Tissue Response to Injury

Question 1

What is a grade 1 tissue injury?

Answer 1

Ache after activity, mild local tenderness and local inflammatory changes

Question 2

What is a grade 2 tissue injury?

Answer 2

Ache or pain at onset of activity/after activity, local tenderness, some ROM limitation, weakness

Question 3

What is a grade 3 tissue injury?

Answer 3

Constant ache exaggerated by activity, local tenderness, loss of ROM, weakness, possible atrophy

Question 4

What are the 3 phases of the healing process?

Answer 4

Inflammatory response, fibroblastic repair, maturation/remodelling

Question 5

What is the treatment for the inflammatory response phase?

Answer 5

RICER and no HARM

Question 6

What are the indicators for referral during the inflammatory response phase?

Answer 6

• Unable to bear weight
• Unable to move injury through 50% ROM
• Joint swells majorly within 1-2 hours

Question 7

What occurs during the fibroblastic repair phase?

Answer 7

Scar formation (fibroplasia)

Question 8

What is cicatrisation?

Answer 8

Development of cicatrix scar tissue (avascular, contracted, firm) during the fibroblastic repair phase, characterised by discolouration

Question 9

What is the treatment for the fibroblastic repair phase?

Answer 9

Anti-inflammatories, physiotherapy, stretching (passive then active)

Question 10

What occurs during the maturation of cicatrisation?

Answer 10

Muscle wasting, weakness and loss of proprioception and skill

Question 11

What occurs during the maturation/remodelling phase?

Answer 11

Realignment of collage and continued breakdown and synthesis of collagen (type 3 becomes type 1)

Question 12

What are the aims of treatment for tissue injuries?

Answer 12

Assist healing, regain length and strength of tissues, regain function

Question 13

During what phase of healing should activity be added?

Answer 13

Repair phase

Question 14

What type of exercises should be incorporated into the maturation/remodelling phase?

Answer 14

Aggressive ROM and strength exercises

Question 15

What are the four types of soft tissue?

Answer 15

• 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)

Question 16

What is metaplasia?

Answer 16

Transformation of tissue from one type to another, abnormal type

Question 17

What is dysplasia?

Answer 17

Abnormal development of tissue

Question 18

What is hyperplasia?

Answer 18

Excessive proliferation of normal cells

Question 19

What are the characteristics of cartilage healing?

Answer 19

• Limited capacity to heal
• Little or no direct blood supply
• Chondrocyte and matrix disruption

Question 20

What are the characteristics of ligament healing?

Answer 20

• Similar healing course as other vascular tissues

- Repair phase often involves random laying down of collagen

Question 21

What are the factors affecting ligament healing?

Answer 21

• Surgically-repaired ligaments usually stronger
• Intra-articular tears
• Exercised ligaments are stronger

Question 22

What are the characteristics of skeletal muscle healing?

Answer 22

• Initial bleeding
• Proliferation of ground substance and fibroblasts
• Formation of myoblastic cells

Question 23

What are the characteristics of tendon healing?

Answer 23

• Requires dense fibrous union of separated ends
• Abundance of collagen
• Initially adheres to surrounding tissues, then separates

Question 24

What are the characteristics of nerve healing?

Answer 24

• 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

Question 25

What are the healing times for muscles, tendons/ligaments, bones and joints?

Answer 25

• Muscles: 6-12 weeks
• Tendons/ligaments: 12 weeks
• Bones: 6-8 weeks
• Joints: 6-12 weeks

Question 26

What are the prescribed recommendations for NSAIDs?

Answer 26

• Prescribe as early as possible

- Full dosage = 3-5 days

Question 27

What is meant by the ‘ceiling effect’ of NSAIDs?

Answer 27

Beyond a certain dosage they don’t provide additional benefit

Question 28

How are corticosteroids used?

Answer 28

Injected as local treatment of soft tissue inflammation, with 10 days rest between injections

Question 29

What is a possible consequence of repetitive injection of corticosteroids into a joint?

Answer 29

Crystal aropathy, which has a catabolic effect on bone

Question 30

What do analgesics do?

Answer 30

Inhibit perception of pain

Question 31

What does aspirin do?

Answer 31

Masks pain, acts as an anti-inflammatory, reduces fever, promotes excretion of uric acid, reduces platelet stickiness and may produce ulcerations/gastric bleeding

Question 32

What is paracetamol?

Answer 32

An aspirin alternative that is metabolised in the liver and kidney

Question 33

What are the four types of imaging?

Answer 33

X-ray, CT scan, MRI scan and bone scan

Question 34

When is an X-ray used and what is it based on?

Answer 34

Suspected hard tissue problems, based on ionising radiation

Question 35

What does a CT scan do?

Answer 35

Uses computerised tomography to view soft tissue in cross-sectional slices, displaying precise detail

Question 36

What does an MRI scan do?

Answer 36

Produces images of hard and soft tissue (nerve tissue)

Question 37

What does a bone scan do?

Answer 37

Shows elevated levels of osteoblast activity as a darkened hot spot