CH2 - Therapeutic Modalities and the Healing Process

acute injury

an injury in which active inflammation is present that includes the classic symptoms of tenderness, swelling, redness, and so on

chronic injury

an injury in which the normal cellular response in the inflammatory process is altered, replacing leukocytes with macrophages and plasma cells, along with degeneration of the injured structure

fibroplasia

the period of scar formation that occurs during the fibroblastic-repair phase

leukocytes

a white blood cell that is the primary effector cell against infection and tissue damage that functions to clean up damaged cells

macrotears

significant damage to the soft tissues caused by acute trauma that results in clinical symptoms and functional alterations

microtears

minor damage to soft tissue most often associated with overuse

phagocytic cell

a cell that has the ability to destroy and ingest cellular debris

T/F: Loss of function is a sign of the inflammatory process.

False

T/F: Leukocytes are present in both the acute and chronic inflammatory responses.

True

T/F:An injured individual's health, age, and nutrition are factors that influence healing.

True

T/F: You must expose injured structures to increasing loads during the maturation-remodeling phase.

True

T/F: Immobilization is superior to controlled mobilization.

False

The three phases of the healing process, in order, are as follows:

inflammatory-response, fibroblastic-repair, maturation-remodeling

Which of the following type of cell has phagocytic characteristics?

leukocytes

The extracellular matrix, formed by fibroblastic cells, consist of

all of these

During the inflammatory-response phase of the healing process, modalities are used to

both of these

_________ states that bone and soft tissue remodel and realign according to the physical demands placed on them.

Wolff's Law

Approximately how long does the maturation-remodeling phase of the healing process last?

3 weeks to 2 years

Which of the following is not a chemical mediator involved in the inflammatory-response phase?

testosterone

In chronic inflammation, __________ are replaced with macrophages, lymphocytes, fibroblasts, and plasma cells.

neutrophils

signs of inflammation

redness, swelling, tenderness to touch, increased temperature, loss of function

the clotting process:

_____ -> thromboplastin released -> prothrombin -> thrombin -> fibrinogen -> fibrin clot

damaged cell

the clotting process:

damaged cell -> _____ released -> prothrombin -> thrombin -> fibrinogen -> fibrin clot

thromboplastin

the clotting process:

damaged cell -> thromboplastin released -> _____ -> thrombin -> fibrinogen -> fibrin clot

prothrombin

the clotting process:

damaged cell -> thromboplastin released -> prothrombin -> _____ -> fibrinogen -> fibrin clot

thrombin

the clotting process:

damaged cell -> thromboplastin released -> prothrombin -> thrombin -> _____ -> fibrin clot

fibrinogen

the clotting process:

damaged cell -> thromboplastin released -> prothrombin -> thrombin -> fibrinogen -> _____

fibrin clot

The inflammatory-response phase typically lasts _____.

0 to 4 days

The fibroblastic-repair phase typically lasts _____.

2 day to 6 weeks

The maturation-remodeling phase typically lasts _____.

3 weeks to 2 years

inflammatory-response phase, vascular reaction:

_____ -> immediate vasoconstriction -> vasodilation with hyperemia -> stagnation and stasis

injury

inflammatory-response phase, vascular reaction:

injury -> _____ -> vasodilation with hyperemia -> stagnation and stasis

immediate vasoconstriction

inflammatory-response phase, vascular reaction:

injury -> immediate vasoconstriction -> _____ -> stagnation and stasis

vasodilation with hyperemia

inflammatory-response phase, vascular reaction:

injury -> immediate vasoconstriction -> vasodilation with hyperemia -> _____

stagnation and stasis

inflammatory-response phase, cellular reaction:

_____ -> vessels endothelium disrupted -> platelets adhere to collagen -> sticky matrix forms -> formation of a plug -> obstructs local lymphatic drainage -> localizes injury response

injury

inflammatory-response phase, cellular reaction:

injury -> _____ -> platelets adhere to collagen -> sticky matrix forms -> formation of a plug -> obstructs local lymphatic drainage -> localizes injury response

vessels endothelium disrupted

inflammatory-response phase, cellular reaction:

injury -> vessels endothelium disrupted -> _____ -> sticky matrix forms -> formation of a plug -> obstructs local lymphatic drainage -> localizes injury response

platelets adhere to collagen

inflammatory-response phase, cellular reaction:

injury -> vessels endothelium disrupted -> platelets adhere to collagen -> _____ -> formation of a plug -> obstructs local lymphatic drainage -> localizes injury response

sticky matrix forms

inflammatory-response phase, cellular reaction:

injury -> vessels endothelium disrupted -> platelets adhere to collagen -> sticky matrix forms -> _____ -> obstructs local lymphatic drainage -> localizes injury response

formation of a plug

inflammatory-response phase, cellular reaction:

injury -> vessels endothelium disrupted -> platelets adhere to collagen -> sticky matrix forms -> formation of a plug -> _____ -> localizes injury response

obstructs local lymphatic drainage

inflammatory-response phase, cellular reaction:

injury -> vessels endothelium disrupted -> platelets adhere to collagen -> sticky matrix forms -> formation of a plug -> obstructs local lymphatic drainage -> _____

localizes injury response

fibroblastic-repair phase, vascular reaction:

_____ -> increased blood flow -> increased nutrients for tissue repair

growth of endothelial capillary buds

fibroblastic-repair phase, vascular reaction:

growth of endothelial capillary buds -> _____-> increased nutrients for tissue repair

increased blood flow

fibroblastic-repair phase, vascular reaction:

growth of endothelial capillary buds -> increased blood flow -> _____

increased nutrients for tissue repair

fibroblastic-repair phase, cellular reaction:

_____ -> formation of granulation tissue -> fibroblasts accumulate along capillary beds -> synthesize extracellular matrix

breakdown of fibrin clot

fibroblastic-repair phase, cellular reaction:

breakdown of fibrin clot -> _____ -> fibroblasts accumulate along capillary beds -> synthesize extracellular matrix

formation of granulation tissue

fibroblastic-repair phase, cellular reaction:

breakdown of fibrin clot -> formation of granulation tissue -> _____ -> synthesize extracellular matrix

fibroblasts accumulate along capillary beds

fibroblastic-repair phase, cellular reaction:

breakdown of fibrin clot -> formation of granulation tissue -> fibroblasts accumulate along capillary beds -> _____

synthesize extracellular matrix

PRICE - protection

protect from additional injury by applying appropriate splints, pads, braces, or other immobilization devices

PRICE - restricted activity

allow inflammation without interfering

PRICE - ice

decrease metabolism to control secondary hypoxic reaction; analgesia

PRICE - compression

mechanically reduces space for swelling to accumulate

PRICE - elevation

reduces pooling of blood in extremities

low-intensity ultrasound

can be effective in facilitating the healing process and can be used safely immediately following injury

modalities for inflammatory-response phase

cryotherapy, intermittent compression, electrical stimulating current, active and passive ROM exercises

modalities for fibroplastic-repair phase

thermotherapy, intermittent compression, electrical stumlating current, ROM and strengthening exercises

modalities for maturation-remodeling phase

deep-heating (ultrasound, shortwave and microwave diathermy), electrical stimulating current