held by covalent bonds)

Question 22

by week two what is making the scar

Answer 22

• Fibroblasts
• Mast cells
• Macrophages

Question 23

What can we do during the subacute repair and regeneration phase

Answer 23

• Functional activities
• Educate patients
• Controlled motion and healing time frames
• Promote healing of tisse (increase in pain, decrease in ROM and strength = over do it)
• Restore soft tissue, muscle or joint mobility
• Progress from PROM → AAROM → AROM
• Develop neuromuscular control, muscle endurance and strength in involved and related muscles
• Submax isometrics at different points in the range → AROM → resistance isotonic
• Maintain integrity and function of associated areas

Question 24

When does the remodeling and maturation phase begin (chronic)

Answer 24

• 60-365+ days

Question 25

what does the remodeling and regeneration phase consist of

Answer 25

- Decrease in tissue vascularity - Better collagen alignment, increase diameter and more densely packed - Scar becomes contracted - Increase tensile strength (70-80% original) - More difficult to remodel after 14 weeks - Maturation or scar model and ligament specific - Water content below normal values - Cross-link profile near normal - Age of scar difficult to distinguish day 42-365 - Pain with overpressure

Question 26

Factors that affect inflammation

Answer 26

- Nutrition - Diabetes - Drugs - Immobilization - Physical agents

Question 27

how do tissues respond to stress in phases?- stress strain curve

Answer 27

- Crimp: slack in collagen tissue - Elasticity: allows the tissue to return to it original shape (2-6%) - Plasticity: where there are some microtears in the tissue (4-8%) - Total failure: complete torn (8%)