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Physical Agents
stages of healing
| Question | Answer |
|---|---|
| What are the 3 main stages of healing | Inflammation, Proliferation, Maturation |
| Goals for acute inflammation | control pain, edema, bleeding, facilitate progression into proliferation |
| Goals for chronic inflammation | Prevent or decrease joint stiffness, control pain, increase circulation, promote progression into proliferation |
| Goals for proliferation stage of healing | control scar tissue formation, ensure adequate circulation, maintain strength and flexibility, promote progression to remodeling stage |
| Goals for maturation stage of healing | Regain strength and flexibility, control scar tissue formaiton |
| How long does inflammation stage last (days) | 1-6 days |
| 4 cardinal signs of inflmmation stage | heat, redness, swelling, pain, (loss of function) |
| 4 responses of inflammation stage | Vascular response, hemostatic response, cellular response, immune response |
| Inflammation stage: Describe vascular response | 1. Norepinephrine causes surrounding area to vasoconstrict 2. Histamine causes undamaged vessels to dilate for 1 hr after tissue damage. 3. Neutrophils line the injured blood vesssel. (Migration) 4. Endothelial lining of vessels comvered by neutrophils |
| Inflammation stage: Describe Hemostatic Response | 1. platelets bind to exposed collagen, releasing fibrin to stimulate clotting. 2. When fibrin and fibronectin enter injured area, they form cross-links with collagen to create a fibrin lattice (scab, hematoma) |
| Inflammation stage: Describe Cellular Response | 1. Migration of leukocytes into area of injury. 2. Neutrophils predominate in early phase 3. 24-48 hrs monocytes predominate 4. Monocytes are converted to macrophages which produce a wide variety of chemicals |
| Inflammation stage: Describe Immune Response | 1. Macrophages present foreign antigen to T lymphocyhtes to activate them. 2. T lymph activates B cells causing them to evolve into plasma cells which make antibodies that bind to specific antigen 4. Compliment system forms the membrane attack system. |
| How long does proliferation stage last | 3-20 days |
| What are the stages of proliferation | Epithelialization, Collagen Production, WOund Contraction, Neovascularization |
| Proliferation stage: Describe Epithelialization | uninjured epithehial cells from margins of injured area reproduce and migrate over injured area covering surface of wound. Thought to be caused by loss of contact inhibition |
| Proliferation stage: Describe Collagen Production | 1.fibroblasts make collagen.2.As increase in # of fibroblasts, they begin to align themselves perpendicular to capillaries.3. Initially weak type III collagen and is replaced by stronger type I collagen by 12th day.4.6 weeks the wound only has 80%strength |
| Proliferation stage: Describe WOund Contraction | 1. COntraction pulls the edge of the injured site together 2. Begins 5 days after injury, and peaks within 2 wks. 3. Myofibroblasts are the primary cells responsible for wound contraction, which possess the contractile qualities of smooth muscle. |
| Proliferation stage: Describe neovascularization | Development of new blood supply (angiogenesis). |
| How long does Maturation stage last | 9 days - On |
| What happens during maturation | 1. Fibroblasts dissapear 2. Collagen fibers become organized along lines of stress 3. weak hydrogen bonds are replace by strong covalent bonds 4. Blood vessels disappear and become white 5. Collagen turnover becomes stress dependent |
| Local Factors that affect the healing process | Type, size, injury, infection, vascular supply, external forces, mvmt |
| Systemic factors that affect healing process | Age, disease, medications, nutrition |
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