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06 - Functional Modalities > 06-02: Tissue Repair > Flashcards

06-02: Tissue Repair Flashcards

1
Q

Acute vs. Chronic

A
  • All injuries have beginning point (Acute)
  • Trauma = Acute
  • Overuse, repetitive = chronic
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2
Q

Macrotears

A
  • Greater soft tissue damage
  • Results in clinical Sx and functional loss
  • Associated with acute trauma
  • Includes Fx, dislocations, subluxations, sprains, strains, contusions
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3
Q

Microtears

A
  • Minor damage
  • May not see clinical signs/symptoms in early stages
  • Associated with overuse
  • Includes repetitive motion injuries
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4
Q

Primary injuries

A

Microtears and Macrotears

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5
Q

Secondary injuries

A

Inflammatory or hypoxia responses that occur with macrotears and microtears

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6
Q

3 phases of healing

A
  • Inflammatory response phase
  • Proliferative phase (Fibroblastic-repair)
  • Maturation-remodeling phase
  • Phases overlap and have no definite beginning and ending - although there are ranges
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7
Q

Inflammatory-Response Phase

A
  • Lasts 0-4 days
  • Occurs secondary to trauma or disease
  • Presents with calor (heat), rubor (redness), tumor (neoplasm; solid lesion), dolor (pain)
  • Phagocytic cells (leukocytes) enter injured area to begin cleaning up injury by-products (blood, damaged cells)
  • Prepares for repair
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8
Q

Inflammatory Phase of Healing (Thromboplastin –> Fibrin Clot)

A
  • Takes blood 11-16 secs to clot

- Thromboplastin –> Prothrombin –> Thrombin –> Fibrinogen –> Fibrin Clot

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9
Q

Inflammatory Phase of Healing (Injury –> Clot)

A

Injury to cell –> Chemical mediators liberated –> Vascular reaction –> Platelets, leukocytes adhere to vascular wall –> Phagocytosis –> Clot formation

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10
Q

Chronic inflammation

A
  • Results when acute inflammatory response does not respond sufficiently to eliminate the injuring agent and does not restore tissue to its normal physiological state
  • Involves macrophages, lymphocytes, plasma cells
  • Causes tissue necrosis and fibrosis
  • Can occur with overuse injury
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11
Q

Fibroblastic-Repair Phase

A
  • Begins within few hours through 4-6 weeks
  • Inflammatory S/S diminish, scar formation increases, tenderness decreases
  • Granulation tissue increases, growth of endothelial capillary buds (restore blood supply)
  • Increased blood = nutrients for tissue regeneration
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12
Q

Fibroblastic-Repair (Granulation)

A
  • Delicate reddish granular, connective tissue that fill in gaps during healing
  • Breakdown of fibrin clot
  • Consists of fibroblasts, collagen, capillaries
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13
Q

Fibroblastic-Repair (Ground Substance)

A
  • Fibroblasts parallel to capillaries
  • Collagen random pattern –> forms a scar
  • Non-elastic tissue
  • Increased collagen = increased tensile strength
  • Fibroblasts decrease, begins maturation phase
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14
Q

Maturation-Remodeling Phase

A
  • Day 9 and ongoing
  • Long term; scar forms after 3 weeks, but can take up to years to fully mature
  • Collagen Re-orientation
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15
Q

Collagen re-orientation

A
  • Tensile forces cause collage to reorganize; increases tensile strength of scar
  • Collagen realigns parallel to lines of tension
  • Scar rarely as strong as original tissue
  • Scar is non-vascular
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16
Q

Scarring

A

Forms when collagen production > lysis

17
Q

Keloid Scar

A
  • Extends beyond boundaries of the original wound and damages healthy tissue
  • Treat with compression, steroid injections, cryotherapy, surgery
18
Q

Hypertrophic Scar

A
  • Remains within boundaries of original wound; increase in collagen production
  • Resolves over time
  • Treat with steroids, compression
19
Q

Factors that impede healing

A
  • Extent of injury (microtears, macrotears)
  • Edema
  • Hemorrhage
  • Poor vascular supply (lead to avascular necrosis)
  • Separation of tissue
  • Muscle spasm
  • Atrophy
  • Corticosteroids (Long-term)
  • Keloids and hypertrophic scars
  • Infection
  • Humidity, climate, oxygen tension
  • Health, age, nutrition
20
Q

Modalities - Promote Healing

A
  • Begin on Day 1 following injury
  • Modalities are adjiunct to PT interventions, not treatment in and of themselves
  • Modalities facilitate pt’s ability to participate in exercise and functional activities
21
Q

Indications for modalities

A
  • Inflammation and repair
  • Pain
  • ROM Restriction
  • Abnormal tone
22
Q

Modalities - Initial Acute Injury Phase

A
  • Rest for 48-72 hours
  • Goals: Reduce edema, reduce pain
  • Modalities: Cryotherapy, Compression (Ace Wrap), Electrical stimulation. Ultrasound (nonthermal parameters), Low-power laser
23
Q

Modalities - Inflammatory Response Phase

A
  • Goals: Reduce pain, reduce edema, increase ROM at end of initial stage
  • Modalities: Cryotherapy, Intermittent compression, E-stim, Low-power laser, Exercise
24
Q

Modalities - Fibroblastic Repair Phase

A
  • Goals: Promote healing, promote scar formation, increase circulation
  • Modalities: Thermotherapy, Intermittent compression, E-stim, Low-power laser, Exercise
  • Precaution: Don’t use modalities that increase edema
25
Q

Modalities - Maturation Remodeling Phase

A
  • Goals: Return to activity, very little to no pain

- Modalities: Any modality can be used, deep heating modalities (ultrasound, diathermy), E-stim, Low-power laser

26
Q

Progressive mobility

A
  • Wolff’s Law: Bone and soft tissue respond to physical demands placed on them, causing remodeling or realignment along tensile force
  • Immobilization: Beneficial during inflammatory phase
  • Tissue Repair: Return to normal flexibility and strength
  • Remodeling: Aggressive AROM and strengthening exercises
  • Pain may guide intensity of exercise
  • Exacerbation of pain or edema must be reported to PT

06 - Functional Modalities (21 decks)

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