overview/management of acute inflammation

cardinal signs of acute inflammation

swelling, heat, redness, pain, loss of function

acute inflammation

response of vascularized tissues to injury or infection

purpose of acute inflammation

bring cells and molecules of defense to sites where they are needed, eliminate bad factors and remove damaged tissue

what does acute inflammation do

gets rid of initial cause of injury

remove dead tissues, cells, debris

initiate process of tissue repair

process of tissue repair

inflammation, proliferation, maturation

turning on inflammation

recognition, recruitment, removal

turning off inflammation

regulation, resolution

hematocrit

solid parts of blood

platelets

thrombocytes, particles, aid in clotting

white blood cells

leukocytes, neutrophils, monocyte/macrophage

sentinel cells

recognize microbes released by damaged tissue, phagocytize microbes and debris, release cytokines

cytokines

secreted by immune response cells that modulate immune response, can be inflammatory or anti-inflammatory

histamine

released by mast cells, vasodilation

prostaglandins and leukotrines

produced in response to cytokines, vasodilation, platelet activation

hemostasis

immediate response to prevent blood loss, triggers vasoconstriction, platelet formation, fibrin clot formation

vasoconstriction

constriction of blood vessels, reduces flow

platelet activation

primary component of clots, stick to exposed collagen fiber of exposed vessel, activate other platelets

fibrin clot formation

platelets trigger release of fibrin, fibrin stabilizes thrombin plug

injury recognition

by sentinel cells, release of inflammatory mediators

imflammatory mediators

cytokines, histamine, prostaglandins, bradykinins, leukotrienes

how cells are recruited

inflammatory mediators act on local blood vessels, vasodilation, vascular stasis, increased vessel permeability

vasodilation

increases blood flow

vascular stasis

decrease velocity of blood flow

increased vessel permeability

pores in vessel make it leaky, fluid leaks out and causes edema

types of cell recruitment

extravasation and chemotaxis

extravasation

cells to outside of vasculature, roll adhere and migrate

chemotaxis

cells to site of injury

selectins role in extravasation

catch onto carbs on leukocyte, hold onto briefly then let go and leukocyte rolls along vessel wall

adherence and migration of extravasation

firmly attach to wall, squeeze between cells into adjacent tissue

process of chemotaxis

cells use actin and myosin to move to site of inflammation, attracted by signals from cytokines

removes damaged tissue

neutrophils and macrophages

neutrophils

phagocytosis, degranulation, release enzymes, blow everything up

macrophages

clean up debris, start to release anti-inflammatory mediators

how is inflammation downregulated

removal of injury stimulus, short neutrophil lifespan, anti inflammatory mediators

how does inflammation resolve

fibroblast proliferation and migration to injury area, produce collagen and ECM components

chronic inflammation

too much, persistent, prolonged, repeated injury

fibrosis

scarring

result of too little inflammation

delayed healing, non-healing

cryotherapy

ice

function of cryotherapy

promotes heat withdrawal, lowers temp

what does decreasing tissue temp do?

reduce pain, tissue metabolism, and muscle spasm

reduce inflammatory and immune processes

what kind of effects does cryotherapy have?

hemodynamic, decreases blood flow

what are the effects of cryotherapy on peripheral nerves?

slows nerve conduction, analgesic effect, relaxes muscle spasm

effects of cryotherapy on muscle

decreases force output, reverses muscle inhibiton

when to not use cryotherapy

open wounds, cold intolerance, impaired circulation

when to be careful using cryotherapy

sensory deficits, hypertension, elderly people

stages of cryotherapy

cold, pain, aching, numbness

what does compression of site do?

reduce inflammatory cytokines, increase capillary flow, reduce capillary leakage, limit edema diffusion

what does elevation of the limb do?

assist fluid return to heart, reduce local pressure, reduce edema

when to not use compression

uncontrolled heart disease, arterial disease, skin abnormalities, peripheral neuropathy

optimal laoding

controlled mechanical stress, gradual progression of weight bearing and loads

ROM optimal loading

active or passive, muscle inhibition along with joint or soft tissue trightness

manual therapy optimal loading

passive, mobilization or manipulation

4 outcome of management

complete resolution, abscess formation, healing by fibrosis, chronic inflammation

documentation needed about treatment

body part treated, patient position, method, dosage, patient response, outcome