Tissue Response to Pain

Question 1

pain sources:
cutaneous

Answer 1

thru skin

Question 2

pain sources:
deep somatic

Answer 2

thru bony structures

Question 3

pain sources:
visceral

Answer 3

pain in diff area than injury

Question 4

pain sources:
psychogenic

Answer 4

in situation resemble previous pain

Question 5

sclerotomic pain

Answer 5

Deep, aching, and poorly localized; slow and fast characteristics

Question 6

dermatomic pain

Answer 6

sharp and well localized

Question 7

fast v slow pain

Answer 7

fast: pain accelerates when doing more in that area
slow: always hurts (throbbing)

Question 8

local v referred pain

Answer 8

local: pain right where the injury occurred
referred: pain diff area than injury

Question 9

myofascial pain

Answer 9

Trigger points: hyper contracted knot or a hyper irritable spot in the facia surrounding the muscle (feels like a P)
Referred to a reference zone
Causes shooting pain

Question 10

nociceptors

Answer 10

receptors in body to recognize pain
- periosteum, skin, teeth, organs
- afferent nerve fibers: transmit pulses towards spinal cord

Question 11

healing process phases

Answer 11

• inflammatory response
• fibroblastic repair
• maturation and remodeling

Question 12

Goals of inflammation

Answer 12

• protect the area
• localize the injury
• decrease injurious agents
• prepare for repair and remodel

Question 13

inflammatory phase

Answer 13

• 1st phase of healing process
• body’s defense mechanism (need for heal)

Question 14

healing (inflammatory response)

Answer 14

• begins immediately
• injury results in altered metabolism
• initial reaction by leukocytes and phagocytic cells

Question 15

inflammatory response timeline

Answer 15

• Local vasoconstriction reduces blood loss at injury site
• Platelet reaction (clotting)
• Coagulation cascade

Question 16

chronic inflammation

Answer 16

= failure to heal!
- as inflammation persists necrosis and fibrosis prolong the process
- granulation and fibrotic tissue develop in highly vascular and loose CT

• due to overuse, tissue not restored to physiological state, and cause shift from acute to chronic

Question 17

Fibroblastic Repair Phase

Answer 17

Second phase of the healing process, leading to scar formation and repair of the injured tissue

Question 18

Scar Formation

Answer 18

○ Capillary buds form
○ Granulation tissue develops
○ Collagen is laid down
○ Scar tensile strength increases
○ Normal sequence = minimal scarring
○ Persistent inflammation = extended fibroplasia

Question 19

Fibroblastic Repair Phase timeline

Answer 19

• 2 days - 6 weeks
• hematoma (bad bruise) decrease in size
• strength increase = vascularization decrease (whiter)
• scar tissue is fibrous, inelastic, not pre-injury strength

Question 20

1st Intention Healing:

Answer 20

• Happens when wound edges are closely approximated
• Minimal scarring

Question 21

2nd Intention Healing

Answer 21

§ Wound edge gapping
§ Scar tissue abundant & used to bridge the gaps
§ Common in musculoskeletal type injuries

Question 22

Maturation & Remodeling Phase

Answer 22

-Long term process (start 3 weeks after injury)
-Realigned collagen
-Increased strength
-Tissue gradually assume normal appearance
-May require several years
- overlap repair
-Bone can heal best when under stress/demand

Question 23

Wolff’s Law

Answer 23

• Progressively load tissues through the rehabilitation process
• Pain indicates the rate of progression

Question 24

progressive mobility

Answer 24

as healing moves into repair phase, add controlled activity.
- during remodeling aggressive ROM and strength training should be added

Question 25

Cartilage Healing

Answer 25

- limited capacity to heal, little or no direct blood supply -Healing depends on the blood supply to the cartilage*

Question 26

Ligament Healing

Answer 26

- similar to repair phase (lay down collagen, scar forms, realign in reaction to joint stresses) - surgically repaired stronger due to lack of scaring - up to 12 months - muscles strengthen joint (exercise v immobilization)

Question 27

skeletal muscle healing

Answer 27

- Initial bleeding followed by proliferation of ground substance and fibroblast - Myoblastic cells form = regeneration of new myofibrils - Collagen will mature and orient along lines of tension - Healing could last 6-8 weeks depending on muscle injured

Question 28

Tendon Healing

Answer 28

- Abundance of collagen is required for good tensile strength. - Tissue not sufficiently strong for tension until weeks 4-5

Question 29

Nerve Healing

Answer 29

- regeneration w/in nerve fiber - proximity of injury to nerve cells make regeneration difficult - 3-4mm per day - PNS heal better than CNS

Question 30

Acute bone healing

Answer 30

1. hematoma formation 2. Cellular proliferation 3a. Soft callus formation 3b. Hard callus formation 4. Ossification 5. Remodeling

Question 31

hematoma formation

Answer 31

- in first 48hrs hematoma w/in medullary cavity and surrounding tissue develops - blood supply disrupted by cell debris and clotting vessels

Question 32

soft callus formation

Answer 32

- random network of woven bone - formed by bone fragments that bridge fracture gap - internal callus creates rigid immobilization

Question 33

hard callus

Answer 33

- osteoblasts lay down cancellous bone, replace cartilage - crystallization of callus, remodeling begins - less than ideal immobilization makes cartilaginous union instead of bony

Question 34

ossification

Answer 34

- complete when bone is laid and callus is absorbed by osteclasts - adapt to applied stress (Wolff's Law) - 3-8 wks (depend on severity, site, age, extent)

Question 35

acute fracture management

Answer 35

- immobilized until x-rays reveal the presence of a hard callus - fractures can limit participation for weeks or months - Factors that interfere with healing: poor blood supply, poor immobilization, infection