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Musculoskeletal Lecture > Tissue Healing and Pain > Flashcards

Tissue Healing and Pain Flashcards

1
Q

what is the healing process

A

physiological response of tissue following trauma

  • healing process is a continuum
  • impacted by:
  • -proper identification of healing phase
  • appropriate progression/regression of therapeutic program
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2
Q

types of injury

A

primary

secondary

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3
Q

types of injury: primary

A

primary

  • acute or chronic in nature
  • a result of
  • -macrotrauma: produces immediate pain and disability
  • -microtrauma: overuse injuries and result from repetitive loading or incorrect mechanics from normal or abnormal loads
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4
Q

types of injury: secondary

A

-cellular death as a result of primary injury, leads to functional deficits

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5
Q

what is inflammation

A

a protective response by an organism to remove the irritating stimulus and initiate the healing process

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6
Q

5 clinical signs of inflammation

A
  • calor
  • tumor
  • rubor
  • dolor
  • functio laesa (loss of function)
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7
Q

what causes the signs of inflammation?

A

calor: increased vascularity
rubor: increased vascularity
tumor: blockage of lymphatic drainage
dolor: pressure or chemical irritation of pain sensitive structure
functio laesa: occurs as a result of pain and swelling

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8
Q

3 main phases of healing

A
  1. inflammatory phase/acute/protective stage
  2. proliferation phase/subacute/controlled motion
  3. maturation phase/chronic/return to function
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9
Q

healing phase of hemostasis

A
  • without this phase yo bleed out
    1. body vasoconstricts
    2. platelets get sticky/form a plug
    3. clotting
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10
Q

inflammatory phase

A
  • time frame:0-6 days
  • critical to entire healing process
  • characterized by 5 signs of inflammation
  • not all patients follow time frame
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11
Q

acute phase: process

A

-disposal of injury bi-products
-localized to trauma area-local vascular changes
-protective response
-sets the stage for repair
-disturbed fluid exchange
-migration of leukocytes from blood to tissues
ONLY OCCURS IN VASCULAR TISSUE

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12
Q

clinical picture (acute)

A
  • painful movement
  • patient guarding
  • increased tissue tension
  • increased edema
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13
Q

proliferation (subacute) phase

A
  • time frame: 3-20 days
  • purpose: to cover the wound and impart strength to the injury site
  • injured site has the greatest amount of collage, yet tensile strength of tissues can be as low as 15% of normal tissue
  • go slowly, easy to impart more damage
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14
Q

process (subacute)

A
  • growth of capillary buds into wound is stimulated by lack of O2
  • increased blood flow to the area delivering nutrients for regeneration
  • collagen fibers deposit in random fashion scarring the tissues
  • -designed to withstand tensile forces
  • as tensile strength increases and fibroblastic activity decreases, signals the beginning of the maturation phase
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15
Q

clinical picture (subacute)

A
  • signs and symptoms of inflammatory subside
  • patient may indicate tenderness to touch
  • patient will typically complain of pain when movement stresses injured tissue
  • tenderness and movement pain will typically decrease during this phase
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16
Q

maturation phase

A

time frame: 20 days to 3 years

-purpose: realignment or remodeling of the collagen fibers that make up scar tissue

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17
Q

clinical presentation (chronic)

A
  • no signs of inflammation
  • contractures or adhesions may limit motion
  • pain felt well after tissue resistance, typicaly w/passive overpressure
  • function limited by:
  • -weakness
  • -poor endurance
  • -poor neuromuscular control
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18
Q

maturation phase: rehabilitation considerations

A
  • wolffs law: tissues respond to the demands placed upon them causing remodeling or realignment of fibers along lines of tensile force
  • aggressive AROM and strengthening key at the start of this phase
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19
Q

factors that impact rate of healing

A 
extent of injury
edema
hemorrhage
poor vascular supply
separation of tissue
muscle spasm
atrophy
corticosteroids
keloids and hypertrophic scars
infection
humidity, climate, oxygen tension
health, age, nutrition
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20
Q

extent of injury

A

micro/macro

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21
Q

edema

A

drainage, cell death

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22
Q

hemorrhage

A

excessive blood flow, cell death

23
Q

PVS

A

reduced bloodflow, cell death

24
Q

ST

A

partial tear, excessive scar tissue

25
Q

atrophy

A

needs to be mobilized quick

26
Q

cotricosteroids

A

no more than 3 injections into area in 12 months

-reduces tensile integrity of tendon

27
Q

keloid

A

excessive scar tissue formation

28
Q

chronic inflammation

A
  • acute inflammatory response does not sufficiently eliminate the injury agent and restore tissue to its normal state
  • low grade inflammation process causing:
  • -damage to connective tissue
  • -tissue necrosis and fibrosis
  • -appears to be related to microtrauma
  • -resistant to physical and pharmacological treatment
29
Q

what we know about pain

A
  • subjective (different for everyone)
  • past experience impacts perception of pain
  • warning mechanism
  • protects against injury
  • prevents further injury
  • can persist long after it is no longer useful
30
Q

types of pain

A
  1. acture
  2. chronic
  3. referred
  4. radicular/radiating
  5. deep somatic (systemic, organ)
31
Q

acute

A

experienced after injury has taken place and tissue damage is occuring

32
Q

chronic

A
  • defined as pain lasting longer than 6 months
  • persistent pain
  • -extension of chronic pain
  • -described as pain that does not respond to intervention of a treatable condition
33
Q

referred

A
  • pain perceived to be in an area that has little relation to the pathology
  • can be long lasting due to:
  • -altered reflex patterns
  • -continued mechanical stress on muscles
  • -learned habits of guarding
  • -development of trigger points
34
Q

radiating

A
  • caused by irritation of nerves and nerve roots

- ex lumbar nerve roots may be compressed by herniated disc->pain down the lower extremity to the foot

35
Q

deep somatic

A
  • pain emanating from a sclerotome

- often a discrepancy between the site of the pain and the location of the pathology

36
Q

assessing pain

A
  • subjectivity makes it difficult to quantify
  • many tools developed
  • -type of pain
  • -quantify of pain intensity
  • -evaluate the effect of pain on function
  • -psychological impact of pain
  • assess the psychosocial response to pain and injury
37
Q

what do we gain from rating pain

A
  • improves communication
  • directs clinician testing
  • standard measure for monitoring progress
  • provides documentation of progress for physicians and third party payers
38
Q

what does the patient gain

A
  • reassure the patient

- reinforce the commitment to the plan of treatment

39
Q

pain scales

A
  1. VAS
  2. Pain chart
  3. mcGill pain questionnaire
  4. activity pattern indicators pain profile
  5. numeric pain rating scale
40
Q

VAS

A

completed daily or pre/post intervention

41
Q

pain charts

A
  • establishes spatial properties of pain
  • assess location of pain and number of subjective components
  • draws/colors areas corresponding to nature and location of pain
  • could be completed daily
42
Q

mcgill pain questionnaire

A
  • 78 words that describe pain
  • takes approcimately 20 min to complete
  • commonly used for pt with LBP
  • effectively shows change when administered every 2-4 weeks
43
Q

pain scales: activity pattern indicators pain profile

A
  • 65 question, self report tool
  • examines functional impairment associated with pain
  • Measures frequency of certain behaviors
44
Q

numeric pain scales

A
  • most common acute pain profile
  • used before and after intervention
  • -if pain relief is reported, patient is asked about extent and duration of relief
  • other questions associated:
  • -portion of the day experiencing pain relief
  • -amount of sleep in past 24 hours
  • -medication required for pain control
  • helps clinician assess changes in pain, appropriate interventions, and communicate clearly about recovery
45
Q

can we measure pain during our objective exam?

A

ROM TPO

FTPO

46
Q

ROM TPO

A

ROM to pain onset

-until pain starts

47
Q

FTPO

A

force to pain onset

  • isometric brake testing
  • weak and painless-MMT, objectively quantify strength
  • weak and painful
48
Q

pain management

A
  • identify source of pain
  • select appropriate interventions for the individual pt based on current best evidence, clinician expertise and pt preference
49
Q

pain management strategies

A
  1. encourage activities that influence the perception of pain
  2. extensive pt education
  3. validate pt pain
  4. incorporate pain modulating modalities where appropriate
  5. use pt response to intervention to guide treatment session
50
Q

encourage activities that influence the perception of pain

A
  • motivation techniques
  • relaxation techniques
  • meditation
  • diaphragmatic breathing
51
Q

extensive pt education

A
  • explain what the pt should expect during the recovery process
  • discuss the signs of inflammation, dysfunction, and atrophy
  • encourage gentle progression of activity to:
  • -improve blood flow to tissues
  • -promote nutrition of tissues
  • -reduce stiffness and guarding
52
Q

validate your pt pain

A
  • throw judgement out the window

- all pain is very real to the pt, even if psychomatic in origin

53
Q

use pt response to intervention to guide treatment session

A
  • constantly reassess pts response to intervention
  • establish baseline
  • inquire during activity about symptoms
  • re-assess pain level post activity
  • if improved->continue
  • if same-> continue but consider intensity, repetitions, load
  • if worse-> stop and re-evaluate intensity, load, repetitions, activity

Musculoskeletal Lecture (4 decks)

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