Tissue Response to Injury Flashcards
What is a grade 1 tissue injury?
Ache after activity, mild local tenderness and local inflammatory changes
What is a grade 2 tissue injury?
Ache or pain at onset of activity/after activity, local tenderness, some ROM limitation, weakness
What is a grade 3 tissue injury?
Constant ache exaggerated by activity, local tenderness, loss of ROM, weakness, possible atrophy
What are the 3 phases of the healing process?
Inflammatory response, fibroblastic repair, maturation/remodelling
What is the treatment for the inflammatory response phase?
RICER and no HARM
What are the indicators for referral during the inflammatory response phase?
- Unable to bear weight
- Unable to move injury through 50% ROM
- Joint swells majorly within 1-2 hours
What occurs during the fibroblastic repair phase?
Scar formation (fibroplasia)
What is cicatrisation?
Development of cicatrix scar tissue (avascular, contracted, firm) during the fibroblastic repair phase, characterised by discolouration
What is the treatment for the fibroblastic repair phase?
Anti-inflammatories, physiotherapy, stretching (passive then active)
What occurs during the maturation of cicatrisation?
Muscle wasting, weakness and loss of proprioception and skill
What occurs during the maturation/remodelling phase?
Realignment of collage and continued breakdown and synthesis of collagen (type 3 becomes type 1)
What are the aims of treatment for tissue injuries?
Assist healing, regain length and strength of tissues, regain function
During what phase of healing should activity be added?
Repair phase
What type of exercises should be incorporated into the maturation/remodelling phase?
Aggressive ROM and strength exercises
What are the four types of soft tissue?
- Epithelial tissue (skin, vessel & organ linings)
- Connective tissue (tendons, ligaments, cartilage, fat, blood, bone)
- Muscle tissue (skeletal, smooth & cardiac)
- Nerve tissue (brain, spinal cord & nerves)
What is metaplasia?
Transformation of tissue from one type to another, abnormal type
What is dysplasia?
Abnormal development of tissue
What is hyperplasia?
Excessive proliferation of normal cells
What are the characteristics of cartilage healing?
- Limited capacity to heal
- Little or no direct blood supply
- Chondrocyte and matrix disruption
What are the characteristics of ligament healing?
- Similar healing course as other vascular tissues
- Repair phase often involves random laying down of collagen
What are the factors affecting ligament healing?
- Surgically-repaired ligaments usually stronger
- Intra-articular tears
- Exercised ligaments are stronger
What are the characteristics of skeletal muscle healing?
- Initial bleeding
- Proliferation of ground substance and fibroblasts
- Formation of myoblastic cells
What are the characteristics of tendon healing?
- Requires dense fibrous union of separated ends
- Abundance of collagen
- Initially adheres to surrounding tissues, then separates
What are the characteristics of nerve healing?
- Regeneration can take place within a neuron (more difficult if near nerve cell)
- Requires optimal environment
- Injured CNS nerves fo not heal as well as PNS nerves
What are the healing times for muscles, tendons/ligaments, bones and joints?
- Muscles: 6-12 weeks
- Tendons/ligaments: 12 weeks
- Bones: 6-8 weeks
- Joints: 6-12 weeks
What are the prescribed recommendations for NSAIDs?
- Prescribe as early as possible
- Full dosage = 3-5 days
What is meant by the ‘ceiling effect’ of NSAIDs?
Beyond a certain dosage they don’t provide additional benefit
How are corticosteroids used?
Injected as local treatment of soft tissue inflammation, with 10 days rest between injections
What is a possible consequence of repetitive injection of corticosteroids into a joint?
Crystal aropathy, which has a catabolic effect on bone
What do analgesics do?
Inhibit perception of pain
What does aspirin do?
Masks pain, acts as an anti-inflammatory, reduces fever, promotes excretion of uric acid, reduces platelet stickiness and may produce ulcerations/gastric bleeding
What is paracetamol?
An aspirin alternative that is metabolised in the liver and kidney
What are the four types of imaging?
X-ray, CT scan, MRI scan and bone scan
When is an X-ray used and what is it based on?
Suspected hard tissue problems, based on ionising radiation
What does a CT scan do?
Uses computerised tomography to view soft tissue in cross-sectional slices, displaying precise detail
What does an MRI scan do?
Produces images of hard and soft tissue (nerve tissue)
What does a bone scan do?
Shows elevated levels of osteoblast activity as a darkened hot spot
