Term
| Components of tissue healing |
|
Definition
-fibronectin
-proteoglycans and elastin
- collagen
- growth factor
- chemical mediators |
|
|
Term
|
Definition
-Hemostasis and degeneration
-inflammation
-proliferation and migration phase
-remodeling and maturation phase |
|
|
Term
|
Definition
-formation of scaffold, provides tensile strength
-glue
-attracts fibroblasts and macrphages by chemotaxis
-fibroblasts secrete more fibronectin
-fibronectins binds to proteoglycans and collagen, further stabilizing |
|
|
Term
| Proteoglycans and elastin |
|
Definition
-secreted by fibroblaasts
- proteoglycans bind to fibronectin and to collagen to stabilize
- retain water, aid in hydration of tissue |
|
|
Term
|
Definition
-most important in providing structural support and tensile strength
- most abundant protein in the body, at least 27 different types |
|
|
Term
|
Definition
-protein that regulate the number of cellular reactions involved in healing
- |
|
|
Term
| hemostasis - goals and timeline |
|
Definition
day 1-3
stop bleeding
form clot
begin inflammatory phase |
|
|
Term
| Inflammation and timeline |
|
Definition
new framework for blood vessel growth
day 3-20 |
|
|
Term
Proliferation and granulation
and timeline |
|
Definition
Pulls wound closed
week 1-6 |
|
|
Term
remodeling and maturation
and timeline |
|
Definition
final proper tissue
week 6 - 2 years |
|
|
Term
|
Definition
every ear has low piercing
erythema
edema
heat
loss of function
pain |
|
|
Term
|
Definition
Type I - strong dermal
type II - thinner (cartilage, ear, nose)
Type III - Vascular and visceral tissues |
|
|
Term
mechanical stress thresholds
components and effect of overload or underload stress |
|
Definition
thresholds for injury, increased tolerance, maintenance, and atrophy.
baseline increases with increased stress |
|
|
Term
| cell injury can be the result of |
|
Definition
-injurious stimuli
-inability to adapt to stress |
|
|
Term
| cell injury can result in |
|
Definition
reversible injury - return to normality
irreversible injury - necrosis or apoptosis |
|
|
Term
| characteristics of reversible cell injury |
|
Definition
mild, short duration
-cell swells with Intracellular fluid
-Sodium(Na) and Calcium(Ca) influx
-increased endoplasmic reticulum and mitochindria activity
-ribosomes released from endoplasmic reticulum
-blebs break off to protect the nucleus |
|
|
Term
| characteristics of irreversible cell injury |
|
Definition
-mitochondria no longer produce ATP
-nucleus dies
-lysosomes break down the cell
-dead cells released to ECF - can be tested for to assist in diagnosis |
|
|
Term
necrosis vs apoptosis
-cell size |
|
Definition
necrosis - enlarged (swelling)
apoptosis - reduced (shrinkage) |
|
|
Term
necrosis vs apoptosis
-nucleus |
|
Definition
necrosis- pyknosis>karyorrhexis>karyolysis
apoptosis - fragmentation |
|
|
Term
|
Definition
-cell growth/division
-differentiation
-migration
-biosynthesis/degradation of proteins
-angiogenesis |
|
|
Term
| chemical mediators of inflammation |
|
Definition
histamine
platelet activating factor
Arachidonic Acid Derivatives
cytokines
blood coagulation
phagocytosis |
|
|
Term
| histamine role in inflammation |
|
Definition
| vasodilator, increasing permeability so blood cells can exit |
|
|
Term
platelet activating factor
-role in inflammation |
|
Definition
|
|
Term
arachidonic acid derivatives
-role in inflammation |
|
Definition
| formation of prostaglandins(pain) and leukotriens (fever) |
|
|
Term
cytokines
-role in inflammation |
|
Definition
| affect metabolic and hemodynamic changes |
|
|
Term
phagocytosis
-role in inflammation |
|
Definition
| inactivates and removes the inflammatory stimulus |
|
|
Term
hemostasis
timeline and specific events |
|
Definition
24-48 hours
-coagulation
-platelets send out growth factors to attract RBC & WBC
-Degeneration/necrosis of dead cells
-start inflammatory phase |
|
|
Term
inflammation
-time line and goals |
|
Definition
-starts day 3, lasts 2-3 weeks
goals
-inactivate the cause of injury
-break down/clean up dead cells
-initiate healing |
|
|
Term
inflammation
-time line and events |
|
Definition
-from day 3 for about 2-3 weeks
events
-neutrophils move in
-macrophages move in
-fibroblasts, epithelial cells, and vascular endothelial cells move in to form granulation tissue |
|
|
Term
| inflammation pain can be caused by |
|
Definition
prostaglandins - chemical pain
pressure on nerve
swelling of nerve |
|
|
Term
proliferation and migration phase
-time line
-components |
|
Definition
-weeks 1-6
components
-phagocytosis
-macrophages
-angiogenesis
-lymphatic channels open to drain dead tissue
-at 3 weeks, greatest mass, but tensile strength only 15% normal |
|
|
Term
|
Definition
-endothelial cells from edge of necrotic tissue proliferate
-capillary budding w/in 24 hours
-granulation tissue from fibroblasts form collagen and elastin
-fibrinolysin produced to dissolve clots and fibrin
-vascular network established |
|
|
Term
|
Definition
-bacterium is coated with G antibody and compliment
-pulled in
-vacuole and lysosomes destroy |
|
|
Term
Remodeling and maturation phase
-time line
-events |
|
Definition
3-4 weeks -- year or longer
events
-scar tissue reduced and remodeled
-scar tissue strengthens
--tissues contract to approximate the margins |
|
|
Term
|
Definition
| mature scar takes 12-18 months and is 20-30% weaker than original |
|
|
Term
primary intention
(healing) |
|
Definition
| edges unite, no granulation |
|
|
Term
secondary intention
(healing) |
|
Definition
|
|
Term
tertiary intention
(healing) |
|
Definition
| granulation fills wound but epithelium fills over the top - overshoot |
|
|
Term
|
Definition
| regeneration/repair can only occur when the basement membrane is intact |
|
|
Term
|
Definition
| wallerian degeneration, or the degeneration of axon detached from the cell body |
|
|
Term
| skeletal muscle damage/repair |
|
Definition
repair/regeneration begin immediately
-repairs in the form of connective tissue scar
-structural integrity maintained, but not completely functional |
|
|
Term
|
Definition
cortical - 80%
cancellous (spongy) - 20% |
|
|
Term
| bone regeneration and remodeling |
|
Definition
1. fracture and bleeding stimulates cytokines, GF, and osteoprogenitor to form callous
2. clotting forms fibrous network/soft callous
3. soft callous to bony callous in 2 weeks
4. healed in 6-12 weeks, but remodeling can go on for a year+ |
|
|
Term
| tendon and ligament damage/repair |
|
Definition
-inflammatory stage -> proliferative phase at 2-3 weeks
-2 weeks, collagen fibril bundles provide tissue strength.
- Area remains immobilized, and lack of stress causes collagen to deposit in random alignment
-maturation and remodeling at 3 weeks
-type III collagen replaced with type I, which aligns along tensile forces
-12-16 weeks before tendon can be stressed, 40-50 weeks until normal |
|
|
Term
| tangential zone of articular cartilage |
|
Definition
-type II collagen
-oriented tangentially
-offer greatest resistance to shearing |
|
|
Term
| tidemark of articular cartilage |
|
Definition
located in the calcified zone, at the boundary between calcified and uncalcified cartilage
-separated hyaline cartilage from subchondral bone |
|
|
Term
|
Definition
hyaline
fibrocartilage
elastc cartilage |
|
|
Term
| hyaline cartilage examples |
|
Definition
| ends of bones, ribs, nose, larynx, trachea |
|
|
Term
|
Definition
| intervertebral discs, joint capsule, ligaments |
|
|
Term
| elastic cartilage examples |
|
Definition
| ligamentum flavum, external ear, epiglottis |
|
|
Term
|
Definition
| occurs by fibrous scar, if at all |
|
|
Term
|
Definition
| lines the inner surface of the joint capsule |
|
|
Term
| effects on synovium from joint injury |
|
Definition
hemorrhage
hypertrophy
hyperplasia of synovial lining cells
mild chronic inflammation |
|
|
Term
| immobilization of joint effects synovial membrane |
|
Definition
| synovial membrane hypertrophies and forms adhesions between itself and articular cartilage |
|
|
Term
vertebral disk
-blood supply
-nerve supply |
|
Definition
-blood supply only to the outer anulus
-sinuvertebral nerves supply outer annulus |
|
|
Term
meniscus
-structure
-blood supply |
|
Definition
-fibrocartilaginous structure, mostly collagen, oriented to resist compression and lateral loading
-vascular at birth
-only outer 10-30% vascular in adulthood |
|
|
Term
| phases to consider in rehab |
|
Definition
inflammatory phase
proliferative phase
remodeling phase |
|
|
Term
| inflammatory phase treatment |
|
Definition
-promote early healing & prevent negative effects of rest
-passive movement, massage, muscle setting (isometric)
-AAROM, resistive, modified aerobic in other areas
-proper dosage of rest and movement |
|
|
Term
| proliferation and migration phase treatment |
|
Definition
5-21 days up to 6 weeks
-promote healing(monitor tissue)
-gentle active, open/closed chain stabilization, muscle endurance
-progressive PROM ->AAROM ->AROM
-multi-angle isometrics ->isotonic
-low intensity functional activity
-inflammation should be decreasing, there should not be lasting resting pain |
|
|
Term
| Remodeling and maturation phase treatment |
|
Definition
1.5months----6-12months: return to function
-increase strength and alignment of scar
-stretching, strengthening, endurance
-increasing tissue mobility, joint mobilization, cross fiber massage, neuromuscular inhibition
-progress all exercise,
-should be no signs of inflammation |
|
|
Term
|
Definition
-deeo vein thrombosis
-atrophy, decreased strength, decreased stress tolerance
-decreased fitness
-adhesions
-loss of motion |
|
|
Term
|
Definition
-immobilization followed by mobilization may help in regeneration, and fiber orientation with reduced scar formation
-return to sports is safe with 80% return of strength |
|
|
Term
|
Definition
-good for early symptom control during early phases of healing
- long term use interrupts biologic healing process |
|
|
Term
| immobilizations that carry risk of DVT |
|
Definition
bed rest
limb in cast or splint
extended non-weight bearing (after injury, or long plane flight) |
|
|
