Tissue Response Flashcards
define pain
a negative sensory and emotional experience associated with actual or potential tissue damage
what is an individuals pain perception influenced by? (4)
physical, chemical, social & psychological
what factors are involved in pain? (3)
-Anatomical structures-muscle/tendon/ligaments
-Physiological reactions- swelling/bruising/bleeding
-Psychological, social, cultural/cognitive factors (certain sport cultures athletes don’t like to admit they are injured)
pain is a major indicator of what?
injury
what 3 sources can pain originate from?
- somatic- skin, muscle, skeleton, joints
- visceral- internal organs (disease or injury) includes diffuse & refered pain
- psychogentic- anxiety/depression/stress, sensation is often felt too
what receptor produces pain and where are they
nociceptors, found in the skin, periosteum and some internal organs
what are afferent nerve endings, what are they sensitive to?
Transmit impulses towards the brain/spinal cord. Sensitive to mechanical, thermal and chemical energy.
what are the 3 pain categories
fast vs slow pain
acute vs chronic pain
local vs referred pain
speed, feeling & location of fast vs slow pain
fast:
-within 0.01 sec
-feels bright, sharp/electric
-felt mainly superficial or within the skin
slow:
-after 1 sec & increases over time
-achy/throbby
-can occur at skin and deeper into the joint or area
acute vs chronic pain
timeline, MOI, area & mechanically provoked?
acute: <last 3months, caused by an event, localized & mechanically provoked
Chronic: >last 3months, overuse injury, widespread/diffuse/referred pain & not mechanically provoked
define referred pain
percieved pain at location that is remote from the site of the tissues actually causing the pain
what are the 3 types of referred pain
- myofascial- trigger points
- sclerotomic- musculature
- dermatomic- skin
what is myofascial pain & characteristics
trigger points
characterized by:
-tender to compress
-accompanied by tight bands of tissue
-can be acute or chronic
-may give rise to deep referred pain
what is sclerotome pain & characteristics
and area of bone or fascia that is supplied by a single nerve root
characterized by:
-deep, aching and poorly localized pain
-autonomic changes could arise (increased BP, and sweating)
what is dermatonic pain & its characteristic
sharp and well localized, in the area of skin that is supplied by a single nerve root, skips autonomic responses
what is the best way to get a reflection of pain and discomfort
self reports
what are other ways to assess pain that does not include self reports (7)
1.questionaries
2. assessments
-visual analog scales 1-10
-pain charts
-McGill pain questionare
-Activity pain indicator profiles
-Numeric rating scales
pro & cons of visual pain scales
pro: can be used for quick on field pain assessment
con: subjective and pain level may not correlate to severity of injury
pro and cons of pain charts (with explainations)
PRO: can be used quickly on field
CON: gives them the option (or sort of tells them) how they feel without them really thinking about it
pro and con of McGill pain questionare
PRO: Can be used in clinic, in depth questionare
CON: takes a while to complete/ must be done before seeing a professional, cannot be done on field.
why is understanding soft tissue healing important for injury management (3)
-understand the phases of healing
-know where/how to start rehab/ return to work/play
-create optimal environment for healing
what are the 3 phases of healing and their estimated time lines
- inflammatory phase (day 0-6)
- fibroblastic repair phase (day 3-21)
- maturation and remodelling phase (day 21+)
goals of phase 1- Inflammation (4)
- protect
- localize
- decrease injurious agents
- prepare for repair & remodelling
what is the PIER method
Protect, Ice, Elevate, Rest
what are the cardinal signs of inflammation (5)
- pain
- swelling
- redness
- heat
5.loss of function
what occurs during the inflammatory phase? (4)
1.Local vasoconstriction
2. Vasodialation
3. platelet reaction
4. activation of coagulation cascade
what happens in vasocontriction
last no more than 10minutes, larger blood vessels constrict (due to neurotransmitters) & smaller arteries/viens and capillaries (due to serotonin)
This results in less blood flow to the area
what happens in platelet reaction
after vasoconstriction there is vasodialation
-initiate clotting
-individual cells combine with fibrin
-serotonin, adreniline, norardrenaline, and histamine are released for healing
-ATP is needed
-Results in occlusion of the ruptured vessel
what happens in the coagulation cascade
-fibrinogen molecules are turned to fibrin
-prothombin converts to thrombin
-resulting in clot formation to reduce bleeding
what happens if inflammation pursists (3)
-leads to pdnedema
-necrosis and fibrosis prolong healing process
-granulation and fibrotic tissue continue to develop within highly vascular and loose connective tissue
what happens if acute injury turns chronic (3)
-associated with overuse/overload and cumulative micro trauma
-tissue does not restore to normal physiologic state (unable to heal due to lack of rest)
-needs a different course of treatment
what happens in vasodialation (3)
- neurophils and macrophages- rid the injury site of debris/infectious agents
- mast cells and basophils- stimulate histamine to promote vasodialation
- bradykinin- promotes vasodialation and increase permability of blood vessel walls
what occurs beacuse of vasodialation
swelling
why does swelling occur
-because the walls are more permable
-increased pressure within the vessel forces exudate into the tissue
-provides critical body defense by diluting toxins & enables delivery of cells that remove damaged tissue
steps to the inflammatory response sequence (6)
- injury to cell
- chemical mediators liberated
- vascualr reaction (vasoconstriction/vasodialation/exudate)
- Clean up- platelets & leukocytes adhere to vascualr wall
- Phagocytosis
- clot formation
what happens in phase 2: fibroblastic repair phase
- development of new blood vessels
- fibrous tissue formation
- generation of new epithlial tissue
- wound contraction
- creation of scar tissue/formation
what happens during scar formation
- accumulation of exudate fluid to form connective tissue & generate new collogen (from fibroblasts)
- new collogen cross links contribute to stabilization of the wound site
- there is an increase in number of blood vessels present
What is 1st intention healing
-happens when wound edges are close together
-minimal scarring
what is 2nd intention healing
-wound edges are further apart (gapping)
-scar tissue is abundant and used to bridge the gaps
-common in msk injuries
what is maturation & remodelling. How long can it take?
a long term process, over lapping with the regeneration phase that realigns collagen
can take several years to complete.
why is it important to understand soft tissue healing for injury management?
important to know how much to stress the injured area without causing distress.
define wolffs law
-progressivley load tissue through the rehab process
-pain indicates rate of progression
(stress without distress)
what is the role of progressive mobility
controlled activity should be controlled in the repair phase. Aggressive ROM and strength exercises should be encorporated
what factors impede healing (14)
-edema
-extent of injury
-hemorrhage
-poor vasular supply
-separation of tissue
-muscle spasms
-atrophy
-foreign bodies
-corticosteroids
-keloid & hypertrophic scars
-infection
-humidity/climate/oxygen tension
-health/age/nutrition
-inapproariate care (no rehab)
soft tissues of the body (4) & what each contains
- nervous tissue- brain, spinal cord, nerves
- epithelial tissue- Lining of GI/other hollow organs & skin
- muscle tissue- cardiac, smooth, skeletal
- connective tissue- fat/soft padding, bone, tendon
3 types of cartilage
- Hylene- smooth surfaces
- Fibrin- strength
- Elastic- strength/support & structure
Cartilage healing (3)
-little/no direct blood supply so substances for repair are limited
-depends on subchondral bone is also dispruted (bone has better blood supply than cartilage).
-course of healing caries when chondrocytes are detroyed
Ligament healing
-what happens
-full healing time
-repair phase involves random laying down of collagen, a scar forms, and will mature and realign in reaction to joint stresses and strain (rehab is done to stress the random collagen and lay it down more stratigically)
-heal time 12 months
why are surgically repaired ligaments stronger
decrease in scar formation
why strengthen the muscle around the joint with the ligament injury
increased tension will increase joint stability
skeletal muscle healing
-what happens
full healing time
-hemorrhage and edema followed by phagocytosis & proliferation of ground substance and fibroblast.
-6-8 weeks depending on muscle injured
Myositis Ossification definition & signs/symptoms
-bone forms inside your muscle/soft tissue. After a traumatic injury & effects large muscles
sign/symptoms: Lump
-fast growing
-painful
-swollen
-tender
-warm to touch
Tendon Healing
-what happens if there is too much collagen
-abundance of collagen is needed for good tensile strength, but too much will result in fibrosis and may interfere with gliding
define fibrosis
thickness or scarring of tissue
Nerve Healing
-what type of nerves
-difference between nerve healing & other soft tissue healing
-what makes healing more difficult?
-peripheral nerves not CNS
-nerves regenerate, other soft tissue creates new tissue for healing
-proximity of injury to nerve cells make it more difficult for healing
bone healing remodelling. What happens?
-blood vessels in periosteum are damaged, blood clot forms a fractured hematoma.
-blood vessels grow into the fracture and fibrocartilage soft callus forms
-the fibrocartilage becomes ossified and forms a bony callus made of spongey bone
-Osteoclast remove excess tissue from bony callus and osteoblast create new bone in original appearance
Factors on bone healing time (4)
- severity of fracture
- site of fracture
- extensiveness of overall trauma
- age of patient
when and where do hematomas form
with 48 hours of the injury & in the medullary cavity /surrounding tissues
what is a soft callus, what is it formed from & what is its job
-random network of woven bone
-formed by bone fragments
-Bridge the fracture gap & creates rigid immobilization early
what is a hard callus
-more well formed callus as osteoblasts lay down cancellous bone to replace cartilage.
When is ossification complete
when bone has been laid down & the excess callus has been restored by osteoclasts
3-8 weeks
acute fracture management
must be immobilized until x-rays reveal the presence of a hard callus
Define stress fracture
-what causes it
-how to help
-microfracture in bone
-caused by repeated forces, axial compression or tension from muscle pulling
-decrease activity and eliminate excess stress
how to manage inflammation
(PIER)
Pressure (limit swelling
Ice (pain relief, analgesia, decrease blood flow and metabolic need)
Elevation (limits swelling, improves lymphatic drainage)
Rest (Limits swelling, protects against reinjury)
When to use heat vs ice
heat-not with acute injuries, not with in 48-72 hours of swelling. Too much blood flow will go to the area
ice- acute injuries
exercise management of injury (4)
ROM
Endurance
Strength
Prevent atrophy
injury management concepts (3)
- drugs (NSAIDS/Analgesics)
- therapeutic modalities (heat/ice)
- Exercise (rehab)
