Healing Process Flashcards
(62 cards)
1
Q
What happens to the blood vessels when a injury initially occurs?
A
vasoconstriction followed by vasodilation
2
Q
What is the purpose of the vasodilation follow injury?
A
influx of nutrients (blood, platelets, clotting factors)
3
Q
What are the three phases of the healing process?
A
- Inflammatory response phase (recruit cells and nutrients)
- Fibroblastic repair phase (scab)\
- Maturation & remodeling phase (hardens/skin)
4
Q
What is important to remember about the phases although they are separate phases?
A
they are a continuum (overlaps)
5
Q
What are the two types of healing?
A
primary and secondary
6
Q
What other phase is included in the healing process?
A
Hemostasis
7
Q
Primary Injury
A
In sports setting typically described as being either chronic or acute
8
Q
Primary injuries occur from what?
A
Microtraumatic or Macrotraumatic
9
Q
Macrotraumatic
A
result of acute trauma and produce immediate pain and disability
- Fractures, dislocations, subluxations, sprains, strains, contusions
10
Q
Microtraumatic
A
Overuse injuries
- Repetitive overloading or incorrect mechanics
11
Q
Secondary Injury
A
The inflammatory or hypoxia response that occurs with the primary injury
12
Q
Hypoxia
A
An absence of enough oxygen in the tissues to sustain bodily functions.
13
Q
Chronic and acute injuries both cause what reaction?
A
reduced function
14
Q
Reduced function for a chronic injury looks like what?
A
- inappropriate neural feedback
- increased tissue stress
15
Q
Reduced function for a acute injury looks like what?
A
- scar tissue adhesions
- atrophy
16
Q
The effects of reduced function caused by an acute and chronic injury both cause what?
A
dysfunctional movement with neural changes
17
Q
What are the 3 R’s of rehabilitation?
A
- relieve symptoms
- restore deficiencies
- return to function
18
Q
Relieve symptoms: Acute
A
modalities; no exercise
19
Q
Relieve symptoms: Chronic
A
identify causes
20
Q
Restore deficiencies
A
- manual therapy
- ROM exercises
- strength-endurance exercises
- balance-coordination exercises
21
Q
Return to function
A
- functional exercises
- acticity-specific exercises
22
Q
Define hemostasis
A
Process of stopping blood flow through the locally damaged vessels and into the injury
site
23
Q
What is the shortest stage of healing?
A
hemostasis
24
Q
Why is the hemostasis phase so important?
A
none of the other healing
phases can begin until hemostasis occur
25
What is proliferation (organization)?
Phase begins with the transition from debridement to angiogenesis and formation of
granulation
26
Define debridement
the removal of damaged tissue or foreign objects from a wound.
27
Define angiogenesis
is the formation of new blood vessels.
28
Define granulation
is the primary type of tissue that will fill in a wound that is healing by secondary intention.
29
How long is the proliferation phase typically?
5 days following injury
to around day 21
30
Remolding phase
- Much yet to be understood about this phase
- Wound tissue converts to scar tissue
- Collagen transition
- Wound sensitivity lessens
31
Growth factors
- Roles not fully understood
- Function in healing
- Types of growth factors
- Chronic inflammation
32
What occurs during the Inflammatory Response Phase?
- Process of healing begins immediately
- Redness, swelling, tenderness, increased temperature
- Response is critical to the rest of the healing process
33
Vascular Reaction
- Involves:
- vascular spasm
- formation of platelet plug
- blood coagulation
- growth of fibrous tissue
- Immediate response of tissue damage is vasoCONSTRICTION then replaced by rapid hyperemia
34
How long does the vascular reaction/initial effusion of blood and plasma last?
24-36 hours
35
Define hyperemia
an excess of blood in the vessels supplying an organ or other part of the body.
36
The vascular reaction is what kind of response?
inflammation response
37
What are the three important chemical mediators?
- histamine
- leukotaxin
- necrosin
38
Histamine function
Responsible for vasodilation and increased cell permeability
39
Leukotaxin function
Responsible for margination in which leukocytes line up
along the cell walls
40
Necrosin function
Responsible for phagocytic activity
41
What are the effects of a histamine?
- histamine causes capillary permeability and vasodilation
- capillary permeability causes edema, edema causes pain and altered function
- vasodilation causes blood flow, blood flow causes redness and heat
-
42
Formation of a Clot Process
- Injury exposes collagen in vascular wall where
platelets can adhere to create a sticky matrix
- Plug obstruct local lymphatic fluid drainage and localizes injury response
- Clot formation begins around 12 hours after injury and is completed around 48 hours
- Initial inflammatory phase lasts up to 2-4 days after initial injury
43
Chronic Inflammation cause and process
- Occurs when the acute inflammatory phase does not eliminate the injuring agent and
restore tissue to its normal physiological state
- Leukocytes are replaced with macrophages, lymphocytes and plasma cells
- Exact mechanism is still unknown, seem to be
associated with overuse and overload with cumulative microtrauma
44
What is a NSAID's?
Nonsteroidal anti-inflammatory drugs
45
What medicine is not a NSAID's?
Tylenol
46
Firbroblastic Repair Phase
- Proliferative and regenerative activity leading to scar formation and repair of the injured tissue follows the vascular and exudative
phenomena of inflammation
- Period of scar formation is referred to as fibroplasia
- Endothelial capillary growth into the wound stimulated by lack of oxygen
- Wound starts to heal aerobically
- Increased oxygen delivery will increase blood flow which delivers more nutrients
- Formation of granulation tissue
- On about day 6-7 fibroblasts begin producing collagen fiber that are deposited in a random
fashion
- As collagen proliferates, tensile strength of the wound rapidly increases
47
When does the Fibroblastic Repair Phase begin?
few hours after injury and can last 4-6 weeks
48
What marks the beginning of the maturation phase?
As tensile strength increases, fibroblasts diminish
49
Maturation- Remodeling Phase
- Phase features a realignment or remodeling of the collagen fibers that make up scar tissue
according to the tensile forces to which the scar is subjected
- With increased stress and strain, the collagen fibers realign in a position of maximum efficiency parallel to the lines of tension
- Typically by the end of 3 weeks a firm, strong, nonvascular scar exists
50
What is Wolff’s law?
bone and soft tissue will respond to the physical demands placed on them
51
Role of Progressive Controlled Mobility During the Healing Process
- Critical that injured structures be exposed to progressively increasing loads throughout
rehabilitation process
- As remodeling phase begins, aggressive active range of motion and strengthening exercises should be incorporated to facilitate tissue
remodeling and realignment
52
What factors impede healing?
- Extent of Injury
- Edema
- Hemorrhage
- Poor vascular supply
- Separation of tissue
- Muscle spasm
- Atrophy
- Corticosteroids
- Keloids and hypertonic scars
- Infection
- Humidity, climate & oxygen
tension
- Health, age and nutrition
53
What is the primary function of a ligament?
- Provide stability to a joint
– Provide control of the position of one articulating bone to another during normal joint motion
– Provide proprioceptive input or a sense of joint position through the function of free nerve endings or mechanoreceptors
54
Sprain _____________, strain ___________.
ligaments, muscles
55
Grade 1 Sprain
- mild stretching
- mild (or no)joint instability
- mild pain
- mild swelling
- mild joint stiffness
56
Grade 2 Sprain
- Moderate tearing or stretching
- moderate instability
- moderate (or severe) pain
- moderate swelling
- moderate joint stiffness
57
Grade 3 Sprain
- complete rupture
- severe joint instability
- severe pain
- severe swelling
- severe joint stiffness
- will probably require some type of immobilization
58
Ligament Healing
Healing process in the sprained ligament follows the same course of repair as with other
vascular tissues
- If sprain occurs outside of joint capsule (extraarticular ligament) bleeding occurs in
subcutaneous space
- If sprain occurs inside of joint capsule (intraarticular ligament) bleeding occurs inside joint capsule
59
Why is it essential that torn ends of ligament be reconnected?
Failure to produce enough scar and failure to reconnect the ligament are two reasons why
ligament will fail
60
How long does the maturation of a scar (ligament healing) take?
12 months
61
How does level of activity affect ligament healing?
- Actively exercised
ligaments are stronger than those that are immobilized
- Ligaments immobilized for several weeks after injury tend to decrease in tensile strength as well as a weakening at the insertion of the bone
62
What other factor affects ligament healing?
Other structures surround the joint (muscles) must be strengthened
