Injury, Inflammation, and Healing

Question 1

8 mechanisms of cellular injury:

Answer 1

• ischemia
• infectious
• immune
• genetics
• nutritional
• physical
• chemical
• psychosocial

Question 2

the phases of normal healing for all tissue types

Answer 2

• hemostasis and degeneration
• inflammation
• proliferation and migration
• remodeling and maturation

Question 3

stage:

• immediately after injury body tries to stop bleeding via platelets, hematoma, necrosis of dead cells
• abnormal: low platelets or blood thinner meds
• cytokines are released
• causes inflammation-growth factors and fibroblasts

Answer 3

1: hemostasis and degeneration

Question 4

stage:

• protective and curative
• replaces injured tissue
• begins with formation of blood clot (vasodilation)
• leukocytes, macrophages and proteases
• growth factors, chemokines and cytokines
• about 5 days: fibroblasts
• chronic disease

Answer 4

2: inflammation

Question 5

cardinal signs of inflammation (5):

Answer 5

• erythema (rubor)
• heat
• edema
• pain
• loss of function

Question 6

type of inflammation:

• protective
• proteins and fluid build-up
• slower in older adults
• subsides in presence of small amount of necrosis
• will heal on its own

Answer 6

acute (normal)

Question 7

type of inflammation:

• large/prolonged injury
• delays healing
• common in older adults
• occurs with larger amount of necrosis or lack of intervention
• requires skilled care

Answer 7

chronic (pathologic)

Question 8

stage:

• starts ~2 days after injury (overlaps w/ inflammation)
• endothelial cells proliferate to establish vascular network for O2 and nutrients (angiogensis)
• new vessels are “leaky” (edema)
• fibroblasts synthesize collagen
• lasts for several weeks
• healing can also stall at this phase, again d/t poor control of co-morbid disease

Answer 8

3: proliferation and migration

Question 9

stage:

• scar tissue reduced and remodeled
• reorientation of collagen and strength regained
• mature scar 3-4 months
• lasts for 1-2 yrs

Answer 9

4: remodeling and maturation

Question 10

muscle injury etiology (4):

Answer 10

• contusion (blunt force)
• laceration (open wound)
• strain
• stiffness

Question 11

an injury to muscle, typically occurring at the myotendinous junction. Over straining of the myofiber likely during eccentric contraction. May have significant bleeding

Answer 11

strains

Question 12

Etiology: a tensile, mechanical stress/trauma

Answer 12

strains

Question 13

there are # grades of strains

Answer 13

3

Question 14

strain grade #:

• minor discomfort and swelling
• a few torn muscle fibers
• minimal loss of strength and movement

Answer 14

1

Question 15

strain grade #:

• moderate to severe pain
• pain with muscle contraction that limits activity
• measurable loss of strength

Answer 15

2

Question 16

strain grade #:

• severe pain
• complete rupture of muscle belly or muscle-tendon complex
• severe loss of function

Answer 16

3

Question 17

muscle regeneration reorganization of scar tissue takes up to ______.

Answer 17

1 year

Question 18

4 causes of muscle stiffness:

Answer 18

• microfibrous adhesions
• increased collagen fibers
• electrolyte changes
• release of muscle enzymes

Question 19

a injury to a ligament

Answer 19

sprain

Question 20

etiology: the ligament is mechanically stressed

Answer 20

sprain

Question 21

order of ankle sprain faiure (3):

Answer 21

1. ATFL
2. calcaneal fibular
3. PTFL

Question 22

there are # grades of sprains

Answer 22

3

Question 23

sprain grade #:

• minimal pain
• no significant instability

Answer 23

1

Question 24

sprain grade #:

• severe pain
• minimal to moderate joint instability but definite joint end feel
• partial tear of ligaments

Answer 24

2

Question 25

sprain grade _#_: - severe pain during injury, less pain after - very unstable joint, no joint end feel - ligament has been completely torn

Answer 25

3

Question 26

healed ligament will be _#_ to _#_% weaker in tensile strength than before injury

Answer 26

30-50%

Question 27

treatments that stabilize joint (2):

Answer 27

- put ligament in optimal length | - position can reduce scarring

Question 28

early controlled ______/_____ of ligament can promote healing and improve post-injury tensile strength

Answer 28

mobilization/loading

Question 29

In a ligament injury, ______ is slower than strength to return, which contributes to re-injury

Answer 29

proprioception

Question 30

4 types of cartilage:

Answer 30

- articular - fibrocartilage - elastic - fibroelastic

Question 31

3 healing challenges of cartilage:

Answer 31

- avascular - aneural - alymphatic

Question 32

bone fracture signs (4):

Answer 32

- visual/palpable change in anatomy (deformity) - radiographic changes - inflammation - crepitus (noise)

Question 33

bone fracture symptoms (3):

Answer 33

- severe, persistent pain - point tenderness - inability to bear weight

Question 34

type of fracture that results when the skin is broken and the bone is exposed. Very high risk for infection and total disruption of the bone.

Answer 34

open fracture

Question 35

type of fracture where the bone is broken, but the skin remains intact

Answer 35

closed fracture

Question 36

type of fracture where the bone fragments are separated completely. The bone is broken in 2 or more pieces.

Answer 36

complete fracture

Question 37

type of fracture where the bone is only partially broken. The bone fragments are still partially joined.

Answer 37

incomplete fracture

Question 38

type of fracture: a single break in the bone. Bone ends maintain their alignment and position

Answer 38

simple fracture

Question 39

type of fracture: multiple fracture lines and bone fragments

Answer 39

comminuted fracture

Question 40

type of fracture: common in vertebrae and osteoporosis. Occurs when a bone is crushed and results in significant pain and disability

Answer 40

compression fracture

Question 41

type of fracture: similar to a compression fracture. One end of the bone is forced into the adjacent bone. Common in car accidents and falls

Answer 41

impacted fracture

Question 42

type of fracture: results from weakness in bone structure due to conditions such as a tumor, hormonal imbalance or osteoporosis. The break occurs spontaneously or with very little stress on the bone.

Answer 42

pathological fracture

Question 43

type of fracture: results from repeated excessive stress. Common overuse injury, most often seen in athletes who run and jump on hard surfaces. Common in tibia, femur, and metatarsals.

Answer 43

stress fracture

Question 44

type of fracture: if the epiphyseal plate is separated from the epiphysis of diaphysis without proper treatment, growth will not be normal.

Answer 44

epiphyseal fracture

Question 45

type of fracture: a fragment of bone at the insertion of a muscle, tendon, or ligament becomes detached as the result of excessive tension. A piece of bone pulled free (usually occurs near the joint line)

Answer 45

avulsion fracture

Question 46

classification by direction of fracture line (4):

Answer 46

- transverse fracture - linear fracture - oblique fracture - spiral fracture

Question 47

type of fracture: fracture is at right angle to the bone's long axis

Answer 47

transverse

Question 48

type of fracture that is parallel to the bone's long axis

Answer 48

linear

Question 49

type of fracture: the fracture is at an angle to the diaphysis of the bone. The fragments tend to override as a result of muscle contraction, unless stability is maintained by fixation.

Answer 49

oblique fracture

Question 50

type of fracture: a break that angles around the bone. usually due to a twisting injury and requires fixation

Answer 50

spiral fracture

Question 51

4 bone healing phases:

Answer 51

- hematoma - inflammation - reparative phase - bone remodeling

Question 52

bone healing phase: fracture blood clot, fibrin and platelets

Answer 52

hematoma

Question 53

bone healing phase: - vasoactive (heat, redness, swelling, pain) - fibrin meshwork, fibroblasts - phagocyte cells to area of inflammation to remove hematoma - chondroblasts brought to the site of injury

Answer 53

inflammation

Question 54

bone healing phase: - soft callus formation ~2 weeks - soft callus replaced by hard callus usually 6-12 weeks - fracture is now stable at end of this phase

Answer 54

reparative phase

Question 55

bone healing phase: - bone restructures itself over a period of ~1 yr, medullary canal is restored - callus is reabsorbed and the anatomic contour of the bone is regained - Wolff's Law - from disorganized to mature organized bone tissue

Answer 55

bone remodeling

Question 56

law that states that bone forms and remodels in the direction of forces (mechanical stresses) acting on it.

Answer 56

Wolff's Law

Question 57

preservation and restoration of function in fracture management:

Answer 57

- AROM exercises for the rest of the body | - strengthening exercises

Question 58

ORIF:

Answer 58

Open Reduction Internal Fixation | - use of pins, plates, and or rods to position bones in anatomical alignment

Question 59

OREF:

Answer 59

Open Reduction External Fixation | - cyborg/Frankenstein

Question 60

4 complications during fracture healing:

Answer 60

1. infections 2. ischemia 3. nerve damage 4. slowed healing

Question 61

3 types of abnormal fracture healing:

Answer 61

- delayed union - non-union - mal-union

Question 62

factors that could cause a _____ ____ are poor health, poor circulation, and infection

Answer 62

delayed union

Question 63

a fracture that does not heal. Causes may include poor health, poor circulation, infection and fracture mismanagement

Answer 63

non-union

Question 64

the fracture heals in an unacceptable position and could cause a significant impairment

Answer 64

mal-union

Question 65

therapy considerations for preservation and restoration of function (4):

Answer 65

- AROM exercises for rest of body - strengthening exercises - we do not treat fracture - immobilization is bad

Question 66

clinical presentation of a fracture SandS (5):

Answer 66

- quick onset of pain: local tenderness - hot and limited ROM - bruising (if blood vessels damaged) - immediate swelling - altered joint end-feel (grades 2 and 3)