Transcript Ch 6 - Tissue Healing and Wound Care

Tissue Healing and
Wound Care
Chapter 6
Categorize Force Relative to
Direction
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Compression
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Axial
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Force that acts on the long axis of a structure
Tension
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Axial load that produces a crushing or squeezing type force
Axial force in opposite direction; pulling or stretching the tissues
Shear
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Force parallel to a plane passing through the object
Tends to cause sliding or displacement
Categorize Force Relative to
Direction (cont.)
Element of Time
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Acute injury
Results from a single force
 Causative factor - macrotrauma
 Characterized by a definitive moment of onset
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 Chronic
or stress injury
Results from repeated loading
 Causative factor - microtrauma
 Characterized by becoming more problematic
over time
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Soft Tissue – Anatomic Properties
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Collagen
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Primary constituent of skin,
tendon, ligaments
Protein substance strong in
resisting tensile forces
Elastin
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Protein substance
Adds elasticity
Skin
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Epidermis
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Dermis
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Multidirectional
arrangement of collagen
Subcutaneous /
Hypodermal Layer
Tendons
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Muscle to bone
Dense connective tissue
with unidirectional
bundles of collagen and
some elastin
Collagen - parallel
arrangement
Two times as strong as
muscle it serves
Aponeuroses
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Attach muscle to other muscles or bone
Dense connective tissue
Strong, flat, sheet-like
Muscle
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Viscoelastic
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Extensibility - ability to be
stretched
Elasticity - ability to return to
normal length
Viscoelasticity allows muscle to
stretch to greater lengths over
time in response to a sustained
tensile force
Muscle (cont.)
 Contractility
 Isometric
 Concentric
 Eccentric
- ability to develop tension
Joint Capsule
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Membrane that encloses a joint; composed
primarily of collagen
Function: hold bones in place
Inner lining: synovial membrane
Exit for waste; entrance for nutrients
 Secretes synovial fluid (lubricates and nourishes)
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Ligaments
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Bone to bone
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Collagen is interwoven
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Resists large tensile loads
along the long axis of the
ligament and smaller loads
from other directions
Collagen and elastin
intermixed (more elastic
than tendons)
Bursa
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Fluid-filled sacs
Reduce friction
Common sites – areas of friction
Skin Injury Classifications
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Abrasions
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Blisters
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Accumulation of fluid between epidermis
and dermis
Skin bruises
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Scraping away of layers of skin
Accumulation of blood within skin
Incisions
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Clean cut
Skin Injury Classifications (cont.)
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Lacerations
 Irregular
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tear
Avulsions
 Complete
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separation of skin
Punctures
 Penetration
of skin and underlying tissue
Contusion
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Mechanism: compression
Signs and symptoms (S&S)
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Basis for rating severity – ROM
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Onset - acute
Pain - localized
Ecchymosis: if superficial
Restrictions in ROM
Swelling
Associated nerve compression
1st – little or no restriction
2nd – noticeable reduction
3rd – severe restriction
Concern: can lead to muscle strain
Strain
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Stretch or tear of a muscle or tendon
Mechanism: tension force
Most common site for tears: near the
musculotendinous junction
Key factor: magnitude of force and
structure's cross-sectional area
Classification of Strains
1st
2nd
3rd
damage to fibers
few fibers torn
nearly half torn
all fibers torn
weakness
mild
moderate (reflex
inhibition)
severe
muscle spasm
mild
moderate
severe
loss of function
mild
moderate
severe (reflex inhibition)
swelling
mild
moderate
severe
palpable defect
no
no
yes (if early)
pain-contraction
mild
moderate /severe
none/mild
pain-stretching
yes
yes
no
ROM
decreased
decreased
depends on swelling
Cramps and Spasms
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Involuntary muscle contraction
Cramp
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Biochemical imbalance, fatigue
Types
Clonic - alternating contraction/relaxation
 Tonic - constant
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Spasm
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Reflex action due to:
Biochemical or
 Mechanical blow to nerve or muscle
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Tendinitis and Tenosynovitis
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Tendinitis
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Inflammation of tendon
Pain and swelling with tendon movement
Problems - repeated microtrauma
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Degenerative changes
Tenosynovitis
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Inflammation of synovial sheath
S&S
Acute: rapid onset, crepitus, local swelling
 Chronic: thickened tendon, nodule formation in sheath
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Myositis Ossificans
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Ectopic calcification - located in place other
than normal
Bone (calcium) is deposited within a muscle
Usually macrotrauma, but can be microtrauma
Chronic Conditions
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Result of repeated irritation of tissues
Classification
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Stage 1: pain after activity only
Stage 2: pain during activity, does not restrict performance
Stage 3: pain during activity, restricts performance
Stage 4: chronic unremitting pain, even at rest
Problem – low-grade inflammatory condition that
results in collagen resorption and scarring
Sprain
Stretch or tear of ligament
 Mechanism of injury (MOI) – tension force
 Compromises the ability of the ligament to
stabilize the joint
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Classification of Sprains
1st
2nd
3rd
damage to ligament
few fibers torn
nearly half torn
all fibers torn
distraction stress
<5 mm
5-10 mm
>10 mm
weakness
mild
moderate/severe
moderate/severe
muscle spasm
none
none/minor
none/minor
loss of function
mild
moderate/severe
severe
swelling
mild
moderate
moderate/severe
pain-contraction
none
none
none
pain-stretching
yes
yes
no
ROM
decreased
decreased
increase or decrease
Dislocation/Subluxation
Subluxation – Partial or incomplete dislocation
 Joint force beyond normal limits
 MOI: tension, compression, or shear
 S&S
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Loss of limb function
 Deformity
 Swelling
 Point tenderness
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Bursitis and Osteoarthritis
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Bursitis
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Inflammation of bursa
Acute or chronic
MOI: compression or rubbing
S&S: swelling, pain, loss of function, eventual degeneration
Osteoarthritis
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Degeneration of articular cartilage
S&S: pain and limited movement
No definitive cause; rather, several contributing factors
Soft Tissue Healing
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Inflammatory phase (0-6 days)
 Begins immediately following injury
 Most critical
 Phagocytic cells clean up the debris caused by the
injury
 Symptoms
Swelling
 Tenderness
 Warmth
 LOF
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Soft-Tissue Healing Cont’d…
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Fibroblastic Repair Phase (Proliferative)
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Scar formation and repair of tissue
Signs of inflammatory phase subside
Still pain with movement or touch that will fade
First few hours to 3 – 21 days
Maturation-Remodeling Phase
 Long term process
 Realignment or remodeling of the scar tissue according to the
forces it is subjected to
 May require several years
Soft Tissue Wound Care
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Open wound
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Follow universal precautions and infection control
standards
General
 Apply pressure
 Cleanse the wound
 Dress and bandage the wound
 Use of creams or ointments
 Re-dress and inspect
Closed wound
Goal: reduce inflammation, pain, and secondary
hypoxia
 Treatment: RICE – rest, ice, compression, and
elevation
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Long Bones – Anatomic Properties
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Primary constituents:
minerals, collagen, water
Components
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Diaphysis
Shaft - hollow, cylindrical
 Medullary cavity - shock
potential improves
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Long Bones – Anatomic Properties
(cont.)
 Epiphysis
 Ends
of long bones
 Epiphyseal plate - cartilaginous disc found near
ends of long bones
 Periosteum
 Sheath
covers bone
 Life support system
Long Bones – Anatomic Properties
(cont.)
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Bone growth
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Longitudinal
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Continues until epiphysis
closes
Diameter
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Can continue to grow
through the lifespan
Fractures
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Disruption in the continuity of bone
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Closed or open
Type of fracture determined by:
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Force applied
The health and maturity of bone at the time of
injury
Types of Fractures
Stress Fractures & Osteopenia
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Stress Fractures
Fracture results from repeated loading with
lower magnitude forces
 Can become worse over time
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Osteopenia
Reduced bone mineral density that predisposes
individual to fracture
 Possible causes: amenorrhea, hormonal factors,
dietary insufficiencies
 Precursor to osteoporosis
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