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Traumatology > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

After mechanical trauma, what happens?

A

immediate sympathetic blanching

reddening by histamine, bradykinin, prostaglandin

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2
Q

Chemotactic factors create reflexes in capillaries…

A

Migration of protein molecules to borders
Parementation- proteins aligning tightly on capillary walls
Immigration- vasodilation of capillary walls to allow proteins to interstitial tissue (causes edema)

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3
Q

Pain leads to this cycle of events…..

A 
Type IV mechanoreceptors fire
muscle guarding
increased tension
tissue deprived of vascularity/nutrition
increased retained metabolites
increased irritation rates
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4
Q

How do you manage pain?

A

beginning active pain free motion to activate muscle pump

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5
Q

Fibrous reaction from clotting mechanism can lead to…

A

Limited muscle elongation
restricted joint motion
limited tendon function
fascial shortening

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6
Q

Scar formation on tendon leads to….

A

painfully scarred down with adhesions
limited tensile strength
pain to stretch

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7
Q

Scar formation in muscle leads to…

A

limit extensibility

limited excursion

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8
Q

Scar formation in joint leads to….

A

limit extensibility
limited excursion
poor contractile ability
muscle guarding

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9
Q

Scar formation in fascia leads to…

A

myofibroblast active to shorten tissue and limit ROM

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10
Q

Membrane surrounding an individual muscle fiber

A

Basal Lamina

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11
Q

Peptide hormone that causes vasodilatation and increased permeability of blood vessels

A

Bradykinin

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12
Q

Cartilage cell responsible for synthesizing the ECM of cartilage which includes collagen, proteoglycans, and glycoproteins from amino acids and sugar

A

Chondroblast

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13
Q

fibrous glycoprotein found in connective tissue

synthesized from fibroblasts

A

collagen

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14
Q
  • chemical messenger that helps regulate the immune response

- call in more white blood cells as needed

A

cytokine

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15
Q

fibrous protein found in connective tissue

A

elastin

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16
Q

connective tissue cell that produces collagen, elastin, and proteoglycans such as GAG

A

fibroblast

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17
Q

glycoprotein with important role in adhesion of connective tissue cells

A

fibronectin

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18
Q
  • has a protein portion to which carbs attach
  • important role in interaction between adjacent connective tissue cells to collagen
  • examples: fibronectin and laminin
A

glycoprotein

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19
Q
  • AKA acid mucopolysacharrides
  • found linked to a long protein as components of proteoglycans
  • List all
A 
glycosaminoglycan
chondroitin-4 sulfate
chondroitin-6 sulfate
dermatan sulfate
heparin sulfate
hyaluronic acid
keratan sulfate
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20
Q
  • formed during the repair phase of healing

- contains myofibroblasts, fibroblasts, ECM, rich vascular supply

A

granulation tissue

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21
Q

-fluid, semifluid, or solid material that occupies the intercellular spaces in fibrous connective tissue, cartilage, or bone
-contributes greatly to strength of connective tissues
mixture of water, GAG, proteoglycans, and glycoproteins
-strongly hydrophilic

A

ground substance

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22
Q

fibrin blood clot that forms immediately at the site of trauma in tissues with a vascular supply

A

hematoma

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23
Q
  • amine compound that is released by damaged mast cells

- produces vasodilation and increased vascular permeability of blood vessels

A

histamine

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24
Q
  • acid mucopolysaccharide that is strongly hydrophilic
  • takes up hydrodynamic volume 1000 times the space occupied by the chain itself
  • found in synovial fluid and in ground substance of connective tissues
A

hyaluronic acid

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25
Q

excessive amount of calcium in the blood

A

hypercalcaemia

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26
Q

excessive amount of calcium in the unrine

A

hypercalciuria

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27
Q

excessive amount of phosphate in the urine

A

hyperphosphaturia

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28
Q

Membrane surrounding an individual muscle fiber

A

Basal Lamina

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29
Q

Peptide hormone that causes vasodilatation and increased permeability of blood vessels

A

Bradykinin

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30
Q

Cartilage cell responsible for synthesizing the ECM of cartilage which includes collagen, proteoglycans, and glycoproteins from amino acids and sugar

A

Chondroblast

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31
Q

fibrous glycoprotein found in connective tissue

synthesized from fibroblasts

A

collagen

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32
Q
  • chemical messenger that helps regulate the immune response

- call in more white blood cells as needed

A

cytokine

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33
Q

fibrous protein found in connective tissue

A

elastin

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34
Q

connective tissue cell that produces collagen, elastin, and proteoglycans such as GAG

A

fibroblast

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35
Q

glycoprotein with important role in adhesion of connective tissue cells

A

fibronectin

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36
Q
  • has a protein portion to which carbs attach
  • important role in interaction between adjacent connective tissue cells to collagen
  • examples: fibronectin and laminin
A

glycoprotein

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37
Q
  • AKA acid mucopolysacharrides
  • found linked to a long protein as components of proteoglycans
  • List all
A 
glycosaminoglycan
chondroitin-4 sulfate
chondroitin-6 sulfate
dermatan sulfate
heparin sulfate
hyaluronic acid
keratan sulfate
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38
Q
  • formed during the repair phase of healing

- contains myofibroblasts, fibroblasts, ECM, rich vascular supply

A

granulation tissue

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39
Q

-fluid, semifluid, or solid material that occupies the intercellular spaces in fibrous connective tissue, cartilage, or bone
-contributes greatly to strength of connective tissues
mixture of water, GAG, proteoglycans, and glycoproteins
-strongly hydrophilic

A

ground substance

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40
Q

fibrin blood clot that forms immediately at the site of trauma in tissues with a vascular supply

A

hematoma

41
Q
  • amine compound that is released by damaged mast cells

- produces vasodilation and increased vascular permeability of blood vessels

A

histamine

42
Q
  • acid mucopolysaccharide that is strongly hydrophilic
  • takes up hydrodynamic volume 1000 times the space occupied by the chain itself
  • found in synovial fluid and in ground substance of connective tissues
A

hyaluronic acid

43
Q

excessive amount of calcium in the blood

A

hypercalcaemia

44
Q

excessive amount of calcium in the unrine

A

hypercalciuria

45
Q
  • newly synthesized or repaired tissue that is not the same as the injured tissue
  • original tissue did not regenerate and was replaced by a dense meshwork of collagen fiber bundles
A

scar

46
Q

any disease or injury that is induced unintentionally from medical treatment by physician

A

iatrogenic

47
Q
  • white blood cells that include neutrophils, lymphocytes, and monocytes (macrophages)
  • phagocyte that acts as scavenger to fight infection
A

leukocyte

48
Q
  • main role is that of phagocytosis of necrotic tissue, debris, and pathogens at injury site
  • stimulates neoangiogenesis and fibroblast proliferation
  • mononuclear phagocyte
A

macrophage

49
Q
  • connective tissue cell important in the defense mechanism during injury or infection
  • facilitates blood coagulation
  • releases histamine when damaged
A

mast cells

50
Q

cell with one nucleus

A

mononucleated

51
Q
  • mononucleated muscle precursor

- differentiate into new skeletal muscle

A

myoblast

52
Q
  • contain contractile elements that cause scar tissue shrinkage
  • most active from day 5 - 21
A

myofibroblast

53
Q
  • formed by cytoplasmic fusion of myoblasts

- precursor to newly formed skeletal muscle

A

myotubes

54
Q

List 10 factors affecting the healing of connective tissues

A 
Age
Gender
Temperature
Type of Injury
Dietary intake
Hormonal influences
pH and lactate concentration
drugs
muscular forces
mobility
underlying diseases
55
Q

development of new blood vessels

A

neoangiogenesis

56
Q
  • white blood cell phagocyte

- AKA polymorphonuclear leukocyte

A

neutrophil

57
Q

bone cell capable of synthesizing new bone

A

osteoblast

58
Q

act of ingesting material such as necrotic debris or pathogens

A

phagocytosis

59
Q
  • first to reach site of injury

- releases powerful enzymes

A

polymorphonuclear leukocyte

60
Q

fatty-acid intimately involved in the inflammatory phase of healing

A

prostaglandin

61
Q
  • noncollagenous macromolecule interwoven with collagen fiber and elastin
  • important properties related to the strength, function, and integrity of connective tissues
  • contains protein core and GAG side chains
A

proteoglycan

62
Q
  • reserve cells with myogenic, muscle regenerating, capacity
  • lie between a muscle fiber and basal lamina
  • can differentiate into myoblasts and myotubes
  • may represent myoblasts that did not fuse into multinucleated muscle fibers during embryonic myogenesis
A

satellite cell

63
Q
  • newly synthesized or repaired tissue that is not the same as the injured tissue
  • original tissue did not regenerate and was replaced by a dense meshwork of collagen fiber bundles
A

scar

64
Q

What are the four classical signs of inflammation?

A

heat
swelling
redness
pain

65
Q

The initial sympathetic reaction to trauma is ________ which lasts no more than a few _______

A

vasoconstriction

minutes

66
Q

How long does the inflammatory phase last?

A

7 days

67
Q

How long after injury before the repair phase begins?

A

48 hours

68
Q

What is role of fibroblasts in healing?

A

formation of granulation tissue by producing collagen and GAG

69
Q

How long after injury does remodeling phase begin and how long does it last?

A

Begins 14 days after injury and may last up to a year or more

70
Q

What happens to collagen during the remodeling phase?

A
  • collagen in granulation tissue shifts from mostly Type III collagen to being mostly Type I.
  • collagen synthesis diminishes
  • further cross-linking of collagen fibers
  • fibers realign themselves along the lines of mechanical stress
71
Q

What does “secondary intention” signify?

A
  • large tissue defect must be filled with granulation tissue resulting in an extensive scar because the edges of the wound cannot be approximated
  • inflammation is usually more intense and lasts longer
  • wound contracture is an integral part of this type of healing
72
Q

List 10 factors affecting the healing of connective tissues

A 
Age
Gender
Temperature
Type of Injury
Dietary intake
Hormonal influences
pH and lactate concentration
drugs
muscular forces
mobility
underlying diseases
73
Q

Describe the characteristics of the 3 phases of wound healing

A
  • inflammation, repair, remodeling
  • inflammation phase limits the extent of tissue damage and spread of infection. Involves removal of necrotic debris and pathogens
  • repair phase produces granulation tissue and promotes vascularization
  • remodeling phase begins with maturation of granulation tissue which is characterized by formation of dense fibrous scar tissue and reduction in number of cells and amount of vascular tissue
74
Q

Name at least 6 ways immobilization affects the healing process of muscle

A 
increased granulation tissue
atrophy of muscle (slow > fast)
increased connective tissue
decreased neural activity
delayed maturation of scar tissue
decreased capillary density
decreased number of sarcomeres and mitochondria
decreased protein synthesis
transformation of slow twitch fibers to fast twitch
75
Q

what effect does early mobilization have on healing process of muscle?

A

allows for rapid resorption of scar tissue and optimal structural organization of regenerating muscle fiebrs

76
Q

Describe the vascular changes and functions that occur after trauma.

A
  • initially, blood vessels are torn and blood flows into the area and a clot is formed
  • vasoconstriction occurs with help from platelets releasing serotonin (seconds to minutes).
  • WBCs travel to margins of blood vessel wall where they remain until change in permeability of blood cell wall allows them to pass through
  • region of primary trauma, degenerating cells release the vasodilator histamine
  • with vasodilation, WBCs and macrophages enter into trauma zone along with proteins, colloids, and water
77
Q

What is a hematoma and what is its function?

A
  • hematoma is a fibrin clot that forms immediately at the site of trauma in tissues with vascular supply
  • functions to limit blood loss and also acts as a scaffold to support cell migration
78
Q

What is a neutophile and what does it do

A

type of white blood cell that releases proteolytic enzymes that degrade the ECM

79
Q

What is a macrophage and what does it do

A

-mononuclear phagocytes that ingests cellular debris, neutrophil carcasses, fibrin

80
Q

Describe healing by “third intention.”

A
  • when healing is delayed by infection or contamination
  • wound stays open, preventing granulation tissue from covering the injured tissue until neutrophils and macrophages remove all bacteria and debris
81
Q

List the tissues that are not capable of some sort of regeneration.

A 
cartilage
nerve (CNS)
disc
meniscus (inner portion)
cruciate ligaments
82
Q

What is myositis ossificans and what are the risk factors for its development?

A
  • abnormal bone formation within a muscle
  • risk factors: hematoma formation, severe contusions, early exercise, youth, injury to bone or periosteum, injury near musculotendinous junction, and/or multiple episodes of trauma
83
Q

In a 21 year old athlete, approximately what portion of the knees menisci is capable of classic healing response?

A

outer one quarter to one third

84
Q

Describe healing process following an injury to articular cartilage that does not penetrate down to subchondral bone.

A
  • does not involve trauma to blood vessels
  • will not follow “classical” stages of healing
  • does not repair itself
  • necrosis occurs at margins of injury together with short lived signs of increased metabolic activity
85
Q

What is required in order for a tissue to launch an inflammatory response following trauma?

A

blood supply

86
Q

What effect does immobilization have on articular cartilage?

A
  • excessive immobilization will lead to loss of joint motion and WB capacity
  • decreases water and proteoglycan content with increased metabolic activity
  • chondral surface will become soft and fragmented, chondral collagen fibers will disintegrate, subchondral bone will atrophy, and increase in chondrocyte necrosis
87
Q

What portion of the vertebral disc is capable of classical healing response?

A

outer portion of annulus fibrosus

88
Q

What effect does smoking have on vertebral disc?

A

Facilitates degenerative disc disease and promotes malnutrition by decreasing circulation and metabolism within the disc

89
Q

How long does it normally require before union occurs at a fracture site?

A

Union normally occurs in 4-6 weeks for an arm and 8-12 weeks for a leg

90
Q

What 3 factors are most important in pursuit of increasing bone density?

A

Physical activity, Hormonal factors, and nutrition

91
Q

What are the physiological effects of applying cold pack to patient?

A
  • can limit secondary tissue damage due to hypoxia
  • accomplished by decreasing metabolic rate within the tissue and subsequently reducing that tissue’s need for oxygen which will help limit the extent of hypoxia-induced damage
  • increase stiffness and decrease inflammation, metabolic rate, muscle spasm, and pain
92
Q

How long does vasoconstriction action of ice last?

A

no more than 5 minutes

93
Q

What effect does temperature of 40-45 degrees C have on musculoskeletal tissues?

A

Collagen bonds partially melt and tissue becomes fragile

94
Q

What are the effects of protein deficiency on the healing process?

A

-Decreased collagen synthesis, proteoglycan synthesis, neovascularization, and fibroblast proliferation along with an increase in edema, catabolism of tissues, wound infections, and amount of time required to heal

95
Q

What are the effects of corticosteroid injections of musculoskeletal tissues?

A
  • impairment of wound healing, cessation of all collagen synthesis in granulation tissue, inhibition of fibroblastic functions, and inhibition of fibrous scar formation
  • Side effects: osteoporosis, myopathy, psychiatric complications, increased susceptibility to infection, and bone osteonecrosis
96
Q

What effect do NSAIDs have on healing process?

A
  • inhibit function of macrophages which can lead to an inhibition of muscle fiber regeneration
  • produce an increase in non-absorbed necrotic muscle tissue
  • inhibit synthesis of Type II collagen and GAG
  • induce adverse affects on bone and tendon healing, and produce GI side effects: ulceration, hemorrhage, and/or perforation
97
Q

Loss of a negative extracellular environment causes severe ______

A

edema

98
Q

In addiction to causing pain, prostaglandin E causes ________

A

vasodilation

99
Q

Explain how scar tissue can give rise to pain.

A
  • 1st degree healing myofibroblastic activity increases which shrinks and shortens tissue
  • influx of capillaries stops during second degree compression and they disappear
  • Type IV mechanoreceptors from the capillary walls are left behind, which stretch and cause pain

Traumatology (1 decks)

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