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Soft tissue Injury and Repair (Ch.3 Ortho PT secrets) Pt 1 - Coggle Diagram
Soft tissue Injury and Repair (Ch.3 Ortho PT secrets) Pt 1
Initial response to soft tissue injury: Inflammatory Response due to trauma, surgery, or metabolic/infectious disease
Signs of inflammation
-erythema (rubor)
-swelling (tumor)
-elevated tissue temperature(calor)
-pain (dolor)
-local vasodilation, fluid leakage into extracellular/vascular spaces and impaired lymphatic drainage responsible for redness, swelling, and temp inc
-pain is result of mechanical distension and pressure of the soft tissues and chemical irritation of pain-sensitive nerve receptors
basic vascular and cellular activities associated with inflammatory reaction
Blood vessels vasoconstrict several seconds to few minutes:
-mediated by norepinephrine
-serotonin release by mast cells, secondary prolonged vasoconstriction occurs to slow bleeding
Margination: leukocytes adhere to vessel wall
chemotaxis: movement of white blood cells through extravascular space toward site of injury which begins process of phagocytosis and removal of cellular debris
chemical mediators
histamine: release results in vascular permeability. released by granules of mast cells
serotonin: is potent vasoconstriction. released by granules of mast cells
kinins (bradykinin): causes marked vascular permeability
prostaglandins: pro-inflammatory
-sensitize pain receptors, attract leukocytes to the inflamed area, increase vascular permeability
aspirin, NSAIDs and steroids primary mode of action is to inhibit prostaglandin synthesis (deactivate cyclooxygenase)
Phases of healing
Inflammatory phase:
-begins immediately, lasts 24-48, some aspects may cont up to 3 weeks
Proliferative phase:
-may begin soon after inflammatory phase, most extensive 21 days after injury
remodeling phase:
-3 weeks after injury, lasts up to 2 years
-in many cases majority of remodeling has occurred by 2 months
fibroblasts: most common connective tissue cell and most prominent in proliferative and remodeling phases
-lays most of the fibers and ground substance for connective tissue
-signaled by injury to rapidly multiply and mobilize free connective tissue cells to injured area
Connective Tissue matrix:
-fibrous elements: collagen, elastin, and reticulin
-ground substance: walter, salts, glycosaminoglycans
-provides strength and support of soft tissue
-means for diffusion of tissue fluid and nutrients bw capillaries and cells
Factors that affect connective tissue repair after tissue injury
availability of blood supply, proteins, minerals, and amino acids
hormones and enzymes
Steroids suppress mitotic activity of fibroblasts which results in diminished deposition of follagen fibers and tensile strength
mechanical stress and infection
Antibiotics inhibit protein synthesis and may adversely effect wound healing and scar formation
disease process (ie DM) can significantly retard wound healing
Nutrition:
-collagen synthesis especially sensitive to availability of proper nutrients
-lack of vitamins A and C impede process of collagen synthesis
-glucosamine-especially important for connective tissue repair and production
-glucosamine is precursor to chondroitin and hyaluronic acid and inc proteoglycan production
-efficacy of dietary supplements has not been well established in their effect on joint disease
-recent research indicates that glucosamine may limit the advance of joint space narrowing associated with OA
Effects of Age on soft tissue injury healing :
-attenuated metabolic activity, decreased vascular supply, diminished collagen cellular biosynthesis, delayed collagen remodeling, and decreased wound strength
-note that clinical experience indicates older patient's often undergo surgical treatment with no adverse healing responses related to aging