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Pathophysiology 1 > Soft Tissue Healing > Flashcards

Soft Tissue Healing Flashcards

1
Q

DEFINE SPRAIN

A

Sprain is a tear or stretch of a ligament

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2
Q

Functions of ligaments

A

Fibrous band of connective tissue that connects bone to bone

Stabilises and supports joints in the body, eg TALOCRURAL joint

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3
Q

Soft tissue injury categories

A

GRADE 1/ Mild ligament sprain = parallel collagen fibres with small tears along.

GRADE 2/ moderate ligament sprain = large but incomplete tear- not through whole cross section of ligament

GRADE 3/ severe ligament sprain= Complete tear through whole cross section of ligament

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4
Q

Define STRAIN

A

Injury to a muscle or tendon- overlengthening or over contracting a muscle causing tear of collagen

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5
Q

Internal and external strain

A

Internal - strain caused by over stretching or over lengthening muscles in body

External- eg damage to muscles or tendons from being kicked

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6
Q

Basic muscle structure

A

Myofibrils make up muscle fibres
Muscle fibres collaborate into a fascicle
Perimysium surrounds fascicles
Outer muscle surrounded by epimysium

Epimysium separates muscle from other tissues and allows muscle to glide freely over structures

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7
Q

Grade 1 soft tissue injury

A 
Ligament, tendon or muscle overstretched with only micro tears. 
Localised pain and tenderness
No visible bruising 
Minimal swelling 
Minimal loss of function 
Ligament = no ligament laxity (looseness)
Muscle= no loss of muscle strength and ROM only down by a max. Of 10 degrees
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8
Q

Grade 2 soft tissue injury

A

Partial / incomplete tear of ligament, tendon or muscle (some of cross section).
Immediate onset of cardinal signs - warmth, redness, swelling, pain and loss of function
Poorly localised pain
Moderate swelling
Bruising visible
Impairment and painful ROM

Muscle = decrease in strength and pain on contraction 
Ligament = joint may be unstable
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9
Q

Grade 3 soft tissue injury

A

A complete rupture of tendon, ligament or muscle.
Sprain = the ligament has totally torn and joint is unstable
Strain= muscle or tendon, inability to contract muscle and separation evident sometimes
Grade 3 = immediate acute pain , all cardinal signs and pop or crack
Later on= symptoms may be less than a grade 2
May require immobilisation or surgery.

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10
Q

Limitations to grade one two three system

A

Symptoms don’t always correlate to the given chart

Not always accurate diagnosis or length of time until recovery

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11
Q

Brutus athletics muscle injury

A 
A= myofascial injury 
B= musculotendinous 
C= intratendinous injury 
0= pain is referred, no tissue damage in MRI
1= small injury (less than 10% tissue damage)
2= larger tear of muscle (10-50%)
3= more than 50% torn 
4= complete tear of the muscle through full cross section
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12
Q

Positives and negatives of that system

A

Positives - more accurate information and imagery

Negatives - NHS can’t fund that many MRI scans
MRI within 24 hours not possible in NHS

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13
Q

Factors that cause soft tissue damage

A

I I I I

Injury - physical, electrical, thermal, radiational and chemical

Infection- virus , bacteria , fungi and Protozoa . Can transfer from one part of body to soft tissue and damage it

Infarction- part of tissue cut off from blood supply eg, MI

Immune reactions- foreign protein hypersensitivity allergies
Auto immune diseases like RA , ankylosing spondylitis and MS.
Attacks healthy tissue and damages it!

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14
Q

Types of body tissue

A

PARENCYHMAL TISSUE

STOMAL / INTERSTITIAL TISSUE

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15
Q

Parenchymal tissue

A

Functional cells of organs

Eg, neuronal tissue in brain, cardiac myocyte in heart, epithelial tissue in skin and hepatocyte cells in liver

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16
Q

STOMAL / interstitial tissue

A

Connective tissue parts of organs

This connective tissue contains cell types like fibroblasts, blood vessels, nerves and nerve endings

17
Q

3 types of tissue healing

A

RRR

Resolution- rapid healing of mild injury. Epithelial cells slough and regenerate as required.

Regeneration - specialised tissue replaced by proliferation of surrounding undamaged cells eg, injured tissues repaired with parenchyma

Repair (replacement) - lost tissue replaced with granulation tissue (matures to scar tissue)

18
Q

What types of cell are there for regeneration ?

A

LSF - kasabian

LABILE CELLS- constantly turn over and regenerate. Eg, skin cells

STABLE CELLS- can divide and regenerate but stops growing once growth stops. It is supportive framework if damage occurs as can regenerate if needed. Eg, liver tissue

FIXED / PERMANENT CELLS- non dividing cells
No mitosis 
So they can’t regenerate if injured 
Tissue repair leaves a scar
Eg, nerve , muscle and cardiac cells
19
Q

TISSUE REGENERATION

A

Injury in parenchymal tissue with labile or stable cells can regenerate.
Injury to fixed cells has a tissue repair process

In parenchymal, cells:
Growth factors release from damaged cells and tissues
Platelet derived growth factor and cytokines to increase mitotic divisions

Injured tissue replaced with parenchymal cells
Little evidence of injury after repair

20
Q

TISSUE REPAIR STEPS

A

BIPR

Bleeding phase = 6-8 hrs
Inflammation= 2-3 weeks
Proliferation= days to months
Remodelling= weeks to months

Some overlap

21
Q

Bleeding phase

A

Occurs immediately after injury
Relatively short lived
Vascular tissue like muscle bleeds for longer
Other tissues ligaments and tendons for example, bleed less in volume and duration
On average = 4-6 hours bleeding , but some people bleed longer

22
Q

Inflammatory phase

A 
VCPL
Vascular phase- changes in blood flow and exudation of protein rich exudate 
Cellular phase - leucocyte emigration 
Phagocytosis 
Lymphatic drainage

Starts after 2 hrs, worsen in 2-3 days and continues for 2-3 weeks

Damage cells release histamine, bradykinin and prostaglandins which cause blood vessels to dilate. Fluid from blood leaks out into limb causing oedema

Leucocyte emigration- chemicals encourage WBCs to the area. Neutrophils fight bacterial infection and macrophages use phagocytosis.

Lymphatic drainage- carries excess fluid and products of inflammation back to bloodstream to be removed from body

23
Q

Proliferation phase

A

24-48 hrs after injury
Fibroblasts, macrophages and blood vessels proliferate to form granulation tissue
Angiogenesis causes new blood vessels to form in tissue
Capillary network is leaky
WBC and plasma protein leak into tissue

Fibroblasts secrete weak type three collagen and that reaches peak at 5-7 days then lasts many weeks

Granulation tissue matures:
Lymphatic development
Nerve fibre in growth
Mast cell division

24
Q

Remodelling / maturation phase

A

Begins at 3 weeks + can last 2 years
Continuous remodelling of scar tissue by:
Type 1 collagen secreted by fibroblasts
Lysis by many collagenase enzymes

Physical stress should be done in this phase.

Too much stress re injures
No stress won’t repair it.

25
Q

Primary intention healing

A

Wound edges joined by stitches , Steri strips and skin glue
Eg, paper cut or surgical wound

Skin surfaces approximated

Less tissue loss

Wound healing quick and easy

Less scar formation

26
Q

Secondary intention healing

A

Larger wounds where you can’t approximate skin surfaces

Loss of tissue at the wound

Edges can’t be brought together

Eg, pressure ulcer

More scar formation
Open wound = great risk of infection
Longer repair and healing time

27
Q

Tertiary intention

A

Keeping wound open to aid healing process

28
Q

Factors affecting wound healing

A 
Nature of injury 
Site of injury - cell types 
Temperature 
NSAIDS and corticosteroids delay healing
Prolonged use antibiotics 
Movement - immobilised or needs movement 
Malnutrition impacts collagen synthesis from fibroblasts 
Age - wounds heal slower as older 
Blood flow and o2 supply 
Infection 
Wound separation 
Foreign bodies 
Adhesion to bones and tissues
29
Q

Complications of tissue repair

A

Acronym- I Understand Daves Kind Aunty

INFECTION- microorganisms can invade open wound

ULCERATION- crater like lesions of skin or mucus membranes

DEHISCENCE- deficient scar formation and the wound separates

KELOID DEVELOPMENT - excessive collagen production and hypertrophic scars

ADHESIONS- between cavities and tissues has fibrous connections causing pain on contraction

30
Q

POLICE STANDS FOR

A

Protection
Optimal loading
Ice compression
Elevation

31
Q

ICE PRICE AND RICE

A

Ice, compression and elevation

Rest, ice, compression and elevation

Protect, rest, ice, compression and elevation

32
Q

PEACE AND LOVE

A

Protection- don’t do activities that cause pain
Elevation - higher than the heart
Avoid anti inflammatories- they slow the repair process
Compression- elastic bandage or tape to reduce swelling
Education - avoid unnecessary passive treatments or investigations

Load- you know when is safe to increase load
Optimism - be confident and positive
Vascularisation - choose painless cardio to increase blood flow to injured tissue
Exercise- active approach to restore mobility, strength and proprioception

33
Q

Why progressive overloading?

A

Restores strength and structure of collagenous tissue, and lots of unloading would change tissue structure and biomechanics and damage them .

Pathophysiology 1 (22 decks)

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