Chapter 10 Notes

 

Terminology

 

€          acute pain - Pain that protects the body from something harmful.

€          complement system - A series of enzymatic proteins in normal serum that, in the presence of a specific sensitizer, destroy bacteria and other cells.

€          exudate - Fluid with a high protein content and cellular debris that comes from blood vessels and accumulates in the area of the injury.

€          fibroplasia  - A period of scar formation. 

€          gate control theory - Theory that subthreshold pain stimuli may be blocked at a "gate" in the spinal cord and thus are never processed by the brain and perceived as pain.

€          hard callus - Gradual connection of bone filaments to woven bone at a fracture site.

€          inflammation - Fundamental reaction of the body to protect, localize, and rid the body of injuring agents.

€          leukocytes  - White blood cells.

€          lymphocytes – Cells that are the primary means of providing the body with immune capabilities.

€          macrophage – A phagocytic cell of the immune system.

€          margination - Movement of leukocytes from the center of the blood flow to become concentrated and lined up adhering to the endothelial walls.

·         mast cells - Connective tissue cells that contain heparin and histamine and are the first line of defense.

€          osteoclast - Bone cell that comes from the periosteum involved in bone healing; destroys and reabsorbs bone as a pathological response.

€          osteocyte - Cell that forms and destroys bone as in the natural ongoing process of remodeling.

€          permeable - Characteristic of membranes, allowing substances to pass through.

€          phagocytosis - Engulfing of matter by white blood cells to destroy it.

€          primary healing - Healing over an injury that is evenly closed (incision). Edges are held in close approximation; little granulation tissue formed.

€          referred pain - Pain perceived as coming from a site other than the                      injury.

€          regeneration - Restoration of destroyed tissue.

€          secondary healing - Results when there is a gaping lesion and large tissue loss leading to replacement by scar tissue.

€          trigger point - Specific sensitive area of muscle.

 

Chapter 10 - Lecture Outline


Tissue Response to Injury

 

Tissue healing and the cause of pain are not clearly understood.  However, what is not known must be studied as a foundation for proper injury management.

Inflammatory Response

 

Acute Inflammation

 

Chronic Inflammation

 

Cardinal Signs of Inflammation

 

Rubor (redness)

Tumor (swelling)

Color (heat)

Dolor (pain)

Functio laesa (loss of function)

 

Phases of the Inflammatory Response

(3 separate phases)

 

1. Acute phase

2. Repair phase

3. Remodeling phase

 

Phase I: Acute Phase

 

 

First hour

 

Second hour

 

Cellular response

 

 

Cellular mediation

 

 

Complimentary systems

 

Bleeding and exudate

 

Phase II: Repair Phase

Repaired through 3 phases

–Resolution

–Restoration

–Regeneration

 

Scar formation

 

Primary healing (healing by first intention)

 

Secondary healing (heal by secondary intention)

 

Regeneration

 

Phase III: Remodeling

 

Chronic Inflammation

 

Characteristics of Chronic Inflammation

 

Factors That Impede Healing

Extent of injury

Edema

Hemorrhage

Poor Vascular Supply

Separation of Tissue

Muscle Spasm

Atrophy

Corticosteroids

Keloids and Hypertrophic Scars

Infection

Humidity, Climate, Oxygen Tension

Health, Age, and Nutrition

 

Soft Tissue Healing

 

Cell structure/function

 

Tissues of the Body

€Bone - not classified as soft tissue

€4 types of soft tissue

 

 

Soft Tissue Adaptations

€Metaplasia

€Dysplasia -

€Hyperplasia-

 

Atrophy

Hypertrophy

 

Cartilage Healing

 

 

Ligament Healing

 

 

Skeletal Muscle Healing

 

 

Nerve Healing

 

Management Concepts

 

Drug utilization

 

Therapeutic Modalities

 

Heat stimulates acute inflammation (but works as a depressant in chronic conditions)

 

Cold is utilized as an inhibitor

 

Electrical modalities

 

Treatment of inflammation

Ultrasound, microwave, electrical stimulation (includes transcutaneous electrical muscle stimulation and electrical muscle stimulation

 

Therapeutic Exercise

Major aim involves pain free movement, full strength power, and full extensibility of associated muscles

Immobilization, while sometimes necessary, can have a negative impact on an injury

 

Adverse biochemical changes can occur in collagen

Early mobilization (that is controlled) may enhance healing

 

Fracture Healing

 

Acute Fracture of Bone

 

Hematoma Formation

 

Acute Fracture Management

 

Infection

 

Pain Categories

Pain sources

Fast versus slow pain

Acute versus chronic

Projected or referred pain

 

Pain sources

 

Fast versus Slow Pain

 

Acute versus Chronic Pain

 

Projected (Referred) Pain

 

Myofascial Pain

 

Sclerotomic and dermatomic pain

 

Pain modulation

 

 

Pain assessment

 

€Heat/Cold

 

Induced analgesia

 

Pharmacological Agents

 

Psychological Aspects of Pain

 

Pain can be subjective and psychological

 

Pain thresholds vary per individual

Pain is often worse at night due to solitude and absence of external distractions

Personality differences can also have an impact

A number of theories relative to pain exist and it physiological and psychological components

Athlete, through conditioning are often able to endure pain and block sensations of minor injuries