Chapter 10 tissue response 2 injury

Care and prev

Phases and time for healing

Inflam = injury 2 day 4

fibroblast repair = day 4-wk 6

maturation remodleing= wk 6- 2/3 yrs

Signs of inflammation

color, heat, loss of function, swelling, tender

Inflammatory phase

healing immendiately

leukocytes (protect and localize) and phagocytes ( dec injurous agents and prepare for healing)

chem mediators

from invading organisms, damaged tissue, plasma enzymes and WBCs

Histamine- injured mast cells; vasodialation and inc permeablity

Leukriines and prostagladins- margination (adhere of cell walls)

cytokines- reg lukocytes and attract phagocytes

Vascualar response

vascocontriction and coagulation to seal BV abd release chem mediators

after vasodialtion( to inc BF), dec bf and inc blood viscocity to swell

Clot formation

platelts adhere to exposed collagen and clot; obstruct drainage and localize injury response

Fibroblastic repair

scar formation thru 2 phases; resolution and regeneration

Scar formation

form delicate CT (gradulation)

Fibroblast —> extracelluar matrix

tensile strength inc; collagen 80-90%

Maturation and remodleing

long-term

realignment of collagen 2 tensile forces

break and synth of collagen = inc strength

take several years

Repair phase

add controlled activity; normal flex and strength

remodling

agressive ROM and strenght exercises

facilitate remodling aand realignment

metaplasia

tissue from one type 2 another

displasia

abnormal dev of tissueh

hyperplasia

excessive amount of cells in normal tissue arangmenta

athrophy

dec size of tissue, cell death, reab or dec cell proliferation

hypertrophy

inc size of tissue w/o changing # of cells

Lig healing

random laying of collagen - realign w stress and strain

12 months may need 2-3 yrs for 5-6x strongerFa

factors effecting healing

surgically repaired = stronger and dec scar form

synovial fluid in intraartc tear prevent clotting

exercises lig stronger so muscle must be strenghtened

Skeletal muscle healing

bleeding followed by fibroblast and ground substance

myoblastic cells form-new myofibrils

6-8 wks

collagen mature and orient along tensile

tendon healing

require dense fibers; need alot of collagen for tensile strength - too much interfere w gliding

wk 2- adhere 2 surrounding tissues

wk 3- tendon grad sep

tensile strenght not enough til 4-5 wks

nerve healing

3-4mm per day

not regenraete; prox to nerve cell is more difficult

CNS dont heal as quickly as PNS

Therupudic mod

heat faciliate acute inflammation

cold slows inflammation

electrical treat inflammation

therapudic exercise

pain free move; full strenght power and extensibity of muscle

immoblie means neg impact; need early moblization

prolotherapy

injection of irrantant

inc inflammation to enhance healing

strenghtening weak CT to reduce pain

3-6 wks- limited evidence 2 supportP

platlet rich plasma

ususe own platlets to promote natural healing of musculosketal

sep plalet rich from platlet poor then inject into and around injured tissues; GF and protein stim would healing and tissue rep via stem cells

healing of stress fractures

bone changes in response to stress

osteoclast > osteoblastic means more suceptibel to fractures; balnce should be equalm

myofascial pain

trigger points or small hyperirratble areas within muscle, bombarment of CNS

Sclermotomic pain

deep aching and paoorly localized; projected to multiple areas of the brain (depression)

Dermatomic pain

sharp and localized; thalamus and cortex directly

Nocirecptors

pain receptors, free nerve endings sensitive 2 mechical, thermal and chemical

Pain info course

1st order peripheral A fibers

2nd order spinal cord adn to dorsal horn A beta, A delta

3rd order ascending spinal tracts to brain

Pain inhibitors

endorphins and seratonin

Gate theory

Pain stimualtion interfered with by senosory so pain is never felt