Tissue Healing, Scar Tissue, Fractures Flashcards
Which layers of the skin are damaged by first degree burns?
The epidermis (and sometimes the upper dermis).
What type of burn causes mild pain and redness. E.g. Sunburn, minor scald?
First degree burns
What is the healing time for a first degree burn?
3-6 days
Superficial skin layer over the burn may peel off in 1-2 days
T/F: Healing for first degree burn is resolution with scar tissue.
False: there is no scar tissue
Which type of burn is characterized by destruction of the epidermis and part of the dermis?
Second degree burns.
T/F: Second degree burns cause pain, redness, and blisters that may ooze.
True
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.
Second degree burns
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.
Third and fourth degree burns (full thickness)
T/F: third and fourth degree burns are generally very painful.
False: generally there is no pain in the area because nerve endings are destroyed.
Which types of burns require skin grafting as no cells are available for regeneration of new skin?
Third and fourth degree burns (full thickness)
Complications of healing from burns: 1) _________ of scar tissue, development of 2) ____________ that lead to joint stiffness.
1) Hypertrophy
2) Contractures
Therapies can alleviate ______ and _________ (a common complaint from burn patients).
Pain and itching
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.
1) Edema
2) Anxiety
T/F: Regarding burns, massage is most helpful to ease symptoms after emergency care and in recovery phase.
False: Massage may help ease these symptoms both in emergency care and in recovery phase.
Massage can also help with better remodelling of _______ tissue.
Scar tissue
Therapeutic Touch (TT) is based on the theory that the body, mind and emotions form a “___________________”.
“Complex energy field”
T/F: Physician’s consultation is required before therapies for burn patients.
True
T/F: Massage is always contraindicated directly on a acute burn, even a First Degree burn, such as a sunburn.
True. However, if it is only part of the body that is sunburned, you could use cool compresses on that part and massage elsewhere.
Lesion or trauma/inflammation to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch.
Muscle strain/tear
A direct, blunt, compressive force to a muscle, tearing and crushing the underlying muscle fibres.
Muscle contusion
Prolonged performance of repetitive actions, causes pain and impairment of function of tendons and muscles involved.
Repetitive Strain Injury
Hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.
Trigger point
What is the difference between an Active and Latent Trigger Point?
Active Trigger Point: painful without palpating e.g. causing a tension headache
Latent Trigger Point: not painful unless palpated
Articulating surfaces are no longer intact
Dislocation
Incomplete or partial dislocation of a joint (or other structure)
Subluxation
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
Swelling and irritation of a bursa (fluid filled sac between structures that reduce friction)
Bursitis
Swelling or haemorrhage resulting in build-up of pressure in muscle unit
Acute Compartment Syndrome
Increased pressure from Acute Compartment Syndrome leads to decrease 1) -> 2) -> 3) -> 4).
1) Decreased blood flow
2) Ischemia
3) Gangrene
4) Necrosis
Acute Compartment Syndrome causes severe pain, palpable tightness, _______ appearance
shiny
With Acute Compartment Syndrome fascial surgery (fasciotomy) is done within __ hours to minimize damage.
12 Hours
Acute Compartment Syndrome is not to be confused with ____________________ Syndrome, which is not a medical emergency
Chronic/Exertional Compartment Syndrome
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
Muscle strain occurs when _________ exceeds the weakest structural element
Tension
Muscle strain is usually located __ to __ mm from the muscle tendon junction
0.1 to 3mm
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
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
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
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
Blow to a part of the body, tearing/crushing underlying muscle fibres and connective tissue without breaking the skin.
Contusion
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
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.
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
Which stage of muscle healing is associated with Haemorrhage, edema formation, myofibril retraction, nerve axon damage, mononuclear invasion, phagocytosis?
Inflammatory / Acute
0-72 hours
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
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)
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)
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
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
Broad term encompassing painful conditions relating to tendon injury.
Tendenopathy
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
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
Inflammation of a tendon sheath.
Tendosynovitis
A tear in a ligament.
Sprain
Injury where a body structure is forcibly detached from its normal point of insertion by either trauma or surgery
Avulsion
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
T/F: During tendon and ligament injury, bleeding into joint capsule expedites healing.
False: it delays healing
The initial inflammatory phase of tendon healing lasts about ______ hours.
24 Hours
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
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
The proliferative phase of tendon healing begins __________ after injury and lasts __________
A few days
A few weeks
During the proliferative phase of tendon healing, _______________ develop at the site.
Granulation tissue
