MIDTERM (inflammatory process, wounds & burns, spasms, scar tissue, trigger points) Flashcards
(108 cards)
1
Q
what is the inflammatory process?
A
part of healing injured tissue
2
Q
ultimate goal of the inflammatory process
A
promote a strong, mobile scar, possible full pain-free movement, full strength
3
Q
causes of tissue damage
A
internal / external
common causes: trauma, infection, immune response, extreme heat/ cold, ischemic damage, radiation damage
4
Q
re-epithelialization
A
replication of missing cells
5
Q
granulation tissue
A
fibroblasts synthesize collagen that form loose CT matrix (1st / 2nd intention healing)
6
Q
scar tissue
A
mature collagen repair
7
Q
primary / first intention healing
A
occurs when there is some tissue loss & wound edges are approximated - healing is efficient with only small amounts of collagen produced to repair tissue
8
Q
secondary / second intention healing
A
when there is extensive tissue loss / large area affected, wound edges cannot be bought together easily - healing takes longer through re-epithelialization
9
Q
factors that affect the healing process
A
-severity of injury
-age
-infection
-presence of foreign material
-nutritional support
-existing conditions
-adequate blood supply
-wound separation
-effects of some drugs
-smoking
10
Q
ACUTE STAGE
A
from moment of injury up to 3/4 days post-injury
redness, swelling, heat, pain, possible loss of function, muscle spasm & guarding, bruising (purple, blue, red)
11
Q
ACUTE treatment goals
A
-limit inflammatory process
-reduce pain & swelling
-decrease SNS firing
-prevent re-injury
-protective spasms reduced but not removed
-compensatory structures treated
12
Q
STAGES OF HEALING
A
acute
early subacute
late subacute
chronic
13
Q
EARLY SUBACUTE STAGE
A
within two days of injury and may continue for up to 3 weeks
diminished signs of inflammation, pink, warm tissue, less pain, muscle spasm diminished, bruising unchanged
14
Q
EARLY SUBACUTE treatment goals
A
-continue to decrease effects of inflammation, pain, swelling, & spasms
-maintain available ROM & strength
15
Q
ACUTE hydrotherapy
A
cold application
16
Q
EARLY SUBACUTE hydrotherapy
A
cold applications - introduction of mild contrast
17
Q
LATE SUBACUTE STAGE
A
begins 2-3 weeks after
may be pocket of residual swelling, minimal discomfort, potential loss of ROM due to adhesions & muscle weakness, if bruising: yellow, green, brown
18
Q
LATE SUBACUTE treatment goals
A
-decrease remaining edema
-reduce trigger points, pain & adhesions
-improve ROM & muscle strength
19
Q
LATE SUBACUTE hydrotherapy
A
hot & cold contrast applications
20
Q
CHRONIC STAGE
A
about 2-3 weeks post injury & continues for up to 1-2 years
inflammatory process resolved, likely no edema, potential loss of ROM & decrease in function, may be pain with overpressure
21
Q
CHRONIC treatment goals
A
-reduce restrictive adhesions & trigger point
-restore ROM & strength to affected areas
-treating compensatory areas
22
Q
CHRONIC hydrotherapy
A
hot & cold contrast applications
23
Q
what is an injury?
A
disruption of the continuity of any tissue
24
Q
epidermis
A
outer layer of skin
cell have short life span (28-30 days) which results in continuous sloughing off & renewal
25
dermis
beneath epidermis
anchors & nutritionally support
composed of elastin & collagen which gives tissue flexibility & strength
contains sebaceous & sweat glands, hair follicles, nerve receptors, blood & lymphatic vessels
26
subcutaneous
contains adipose tissue, larger blood vessels & deep hair follicles
below this layer are muscles & bone
27
what is a wound?
disruption of the continuity of skin
28
causes of wounds
thermal sources
chemical & electrical sources
mechanical forces - trauma, pressure, shear, friction force
29
types of wounds
-abrasion
-laceration
-incision
-puncture
-animal bite
30
abrasion
superficial wound, ragged edges
result of scrape / tear causing loss of skin
often extremely painful
31
laceration
increased tissue loss with ragged wound edges
sutures / tape may be used to bring edges together
32
incision
clean, approximated wound edges
results from sharp-edged object
sutures / tape used to secure edges together
33
puncture wound
clean edges with small entry, can penetrate deeply
can close over at entry before rest of damage heals: increased risk of infection
34
animal bite
combination of crush, laceration & puncture wound
35
what is a burn?
specific type of wound caused by external thermal agent
36
types of burns
-superficial burn
-partial-thickness burn
-full-thickness burn
37
superficial burn
first degree burn
effects epidermis
result of prolonged exposure to low heat / quick high heat
some mild localized edema
healing is rapid without scar tissue
38
partial thickness burn
second degree burn
extends to dermis
redness, pain, localized edema, blistering
increased edema & risk of infection
less pain due to nerve damage
can re-epithelialize with good function & minimal scar tissue
39
full thickness burn
third/ fourth degree burn
damage to all layers
dry, inelastic, white, waxy, charred in colour
painless because of nerve damage
re-epithelialize not possible (skin grafts required)
40
41
"rule of nines"
% of body surface damaged by burn
42
hypertrophic scar
destruction of collagen combined with contraction of myofibroblasts causes "heaped up" appearance of scar
43
complications of burns
-breathing
-inhalation injuries
-GI complications
-renal complications
-heterotrophic calcification
-burned skin
-thermoregulation impairment
-peripheral vascular damage
-sensory impairment/ loss
-subluxation & dislocation
-amputation
44
CI's for burns
-infection risk: wash hands, gloves, oil not used around wound
-avoid direct contact with burns that produce blisters
-pressure directed toward injury site (acute)
45
acute & early subacute: TREATMENT CONSIDERATIONS
-promote relaxation
-reduce pain
-reduce edema
-prevent infection
-encourage activity
46
acute & early subacute: MASSAGE
-diaphragmatic breathing
-massage to unaffected areas (promote relaxation & stress reduction)
-affected limb elevated, massage proximal to injury
-distally, only techniques that do not increase circulation
47
late subacute & chronic: TREATMENT CONSIDERATIONS
-reduce any remaining edema
-decrease SNS firing
-decrease pain
-increase local circulation
-reduce adhesions
-improve ROM
48
late subacute & chronic: MASSAGE
-diaphragmatic breathing
-edema treated if present
-massage proximal to injury site
-decrease adhesions
-STRETCH scar tissue
-hydro: warm, prior to stretching, cold: decrease pain
-joint play
49
what is a spasm?
involuntary, sustained contraction of a muscle
50
what is a cramp?
painful, prolonged muscle spasm
51
reflex muscle guarding
muscle spasm in response to pain, due to local injury & is present in acute stages
52
intrinsic muscle spasm
involuntary self-perpetuating pain-spasm cycle
-pain from direct/ indirect trauma, infection, increase in SNS, emotional stress, cold tissue
53
tone
resistance of relaxed muscle to passive stretch / elongation
54
tension
muscle fibers tend to shorten, causing them to perform work
55
hypertonicity
abnormally high tone usually seen with upper motor neuron disorders
56
how does a muscle contract?
-skeletal muscle = bundle of fascicles (grouping of muscle fibers) -> made up of thousands of fine strands = myofibrils -> contains thick & thin filaments arranged in units that repeat along myofibil = sarcomere (basic contractile units of muscle fibers)
-thick filaments (myosin) & thin filaments (actin) overlap and produce contractile force, slide past & shorten sarcomere -> repeated actions = MUSCLE CONTRACTION
57
two structures in spasms
muscle spindles & golgi tendon organ (GTO): transmit proprioceptive information from muscles to CNS to allow proper muscle function
58
muscle spindles
major sensory organs of muscles & aid in control of muscle movements (in muscle belly)
-measure degree (length) & speed a muscle is stretched
59
golgi tendon organ (GTO)
nerve receptors located near their muscular attachments
-sensitive to tension
-when they fire, they inhibit contraction of muscle
-protect muscle from overstretch injury
60
causes of muscle spasms & cramps
-pain
-circulatory stasis
-increased gamma neuron firing
-chilling of muscle
-impaired nutrition supply
-lack of vitamin D
61
symptom picture of spasms & cramps
-pain within muscle (ischemia & retention of metabolites)
-spasm & hypertonicity present
-decreased ROM of joint
-antagonist & synergist affected
-TP's in other muscles may refer
62
H.H questions (spasms)
-general health / contributing factors
-previous injury
-pain: where / quality
-precipitating factors
-onset
-medications
63
palpation (spasms)
-affected muscle: hot = acute congestions, cold = ischemia
-point tender due to ischemia
-texture of acutely spasmodic muscle = firm, dense, congested
-texture of intrinsic muscle = hard & fibrous
-affected muscle is hypertonic, as well as synergist & antagonist
64
contraindications
-DO NOT attempt to completely eliminate reflex muscle guarding that is splinting acute injury
-avoid passively stretching acutely spasmodic muscle
-hot hydro CI'd with spasm from acute injury
-massage locally CI'd with DVT
65
treatment GOALS (spasm)
-break pain-spasm cycle, decrease spasm
-if reflex muscle guarding, do NOT disturb healing process & decrease only portion of spasm present
-decrease pain & SNS
-increase local circulation
-decrease hypertonicity
-once spasm has been reduced, increase ROM
66
TREATMENT (spasm)
-indirect techniques (GTO, O & I), direct techniques may be too painful
-massage to flush metabolites & decrease pain
67
GTO technique (effectiveness)
on muscles whose tendons are long & easily palpable
68
O & I technique (effectiveness)
used when tendon to be treated is short
(variation of GTO release)
69
muscle approximation (effectiveness)
direct technique, lessens stretch on muscle spindles
70
what is scar tissue?
fibrous, collagen based tissue that develops as a result of the inflammatory process
-scar tissue = weaker than tissue it replaces
71
types of scar tissue
-contracture
-adhesion
-scar tissue adhesion
-fibrotic adhesion
-irreversible contracture
-proud flesh
-hypertrophic scarring
-keloid scar
72
contracture
shortening of CT supporting structures around joint (muscles, tendons, joint capsules)
-tissue cannot fully lengthen, reduced ROM
(adhesions & irreversible contractures)
73
adhesion
occurs when reduced motion at joint allows cross-links to form among collagen fibers, reducing ROM (when tissue is left in shortened position for prolonged periods of time)
74
scar tissue adhesion
occurs with injury / acute inflammatory process
collagen fiber formation allows adhesions & contractures to form in random pattern, reducing ROM
75
fibrotic adhesion
occurs with ongoing chronic inflammation that can cause moderate to severe restrictions in ROM (difficult to eradicate)
76
irreversible contractures
occurs when fibrotic tissue / bone replaces muscle & CT
-permanent loss in ROM, can only be restored by surgical means
77
proud flesh scar
thick dermal granulation tissue that results from abnormal healing process
-raised, red structure, susceptible to damage
78
hypertrophic scarring
overgrowth of dermal tissue WITHIN boundaries of wound
79
keloid scar
dermal scar tissue that extends BEYOND original wound, tumour-like growth
-may grow for years / recur
80
effects of massage on scar tissue
-decrease edema before scar tissue develops = removes excess interstitial fluid, reduces amount of scar tissue that develops
-helps soften scar tissue by decreasing fibrotic adhesions & increasing circulation
-helps desensitize
-stretching scar tissue after massage is essential (*realign ribers)
81
CONTRAINDICATIONS (scar tissue)
frictions are CI'd on: proud flesh / keloid scars, anti-inflammatory medications
82
observations (scar tissue)
may be aneural (not innervated) / partially innervated
is avascular (no hair, sebaceous, sweat glands)
83
palpation (scar tissue)
-scar tissue & adhesions = thick, hard areas
-may be cool due to ischemia
-disuse atrophy (muscle weakness) may be present / loss of ROM
84
HYDRO (scar tissue)
-pre treatment: heat
-post treatment: cold (after frictions)
85
GOALS (scar tissue)
-create mobile, functional scar
-periphery of scar treated first, then toward center
-cross-fiber frictions on adhesions
-techniques from least adhered to most adhered
-massage followed by passive stretch to promote alignment of collagen fibers
86
cross-fiber frictions
-developed by James Cyriax
-intended to disrupt & break down existing & forming adhesions in muscles, tendons & ligaments using compression & motion
-used in subacute & chronic stages of healing to break down adhesions
-suggested 10-20 minutes effleurage before frictions performed
87
what is a trigger point?
hyperirritable spot, within discrete taut band of skeletal muscle or its fascia that produces local & referred pain
-point tender on site, often predictable pain referral pattern
-causes affected muscle to shorten
-condition, not a method
88
theory of what causes trigger points
-interaction of calcium & ATP on myofascial tissues that have been stressed in some way, causes tissue to shorten
-generates localized & uncontrolled metabolic activity
-localized acidic fluid environment -> makes nerve endings hyperirritable resulting in pain
-tiny microfilaments in muscles start to stick together (adhesions)
89
myofascial pain syndrome
-most common form of muscle pain
-involves pain with specific "trigger" / "tender" points
-sensory, motor & autonomic symptoms occur
-can occur from soft tissue injury / when use of muscles exceed their ability & normal recovery is disturbed
90
perpetuating factors (trigger points)
-reflexive
-mechanical
-systemic
91
reflexive (trigger points)
-skin sensitive in area of TP
-joint dysfunction
-visceral dysfunction in referred pain pattern
-vasoconstriction
-facilitated nerve segment
92
mechanical (trigger points)
-gait distortion
-immobilization
-vocational stress
-restrictive / ill-fitting clothing & stress
-furniture
93
systemic (trigger points)
-enzyme dysfunction
-metabolic & endocrine dysfunction
-chronic infection
-dietary insufficiencies
-psychological stress
94
types of trigger points
-active
-latent
-primary
-secondary
-satellite
95
ACTIVE TP
-painful at rest & with active/ passive movement of muscle
-prevents muscle from fully lengthening & reduces its strength
-tissue ischemia
-palpation can produce local twitch response & possible referred autonomic phenomena
96
LATENT TP
-opposite to active / more common
-produces pain only when palpated
97
PRIMARY TP
directly activated by acute / chronic mechanical strain or overload of affected muscle
98
SECONDARY TP
activated in overworked synergist / antagonist muscle
99
SATTELITE TP
found in muscles that lie within referral pattern of another TP
100
symptom picture (trigger points)
-pain / tenderness
-sensitivity of active TP can change over several hours / days
-passive stretching & contraction is painful
-possible autonomic symptoms
-palpable taut band
-decreased circulation in muscle local to TP
-decreased ROM
-synergists & antagonists affected
-muscle weakness
101
observations (trigger points)
-antalgic gait may be present if TP is in lower torso / limb
-antalgic posture may be present with active TP
-client may have pained expression
102
palpation (trigger points)
-referral patterns
two methods used: flat palpation & pincer palpation
-may feel like tiny nodule
103
PANNICULOSIS
-thickening of subcutaneous tissue
-no inflammation present
-skin rolling useful to reveal
104
JUMP SIGN
may occur where pain is intense enough to cause client to wince, jump, cry out
105
CONRAINDICATIONS (trigger points)
-avoid vigorous techniques when treating hyperirritable TP's since "kick-back" pain may result
-treating TP's proximal to area with acute inflammation: heat = CI'd
-acute / early subacute (sprains/strains): treatment local to injury CI'd
-avoid prolonged chilling of muscle (may activate TP)
-avoid prolonged ischemic compressions & frictions
-full stretch after TP treatment is completely CI'd if crosses a hypermobile joint
106
POST trigger point treatment
-stimulate circulation
-lengthening the muscle should be completed passively / actively
-moist heat immediately after treatment: soothing & useful
107
methods of treating trigger points
-direct pressure / manipulation
-ice massage
-dry needling
-positional release
-muscle energy
108
trigger point release techniques
-skin rolling
-muscle stripping
-alternate ischemic compressions
-variable pressure technique
-cross-fiber frictions
