Types of Wound Healing Flashcards
Healing by First Intention
AKA primary union
Clean surgical like injury allows edges of wound to approximate
Little to no scar
Healing by Secondary Intention
AKA Secondary Union
Tissue defect is large, may be dirty wound
Typical has a more significant inflammatory reaction
Increased granulation and myofibroblast activity
Produces scar
Realignment Theories - Induction Theory
Scar tries to mimic characteristics of healthy tissue
Tissue structure induces the collagen weave pattern
Clinical Implication - Induction Theory
Separte healing tisues
Positioning of body part, surgical repair consideration
Early controlled motions
Realignment Theories - Tension Theory
Internal/External Stressted contorl the development including stength
Forces with Tension Thoery
Muscle Tension
Temperature changes
Joint Movement
Soft tissue loading and unloading
Clinical Implications for Tension Theory
Phase of repair process when forces introduced
How forces applied
Low load duration stretch
Effects of immobilization
Clinical COnsiderations
Controlled Activity
Tissue develops its maximum strength in direction that the forces are applied
Excessive force will re-njure
Management Goals
Return to Function Increase Strength Increase joint ROM and soft tissue mobility Increase motor control Increase muscle endurance
Immobilization
Muscle has dec number of sarcomeres - dec strength - inc contractile time - dec speed of contraction Inc density of connective tissue at permysial and endomysial levels
More on immobilization
Dec GAGs - so inc number of cross links
Capsule and ligaments thicken
Ligaments are weakened
Effects of Exercise
Increased ligamentous strength
Decrease amount of sarcomere loss
Reduce collagen thickness
Modalities will…
effect healing process
Ultrasound, thermal agents, electrical stimulation
Chronic Inflammation States
Primary cell = macrophage
Stimulation fibroblasts without stimulating other components
Leads to inc amounts of dense CT
Clinical presentation for chronic inflammation
Pain
Swelling
Stiffness that progreses over time
Prcautions
no sign of inflammation
Discomfort as activity progresses but not lasting more than a couple of hours after
Signs that activity is progressing too quickly
Joint sweling
Pain longer than 4 hours and requires meds for relief
Dec in strength of flexibility
Fatigue more easily
Chronic Recurring Pain
Pain that occurs from old injury might be result of:
- Return to function too early
- Scar tissue tearing
- Stressed with repeated or vigorous activity
Tx approach with Chronic Recurring Pain
Treat as an acute injury
Develop program to correct faulty mechancs or faulty habits may be sustaining the problem
Stretchin
- Alignment
- Stabilization
- Intensity
- Duration
- Speed
- Frequency
- Mode
Rules for Stretching
- Position so that you are stretching the target tissue
- Avoid forces and movements that produce a reflex muscular action
- Inc only to functional limits
- Do not produce an inflammatory reaction
Stretching - Patient Sensations
Tightness/Tension in tissue being targeted
Burning sensation in tissue being stretched at 20 sec mark
No distal burning should be felt
In tissues that are chronically inflamed, may have ache in joint
Clinical Observations - Stretching
Relaxation in first 20 sec
Patient holds breath = too much
Relaxation response by patient and tissue
Tissue should be taut but not painful
Response to Stretching Treatment
Body part will feel clumsy or unsteady for first few seconds after
Discomfot lasts for only few minutes after
Improper Technique - Stretching
If patient has sensations of discomfort in areas of distal or proximal
If patient describes pulling sensation during stretch - likely not positioned properly
Sharp, sore joint pain descriptors
If patient feels threatened
