Tissue Repair Flashcards
(116 cards)
1
Q
Mechanisms and characteristics of MSK trauma:
A
- mechanical forces
- tissue susceptibility to trauma
2
Q
Mechanical forces:
A
- tissues can resist a particular load
- forces acting on the body
3
Q
Tissue susceptibility to trauma:
A
- viscoelastic properties
- deformation = yield point
- mechanical failure
4
Q
Stress-strain curve:
A
- y axis = stress or load/unit area
- x axis = strain or deformation/original length
- zone 1 = elastic properties
- zone 2 = plastic changes
- point 1 = yield point
- end point = tissue failure (injury)
5
Q
Macrotraumatic injuries:
A
- acute MOI: able to articulate how injured and why
- known DOI: onset short period of time
- S&S: may produce levels of immediate pain and functional disability
6
Q
Examples of macrotraumatic injuries:
A
- fractures
- dislocations
- contusion
- sprains
- strains
7
Q
Microtraumatic injuries:
A
- chronic MOI: may not be able to articulate how or why injured
- insidious DOI: onset long period of time from repetitive overload, incorrect mechanics, previous injury
- S&S: may be painful but typically able to function
8
Q
Examples of microtraumatic injuries:
A
- tendinitis
- tenosynovitis
- bursitis
9
Q
Secondary systemic complications:
A
- the response to the primary injury
- inflammatory response to focal area occurs over time (seconds or minutes to hours or days)
- secondary tissue response
10
Q
Secondary injury: inflammatory response to focal area includes:
A
- cellular injury mechanism results in edema (swelling), hemorrhage (bruising, redness, warmth)
- impaired metabolism to tissues leads to ischemia (inadequate blood supply to healthy tissues). Results in hypoxic response to surrounding tissues
- creates oxidative stress (toxic tissue) leads to cell death
11
Q
Secondary tissue response:
A
- further tissue trauma
- possibly infection
12
Q
Secondary tissue response may result in:
A
- muscular spasm
- extremity guarding
- more swelling
- more bruising
13
Q
Plan for rehabilitation programming must be built upon the framework for ____ ____.
A
tissue repair
14
Q
Tissue repair:
A
restoration of tissue and of function after an injury
15
Q
2 processes of tissue repair:
A
- regeneration
- replacement
16
Q
Regeneration (tissue repair):
A
healing in which new growth completely restores portions of damaged tissue to their normal state
17
Q
Replacement (tissue repair):
A
healing in which severely damaged or non-regenerable tissues are repaired by scarring
18
Q
Phases of tissue repair are ______ phases.
A
non-definitive
19
Q
Types of responses in each phase:
A
- vascular
- cellular
- chemical
- clinical
20
Q
Phases of tissue response to injury:
A
- inflammatory response phase
- fibroblastic repair phase
- maturation-remodeling phase
21
Q
Clinical responses to tissue injury:
A
- altered cellular metabolism and chemical mediators
- macroscopic characteristics of an inflammatory response
22
Q
Macroscopic characteristics of an inflammatory response includes:
A
- swelling
- heat
- altered function
- redness
- pain: tenderness, point tenderness
23
Q
Plan for clinical responses to tissue injury:
A
initial management and treatment response is critical in the repair and healing process
24
Q
Acute inflammation:
A
- short onset and duration (weeks)
- begins immediately following damage to tissue (MOI)
- change in hemodynamics (blood system), production of exudate (swelling) and leukocytes (garbage collector)
25
Chronic inflammation:
- insidious onset, or has been long duration of time (chronic)
- occurs when the acute inflammation response fails as may be in a state of repeated damage to tissue (months to years)
- as not restored to a normal physiological state, there is a proliferation of extensive scar tissue
26
Proliferation of extensive scar tissue includes:
- chronic change in hemodynamics (injuring agents are not eliminated)
- repeated production of connective tissue and tissue degeneration, production and presence of garbage collectors including macrophages, lymphocytes (different chemical mediators)
27
Phase 1 inflammatory response:
- initial reaction to tissue damage (injury)
- occurring immediately (post injury) from time of injury (0 to 4-7 days)
- injury can be caused by trauma, chemical agents, thermal extremes, pathogenic organisms
28
External injury results in ...
tissue death
29
Internal injury results in ...
tissue (cellular) death
30
How does internal injury result in tissue (cellular) death?
- decreased oxygen to area increases cell death by secondary hypoxic injury
- phagocytosis (garbage collectors) will add to cell death due to excess digestive enzymes
31
In phase 1, goals of a plan may include:
- protect
- localize (secondary injury)
- decrease injurious agents
- prepare for healing and tissue repair
32
Management in phase 1:
- critical to limiting cell death
- Protect, Rest, Optimal loading, Ice, Compression, Elevation are critical to limiting cell death
- RICE --> PRICE --> POLICE
33
Vascular response:
- blood vessels vasoconstrict (serotonin)
- then blood vessels vasodilate (histamine, heparin)
- increase blood flow and permeability results in swelling
- controlled by chemical response, prepares the tissue for cellular response
34
Cellular response:
- mast cells are released in cell damage (heparin, histamine, serotonin)
- phagocytocis
- leukocytes (leukotaxin)
35
Phagocytocis:
damaged tissue encourages leukocytes to enter tissue and clear away all damage (phagocytic activity)
36
Leukocytes (leukotaxin):
allows for cell margination = increase cell permeability for WBC to flow thru cell walls forming exudate
37
Chemical mediators such as ... are released to facilitate healing:
- histamine
- serotonin
- bradykinin
- heparin
- prostaglandins
38
Research in chemical response suggests that decrease mediators =
- decrease inflammation
| - healing needs to progress through the healing process
39
Example of inflammatory response:
1. injury to cell
2. chemical mediators liberated (histamine, leukotrienes, cytokines)
3. vascular reaction (vasoconstriction --> vasodilation --> exudate creates stasis)
4. platelets and leukocytes adhere to vascular wall
5. phagocytosis
6. clot formation
40
Phase 2 =
fibroblastic repair phase
41
In phase 2, _____ and _____ activity occurs resulting in ____ ____ --> ______.
- proliferative
- regenerative
- scar formation
- fibroplasia
42
Phase 2 has 3 phases:
- resolution
- restoration
- regeneration
43
Phase 2 time frame:
- 48 hours to 6 weeks following DOI
| - depends on many factors
44
Phase 2 time frame depends on:
- tissue damage (debris)
- type of tissue (revascularization)
- nutrition (vitamin C)
- health of client
- re-injury
45
What happens during phase 2?
- cleaning of fibrin clot and cellular debris (erythrocytes)
- restore tissue formation of a scar
- regenerates or replacement of tissue by same tissue (increase blood flow delivery (aerobic) for nutrient delivery as capillary buds develop)
46
Phase 2 does not progress until...
swelling (S&S) of acute inflammatory phase begin to subside
47
How does scar formation work?
- granulation tissue (fibroblasts, collagen) develops with breakdown of fibrin clot
- firm, inelastic mass (no capillary circulation yet)
- develops from exudate with high protein and debris level resulting in granulation tissue
- invaded by fibroblasts and collagen deposited randomly forming a dense scar (require 3-14 weeks, may require 6 months for increased scar tensile strength)
48
Tissue examples of scar formation:
- ligaments
| - muscles
49
Phase 3 =
maturation-remodelling phase
50
Phase 3 overlaps with....
previous phase of regeneration phase
51
Phase 3 consists of _____ of ____ over time.
- realignment
| - collagen
52
Phase 3 time frame:
- may require several years to complete (maturation)
| - depends on the amount and type of scar/tissue
53
First 3-6 weeks of phase 3 involves laying down of ____ and strengthening of _____.
- collagen
| - fibres
54
At ~3 weeks in phase 3:
firm, strong, contracted nonvascular scar
55
At ~3 months to 2 years in phase 3:
- enhanced scar tissue strength (remodelling) with ongoing and continued breakdown and synthesis of collagen
- increased stress and strain results in increased collagen realignment
- balance must be maintained between synthesis and lysis
56
How do we consider forces applied in rehab in phase 3?
- balance between immobilization and mobilization time frames relative to tissue repair timelines
- role of mobilization
57
Wolff's Law:
- bone will adapt to the loads under which it is placed
| - muscle will respond to forces (physical demands) placed upon it
58
Initial _____ may be necessary for initiating healing.
immobilization
59
Controlled mobilization into repair phase enhances:
- scar formulation (remodelling)
- revascularization
- muscle regeneration
- fibre reorientation (alignment)
- tensile properties
60
Controlled stability in activity allows for...
gradual return to normal levels of function
61
Epithelial (skin) healing:
full healing capacity through repair phases of healing, scar, stitch for approximation of tissue
62
Cartilage (meniscus, labrum) healing:
healing is limited to slow, poor blood supply, no healing in defective tissue
63
Ligament healing:
- full healing capacity through repair phases
- 3 degrees extent of injury
- may require surgical repair in complete tears (grade 3)
64
Skeletal muscle healing:
- full healing capacity through repair phases
- may result in functional scar tissue
- 3 degrees extent of injury
- may require surgery in complete tears pending approximation
65
Nerve healing:
- peripheral nerve regeneration properties of 3 mm/day
| - CNS regenerates poorly
66
Bone healing:
- full healing capacity
- complex healing (bone repair phases)
- new bone in remodelling phase
67
____ ____ and _____ are necessary for repair. Certain organic _____ (____ conditions) may sow or inhibit the healing process; poor vascular supply.
- blood supply
- nutrients
- disorders (blood conditions)
68
Healing properties due to certain factors may change repair, including:
- past tissue injuries or extent/severity of damage
- irregular or excessive fibrous scar at injury site
- amount of swelling (edema, hemorrhage)
- separation of tissue
69
Other factors that can impede or negatively affect healing:
- poor diets (nutrition)
- health of client
- muscle spasm or atrophy
- pain
- infections
- age
- climate and oxygen tension
70
Pain:
- a symptom
- indicator of injury not of damage
- pain is individual, pain is subjective
71
Factors involved in pain are a mixture of:
- anatomical structures
- psychological, social, cultural and cognitive factors
- physiological reactions
72
Physiological reactions of pain:
- pain receptors: free nerve endings sensitive to extreme mechanical, thermal and chemical energy (ex. skin)
- pain information transmitted to spinal cord via unmyelinated C fibres and A delta fibres
73
Nervous system is _____ in nature.
electrochemical
74
Nociceptive stimuli:
body's processing of harmful stimuli in the nervous system, sensing potential harm
75
Noxious stimuli:
an intensity which would result in tissue injury
76
Nociceptive stimuli is a result of....
chemical, mechanical or thermal stimulation
77
Stimulated ____ _____ send signal of potential harm Travels along _____ nerves via the ____ ____ to the brain. Frequency of firing determines the _____ of the pain.
- pain receptors
- afferent
- spinal cord
- intensity
78
A delta fibres:
- fast conducting
- transmits information to the thalamus concerning location of pain and perception of pain being sharp, bright or stabbing
79
C fibres:
- slower conduction
- transmits info to brain concerning with diffused, dull, aching, throbbing pain
- signal also passed to limbic cortex providing emotional component to pain
80
Pain sources- types of receptors:
- cutaneous (skin)
- deep somatic (bone and joints)
- visceral (body organs)
- psychogenic
81
Cutaneous pain:
- sharp, bright and burning
| - fast and slow onset
82
Deep somatic pain:
originates in tendons, muscles, joints, periosteum, and blood vessels
83
Visceral pain:
begins in organs and is diffused at first and may become localized
84
Psychogenic pain:
felt by the individual but is emotional rather than physical
85
Chronic pain:
- pain continuing beyond average healing timelines
| - chronic pain lasts longer than 6 months
86
Referred pain:
- pain occurs away from the site of injury
| - may elicit motor or sensory response
87
Types of referred pain:
- myofasial
- myotome (muscle)
- dermatome (skin)
- sclerotome (bone)
88
Myofascial pain:
- trigger points
- small hyper irritable areas within a muscle resulting in bombardment of CNS
- can be associated with acute and chronic pain
89
3 ways of describing pain:
- hyperesthesia
- paresthia
- anaglesia
90
Pain modulation: mixture of ____ and _____ factors.
- physical
| - psychological
91
Pain can be _____ and _____, vary per _____, _____ differences also have an impact.
- subjective
- psychological
- individual
- personality
92
Pain is often worse at ____ due to...
- night
| - solitude and absence of external distractions
93
Through ______, we are often able to endure pain and block ______ of minor injuries.
- conditioning
| - sensations
94
Gate theory:
- sensory info from cutaneous receptors enters A-beta afferents to dorsal horn of spinal cord
- pain simultaneously travels along A-delta and c-fibres
- sensory info overrides pain info, closing gate
- pain message never received
- stimulation of large fast nerves can block signal of small pain fibre input
95
Gate control occurs at the level of the ____ _____.
spinal cord
96
Gate theory is the rationale for....
- TENS
- acupressure/puncture
- thermal agents
- chemical skill irritants
97
B-endorphins theory:
- stimulation of pain sensory fibres is required
- neurotransmitters are released by pre-synaptic cells
- noxious stimuli can trigger release of endorphins (norepinephrine) or serotonin
- results in activation of pain inhibition transmission, release from hypothalamus (strong analgesic effects, pain modulator)
98
____ ____ is the best reflection of pain and discomfort. Assessment techniques include:
- self report
| - OPQRST (OPPQRRRSTTT) questions
99
Other subjective assessments of pain:
- visual analog scales (0-10)
- pain charts
- McGill pain questionnaire
- activity pain indicator profiles
- numeric rating scale
100
Describe pain based on ___ of pain.
history
101
Pain impacts the _____ plan: affects .....
- rehabilitation
| - movement or functional movement
102
Pain management:
- use of pain theory
| - understand tools
103
Pain management tools for analgesia:
- therapeutic modality: heat/cold
- therapeutic electrical modality: TENS, acupuncture
- pharmacological agents (drugs): OTC or prescribed
104
Heat does what?
- increases circulation
- blood vessel dilation
- reduces nociception and ischemia caused by muscle spasm
105
Cold does what?
- applied to inhibit pain
- vasoconstriction and decrease blood flow into tissues decrease swelling
- reduce muscle spasm
106
Therapeutic electrical modality does what?
- induce analgesia by targeting pain
| - electrical stimulation agents used to target gate theory
107
Pharmacological agents does what?
- oral, injectable medications to combat inflammation
- non-steroidal anti-inflammatory (NSAID) to decrease vasodilation and capillary permeability: to increase leukocytes to stay in capillaries
- side effects
108
Assist the natural process of the body while doing ___ ____.
no harm
109
Primary goals in rehab plan:
- positive influence on inflammation and repair process
- minimize early effects of inflammatory process
- expedite recovery of function
- prevent recurrence of injury
110
Early effects of inflammatory process:
- pain
- spasm
- edema accumulation
- decreased motion
111
How to expedite recovery of function:
- pain-free movement/ROM
- full extensibility of associated muscles and joint
- acquiring full strength
- cardiorespiratory fitness
- neuromuscular control
112
How to prevent recurrence of injury:
resist future periods of tissue overload through strengthening
113
PLAN for acute injury phase:
- initial swelling management and pain control are crucial (PRICE/POLICE)
- immobilize initially 24-48 hours
- by days 3-4, begin to engage in some mobility exercises (weight bear)
- pain management tools
114
PLAN for repair phase:
- increase cardiorespiratory fitness
- restore full ROM
- restore or increase strength
- re-establish neuromuscular control
- add exercises (modifications, CKC)
- continued pain modulation and swelling control (cryotherapy, electrical stimulation)
115
PLAn for remodelling phase:
- longest phase
- ultimate goal = return to function
- continued collagen realignment (ongoing healing processes)
- pain continues to decrease with activity, limited swelling
- regain activity specific skills (dynamic functional activities, strengthening, plyometric strength)
- functional testing to determine specific skill weakness
- continued use of tools or modalities pending goals (increase circulation to deeper tissues: heat, roller, massage)
116
Why do we want to increase circulation to deeper tissues in the remodelling phase?
enhanced and lymphatic flow will deliver essential nutrients and increase breakdown/removal of waste
