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pt clin med > Principles of Tissue Healing > Flashcards

Principles of Tissue Healing Flashcards

1
Q

Duration of pain is 0-7 days

A

Acute

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2
Q

Duration is 7 days to 7 weeks

A

Subacute

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3
Q

Duration is >7 weeks

A

Chronic

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4
Q

What are the 3 main phases of healing

A
  1. Primary
  2. Secondary
  3. Maturation
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5
Q

What occurs during the primary phase of healing (4)

A
  1. Mitosis in fibroblasts and endothelial cells
  2. Fibroblasts move into the damaged tissue
  3. Small capillary sprouts move into periphery of the damaged area
  4. Phagocytosis
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6
Q

What type of pain is constant pain

A

Chemical pain

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7
Q

What occurs during the secondary phase of healing (3)

A
  1. Fibroblasts and capillaries invade the area
  2. Fibroblasts start to produce collagen
  3. Collagen fibers increase in diameter
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8
Q

What occurs in the maturation phase of healing (3)

A
  1. Continuation of collagen synthesis (slow)
  2. Increase of intramolecular cross-linking of collagen fibers: increase in tensile strength
  3. Orientation of collagen parallel to lines of tension
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9
Q

How long do collagen fibers increase in diameter in the secondary phase of healing

A

7-14 days

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10
Q

How long do collagen fibers increase in tensile strength in the maturation phase

A

2-4 months

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11
Q

Which phase do fibroblasts produce collagen slowly

A

Maturation

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12
Q

What phase do fibroblasts produce collagen fastly

A

Secondary

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13
Q

What are the 2 ways tissue injury can occur

A
  1. Trauma

2. Insidious onset

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14
Q

What is microtrauma

A

Insidious onset

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15
Q

What is macrotrauma

A

Trauma

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16
Q

True or False:

Both macrotrauma and microtrauma result in tissue injury and a resultant imflammatory response

A

TRUE

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17
Q

Does inflammation produce constant or phasic pain

A

Constant

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18
Q

What are the 3 steps of tissue repair

A
  1. Inflammation
  2. Repair
  3. Remodeling
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19
Q

Do connective tissue and muscle regenerate

A

NO

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20
Q

What replaces damaged connective tissue or muscle

A

Inferior fibrous scar tissue

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21
Q

What is inflammation (3)

A
  1. Increased local blood supply
  2. Leaking of plasma proteins and leukocytes from the blood vessels
  3. Accumulation of white blood cells at the site of injury
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22
Q

What are the 4 cardinal signals of inflammation

A
  1. Calor
  2. Rubor
  3. Dolor
  4. Tumor
23
Q

In optimal conditions how long does inflammation last

A

Less than 5 days

24
Q

How long does the tissue repair stage last

A

3 weeks

25
Q

What are the 3 steps of tissue repair

A
  1. Collagen and glycosaminoglycaans that replace the dead and damaged tissue are laid down
  2. Rapid increase in the amount of collagen, damaged nerve endings and capillaries “sprout” and invade the area
  3. Cellular activity is stimulated by physical stresses to the tissue
26
Q

When inactive does collagen turn over occur

A

Yes

27
Q

When inactive does collagen get oriented according to the line of stress

A

No

28
Q

What does appropriate education and movement provide

A

The optimal climate for uncomplicated repair

29
Q

What is remodeling

A

The process of turning weak, immature, and disorganized scar into a functional structure able to perform normal tasks

30
Q

Wound repair is considered optimal if what

A

Remodeling of the scar occurs

31
Q

What does progressively normal use and specific loading increase

A

Strength and flexibility of the scar tissue

32
Q

What does regular application of intermittent stress or loading to bone and normal soft tissue enhance

A

Structural integrity

33
Q

What may disrupt the repair process

A

Prolonged loading

34
Q

What damages scar tissue

A

Prolonged stress

35
Q

What strengthens scar tissue

A

Intermittent stress

36
Q

What is another name for remodeling

A

Wolf’s Law

37
Q

What does failure or inflammation, repair, or remodeling or inadequate or ineffectual repair lead to (2)

A
  1. Chronic pathological changes

2. Repeated structural failure

38
Q

What does failure to remodel result in (5)

A
  1. Collagen shortening over time
  2. Recently formed scar tissue can stretch
  3. Contracture of old scar tissue may continue for years
  4. Cross linkage of newly synthesized collagen fibers can prevent full movement
  5. Nerve endings can cause the scar tissue to be sensitized like normal tissue
39
Q

What does applying regular stress sufficient to provide tension without damage do to the collagen

A

Causes collagen to undergo chemical and structural changes that allow elongation and strengthening of the affected tissue

40
Q

When does the recently formed scar tissue begin to shorten

A

3rd to 6 months

41
Q

What effect the remodeling process (4)

A
  1. Previous trauma
  2. Inflammatory
  3. Degenerative
  4. Past derangement
42
Q

How can we apply sufficient stress without damage

A

Patient response method

43
Q

What is increased pain

A

Goes from 3 to 5

44
Q

What is produced pain

A

Goes from 0 to some level

45
Q

True or False:

You should always ask the patient if the pain has not gone away and gotten worse

A

True

46
Q

True or False:

Chronic conditions in which symptoms remain relatively stable over time appear to get “stuck” in the repair process

A

True

47
Q

What is degenerative tendonopathy thought to be caused by

A

Hypoxia and microtrauma

48
Q

Failure to repair may result from a combination of what (4)

A
  1. Slow or failed healing
  2. Avascularity
  3. Degenerated tissue
  4. Lack of appropriate stresses
49
Q

Failure to remodel leads to what

A

Imperfect repair

50
Q

What are the effects of stress deprivation (3)

A
  1. Weakens and atrophies ligament, tendon, muscle, and bone
  2. Degrades surfaces and tissue interfaces
  3. Causes disorganized tissue to bond randomly together
51
Q

True or False:

Injuries can be made to heal faster than their natural rate

A

False

52
Q

What can happen is the tissue is still stiff and painful long after the expected period of healing

A

The person may become anxious and lose conidence

53
Q

What are the factors restricting normal return to function (9)

A
  1. Poor blood supply or ischemia
  2. Lack of initial protection and reduction of swelling in acute stage
  3. Lack of early mobilization
  4. Continued inflammation
  5. Systemic or local steroids which decrease the tensile strength of wound, slows the rate of wound closure and vascularization
  6. Poor nutrition
  7. Diabetes
  8. Overabundant deposition of collagen
  9. Level of physical activity
54
Q

What does an overabundant deposition of collagen lead to

A

Keloid scar

pt clin med (15 decks)

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