Inflammation and tissue repair

Question 1

minor damage (often with overuse)

Answer 1

microtrauma

Question 2

significant destructions (often with acute trauma)

Answer 2

macrotrauma

Question 3

4 causes of tissue damage:

Answer 3

• direct trauma
• surgery
• pathology and disease processes
• problematic healing and/or presence of infection

Question 4

A non-specific immune response that occurs in reaction to any type of bodily injury regardless of cause; stereotyped response that is identical and predictable regardless of causative factor

Answer 4

inflammation

Question 5

inflammation of rapid onset and rapid resolution. The majority of the response is usually over within 12-24 hours

Answer 5

Acute inflammation

Question 6

inflammation that is less intense but sustained over a prolonged period of time. It may be characterized by chronically elevated WBC count, low grade fever and pain

Answer 6

chronic

Question 7

inflammation that can last for months to years, is pathological, delays healing

Answer 7

chronic

Question 8

a local or generalized condition in which the body tissues contain an excessive amount of fluid (interstitial tissue)

Answer 8

edema

Question 9

the presence of a microorganism that produces tissue damage.

Answer 9

infection

Question 10

Signs and symptoms of this are similar to that of inflammation, so be aware of any acute changes in symptoms such as:

• low grade fever
• pus/drainage with foul odor
• flu-like symptoms

Answer 10

infection

Question 11

The 4 cardinal signs of inflammation:

Answer 11

• heat
• erythema (redness or rubor)
• swelling
• pain

Question 12

____ may be seen with extensive inflammation or in the presence of infection

Answer 12

fever

Question 13

timeframes are ______ and will not be the same for all patients and/or injuries

Answer 13

general

Question 14

3 stages of tissue repair:

Answer 14

1. inflammatory response phase (0-4 days, peaking 24-72 hours post injury)
2. proliferation phase (fibro-blastic repair, day 2 to 6 weeks)
3. maturation (remodeling) phase (3 weeks to 2 years)

Question 15

_____: one year post injury- 50-70% of normal tensile strength

Answer 15

ligament

Question 16

_____ can take 6 months to heal

Answer 16

muscle

Question 17

_____ can take year to years to heal

Answer 17

bone

Question 18

Stage S&S:

• cardinal signs of inflammation are present
• pain to touch with muscle guarding
• pain with motion
• decreased strength

Answer 18

Stage 1: inflammation phase

Question 19

Stage 1 inflammation phase 4 actions:

Answer 19

• vasoconstriction
• vasodilation
• clot formation
• phagocytosis

Question 20

3 treatment principles of inflammation phase:

Answer 20

1. Control the formation of excess inflammation
2. Control pain
3. (P)RICE

Question 21

PRICE

Answer 21

P - protection
R - rest
I - ice
C - compression
E - elevation

Question 22

Stage S&S:

• swelling persists
• cardinal signs are resolving (post 72 hr window)
• pain to touch and pain with motion

Answer 22

Stage 2: proliferation phase

Question 23

Stage 2:

• growth of endothelial capillary buds into the wound is stimulated by lack of oxygen
• the wound becomes capable of healing aerobically
• increased oxygen delivery
• increased blood flow

Answer 23

revascularization

Question 24

Stage 2:

• formation of granulation tissue
• granular mass of connective tissue that fills in the gaps during the healing process
• capillaries grow
• fibroblasts arrange parallel to them
• fibroblastic cells synthesize an extracellular matrix
• fibroblasts produce collegen fibers

Answer 24

formation of scar

Question 25

Treatment goals of the proliferation phase:

Answer 25

1. Facilitate healing by increasing: - enzyme activity - circulation - oxygenation 2. Prevent re-injury

Question 26

Stage S&S: - mild swelling, but should be resolving - all symptoms should continue to be resolving - ROM and strength will gradually become comparable to unaffected side - patient should be returning to functional activities

Answer 26

Stage 3 maturation phase

Question 27

As long as the scar appears redder than surrounding tissue, ____ ____ is still occurring

Answer 27

scar remodeling

Question 28

Usually by the end of week _#_, the scar is firm, strong, and nonvascular

Answer 28

3

Question 29

during maturation phase ____ is in continual synthesis and break down

Answer 29

collagen

Question 30

scar tissue orientation based on stresses placed on it

Answer 30

Stage 3 Maturation phase: | Collagen fiber orientation

Question 31

Treatment goals of the maturation phase

Answer 31

1. increase: ROM, strength, scar mobility | 2. Return patient to prior level of function

Question 32

4 Outcomes of tissue healing:

Answer 32

1. normal, full healing of like tissue 2. scar tissue formation 3. impaired healing/abscess formation 4. chronic inflammation/non-healing

Question 33

Pharmacological management for inflammation involves (3):

Answer 33

- NSAIDS (Ibuprofen, Naproxen, celebrex) - Steroid medications (cortisone, prednisone, dexamethasone) - Aspirin

Question 34

4 physical agents/interventions for treatment of inflammation:

Answer 34

- PRICE (initially) - E-stim, Ionto, non-thermal US, cryotherapy (initially) - Manual techniques - Therapeutic exercise/activities