Tissue Injury and Repair Flashcards Preview

FS Exam 3 > Tissue Injury and Repair > Flashcards

Flashcards in Tissue Injury and Repair Deck (43):
1

Compression Injury

Soft tissue contusions
Disrupt mm fiber and intramuscular bleed results

2

Tension Forces

Strain, Sprain
Ligament and tendon disruptions
Muscle tears

3

Fatigue or stress failure

Microtrauma
Repetitive submaximal stress

4

Grade 1

Mild pain and swelling
Localized tenderness, and pain with tissue stress

5

Grade 2

moderate pain, may have significant swelling, stress greatly increases pain

6

Grade 3

moderate to sever pain, tissue stress usually does not increase pain; if joint stabilizing tissue may have laxity

7

Ultimate goal of treatment

The formation of a strong, mobile, scar at the site of the lesion so that there is complete and painless restoration of function

8

Points to keep in mind with reaching goal in treatment - blood supply

Allow for healing and inflammation
If on prolonged steroir for RA
Body parts with less blood supply (ligaments vs muscle)

9

Points to keep in mind with achieving goal - normal forces

Having the tissue undergo its normal forces

10

Points to keep in mind with reaching goal - existing pathologies

would influence mediators involved in inflammation as well as blood supply

11

Things to keep in mind with reaching goal

Blood supply
Normal forces
Existing pathologies

12

Phases of Injury

1. Hemostasis
2. Inflammatory phase
3. Proliferative (Granulation phase)
4. Remodeling (Maturation) Phase

13

Primary injury effects

Blood into tissue
Cellular death and necrosis

14

Injury Effects - Blood into Tissue

Tissue Degeneration
Clotting mechanism initiated
Clots plug damaged vessels and lymphatics

15

Injury Effects - Cellular death and necrosis

Release of lysosomes
Increased cellular debris

16

Hemostasis Phase - Evaluation

Time of insult (about 15 min)
Pain is low - they just hurt themselves
Minimal swelling
Little mm. guarding
This is best chance you have at figuring out what tissues might be injured

17

Hemostasis Phase - Goals

Life/limb threatening conditions
Control bleeding
Stabilize the area

18

Inflammatory Phase - Acute

15 minutes to 4/6 days
Hemodynamic effects going on:
Dilation of blood vessels
Increased vascular permeability
Increased pain

19

Cardinal Signs of Inflammation

Heat
Redness
Pain
Swelling
Loss of function

20

Secondary Hypoxic Injury

Decreased fluid return
Interstitial space distension

21

Secondary Hypoxic Injury - Dec Fluid Return

Lymphatics are plugged
Fluid is actively being moved into the area
Osmotic pressure increases

22

Secondary Hypoxic Injury - Interstitial Space Distension

Increase distance btw cells and nutrient source
Low PO2 levels

23

Why does early activity worsen the situation

Supply and demand issue
Less nutrients and when we ask it to work, even less

24

Margination of Cells

Neutrophils followed by macrophages
Chemotaxis
Platelets - fibrinogen --> fibrin clot formation
Fibrin clot = scaffold for other cell types

25

Clot Dissolution

Signals the end of inflammatory phase
Fibrinolytic system causes degradation of fibrin clot
Lyphatics open
Edema begins to resolve

26

Goal - Inflammatory Phase - Protective Phase

1. Limit early bleeding
2. Dec. inflammatory exudate
3. Reduce pain and mm. guarding
4. Promote phagocytosis
5. Stabalize part as needed
6. Dec. dysfunctional movements
7. Promote general body fitness

27

Treatments Options

1. RICE/MICE
2. Compression, Ice
3. Stabilization
4. Isometric muscle sets
5. Motion to adjacent areas
6. Modalities (E-Stim)
7. Medications
8. Patient Education

28

Treatment Options - RICE vs. MICE

Rest, Ice, Compression, Elevation
Motion, Ice, Compression, Elecation
Need to be careful with MICE - want passive normal forces but not too much

29

Tx options - Compression and ICe

Ice = reduce blood flow to the area and will dec. chemotaxin factors and dec. inflammation

30

Proliferative Phase (Reconstructive/Subacute)

2-3 days to 21-28 days
Fibroblasts are primary mediator
Granulation starts
First part = neovasculatization (new blood vessels)

31

Fibroblast Activity

Attracted via platelet and macrophage chemotaxis
Produce Collagen matrix
- Type 3 collagen
- Elastin
- Reticulin
- Ground substances (GAGS and Proteoglycans)

32

GAGS and Proteoglycans

Helps stablize tissue
Hydration of tissue
Aid in developing cross links

33

Collagen Production

A variety of collagen types
Protein molecule with triple helix structure - tropocollagen is precursor
Group of 5 to form a microfibril
Intramolecular crosslinks
Intermolecular crosslinks
Collagen organization

34

Most common collagen type

Type I - 80% of collagen in our body

35

First collagen type that is laid down

Type III - will eventually be replaced by Type I

36

Wound Contraction

Some fibroblasts change to myofibroblasts
Some continue to produce collagen

37

Strength factors in wound contraction

Crosslinks developed
GAGs

38

End of Proliferation Phase

21-28 days
Can tolerate bidirectional motion
Scar starts to chrink secondary to the myofibroblast contractile ability
Signals end of fibroblastic phase

39

Management Goal - Controlled Motion

Develop a managable scar
Amount of scarring is inversely related to return of function
Wound ends must remain approximated

40

Treatment

Movement within efected area
Control of inflammation and pain
Protected weight bearing
Gentle stretching - tissue specific
Easy to stress new tissue and surrounding tissue
Multi-angle isometric, AROM, endurance exercises

41

Remodeling Phase - Consolidation Phase

Consolidation stage (3-8 weeks)
# of fibroblasts dec
Dec development of new vascular networks
Collagen fibers continue to replace (50% turnover in first 3 weeks)
Type 3 collagen is being replaced by type 1

42

Remodeling Phase - Maturation Stage

2-18 months
Cell activity continues to decrease but remains higher than surrounding tissue
85% of collagen is replaced by 5 months
Stops responding to conservative treatment at 14 week mark

43

Physiological Characteristics

Collagen synthesis/lysis balance occurs during maturation phase
Although scar is shrinking, strength is increasing
Balance is oxygen deoendent
Fibers will orient themselves based on demand