Week 3 - Inflammation and repair

Question 1

Acute inflammation usually lasts ___ hrs

Answer 1

0-72 hrs

Question 2

During acute inflammatory stage, is there vasodilation or vasoconstriction first?

Answer 2

vasoconstriction (5-10 minutes) –> vasodilation (hours-days)

Question 3

When does the clotting cascade begin?

Answer 3

During the acute inflammatory stage (0-72 hrs)

Question 4

Define exudate

Answer 4

Fluid that leaks out of blood vessels into nearby tissues

Question 5

What happens during the clotting cascade?

Answer 5

• Blood leaking from injury after vasoconstriction helps form a clot
• Exudate is rich in cells for healing
• Prevents further bleeding and infection
• Stimulates healing process

Question 6

The role of white blood cells in healing…?

Answer 6

• clean the wound
• Increase vascular permeability
• Promotes fibroblast activity (synthesise extracellular matrix and collagen)

Question 7

Vasodilation is promoted by various ____________ systems associated with the increased flow into the affected region

Answer 7

plasma cascade systems

Question 8

Inflammation is tissue _____

Answer 8

pressurised

Question 9

Reparation/Proliferation stage is from _____ to ____?

Answer 9

72 hrs to 6 weeks

Question 10

During the reparation/proliferation stage, what is occuring?

Answer 10

• Proliferation of capillaries
• Fibroblasts synthesise collagens and proteoglycans
• Collagen type III, gradually increasing type I synthesis
• Scar tissue: increase collagen III

Question 11

Remodelling phase last from ___ to ____

Answer 11

6 weeks to months

Question 12

What occurs during the remodelling phase?

Answer 12

• Restructuring of the tissue
• Differentiation to tissue specific cells
• Mechanical load -> gradual re-organisation of the tissue

Question 13

In bone healing, the inflammatory response is….?

Answer 13

the formation of haematoma and granulation tissues

Question 14

In bone healing, the reparation/proliferation phase is….?

Answer 14

• Callus formation
• cartilaginous and chondriod tissue
• Ossification of callus
• Hardening of callus consisting primarily of woven bone

Question 15

In bone healing, the remodelling phase is….?

Answer 15

• woven bone (more space in bone -> like aero bar) is gradually replaced by lamellar bone (mature bone)

Question 16

What are 3 types of cartilage articular damage?

Answer 16

1. Loss of cartilage matrix molecules
2. Isolated damage (chondral fracture)
3. Injury to the cartilage and its underlying bone (osteocondral fracture)

Question 17

Is osteoarthritis is a bone or cartilage issue?

Answer 17

Cartilage

Question 18

Osteoarthritis is progressive …?

Answer 18

degeneration of the joint articular cartilage

Question 19

cartilage surface defect vs full thickness defect?

Answer 19

Surface: Relatively stable as long as mechanical changes are minor (but risk of OA)
Full: general healing process, but mechanical integrity will never be complete

Question 20

Cartilage’s healing potential is limited due to…

Answer 20

its avascularity (lack of blood flow)

Question 21

Are haematomas intermuscular or intramuscular?

Answer 21

Can be both

Question 22

A haematoma is…?

Answer 22

A local accumulation of blood after direct injury (collision) or indirect injury (muscle strain)

Question 23

An intramuscular haematoma particularly from repeated trauma leads to greater risk of…?

Answer 23

Myositis ossificans

Question 24

Calcification of a haematoma causes (2)..?

Answer 24

• swelling and hardening of the muscle

- restriction of ROM

Question 25

What two muscles most often experience direct trauma type injuries, so most often identified to exhibit myositis ossificans?

Answer 25

Biceps and quadriceps

Question 26

What is myositis ossificans?

Answer 26

Bone tissue formed within muscle from trauma, often has to be surgically removed

Question 27

What can be 3 problems in healing that occur?

Answer 27

- Capillary persistence post the inflammatory stage - Random arrangement of collagen fibres in the scar tissue (primarily type III, not in parallel with primary loading direction or other fibres) - Immobilisation (evidence for marked decrease in tissue mass and CSA, decreased tensile strength)

Question 28

Do anti inflammatories or opiate based meds help recovery?

Answer 28

May reduce acute pain, but can slow recovery with repeated use as it reduced capillarisation (blood supply)

Question 29

What is tendinopathy

Answer 29

A type of overuse injury, where the tendon is repeatedly strained until tiny tears form

Question 30

Tendons transmit force, store energy, YET the tissue has a slow ______ rate

Answer 30

metabolic

Question 31

Suggested for tendinopathy/chronic injury that it is given _______ of complete rest

Answer 31

2-3 weeks

Question 32

Tendinopathy/chronic injury recovery post rest?

Answer 32

Eccentric strengthening, focusing on tempo control and load (not maximum repetitions)

Question 33

The use of NSAIDS (non-steroidal anti-inflammatory drugs) for tendinopathy

Answer 33

- Theoretically works for pain but | - may masks symptoms and worsen condition

Question 34

The use of corticosteroids for tendinopathy?

Answer 34

- Debatable - can increase collagen synthesis - can be good short term treatment, high frequency of relapse and recurrence

Question 35

Manual/physical therapy approaches for tendinopathy and their efficacy?

Answer 35

- insufficient evidence - may increase collagen? - little effect on inflammation - not very effective

Question 36

Using ice to treat tendinpathy?

Answer 36

- should not be applied prior to sporting participation - Mask ongoing damage - not treatment for tendinopathy

Question 37

Using braces to treat tendinpathy?

Answer 37

- adjunct for joint stabilisation (weak structure loaded in different directions?) - Loading is still transmitted via tendon with a brace - Not good evidence, false sense of security

Question 38

Using technique correlation to treat tendinpathy?

Answer 38

- May be effective if it is caused by that - e.g. Backhand technique for tennis elbow - Only applicable in certain scenarios

Question 39

The use of autogous platelet injection on tendinopathy ?

Answer 39

- Patella -> yes - Elbow -> no (mixed options) - Achille -> maybe

Question 40

DOMS is damage to which part of the muscle

Answer 40

z-line disruption

Question 41

DOMS causes what to circulate?

Answer 41

creatine kinase

Question 42

Do tendinopathy's have swelling?

Answer 42

No (only acute have swelling)