Tissue Healing, Scar Tissue, Fractures Flashcards
1
Q
Which layers of the skin are damaged by first degree burns?
A
The epidermis (and sometimes the upper dermis).
2
Q
What type of burn causes mild pain and redness. E.g. Sunburn, minor scald?
A
First degree burns
3
Q
What is the healing time for a first degree burn?
A
3-6 days
Superficial skin layer over the burn may peel off in 1-2 days
4
Q
T/F: Healing for first degree burn is resolution with scar tissue.
A
False: there is no scar tissue
5
Q
Which type of burn is characterized by destruction of the epidermis and part of the dermis?
A
Second degree burns.
6
Q
T/F: Second degree burns cause pain, redness, and blisters that may ooze.
A
True
7
Q
In which type of burn does healing occur by regeneration from the edges of the blistered area and from epithelial lining of hair follicles and glands. Complications and scar formation can occur.
A
Second degree burns
8
Q
Which type of burn involves both layers of the skin and may also damage underlying muscles, bones, and tendons. Burned site appears pale, charred, and leathery.
A
Third and fourth degree burns (full thickness)
9
Q
T/F: third and fourth degree burns are generally very painful.
A
False: generally there is no pain in the area because nerve endings are destroyed.
10
Q
Which types of burns require skin grafting as no cells are available for regeneration of new skin?
A
Third and fourth degree burns (full thickness)
11
Q
Complications of healing from burns: 1) _________ of scar tissue, development of 2) ____________ that lead to joint stiffness.
A
1) Hypertrophy
2) Contractures
12
Q
Therapies can alleviate ______ and _________ (a common complaint from burn patients).
A
Pain and itching
13
Q
Therapies for burns can diffuse local areas of 1) ________, increase blood flow, and/or reduce 2) __________. It can also help patients feel safe and comfortable with touch again.
A
1) Edema
2) Anxiety
14
Q
T/F: Regarding burns, massage is most helpful to ease symptoms after emergency care and in recovery phase.
A
False: Massage may help ease these symptoms both in emergency care and in recovery phase.
15
Q
Massage can also help with better remodelling of _______ tissue.
A
Scar tissue
16
Q
Therapeutic Touch (TT) is based on the theory that the body, mind and emotions form a “___________________”.
A
“Complex energy field”
17
Q
T/F: Physician’s consultation is required before therapies for burn patients.
A
True
18
Q
T/F: Massage is always contraindicated directly on a acute burn, even a First Degree burn, such as a sunburn.
A
True. However, if it is only part of the body that is sunburned, you could use cool compresses on that part and massage elsewhere.
19
Q
Lesion or trauma/inflammation to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch.
A
Muscle strain/tear
20
Q
A direct, blunt, compressive force to a muscle, tearing and crushing the underlying muscle fibres.
A
Muscle contusion
21
Q
Prolonged performance of repetitive actions, causes pain and impairment of function of tendons and muscles involved.
A
Repetitive Strain Injury
22
Q
Hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.
A
Trigger point
23
Q
What is the difference between an Active and Latent Trigger Point?
A
Active Trigger Point: painful without palpating e.g. causing a tension headache
Latent Trigger Point: not painful unless palpated
24
Q
Articulating surfaces are no longer intact
A
Dislocation
25
Incomplete or partial dislocation of a joint (or other structure)
Subluxation
26
Fluid build-up into an anatomical space, e.g. exudate or transudate in knee joint (vs. edema, which is abnormal fluid accumulation in interstitial spaces)
Effusion
27
Swelling and irritation of a bursa (fluid filled sac between structures that reduce friction)
Bursitis
28
Swelling or haemorrhage resulting in build-up of pressure in muscle unit
Acute Compartment Syndrome
29
Increased pressure from Acute Compartment Syndrome leads to decrease 1) -> 2) -> 3) -> 4).
1) Decreased blood flow
2) Ischemia
3) Gangrene
4) Necrosis
30
Acute Compartment Syndrome causes severe pain, palpable tightness, _______ appearance
shiny
31
With Acute Compartment Syndrome fascial surgery (fasciotomy) is done within __ hours to minimize damage.
12 Hours
32
Acute Compartment Syndrome is not to be confused with ____________________ Syndrome, which is not a medical emergency
Chronic/Exertional Compartment Syndrome
33
Tendinopathies, muscle strains, and muscle tears are assessed using 1), 2) (e.g. Active Resisted testing to test for strength and pain), and 3)(pain from passive movement in the opposite direction of the muscle contraction).
1) tissue tension tests
2) muscle contractions
3) tissue stretch
34
Muscle strain occurs when _________ exceeds the weakest structural element
Tension
35
Muscle strain is usually located __ to __ mm from the muscle tendon junction
0.1 to 3mm
36
Predisposing factors for ________________ include: age, inadequate warm up, limited flexibility, fatigue, overuse syndromes, overstressing the muscle, strength imbalances, previous strains, and altered biomechanics.
Muscle strain
37
Minor stretch or tear to the musculotendinous unit. Minimal loss of strength; the person can continue their activity with mild discomfort.
Grade 1, mild, or 1st degree strain
38
Tearing of fibres, variable from several fibres to the majority of the fibres. May be a snapping sound or sensation, or may be a palpable gap in the muscle. The person has difficulty continuing the activity due to pain and muscle weakness.
Grade 2, moderate, or 2nd degree strain
39
Complete rupture of the musculotendinous unit or avulsion fracture of the bony attachment, snapping sound, and gapping or bunching of the muscle belly. The person cannot continue due to severe pain and muscle weakness.
Grade 3, severe, or 3rd degree strain
40
Blow to a part of the body, tearing/crushing underlying muscle fibres and connective tissue without breaking the skin.
Contusion
41
Type of contusion where a pool of blood collects within damaged tissue, forming a lump over the injury, difficult to distinguish from a complete tear.
Hematoma
42
What's the difference between an Intermuscular and Intramuscular Hematoma?
a. Intermuscular: bleeding between
muscle fascia, heals quickly - typical common bruise
b. Intramuscular: bleeding within a muscle bundle, haemorrhage is more confined and localized. The inflammatory response is exaggerated.
43
Type of contusion where tissue damage is extensive, swelling and bleeding beneath the skin may cause shock (e.g. from fractured bone, dislocated joint, sprain, torn muscle, or other injuries).
Severe cases of contusion
44
Which stage of muscle healing is associated with Haemorrhage, edema formation, myofibril retraction, nerve axon damage, mononuclear invasion, phagocytosis?
Inflammatory / Acute
| 0-72 hours
45
During which stage of muscle healing is the following implicated?
NSAIDS, immobilization, protection. PIER (pressure, ice, elevation, reduced activity) or POLICE or PEACE and LOVE, Lymph drainage (LD)
Inflammatory / Acute
| 0-72 hours
46
During stage of muscle healing is the following implicated?
Partial ROM exercise (stretching) -> gentle resistance work (isometric) -> increase to full ROM resisted exercise (isotonic)
-LD at first, progressing to fascia techniques. GST progressing as healing progresses.
-Later stage, gentle challenging scar tissue techniques, e.g. frictions.
Fibroblastic Proliferation / Subacute (~3-14 days)
47
Which stage of muscle healing is associated with increased rate of collagen synthesis, muscle regeneration by satellite cells, muscle fibres bridging begins, tensile strength approx. 50% normal, contraction still inhibited by edema and pain?
Fibroblastic Proliferation / Subacute (~3-14 days)
48
Which stage of muscle healing is associated with maturation of collagen, increase tensile strength (permanent loss of tissue tensile strength of 7%)?
Remodelling Maturation / Chronic
| ~3 wks to 12+ months
49
During stage of muscle healing is the following implicated?
Progression of activity, Challenge the scar tissue and compensatory structure w/ fascial techniques and frictions (followed by stretch/ice). Decrease TrP, ↓MRT, adhesions, ↑ ROM, etc.
Remodelling Phase
50
Broad term encompassing painful conditions relating to tendon injury.
Tendenopathy
51
Inflammation of tendon resulting from micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden
Tendonitis
52
A degeneration of the tendon’s collagen in response to chronic overuse; (tendonitis is an acute inflammatory condition, whereas this is chronic overuse condition).
Tendonosis
53
Inflammation of a tendon sheath.
Tendosynovitis
54
A tear in a ligament.
Sprain
55
Injury where a body structure is forcibly detached from its normal point of insertion by either trauma or surgery
Avulsion
56
Signs and Symptoms of _____________________
Pain accompanied by tenderness, marked swelling, often discolouration due to hematoma formation, strength and range of movement in the joint are limited. There is highly likely going to be moderate to severe straining of the surrounding muscles, as these generally will fail before a ligament does.
Tendon and Ligament Injury
57
T/F: During tendon and ligament injury, bleeding into joint capsule expedites healing.
False: it delays healing
58
The initial inflammatory phase of tendon healing lasts about ______ hours.
24 Hours
59
During the inflammatory phase of tendon healing, 1), 2), and 3) cells (e.g. neutrophils, monocytes and macrophages) migrate to the wound site and clean the site of necrotic materials by phagocytosis.
1) Erythrocytes
2) platelets
3) inflammatory cells
60
During which phase of tendon healing do cells release vasoactive and chemotactic factors which recruit tendon fibroblast to begin collagen synthesis and deposition.
The inital inflammatory phase
61
The proliferative phase of tendon healing begins __________ after injury and lasts __________
A few days
| A few weeks
62
During the proliferative phase of tendon healing, _______________ develop at the site.
Granulation tissue
63
In this phase, tendon fibroblasts synthesize abundant collagen and other extra cellular matrix components such as proteoglycans.
The proliferation phase
64
The remodelling phase of tendon healing begins __________ after injury.
About 6 weeks.
65
This phase of tendon healing is characterized by decreased cellularity, and decreased collagen synthesis.
The remodelling phase
66
During the remodelling phase, the repair tissue changes to fibrous tissue, this again changes to ___________ tendon tissue after 10 weeks.
Scar-like
67
During the ______________, covalent bonding between the collagen fibres increases, resulting in repaired tissue with highest stiffness and tensile strength.
Later remodelling phase (of tendon healing).
68
T/F Except for degenerative tendons (tendinosis), injured tendons tend to heal.
True
69
T/F The healing tendon typically reaches the biomechanical properties of the tendon prior to surgery.
False
70
Stress on a tendon in the early stages will reopen the tear and lead to development of excessive fibrous tissue in the tendon. This leads to less _________, and decreased ______ at the joint.
Less strength and decreased ROM
71
Name the Grade of this Acute muscle strain.
- Local edema, heat and bruising is minimal or not present.
- Tenderness at site
- Little or no loss of
strength or ROM
- Can continue activity
Grade 1
72
Name the Grade of this Acute muscle strain.
- Tearing of several or many fibres
- Snapping noise/painful sensation at time of injury
- Moderate local edema, heat, hematoma, bruising (red, black and blue)
- Protective mm spasm
- Moderate tenderness, palpable gap in tissue
- Moderate pain with activities that stretch or contract MT unit.
- Moderate loss of strength and ROM
- Difficulty continuing the activity d/t pain and may experience disability the next day.
Grade 2
73
```
Name the Grade of this Acute muscle strain.
- Complete rupture of the muscle/or avulsion
- Snapping/popping noise or sensation at time of injury
- Significant edema, heat and
red/black/blue bruising,
hematoma
- Gap in the tissue, muscle
bunched up/or spasms.
- Severe pain
- Immediate loss of strength
and ROM
- Patient cannot continue
activity.
```
Grade 3
74
Name the grade of this EARLY SUBACUTE muscle strain
- Little or no pain or reduced strength
- Adhesions are forming around injury site
Grade 1
75
Name the grade of this EARLY SUBACUTE muscle strain
- Pain and moderately reduced strength
- Bruising is black and blue with hematoma
- Alteration in the contour of the muscle
- Symptoms are present but reduced from acute phase
- Adhesions, slow healing, protective spasm diminishes, TrP in antagonists and synergists
- Supportive tools may be still in use.
- Decreased ROM
Grade 2
76
Name the grade of this EARLY SUBACUTE muscle strain
- Pain and significantly reduced strength with AR testing.
- Bruising is black and blue with hematoma
- Gap in tissue, muscle may bunched up.
- Symptoms are present but reduced from acute phase
- Adhesions, slow healing, protective spasm diminishes, TrP in antagonists and synergists
- Supportive tools may be still in use.
- Reduced ROM
Grade 3
77
Name the grade of this LATE SUBACUTE muscle strain
| - Pain, edema, inflammation is reduced
Grade 1
78
Name the grade of this LATE SUBACUTE muscle strain
- Pain, edema, inflammation is reduced
- Bruising is yellow, green and brown, hematoma is diminished, gap is still palpable
- Protective muscle spasm is replaced by increased tone in affected mm, antagonists, and synergists
- TrP in affected and compensatory mm
- Adhesions maturing
- Reduced ROM
Grade 2
79
Name the grade of this LATE SUBACUTE muscle strain
- Pain, edema, inflammation is reduced
- Bruising is yellow, green and brown, hematoma is diminished, gap is still palpable
- Protective muscle spasm is replaced by increased tone in affected mm, antagonists, and synergists
- TrP in affected and compensatory mm
- Adhesions maturing
- Range of motion is reduced.
Grade 3
80
Name the grade of this CHRONIC muscle strain
- May have some minor compensation issue (adhesions, trP, etc): normal function
- Adhesions have matured around site, may be cool due to ischemia.
- Possible discomfort due to tissue use or stretch
Grade 1
81
Name the grade of this CHRONIC muscle strain
- Adhesions have matured
- Full ROM of joint crossed by
affected mm may be reduced
Grade 2
82
```
Name the grade of this CHRONIC muscle strain
- Adhesions have matured
- Full ROM of joint crossed by
affected mm may be
reduced.
- If surgery is performed may
be casted; address compensatory issues.
```
Grade 3
83
With the Healing Process in Skeletal Muscle, the Inflammatory Phase can last up to __ hours.
72 hours
84
In musculotendinous injuries, there is myofilament retraction and peripheral muscle fibre contraction within the first __ hours.
24 Hours
85
With the Healing Process in Skeletal Muscle, the ___________ Phase is also called the the fibro-elastic/collagen-forming phase
Proliferation
86
The proliferation phase of skeletal muscle healing can last from about ______ hours to __________ weeks.
48 hours to 6 weeks
87
During the proliferation phase of skeletal muscle healing, Fibroblasts begin to synthesize ____________.
scar tissue
88
During the proliferation phase of skeletal muscle healing, __________ budding occurs, bringing nutrition to the area.
Capillary budding
89
During the proliferation phase of skeletal muscle healing, collagen cross-linking begins and the number of _______________ decreases as more collagen is laid down.
fibroblasts
90
This phase ends with the beginning of wound contracture and shortening of the margins of the injured area.
The Proliferation phase (of skeletal muscle healing)
91
Remodelling and Maturation Phase of skeletal muscle healing lasts from __________ to ____________
3 weeks to 12+ months
92
During the remodelling and Maturation Phase of skeletal muscle, cross-linking and shortening of the collagen fibres promote formation of a tight, strong _____.
scar
93
Final aggregation, orientation and arrangement of collagen fibres occur during this phase.
The remodelling an maturation phase (of skeletal muscle healing)
94
Doxorubicin (Adramycin) given pre-operatively, __________s post-operative wound healing.
Inhibits
95
Glucocorticoids (e.g. prednisone) limit the proliferation of ____________ and the production of collagen, and thus steroids make scars relatively weak.
fibroblasts
96
Hemostatic solutions (e.g. ferric subsulfate, 30% aluminum chloride, silver nitrate - DW) _____ the healing of large wounds.
Slow
97
Some ointments _______ wound healing; these include Neosporin ointment, Silvadene cream, benoxyl peroxide preparations and Eucerin.
Speed
98
Some topical ointments _____ wound healing (DW - these include triamcinolone acetonide ointment (0.1%), Furacin and UPS petrolatum).
Slow
99
__________________ can be flat (ideal), raised (hypertrophic), sunken / pitted (atrophic) excessive and spreading beyond the wound (keloid).
Scar tissue
100
A common type of scarring caused when skin stretches or shrinks quickly.
Stretch Marks / Striae
101
T/F: The propensity for stretch marks may be hereditary, and fluctuating hormone levels, particularly increased cortisone, seem to play a role.
True
102
___________ typically develop during:
- Growth spurts that happen in puberty Pregnancy
- Rapid weight loss or gain
- Weight training when you have rapid muscle
growth
Stretch marks
103
What do Prolonged corticosteroid use on the skin, Cushing’s disease and Marfan syndrome have in common?
They can all cause... stretch marks!
104
When ___________ first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color.
Stretch marks!!!
105
__________ fibres form in edema; therefore, reducing edema prior to scar tissue techniques is important.
Collagen
106
___________ softens scar tissue by freeing restrictions and adhesions and increasing local circulation.
Massage Therapy
107
Stretching after modalities is essential for ___________ of scar tissue.
Realignment
108
T/F: Fibrous tissue can form adhesions from skin to many layers of tissue below, preventing free movement of skin, fascia, and other connective tissue.
True
109
T/F: Scar tissue expands with growth.
False
110
T/F: Scars are aneural and avascular.
True
111
Pain pattern referrals may arise from scar tissue, such as altered ______, _______, and _____________.
Posture
Gait
Biomechanics
112
Typically, surgical wounds seal within ___ hours.
48 hours
113
During the proliferation phase of wound healing, granulation tissue is in place within __-__ days.
5-10 days
114
Until granulation tissue has formed and it clear the wound is healing in a healthy manner, the _”/__cm avoidance rule applies for the therapist.
4"/10 cm rule
115
Problems at the surgical site can include infection, oozing, poor perfusion, swelling, pain at rest – what does a massage therapist do if these occur?
Consult an MD
116
Generally, pain should taper off as the wound heals, but ______ _______ pain is cause for concern.
Sudden acute pain
117
If there is an infection, techniques that improve __________ circulation can potentially be used.
Proximal
118
T/F: The beginning of healing is when infection started, so if there has been an infection, you need to count the days from the beginning of infection to determine what stage of healing the wound is in.
False, the beginning of healing is when infection stops, so if there has been an infection, you need to count the days from the end of infection to determine what stage of healing the wound is in.
119
Collagen synthesis / collagenisation also begins in proliferation phase, in the 2-4 week range. During this period, when tissue is no longer _____, and _________from light pressure, it is safe to start working on the scar.
When the tissue is no longer pink, and bounces back from light pressure.
120
The sooner the scar is treated, the easier and more likely it is that movement and flexibility will return (and it will prevent complications, compensating factors). However, do not stress tissue before this time, as it may cause premature ____________ formation that can get out of control and will not be stressed in proper direction.
collagen
121
While treating a scar, position the patient so that the scar is easily accessible and not in a ___________ position.
Stretched
122
As you palpate the scar tissue, identify differences in the __________ of the scar tissue and areas in which the scar appears to be adhered to tissues adjacent to it or deep to it.
mobility
123
The scar tissue should move freely within the ________ tissue. It is wise to document this movement or lack of movement, e.g. decreased inferior glide, or for circular palpation: restricted at 3 o’clock.
non-scar
124
Identify visual cues/appearances, such as puckering, contracture, hypertrophy (keloid) or discolouration (ideally the scar should be close to the same colour as the skin, either paler or slightly darker).
- ________ red colour may indicate congestion, _______ or edema may indicate lack of
perfusion.
Dark red colour may indicate congestion, white or edema may indicate lack of perfusion.
125
Warm or warm contrast hydro can be used in in 1)_______ stages, deep moist heat/cold post- treatment in 2)_________ stages.
1) early
| 2) later
126
In later stages or with bad scars, use heat and _______ oil (with paraffin wax to seal the heat in) first to do most of the work.
castor oil
127
Fascial techniques should be used to promote mobility and flexibility of the fascia - gentle modified fascial work in early stages. _____________ can be used in later stages and more challenging scars.
Muscle stripping
128
________ and _________ exercise are effective to remodel a scar
Stretching and resistance
129
___________ exercises are useful for joints and ligaments
Proprioceptive
130
If a patient has a complex and/or older scar, collagen fibres still can often be realigned (based on anecdotal experience from RMTs). Get the patient stretching & mobilizing the scar and continuing to regularly use it. Frequency is more important than intensity. Make sure _______ ______ matches scar.
Stretch angle
131
Type of fracture where skin stays intact
Closed/simple
132
Type of fracture where bone breaks the skin, or projects into another cavity.
Open/compound
133
Type of fracture where bone is broken into two or more pieces.
Complete fracture
134
Injury to the smooth articular cartilage and the bone underneath it
Osteochonral
135
Type of fracture where the periosteum is intact (bent or cracked)
Incomplete
136
Type of incomplete fracture common in vertebra
Compression
137
Type of incomplete fracture where broken ends of the bone are jammed together by the force of the injury
Impacted
138
Type of incomplete fracture where bone breaks only on the convex side – often in young people
Greensticks
139
Type of incomplete fracture caused by a missile such as a bullet or shrapnel
Perforation
140
Type of incomplete fracture common in tarsal bones
Stress fracture
141
Fracture healing depends on the type of bone, and amount of _________ that occurs there.
Movement
142
Bone usually takes _ to _ weeks to heal a significant degree.
6 to 8 weeks
143
During inflammatory phase of bone healing, inflammation is at its peak __ hours after a fracture.
48 hours
144
During inflammatory phase of bone healing, ___________ formation or fibrin clot can be expected within 72 hours
Hematoma
145
During inflammatory phase of bone healing, bone ends die off and clean-up of necrotic tissue begins by ___________
Osteoclasts
146
During inflammatory phase of bone healing, hematoma is gradually replaced by ___________ tissue.
granulation
147
What phase of bone healing does this describe?
- A mass of proliferating osteoblasts
- Lasts for approximately six weeks from the time
of injury
- Bony fragments become united by fibrous and
cartilaginous tissue.
- Osteoclasts are present, cleaning up dead
bone and debris.
Soft Callus Formation of Reparative phase
148
What phase of bone healing does this describe?
- Starts when the fracture ends are linked together by soft callus, and lasts until the fragments are firmly united by new bone (3–4 months).
- Bone callus growth begins at the periphery of the fracture site and progressively moves towards the center of the fracture and the fracture gap.
- Soft tissue within the gap undergoes ossification and the callus is converted into rigid calcified tissue (immature/woven bone).
- Reaches a state of “clinical union” but will not support full loads on the bone/muscle, and the fracture is still visible on imaging
Hard/Bony Callus Formation of Reparative phase
149
During remodelling phase of bone healing, -immature/woven bone is then slowly replaced by mature/___________ bone through surface erosion and osteonal remodeling.
lemellar
150
Remodelling occurs by osteoblastic and __________ activity in response to mechanical stress on the bone (Wolff's law).
osteoclastic
151
The remodelling phase of bone healing lasts until the bone has completely returned to its original morphology, including restoration of the __________ canal.
Medullary
152
T/F: Immobilization is a critical part of bone healing; any movement of bone fragments will slow down the initial healing process
True
153
General term for an ankle fracture affecting one or both malleoli, but also often defined as being bi-malleolar.
Potts
154
Fracture of the radius with dislocation of the distal radioulnar joint
Galezzi
155
Fracture of the distal radius with a posterior/ dorsal displacement of the wrist and hand, aka “dinner fork deformity”
Colles
