Tissue Response to Injury Flashcards
What are the four types of pain sources?
- Cutaneous
- Deep Somatic
- Visceral
- Psychogenic
What is sclerotomic pain?
Deep pain with slow or fast characteristics
What is Dermatomic pain?
Sharp, well-localized pain
What kinds of pain do we experience?
fast and slow, acute and chronic, local and referred.
What kind of pain is perceived at the source but also extends to nearby tissues?
Radiating
What is referred pain?
When it is felt in a part of the body that is removed from the tissues causing the pain. eg. heart attack is felt in arm/neck as well as chest.
What is myofascial pain?
Trigger points and referred to a reference zone.
What kind of receptors are nociceptors?
pain receptors that are located in the skin, periosteum. Surround bones, teeth, some organs.
What nerve fibers transmit the impulses toward the spinal cord?
Afferent nerve fibers.
What types of assessment techniques can be used for pain?
Visual analog scale( no pain to severe)
Pain charts
McGill pain questionnare
Numeric rating scale
What are the three phases of healing?
- Inflammatory response phase
- fibroblastic repair phase
- maturation and remodeling phase
What are the goals of phase 1 of inflammation?
Protect, localize, decrease injurious agents, prepare for repair and remodeling
When does the inflammatory response phase occur?
right from injury until 3-4 days post injury.
What are the cardinal signs of inflammation and what is it’s acronym?
SHARP: Swelling Heat Altered function Redness Pain
What cells are involved in the initial reaction from injury?
Leukocytes and phagocytic cells
What are the 3 mechanisms that act to stop blood loss form a wound?
- Local vasoconstriction,
- platelet reaction
- coagulation cascade
What occurs during the platelet reaction (also known as clotting)?
Fibrin forms blood clot/scab, platelets produce chemical mediators.
What cells rid the injury site of debris and what is it called?
Neutrophils and macrophages; phagocytosis
What cells release histamine?
Mast and basophils
What peptide promotes inflammation by vasodilation and therefore increasing permeability of blood vessel walls?
Bradykinin
What contains clotting proteins & antibodies and brings in oxygen and nutrients?
Exudate (pus)
How does clot formation occur?
Platelets adhere to collagen creating a plug (clot).
What aids in localizing an injury?
Clots
What is chronic inflammation?
when the bodies ability to heal fails.
What can occur if inflammation continues?
Necrosis and fibrosis prolong healing process.
When is chronic inflammation common?
Overuse, overload, and cumulative microtrauma.
What occurs during the scar formation?
-capillary buds form, granulation tissue develops, collagen is laid down, scar tensile strength increases.
What is the time frame of fibroblastic repair phase?
2 days to 6 weeks.
What occurs during fibroblastic phase?
Hematomas decrease in size, strength increases, vascularization decreases(becomes whiter) scar tissue is fibrous, inelastic & and not at pre-injury strength.
What is 1st intention healing?
when wound edges are closely approximated and minimal scarring occurs.
What is 2nd intention healing?
when wound edges are gapping and scar tissue is abundant to close gaps. Common in musculoskeletal type injuries.
What is the maturation and remodeling phase?
- long term process
- realignment of collagen
- increased strength
- tissue gradually assumes normal appearance
- may require several years to complete.
When does maturation and remodeling occur?
aprox. 3 weeks post injury and overlaps with repair/regeneration phase. Stress without distress should occur.
What is wolff’s law?
bones will adapt based on stress or demands placed on them. Progressively load tissues throughout rehabilitation process.
How does progressive mobility play a role in healing?
repair phase allows some stress to occur so that injured tissues can strengthen. Activities should be controlled and incorporated slowly.
What might impede healing?
extent of injury, edema, hemorrhage, poor vascular supply, separation of tissue, muscle spasm, atrophy, foreign bodies, corticosteroids, keloid/hypertrophic scars, infection, climate, health/age/nutrition, inappropriate care.
What are the 4 types of tissue in the body?
Epithelial, Connective, Muscle, nerve.
Where is epithelial tissue found?
skin, vessels, organ linings
Where is connective tissue found?
tendons, ligaments, cartilage, fat, blood, and bone
Where types of muscle tissue are there?
Skeletal, smooth and cardiac
What is nerve tissue?
Brain, spinal cord, and nerves
What has little capacity to heal and little/no direct blood supply?
Cartilage
What is an example of cartilage that can be damaged?
Meniscus
How does ligament repair itself?
proper care allows collagen to lay forming scars then realigns by reacting to joint stresses/strain. Takes up to 12 months to heal completely.
Why are surgically repaired ligaments stronger?
Decreased scar formation from surgery.
How can you strengthen ligaments?
exercise strengthens muscles thus reinforcing joint. More tension of muscle will develop better joint stability.
How does skeletal muscle heal?
bleeding followed by proliferation of ground substance/fibroblast. Myoblastic cells form leading to regeneration of myofibrils. Collagen matures and orients along lines of tension.
What is myositis ossifcans?
Bone tissue forms within muscle stemming from an injury.
How long does healing take for skeletal muscle?
6-8 weeks.
What occurs during tendon healing?
Dense fibrous union of separated ends. requires collagen to have tensile strength though too much can lead to fibrosis which will interfere with gliding.
After how many weeks is tissue in tendons sufficiently strong to support tension?
4-5 weeks.
Nerve healing process:
regeneration can take place within nerve fiber;
proximity of injury to nerve cell makes regeneration more difficult;
slow process, 3-4mm per day;
injured CNS nerves do not heal much compared to PN.
What are some considerations for soft-tissue healing?
blood supply and nutrients necessary and play huge role in healing capacity; healing in older patients/those with poor diets make take longer; some disorders(blood conditions) may slow/inhibit healing process.
What 3 phases do bone healing go through?
- inflammatory response
- fibroblastic repair
- maturation and remodeling
What are the stages of an acute fracture?
- hematoma formation
- cellular proliferation
- callus formation
- ossification
- remodeling
What occurs during the hematoma stage and how long does it last?
First 48 hrs hematoma within medullary cavity and surrounding tissue develops. Blood supply is disrupted by clotting vessels and cellular debris.
What occurs during the soft callus stage of bone healing?
It is a random network of woven bone, formed by bone fragments that bridge fracture gaps. Internal callus creates rigid immobilization early.
What occurs during the hard callus stage of bone healing?
Osteoblasts lay down cancellous bone replacing cartilage. Crystallization of callus leads to remodeling.
Less than ideal immobilization produces cartilaginous union instead of bony union.
What occurs during the ossification stage?
Complete when bone has been laid down & excess callus is reabsorbed by osteoclasts.
Bone continually adapts to applied stress (wolff’s law).
Time required depends on severity/site of fracture/age/extent of trauma.
How long does the ossification stage last?
~3-8 weeks.
What does PIER stand for?
Pressure- limit swelling
Ice- pain relief: analgesia, decrease blood flow and metabolic needs
Elevation- Limits swelling (improves lymphatic drainage), decreases blood flow (gravity);
Rest/ Restricted function (defined)- limits swelling, protects against re-injury
What does RICE stand for
Rest
Ice
Compression
Elevation
What are some management concepts for inflammation?
analgesic & NSAIDs
heat/cold, electrotherapy, therapeutic ultrasound
exercise: increase ROM, strength, endurance, prevent atrophy.
