Chapter 10: Exam 1 Flashcards Preview

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Flashcards in Chapter 10: Exam 1 Deck (72):
1

Why is it important for an ATC to know healing process?

Because the ATC helps rehab the injury from diagnosis to healing (short and long term)

2

What must the ATC know about the healing process?

-understand the phases
-know the time frames physiological changes associated with each phase

3

Signs of inflammation (5)

-redness
-swelling
-tenderness
-increased temperature
-loss of function

4

3 phases of the inflammatory response

-inflammatory response phase
-Fibroblastic repair phase
-maturation and remodeling phase

5

Phase 1: Inflammatory Response

Healing process begins immediately after the injury occurs

6

Goal of phase 1 (4)

-protect
-localize
-decrease injurious agents
-prepare for healing and repair

7

Phase 1 vascular response

-vasoconstriction
-vasodilation

8

Vasoconstriction

-first 5-10 minutes post injury
-seal the blood vessels
-damage control
-everything constricts

9

Vasodilation

-5-10 post injury
-initial effusion of blood and plasma (lasts 24-36 hours)
-goal is to bring reinforcements

10

Histamine

Vasodilation

11

Cytokines

Attract phagocytes

12

Leukotrienes

Allow helper cells to adhere (margination)

13

Exudate

Protein layer at site of injury, doesn't permeate so too much for too long is a problem

14

Vasoconstriction

Everything constricts for damage control

15

Clot formation

Contains damage
***do not disrupt the clot (heat and massage)

16

How long is damage control?

First 2-3 days

17

Phase 2: Fibroplastic repair

Rebuilding

18

Scar formation (phase 2)

Disorganized scar tissue

19

Phase 3: Maturation and remodeling

Reorganization of scar tissue

20

Wolff's law

Collagen realigns along the stress lines so rehab in the range of motion you want back

21

Articular cartilage

Shiny white at the end of bones (protection)

22

Miniscis

Cushion between 2 bones

23

Cartilage characteristics

Little to no blood supply so it won't heal itself

24

Meniscectomy

Tear on medial surface will continue to tear so surgically shave around the tear---> shorter recovery time

25

Meniscus repair

Red zone edge tear can heal itself with sutures (8 weeks no weight bearing)

26

Microfracture

Drill holes into the bone to generate tissue repair process

27

Isometric muscle contractions

Causing muscle contractions but not moving through range of motion

28

Nerve healing

Very slow and nerves cannot regenerate but axons can

29

Callus formation

Soft callus---> bony callus (able to see old fracture later in life)

30

Avasular Necrosis

If bones aren't aligned correctly, the bone will lose blood supply and begin to die

31

Pain

Influenced by different factors (psychological)

32

Clot formation

-platelets adhere to collagen
-blood coagulation---> clot formation
-clots wall off damage

33

How long does the inflammatory phase last?

2-4 days after the injury

34

Chronic inflammation

-insufficient inflammatory response results in tissue not being restored to normal physiologic state
-granulation and fibrotic tissue develops (thick scar)
-typically associated with overuse, overload, cumulative micro trauma

35

Phase II

Fibroplastic repair

36

Phase II: Fibroplastic repair

-begins within first few days
-lasts 4-6 weeks
-formation of delicate connective tissue (granulation tissue)

37

Which phase is a temporary scaffold?

Phase II

38

Fibroplasia

Scar formation

39

Scar formation

-Gradual replacement of weak fibrin plug with stronger collagen
-formation of disorganized scar tissue

40

Phase III

maturation and remodeling

41

Phase III: maturation and remodeling

-realignment of collagen along stress lines
-continued breakdown and synthesis of collagen--> increased strength
-Tissue will gradually assume normal appearance

42

Length of time of Phase III

-long term process
-may require several years to complete
-lasts approximately 3 weeks for a strong scar

43

Factors that impede healing

-extent of injury
-Edema
-hemorrhage
-poor vascular supply
-muscle spasm
-atrophy
-keloids and hypertrophic scars
-infection
-humidity, climate, oxygen tension
-health, age, nutrition

44

Wolff's Law (power point)

Bone and soft tissue will respond to the physical demands placed upon them

45

Negative manifestation of Wolff's Law

Osgood Schlatters and myositis ossification

46

healing of articular cartilage

If it fails to clot or has no cell response heals very slowly

47

Cartilage that involves subcontractors bone

(Enhanced blood supply) healing will proceed normally

48

Cartilage healing

Usually requires surgical intervention

49

Ligament repair phase

As scar forms collagen will mature and realign in reaction to joint stress and strain

50

Ligament healing failure

Failure to produce enough scar and failure to reconnect end of ligaments to proper location on bones

51

Healing length of ligaments

Full 12 months

52

Non surgically repaired ligaments

Prone to joint instability

53

Reason intra-articular ligaments fail to heal spontaneously

They can't form a good clot within the synovial joint fluid (ACL)

54

Ligament rehabilitation

-balance between exercising and immobilization
-surrounding muscles must be strengthened to reinforce joint
-preventative

55

Length of healing of skeletal muscles

6-8 weeks depending on injured muscle

56

Skeltal muscles following inflammation phase

Myoblastic cells form--->regeneration of new muscle fibers

57

Skeletal muscle re-injury risk

Prone to reinjury and chronic strain cycle (hamstring)

58

Tendon healing

-abundance of collagen is required for good tensile strength, but too much can result in adhesion and thickening which will interfere with gliding tendon motion

59

Tendon healing time

Tissue not strong enough until week 4-5 to withstand force of muscle contraction

60

Nerve healing scar formation

-scar formation can block approximation

61

CNS and peripheral nerves

Don't regenerate

62

Bone healing acute fractures 5 stages

-hematoma formation
-cellular proliferation
-callus formation
-ossification
-remodeling

63

Bone healing

-hard callus becomes more well-formed as osteoblasts lay down cancellous bone replacing cartilage

64

Complete ossification time

Years

65

Bone immobilization time

3-8 weeks depending on size and location of bone

66

Less than ideal immobilization

Produces cartilaginous Union instead of bony callus

67

Acute fracture management

-must be appropriately immobilized until x-Ray reveals the presence of a hard callus

68

What areas must not interfere with bone healing

-poor blood supply
-poor immobilization
-infection

69

stress fracture cause

-constant stress can impact bone resorption, leading to micro fracture

70

Stress fracture healing

-early recognition to prevent complete fracture
-decreased activity and elimination of factors causing excess stress

71

Osteoclastic activity>osteoblastic activity

Bone becomes more prone to fractures

72

Pain

-inhibit healing by limiting motivation and willingness
-goal of clinician is to manage patients perception of pain