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FS Exam 3 > Tissue Injury and Repair > Flashcards

Tissue Injury and Repair Flashcards

1
Q

Compression Injury

A

Soft tissue contusions

Disrupt mm fiber and intramuscular bleed results

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2
Q

Tension Forces

A

Strain, Sprain
Ligament and tendon disruptions
Muscle tears

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3
Q

Fatigue or stress failure

A

Microtrauma

Repetitive submaximal stress

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4
Q

Grade 1

A

Mild pain and swelling

Localized tenderness, and pain with tissue stress

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5
Q

Grade 2

A

moderate pain, may have significant swelling, stress greatly increases pain

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6
Q

Grade 3

A

moderate to sever pain, tissue stress usually does not increase pain; if joint stabilizing tissue may have laxity

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7
Q

Ultimate goal of treatment

A

The formation of a strong, mobile, scar at the site of the lesion so that there is complete and painless restoration of function

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8
Q

Points to keep in mind with reaching goal in treatment - blood supply

A

Allow for healing and inflammation
If on prolonged steroir for RA
Body parts with less blood supply (ligaments vs muscle)

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9
Q

Points to keep in mind with achieving goal - normal forces

A

Having the tissue undergo its normal forces

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10
Q

Points to keep in mind with reaching goal - existing pathologies

A

would influence mediators involved in inflammation as well as blood supply

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11
Q

Things to keep in mind with reaching goal

A

Blood supply
Normal forces
Existing pathologies

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12
Q

Phases of Injury

A
  1. Hemostasis
  2. Inflammatory phase
  3. Proliferative (Granulation phase)
  4. Remodeling (Maturation) Phase
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13
Q

Primary injury effects

A

Blood into tissue

Cellular death and necrosis

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14
Q

Injury Effects - Blood into Tissue

A

Tissue Degeneration
Clotting mechanism initiated
Clots plug damaged vessels and lymphatics

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15
Q

Injury Effects - Cellular death and necrosis

A

Release of lysosomes

Increased cellular debris

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16
Q

Hemostasis Phase - Evaluation

A 
Time of insult (about 15 min)
Pain is low - they just hurt themselves
Minimal swelling
Little mm. guarding 
This is best chance you have at figuring out what tissues might be injured
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17
Q

Hemostasis Phase - Goals

A

Life/limb threatening conditions
Control bleeding
Stabilize the area

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18
Q

Inflammatory Phase - Acute

A 
15 minutes to 4/6 days
Hemodynamic effects going on:
Dilation of blood vessels
Increased vascular permeability
Increased pain
19
Q

Cardinal Signs of Inflammation

A 
Heat
Redness
Pain
Swelling
Loss of function
20
Q

Secondary Hypoxic Injury

A

Decreased fluid return

Interstitial space distension

21
Q

Secondary Hypoxic Injury - Dec Fluid Return

A

Lymphatics are plugged
Fluid is actively being moved into the area
Osmotic pressure increases

22
Q

Secondary Hypoxic Injury - Interstitial Space Distension

A

Increase distance btw cells and nutrient source

Low PO2 levels

23
Q

Why does early activity worsen the situation

A

Supply and demand issue

Less nutrients and when we ask it to work, even less

24
Q

Margination of Cells

A

Neutrophils followed by macrophages
Chemotaxis
Platelets - fibrinogen –> fibrin clot formation
Fibrin clot = scaffold for other cell types

25
Q

Clot Dissolution

A

Signals the end of inflammatory phase
Fibrinolytic system causes degradation of fibrin clot
Lyphatics open
Edema begins to resolve

26
Q

Goal - Inflammatory Phase - Protective Phase

A
  1. Limit early bleeding
  2. Dec. inflammatory exudate
  3. Reduce pain and mm. guarding
  4. Promote phagocytosis
  5. Stabalize part as needed
  6. Dec. dysfunctional movements
  7. Promote general body fitness
27
Q

Treatments Options

A
  1. RICE/MICE
  2. Compression, Ice
  3. Stabilization
  4. Isometric muscle sets
  5. Motion to adjacent areas
  6. Modalities (E-Stim)
  7. Medications
  8. Patient Education
28
Q

Treatment Options - RICE vs. MICE

A

Rest, Ice, Compression, Elevation
Motion, Ice, Compression, Elecation
Need to be careful with MICE - want passive normal forces but not too much

29
Q

Tx options - Compression and ICe

A

Ice = reduce blood flow to the area and will dec. chemotaxin factors and dec. inflammation

30
Q

Proliferative Phase (Reconstructive/Subacute)

A

2-3 days to 21-28 days
Fibroblasts are primary mediator
Granulation starts
First part = neovasculatization (new blood vessels)

31
Q

Fibroblast Activity

A

Attracted via platelet and macrophage chemotaxis
Produce Collagen matrix
- Type 3 collagen
- Elastin
- Reticulin
- Ground substances (GAGS and Proteoglycans)

32
Q

GAGS and Proteoglycans

A

Helps stablize tissue
Hydration of tissue
Aid in developing cross links

33
Q

Collagen Production

A 
A variety of collagen types 
Protein molecule with triple helix structure - tropocollagen is precursor
Group of 5 to form a microfibril
Intramolecular crosslinks
Intermolecular crosslinks
Collagen organization
34
Q

Most common collagen type

A

Type I - 80% of collagen in our body

35
Q

First collagen type that is laid down

A

Type III - will eventually be replaced by Type I

36
Q

Wound Contraction

A

Some fibroblasts change to myofibroblasts

Some continue to produce collagen

37
Q

Strength factors in wound contraction

A

Crosslinks developed

GAGs

38
Q

End of Proliferation Phase

A

21-28 days
Can tolerate bidirectional motion
Scar starts to chrink secondary to the myofibroblast contractile ability
Signals end of fibroblastic phase

39
Q

Management Goal - Controlled Motion

A

Develop a managable scar
Amount of scarring is inversely related to return of function
Wound ends must remain approximated

40
Q

Treatment

A

Movement within efected area
Control of inflammation and pain
Protected weight bearing
Gentle stretching - tissue specific
Easy to stress new tissue and surrounding tissue
Multi-angle isometric, AROM, endurance exercises

41
Q

Remodeling Phase - Consolidation Phase

A 
Consolidation stage (3-8 weeks)
# of fibroblasts dec
Dec development of new vascular networks
Collagen fibers continue to replace (50% turnover in first 3 weeks)
Type 3 collagen is being replaced by type 1
42
Q

Remodeling Phase - Maturation Stage

A

2-18 months
Cell activity continues to decrease but remains higher than surrounding tissue
85% of collagen is replaced by 5 months
Stops responding to conservative treatment at 14 week mark

43
Q

Physiological Characteristics

A

Collagen synthesis/lysis balance occurs during maturation phase
Although scar is shrinking, strength is increasing
Balance is oxygen deoendent
Fibers will orient themselves based on demand

FS Exam 3 (10 decks)

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