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MSS > Injury and Healing Handout > Flashcards

Injury and Healing Handout Flashcards

1
Q

steps in soft tissue healing

A
  1. bleeding, degeneration, disruption (sec-min)
  2. clot formation (min-hrs)
  3. inflammation (min-days)
  4. repair, regeneration (hrs-mos)
  5. remodeling (mo-yrs)
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2
Q

what is the process of bleeding, degeneration & disruption? (timeline)

A

immediately following injury. proteases are released by myofiber degeneration.

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3
Q

what do proteases get released by/do?

A

released by myofiber degeneration. do auto-digestion of damaged tissue; chemotaxis of neutrophils and macrophages to the area.

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4
Q

what does vessel injury cause?

A

it exposes clotting factors and platelets to collagen; activation of complement and kinin, plasmin generation and stimulates platelet degranulation

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5
Q

process of clot formation?

A

min- hrs. clot of fibrin, platelets, red cells, debris. scaffolding for fibroblast repairs.

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6
Q

inflammation process?

A

min-days. protective. eliminate necrotic cells and tissues from insult, initiate repair

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7
Q

cardinal signs of inflammation?

A

heat, redness, swelling, pain, loss of fxn. esp prominent in acute inflammation.

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8
Q

what is acute inflammation?

A

rapid in onset, short duration, lasts mins-days, predominantly neutrophilic leukocyte accumulation

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9
Q

what is chronic inflammation?

A

days to yrs. influx of lymphocytes & monocytes (tissue macrophages), associated vascular proliferation/fibrosis (scarring)

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10
Q

macrophage fxn?

A

induce local inflammatory response. stimulate cytokine release, chemotactic factors from T cells. recruit progenitor and satellite cells

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11
Q

what cytokines do MP stimulate?

A

IL-1, 6, 8 and IGF-1

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12
Q

repair/regeneration process?

A

hours to months.

  1. proliferation
  2. tissue repair by reneration
  3. scar tissue contraction
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13
Q

proliferation process?

A

hours-wks. prolif of surrounding fibroblasts, migration into wound. produce collagen matrix. phagocytes digest. granulation tissue with neovascularization. myofibroblasts contract.

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14
Q

what do phagocytes do?

A

release enzymes to digest exudage, fibrin clot and debris (clot easily disrupted)

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15
Q

granulation tissue modification

A

vascular budding & recanalization restores vasc connections in 3-4 days. granulation tissue bridges gaps days 7-10. spread of area of inflammation and edema into surrounding normal tissue 21 days. 6 weeks back to normal.

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16
Q

labile tissue repair results in?

A

regeneration with complete restoration of form and function. eg bone marrow, most surface epithelia, bones

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17
Q

permanent tissue repair results in?

A

replacement with connective tissue and scar formation. eg skeletal muscles, cartilage.

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18
Q

scar tissue contraction process?

A

after 2 weeks, can withstand typical stresses. 3+ mo near normal strength

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19
Q

remodeling process?

A

months-years. 6 mo fibrils more oriented to lines of stress. 1-2 years = final remodeling

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20
Q

bone healing process?

A
  1. bleeding
  2. clot formation
  3. inflammatory stage
  4. repair stage
  5. remodeling stage
    + variables
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21
Q

bleeding timeline?

A

seconds-minutes

22
Q

clot formation process?

A

minutes-hours. w hematoma formation

23
Q

inflammatory stage process? inhibitors?

A

hours-days. prostaglandin infiltration. fibroblasts lay down stroma. granulation tissue formation. altered by prostaglandin inhibitors, cytotoxic meds.

24
Q

process of infiltration of inflammatory cells and fibroblasts? where?

A

prostaglandin mediated. inflammatory cells = macrophages, monocytes, lymphocytes, PMNs. also fibroblasts. proliferation is under periosteum and in breached medullary canal

25
Q

fibroblasts do what? inhibited by what?

A

lay down stroma to support vasc growth. inhibited by nicotine.

26
Q

granulation tissue formation includes?

A

tissue formation + vascular ingrowth and mesenchymal cell migration

27
Q

repair stage of bone takes how long?

A

1-2 weeks to 3+ mo

28
Q

steps of repair?

A
  1. osteoclasts and osteoblasts invade blood clot
  2. collagen matrix forms, osteoid forms soft callus
  3. hard callus formation
  4. consolidation
  5. bony gaps bridged 6-12 mo
29
Q

how do osteoclasts and osteoblasts invade blood clot?

A

osteoclasts burrow thru debris at fracture line. osteoblasts fill remaining spaces.

30
Q

how does soft callus form?

A

ostoid (unmineralized, organic portion of bone matrix) is secreted. 2-6 weeks.

31
Q

how is hard callus formed?

A

4 to 12+ weeks, mineralization of matrix

32
Q

upper vs lower extremity union?

A

4-6 weeks union for upper extremity. 8-12 weeks for lower.

33
Q

consolidation process?

A

callus maturation. 12-26 weeks. woven bone becomes laminar bone.

34
Q

remodeling stage process?

A

1-2 years. thicker lamellae re: stress. reabsorption of under loaded areas. medullary reformation.

35
Q

which deformities remodel better?

A

angular better than rotational

36
Q

what are some variables in bone healing?

A
  1. bone type (cancellous > cortical)
  2. fracture type (spiral > transverse)
  3. blood supply (good > poor)
  4. age (young > old)
  5. general health
37
Q

how does hyaline cartilage heal?

A

heals with fibrocartilage and fibrous tissue (has inferior weight bearing properties)

38
Q

apophysitis due to?

A

overuse/repetitive stress of growth plate. irritation, rarely causes avulsion.

39
Q

common location and what they are? treatment?

A

patellar, calcaneous, hip, elbow. treatment = relative rest.

40
Q

osgood schlatter?

A

patellar tendon insertion on tibial tubercle

41
Q

sever’s?

A

achilles insertion on calcaneous

42
Q

sinding-larsen-johansson

A

patellar tendon origin on inferior patellar pole

43
Q

ASIS?

A

sartorius

44
Q

AIIS?

A

rectus femoris

45
Q

little leaguer’s elbow?

A

medial epicondyle

46
Q

ankle sprain etiology?

A

forced ankle inversion

47
Q

ankle sprain exam?

A

anterior drawer test, squeeze test, external rotation test += suspicious for high ankle sprain

48
Q

squeeze test results?

A

pain at ankle –> high ankle sprain. pain at knee –> maisonneuve fracture

49
Q

loose bodies etiology? treatment?

A

usually traumatic, occasionally metaplastic. surgical or observation

50
Q

loose bodies stx?

A

swelling & locking, or asymptomatic

51
Q

UCL sprain

A

throwing athletes. valgus stress in 20 degrees of flexion causes pain and potentially increased laxity (if higher grade injury)

MSS (28 decks)

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