Tissue States Flashcards
Tissues types that are important from a therapeutic perspective
Muscle Fascia Tendon Ligament Bone Cartilage Joint structure Skin Nerves
Tissue states
Normal
Damaged/injured - varies depending on type
Stages of healing
Scar tissue/fibrosis
Acute vs Chronic injury
- Acute - Recently damaged (1-3 weeks, usually inflammation and start of proliferation),
- Sub acute (3 weeks to 6 months)
- Chronic (more than 6 months) usually due to ongoing pathology such as osteoarthritis, rhabdomyolysis or can be caused when healing process fails e.g. infection
One off incidents vs degenerative conditions
- Degenerative conditions - chronic
- One off incidents - tend to be acute as usually caused by an incident e.g. Slip in field
Medicinal considerations
Can affect stage of healing
Can affect pain levels shown (hide lameness), anti-inflammatory medication
Inflammation
- Part of the complex biological response of body tissue to harmful stimuli
- Tissue damage caused by wound or invading pathogenic organism induces a complex sequence of events collectively known as inflammation
- In the first centaury AD Roman physical Celsus identified four cardinal signs of inflammation
○ Rubor (redness due to capillary dilation resulting in creased blood flow, however consider bleeding at the site as well
○ Tumor (swelling due to the passage of plasma from blood streaming to the damaged site)
○ Calor (heat due to capillary dilation)
○ Dolor (Pain consider the process of pain that we have already discussed
Considerations when dealing with inflammation
Do you want to control it acute vs chronic Pain levels Mobility levels Prescribed drugs
What can we incite and inflammation sites
increased blood flow
decreased blood flow
Decreased fluid retention
What therapies can be used on inflammation
Cryotherapy
Compression (can cause more harm than good)
Massage
Proliferation
- Angiogenesis occurs - laying down of new tissue
- Collagen and proteins used during proliferation
- Accumulation of fibroblasts
- Synthesis of disorganised collagen (type III)
- Disorganised scar tissue forming
- Be careful that too much scar tissue does not occur - fibroblasts keep signalling that more collagen is still needed - can be caused by disease/bacteria or nerve damage
○ Excessive scar tissue needs vet intervention
Qualities of scar tissue
Loss of elasticity causing functional limitation
Harder tissues such as bone that have excessive tissue laid down also causes issues due to soft tissue influence;
- Can cause damage to associated soft tissue by abrasive rubbing
- RoM restriction
- Increase risk of damage e.g. Fracture
- Can affect lymph flow depending on when the scar tissue forms
Remodelling
Overlaps with proliferation
Repairs the injury site/alignment of fibres
What process does scar tissue best respond to?
Loading of the tissue
Bone - weightbearing
Soft tissue - movement - usually in form of exercise - can be done by massage, stretching, isometric exercises, ultrasound
Factors to consider when dealing with phases of healing
Duration of phase - tissue dependent
- Volume of blood flow determines if a tissue heals quickly or slowly
Likeliness of re-injury
Tissue capacity - E.g. How quickly they can heal, animal age, previous fitness level
Husbandry of the animal during the phase
- Is it turned out or boxed
- Proliferation phase does not necessarily need rest but owner may think that rest is what is best for the animal
- Owners don't always comply
Pain
Owner capacity
- Physical
- Time
- FinancialTypes of injury in muscls
Tear
Partial tear
Micro-trauma
Disease
- Neurological
- Infection
Metabolic issuesStates identified in muscles
- Natural resting tone - high and low - Connemara’s/collies/staffies tend to have a high resting tone, hot bloods (Arabs etc). tend to have a higher tone than cob type breeds, cobs/bulldogs tend to have a lower resting tone. There are exceptions to the rul
- Hypertonicity
- Flaccid muscle - lack of neurological input - need diagnosis if not previously diagnosed
- Fasciculation - variation of muscle fibre firing, usually occurs during palpation only
- Spasm - variation of muscle fibre firing - cramping that comes then spasms off, then may recur
- Contracture - variation of muscle fibre firing - permanent
- Atrophy
- Hypertrophy
- Trigger points
Types of injuries in tendons/ligaments
- Intrinsic tear - usually in the core
- Extrinsic tear - usually from the external surface inwards e.g. cut
- Diagnosed by vet - just need to be able to identify that there is an injury in this structure, dynamic assessment is the most common way to identify, but swelling etc. Can occur
Identifying features of injury in tendon/ligament
Lameness - may only be on the turn etc.
Pain on palpation Inflammation/swelling
Types of injuries in fascia
Tears/surgical incisions
dehydration
Identifying features of injury in fascia
- Very taught feeling to tissue on palpation - drum skin
- Puckering of skin
- Hard to tent the skin - different from systematic dehydration
Pain
Types of injuries in bone
Fracture - type, severe vs micro fracture
Periosteum bruising/damage - not overly common
Osteosarcoma - more common in dogs than horses
Identifying features of injury in Bone
Lameness - not always depends on fracture type
Presence of inflammation
X-ray
Pain
Types of injuries in joints
Many different orthopaedic conditions exist
Traumatic damage
Infection
Degeneration e.g. arthritis
Identifying features of injury in Joints
Lameness Gait adaptation Weight shifting Inflammation RoM testing X-ray Pain Decrease in performance
Types of injuries in skin
Lacerations/tears
Bruising
Infection
Fibrosis
- Fibrosis can occur in all tissues of the musculoskeletal system but is more common in the soft tissue - can cause restrictions to locomotion
- Identification of hard/fibrous areas of tissue - scar tissue
- Cause of fibrosis could be from external trauma or intrinsic injury
- Can cause restriction to movement long term - mechanical lameness due to loss of elasticity of tissue
