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S2 PTA 104 disease > Injury, inflammation, and healing > Flashcards

Injury, inflammation, and healing Flashcards

(60 cards)

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1
Q

Mechanisms of cellular injury

A
  • ischemia
  • infectious
  • immune
  • genetics
  • nutritional
  • physical
  • chemical
  • psychosocial
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2
Q

Reversible vs irreversible

A
  • cell death (unable to adapt)
  • adaptation (small damage, no injury. Acute or chronic)
  • repair (scar tissue)
  • regeneration
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3
Q

Issues that affect tissue healing

A
  • physiological
  • general health
  • comorbidities
  • substance use / abuse
  • infection / foreign bodies
  • tissue type
  • medical treatment
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4
Q

Phases of normal healing for all tissue types

A
  1. Hemostasis and degeneration
  2. Inflammation
  3. Proliferation and migration
  4. Remodeling and maturation
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5
Q

Regeneration vs repair pic

A

Pic

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6
Q
  1. Hemostasis and degeneration
A
  • immediately after injry body tries to stop bleeding via platelets, hematoma, necrosis
  • abnormal: low platelets or blood thinner meds
  • cytokines are released
  • causes inflammation (growth factos and fibroblasts
  • ** do not confuse with homeostasis
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7
Q
  1. Inflammation
A
  • protective and curative
  • replaces injured tissue
  • begins with formation of blood clot (vasodilation)
  • leukocytes, macrophage, and proteases
  • growth factors, chemokines, and cytokines
  • about 5 days: fibroblasts
  • chronic disease stall the healing at this phase, failing to progress to the next phase
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8
Q

CSI

A
  • erythema - pain - heat - edema - loss of function
  • *abnormal presentation: pts with diabetes may not “mount” a normal inflammatory response, so these signs may not be obvious
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9
Q

Acute inflammation

A

Normal

  • protective
  • proteins and fluid build up
  • slower in older adults
  • subsides in presence of small amount of necrosis
  • will heal on its own
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10
Q

Chronic inflammation

A

Pathological

  • large / prolonged injury
  • delays healing
  • common in older adults
  • occurs with larger amount of necrosis or lack of intervention
  • requires skilled care
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11
Q
  1. Proliferation and migration
A
  • starts 2 days after injury (overlaps with inflammation)
  • endothelial cells proliferate to establish vascular network for O2 and nutrients (angiogenesis)
  • new vessels are leaky (edema)
  • fibroblasts synthesize collagen
  • lasts for several weeks
  • healing can also stall at this phase, due to poor control of a comorbity
  • abnormal form: hypergranulation
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12
Q
  1. Remodeling and maturation
A
  • scar tissue reduced and remodeled
  • reorientation of collagen and strength regained
  • mature scar 3-4 months
  • lasts for 1-2 years
  • abnormal form: keloid formation (different than hypergranulation)
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13
Q

Healing timeline pic

A

Pic

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14
Q

Muscle injury etiology

A

Contusion (blunt force) - laceration (open wound) - strain - sprain

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15
Q

Strain

A

An injury to a muscle, typically occurring at the myoteninous junction

  • overstraining of the myofibrils likely during eccentric contraction
  • may have signification bleeding
  • etiology: a tensil, mechanical stress / trauma
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16
Q

Grades of strains

A

I: Minor discomfort and swelling, few torn muscle fibers, minimal loss of strength and movement
II: moderate to sever pain, pain with muscle contraction that limits activity, measurable loss of strength
III: severe pain, complete rupture of muscle belly or muscle tendon complex (mm pull or tear), severe loss of función

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17
Q

Muscle healing phases

A
  • hematoma formation and inflammation overlap (24-48 hrs)
  • phagocytosis (6-8 weeks)
  • remodeling: muscle regeneration reorganization of scar tissue takes up to 1 year!
  • 1/3 injuries re-occurs within 1 year
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18
Q

Treatment strains pic

A

Pic

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19
Q

Treatment considerations

A
  1. Inflammatory response depends on extent of damage and degree of vascularization
  2. Active contraction prior to 3 weeks s/p injry can cause further damage
  3. Passive ROM: no increase in tensile strength of tendon/muscle
  4. Mechanical stress of tendons / mm stimulates repair and functional remodeling
  5. Low intensity pulsed ultrasound
  6. Kinesiotaping
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20
Q

Mm stiffness

A

Causes

  • microfibrinous adhesions
  • increased collagen fibers
  • electrolyte changes
  • release of mm enzymes
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21
Q

Sprains

A

Injury to a ligament

  • etiology: the ligament is mechanically stressed
  • 80-85% of ankle sprains inversion, AFTL, calcaneal fibular, PTFL
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22
Q

Grades of sprains

A

I: Minimal pain and no significant instability
II: severe pain, minimal-moderate joint instability but definite joint end feel, and partial tear of ligs
III: severe pain during injury with less pain after, very unstable joint—no joint end feel, and ligament has been completely torn

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23
Q

Treatment sprains pic

A

Pic

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24
Q

Ligament treatment considerations

A
  • healed lig will be 30-50% weaker in tensile strength than before injury
  • treatments that stabilize th joint put lig i optimal length and position can reduce scarring
  • early controlled mobilization and loading lig can promote healing and improve post-injury tensile strength
  • proprioception is slower than strength to return, which contributes to reinjury
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25
Immobilization
Aid early healing and repair/protection from further injury - decreased force generation ability (muscle - decreased tensile strength (ligs and tendons)
26
Mobilization (with pain-free tolerance)
- earlier return to force generation (muscle) - mm fibers reorient in functional patterns - decreased scar tissue formation - earlier gains in tensile strength (ligs and tendon) - collagen fibers orient along lines of stress
27
Cartilage
4 types: - articular - fibrocartilage - elastic - fibroelastic Healing challenges - avasular - aneural - alymphatic
28
Compact bone
Dense, composed of concentric rings
29
Spongy bone
Composed of small needle like or flat pieces of bone (trabeculae)
30
Trabeculae
Form an open network which is filled with bone marrow
31
Signs
Objective/measureable - visual/palpable change in anatomy (deformity) - radiographic changes - inflammation - crepitus (noise)
32
Symptoms
Subjective - severe, persistent pain - point tenderness - inability to bear weight (because they feel it)
33
Types of fractures
1. Open vs closed 2. Complete vs incomplete 3. Simple vs comminuted 4. Compression fracture of spine 5. Impacted 6. Pathological 7. Stress 8. Epiphyseal 9. Avulsion
34
Open vs closed fracture
Open - results when the skin is broken and the bone is exposed - very high risk of infection - total disruption of the bone Closed - the bone is broken, but the skin remains intact
35
Complete vs incomplete fracture
Complete - the bone fragments are separated completely - the bone is broken to form 2+ pieces Incomplete - the bone is only partially broken - the bone fragments are still partially joined - greenstick fracture
36
Simple vs comminuted fracture
Simple: a single break in the bone. Bone ends maintain their alignment and position Comminuted: multiple fracture lines and bone fragments
37
Compression fracture
- common in the vertebrae - occurs when a bone is crushed - common with osteoporosis - results in significant pain and disability
38
Impacted fracture
- similar to a compression fracture - one end of the bone is forced into the adjacent bone - closed fracture - common in car accidents and falls * the neck of the femur is crushed against the pelvis
39
Pathological 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
40
Stress fracture
- results from repeated, excessive stress - common overuse injury, most often seen in athletes who run and jump on hard surfaces - common in the tibia, femur, and metatarsals
41
Epiphyseal fracture
If the plate is separated from the epiphysis or diaphysis without proper treatment, growth will not be normal
42
Epiphyseal pic
Pic
43
Avulsion fracture
- fragment of bone at the insertion of a muscle, tendon, or ligament becomes detached as a result of excessive tension - piece of bone is pulled free (usually occurs near the joint line)
44
Classification by direction of fracture line
1. Transverse 2. Linear 3. Oblique 4. Spiral
45
Transverse fracture
Fracture is at the right angle to the bone’s long axis
46
Linear fracture
Fracture is parallel to the bone’s long axis
47
Oblique 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
48
Spiral fracture
- a break that angles around the bone - usually due to a twisting injury - usually requires fixation
49
1. Hematoma phase of bone healing
Fracture, blood clot, fibrin, and platelets
50
2. Inflammation phase of bone healing
Lasts 24-48 hrs to 2 weeks - vasoactive (heat, redness, swelling, pain) - fibrin meshwork, fibroblasts - phagocyte cells to area of inflammation to remove hematoma - chondroblasts brought to the site of injury
51
3. Reparative phase
- soft callus formation 2 weeks - soft callus replaced by hard callus 6-12 weeks - fracture is not stable at end of this phase
52
4. Bone remodeling
- bone restructures itself over a period of 1 year, medullary canal is restored - callus is reabsorbed and the anatomical contour of the bone is regained - wolff’s law: the bone forms and remodels in the direction of forces (mechanical stresses acting on it) - from disorganized to mature organized bone tissue
53
Fracture management
Fragment reduction: re-alignment fragments - maintenance of alignment: stabilize, immobilize, ORIF, OREF, traction, non-weight bearing - preservation and restoration of function: AROM exercises for the rest of the body and strengthening exercises
54
ORIF
Open reduction internal fixation - surgical repair of fracture - use of pins, plates and/or rods to position bones in anatomical alignment
55
OREF
Open reduction external fixation - painful af - high risk of infection
56
Complications during fracture healing
1. Infections 2. Ischemia 3. Nerve damage 4. Slowed healing - DM - elderly - poor circulation - nutritional deficits - medication such a glucocorticoids
57
Delayed union
Factors that could cause a delayed union are poor health, poor circulation, and infection
58
Non-union
A fracture that does not heal. Causes may include poor health, poor circulation, infection and I fracture mismanagement
59
Mal-union
The fracture heals in a an acceptable position and could cause a significant impairment
60
Therapy considerations
Preservation and restoration of funciton - AROM exercises for rest of body - strengthening exercises - we do not treat the fracture - immobilization is bad!

S2 PTA 104 disease (15 decks)

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