Inflammatory Process

Question 1

Ultimate goal of treating injury?

Answer 1

• Promote a strong, mobile scar.
• As much as possible, full, pain free movement of affected structures and full strength

Question 2

What happens with re-epithelialization?

Answer 2

• Regeneration is possible w/ epithelial cells, nerves and hepatic cells.
• no scar tissue, normal tissue structure results
• if exudate (fluid release) occurs, some fibrosis in tissue will result

Question 3

What is Granulation Tissue?

Answer 3

• Part of any first or second intention healing (tissue repair)
• new blood vessels come support, called “neoangiogenesis”
• fibroblasts are important here, they make collagen fibres they form loose CT matrix (replaces blood clot for acute stage)

Question 4

Healing of Scar Tissue?

Answer 4

• With increased loss of epidermal and dermal layers or damage to mm, tendon, ligaments
• Replaced with tissue different from original tissue
• mature collagen repair is often called scar tissue

Question 5

Primary or First Intension Healing

Answer 5

• With some tissue loss, wound edges are approximated {may be done with tape, sutures, staples}
• healing = efficient, only small amounts of collage made to repair tissue

Question 6

Secondary or Second Intention Healing

Answer 6

• when there’s extensive tissue loss/large surface area
• wound edges cannot be brought together easily
• healing takes longer through re-epithelialization and large amounts of granulation tissue

Question 7

Factors that affect the healing process?

Answer 7

• severity of injury
• age
• infection
• presence of foreign material
• nutritional support
• Exciting conditions
• Adequate blood supply
• Wound separation
• effects of some drugs
• smoking

Question 8

How long is the Acute Phase of tissue healing and inflammatory process?

Answer 8

From ment on injury up to 3-4 days post-injury

Question 9

With acute stage of inflammatory process what is present?

Answer 9

• Redness, swelling, heat, pain, possible loss of function, mm spasm and guarding.
• Bruising will be blue, red or purple

Question 10

What vascular changes happen in the acute stage?

Answer 10

Initial vasoconstriction followed by vasodilation
{This causes observable redness and heat due to dilation of blood vessels}

Question 11

What happens at the end of the acute phase?

Answer 11

Inflammatory process begins to resolve

Question 12

Tx considerations/goals in the acute stage?

Answer 12

Limit inflammatory process, reduce pain & swelling, reduce SNS firing & prevent re-injury, protective spasms are reduced but not removed, compensatory structures are treated

Question 13

How long is the Subacute phase (as a whole) of the inflammatory process?

Answer 13

Within 2 days and continues for up to 3 weeks after injury, up to 6 weeks.

Question 14

How long is early subacute stage?

Answer 14

2 days and may continue for up to 3 weeks

Question 15

Signs of the early subacute stage?

Answer 15

Affected area shows diminished signs of inflammation, with pink, warm, slightly oedematous and less painful tissue, mm spasms diminish
{bruising is vertically unchanged from acute}

Question 16

Treatment goals in the subacute stage of the inflammatory process?

Answer 16

Continue to ⬇️ effects of inflammation, pain, swelling & spasm, while ↔️ the available ROM and strength

Question 17

What are the Hydrotherapy applications during early subacute stage of the inflammatory process?

Answer 17

Includes cool applications and the introduction of mild contrast applications

Question 18

Treatment considerations/goals in the late subacute stage?

Answer 18

⬇️ remaining edema, reduce TP, pain & adhesions, improve ROM and mm strength

Question 19

How long is the late subacute stage of the inflammatory process?

Answer 19

Begins 2-3 weeks of the subacute stage

Question 20

What happens to blood vessels in the late subacute stage?

Answer 20

Neoangiogenesis retract during this stage

Question 21

Symptom picture is the late subacute stage of the inflammatory process

Answer 21

• may or may not be a pocket of residual swelling
• bruising present, changed to yellow, brown or green, then disappears
• pain is experienced with over pressure to affected tissue

Question 22

Tx considerations/goals in the chronic stage of the inflammatory process

Answer 22

⬇️ restrictive adhesions and TP, restore ROM and strength to affected areas

Question 23

How long is the Chronic stage of the inflammatory process?

Answer 23

Overlaps with later part of the late subacute stage at about 2-3 weeks post injury and continues for up to 1-2 years

Question 24

Symptom picture of the chronic stage of the inflammatory process?

Answer 24

-Inflammatory process = resolved, likely no edema but loss of full ROM with subsequent ⬇️ in function is possible, pain may occurs with over pressure
- chronic inflammation may be part of a self-perpetuating cycle if irritating agent like inflammatory arthritis, or inflammation may develop because of micro traumas like tendinitis