Week 1 Tissue Healing Flashcards
Strains mainly affect:
Sprains mainly affect:
Muscle
ligament
What kind of muscles are most commonly strained?
Biarticulate
Sprain
Grade 1:
Grade 2:
Grade 3:
Ligament stretched
incomplete tear
complete tear
Subluxation vs dislocation
subluxation = incomplete/partial dislocation
dislocation = complete loss of anatomical relationship
What is the most common shoulder dislocation direction
hip direction?
anterior
posterior
tendonitis definition
inflammation that can result in scarring or calcium deposits
tendinosis definition
a pathology of chronic degeneration without inflammation
Tenosynovitis definition
inflammation of synovial membrane
tendovaginitis definition
inflammation with thickening of tendon sheath
synovitis definition
inflammation of synovial membrane leading to excessive synovial fluid
What is inflammation of the bursa called?
Bursitis
What bursa are most commonly inflamed
Subacromial
Olecranon
Trochanteric
Prepatellar
Ballooning of the wall of a joint capsule
potentially due to RA
Ganglion
Bleeding into a joint capsule
usually due to trauma
Hemarthrosis
Bruising from direct blow leading to capillary rupture and inflammatory response
Contusion
Adhesion vs Contracture
Adhesion- abnormal aherence of collagen fibers
Leads to reduced elasticity of tissue
Contracture- adaptive shortening of soft tissue (muscle, skin, fascia, capsule). Leads to reduced mobility and flexibility
How does a contracture affect MMT grading?
Still grade it through the available ROM
Reflex muscle guarding vs intrinsic muscle spasms
Muscle guarding- in response to pain
Instrinsic muscle spasm -in reponse to local circulatory and metabolic changes
Severity of tissue injury
grade 1:
grade 2:
grade 3:
Grade 1:Mild pain/swelling within 24 hours
grade 2: moderate pain affecting daily activity, tissues are partially torn
grade 3: near complete or complete tear or avulsion of the tissue
severe pain
later on stress to tissue is usually painless (because its already fully torn)
might see defect w/ palpatation
Myofascial Compartment syndrome
Increased interstitial pressure in a non-expanding myofascial compartment
results in ischemia and can cause tissue damage
What is the endfeel called when they have pain?
empty end feel
The inflammation phase is approximately how long?
Between 0 and day 10
note: stages overlap
The proliferation phase is approximately when
Between day 2 and day 22
note: stages overlap
the remodeling and maturation phase is approximately when?
Day 14 to over a year
note: stages overlap
What are the 5 cardinal signs of inflammation?
Pain
Heat
Swelling
Redness
Loss of function
In the acute stage, what 3 processes are occuring?
Cellular death
coagulation: first vasoconstriction, followed by vaso dilation
phagocytosis
What are the goals of the inflammation phase?
Protect area
RICE (relative rest)
Maintain PROM
Mobilize soft tissues
What 3 processes are happening during the proliferation phase?
Angiogenesis- new blood vessels
Collagen formation
epiphelialization- new skin
What stage does granulation occur?
Proliferation
note: this is also when formation of a scar begins
What are the therapeutic goals during the subacute/proliferation phase
Controlled motion phase
develop mobile scar w/ selective stretching and mobilization
progress to AROM, resistive exercises, build endurance
What happens at the tissue level during the remodeling/chronic stage
new collagen continues to increase its tissue strength for a year
excessive production of collagen can form a scar
What are the clinical signs that someone has entered the remodeling stage/chronic stage
absence of inflammation
pain only after tissue resistance
What are the PT goals for someone in the chronic phase?
Return to function
increase tensile quality of scar
develop functional independence
How long does it take ligaments to heal?
longer than muscles
5-8 days in skin/muscles
3-6 weeks for ligament and tendon
Normal collagen is __________
after an injury type ________ is laid down
A mature repaired ligament is ________ weaker than an injured ligament
type 1
type 3
30-50% weaker
Ligament injury markers by week:
By week 3:
By week 6:
By 12 weeks:
Can tolerate mild tenson
can begin to resume low-load normal activities
has regained almost maximum tensile strength
Where are tendon ruptures most common?
At the musculotendinous junction or the tenoperiosteal junction
if a tendon is torn more than __% of the diameter, it needs a surgical repair
50%
What heals slower, tendons or ligaments
tendons due to poor blood supply
Active tension of tendons across a repair site in the first 3 weeks of a repair leads to ______________
poor outcome
tendons exposed to little/no motion are ____________ than tendons exposed to limited motion at 3 weeks
weaker
therefore we must preform passive exercise for these tendoms (PROM)
How does PROM help tendon repair sites
minimize adhesions
assists in fiber orientation
What is the progression of exercise for surgical repairs ?
SLOW transition from passive -> Active assisted -> active -> resisted
Most tendon rehab programs are how long?
Over 6 months, some last 1-2 years
Muscle injury: day 2-5
what needs to happen?
Short term immobilization
Muscle injury: week 2-3
Balance between protection of site and increasing tissue extensibility through motion
Muscle injury: Week 4 to 6
Gentle AROM w/ full range is the goal
no resistance yet
Muscle injury: 6+ weeks
Warm up period
Focus on endurance
can use resistance
W/ clinical management of muscle inuries ______________ is contraindicated especially in 2 joint muscles
eccentric contraction or overstretch
What is the difference between periosteum and articular cartilage
articular cartilage covers the joint surface
periosteum covers everywhere else
What is wolfs law?
Bone is deposited in sites in response to stress
bone is aligned in such a way to efficiently withstand stress
Dr. G says this is a test Q:
For compression fractures, these patients tolerate ____ and not _____
Tolerate : extension
DO not tolerate: flexion
opposite of spondylosis
Fracture repair: inflammatory phase:
What forms?
lasts 1-2 weeks
Soft callus forms after one week
Hard callus forms after several weeks to months
Fracture repair: remodeling phase
Fracture site is now firm and does not move
immobilizaation no longer required, but avoid excessive force to avoid deforming the fracture site
What are the 4 phases of fracture repair?
Hematoma formation
fibrocartilage callus formation
boney callus formation
bone remodeling
Fracture healing times
Children:
Adolescence:
Adults:
4-6 weeks
6-8 weeks
10-18 weeks
What area of the body do fractures heal faster in?
UE > LE
Distal faster than proximal
What are favorable conditions for fracture healing
fx to cancellous bone
adequate blood supply
fracture at end of bone
minimal soft tissue injury
fracture surface is in close proximity
no infection
