Tissue Injury/Healing Flashcards
Sprains
Grade 1: ligament stetched
Grade 2: incomplete or partial tear, most pain, most common, reduced strength
Grade 3: complete tear, no pain, loss of function
Strains
Grade 1: Microtearing of muscle, mild pain and swelling
Grade 2: partially torn muscle, moderate pain, affecting activity
Grade 3: complete or avulsion, severe pain initially, defect, loss of function
Acute Stage of Healing
-inflammatory
-pain early in ROM
-0-10 days
-chemicals irritate nerve endings
PT:
-prevent negative effects of rest
-reduce inflammation, edema, pain
-protect area
Teqniques:
-soft tissue
-estim: tens, IFC
-cryo
-joint mobilizations (I-II)
-ultrasound
Subacute Stage of Healing
-proliferation and repair
-pain at endfeel
-2-22 days
-growth of capillaries, collagen formation, wound is covered, granulation tissue
PT:
-mobilize scar
-promote healing and function (PROM>AAROM>AROM)
-develop neurmuscular control
-pt education about 6w healing
Teqniques:
-soft tissue: Cross friction, TP, MFR, AR
-estim: tens, IFC
-heat: increase circulation
-joint mobilizations (III-IV)
-stretching
-Isometrics, AROM, endurance, WE exercises
Chronic Stage of Healing
-maturation and remodeling
-pain at overpressure
-12 days -1+ yr
-new collagen (type 2) to align with stress
-scar formation
PT:
-return to function
-increase tensile quality of scar
- develop functional independence
-mobilize scar
-improve neurmuscular control
Teqniques:
-soft tissue: Cross friction, TP, MFR, AR
-estim: russian, NMES
-deep heat: increase circulation
-joint mobilizations (III-IV)
-stretching
-increase strength
Ligament Injuries
-trauma, mechanical stress, gender differences
-3-6weeks
-85% type I collagen, turn into type III
-30-50% weaker
Laxity:
-3 weeks= mild tension
-6 weeks= resume normal activities
-12 weeks= almost max tensile strength
Tendon Injuries
-singular incident or cumulative
-patial tear or rupture @ junction
-surgical repair essential for full return if >50% diameter
Healing:
-limited blood supply, 7.5x lower than muscle
-type III collagen aligned randomly (proliferative)
-increase in type 1 lonngitudianlly (remodeling)
Tendon Healing Precautions
-AROM 3 weeks across repair site results in poor outcomes
-should be exposed to limitted motion-PROM
-slow progression from PROM->AAROM->AROM->Resisted
Rehab lasts: 6m-2 years
Causes of Muscle Injury
Mechanical Forces:
stretch, contraction, contusion
Thermal Stresses:
heat or cold
Nerve Injury
Myotoxic Agent:
lidocaine, corticosteroids, venom
Prolonged Ischemia:
compartment syn, tourniquet
Management of Muscle Injury
Short term mobilization (2-5 days)
-manage inflammation and hemorrhage
Cautious mobilization
-2-3 weeks= tissue extensibility & protection
-4-6 weeks= gentle AROM < full range
After 6 week:
-warm up period and endurance activities to reduce reinjury
-avoid eccentric
Bone Remodeling
-balance between building and tearing down
Wolff’s Law:
-bone is deposited in areas of stress
-weight bearing
-lack of stress causes atrophy
Causes of Bone Fractures
-direct violence
-indirectt violence
-diseases of bone
-repeated stresses
Classification of Fractures
Transverse: right angle line, shearing
Oblique/Spiral: twisting force
Comminuted: broken into fragments
Greenstick: splintering of bone
Depressed: bone pressed inward (skull)
Fracture Healing
- Hematoma (6-12h): Blood clot forms and inflammation
- Proliferation (1-2d): granulation tissue and fibrocartilage
- Callous Formation (1-3w):
Soft callous - Ossification (6w): Soft callous replaced by bony callous
- Remodeling (4m-1y): restoration of medullary canal
Factors to Hinder Fracture Healing
-inadequate blood supply
-poor nutritional status
-poor apposition
-infection
-diseases
-corticosteroid
-soft tissue damage
