Inflammation
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| acute inflammation | inflammation that occurs immediately after tissue damage
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| angiogenesis | the growth of new blood vessels
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| cartilage | a fibrous connective tissue that lines the ends of the bones in joints that provide the weight-bearing surface of joints, and that helps to form the flexible portions of the nose and ears
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| chemotaxis | movement of cells toward or away from chemicals
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| chronic inflammation | the simultaneous progression of active inflammation, tissue destruction, and healing. It may last for months or years
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| collagen | the protein in fibers of skin, tendon, bone, cartilage, and all other connective tissue. It is made up of individual polypeptide molecules combined together in triplets to form helical tropocollagen molecules that then associate to form collage fibrils
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| collagenases | enzymes that destroy collagen
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| complement system | a system of enzymatic plasma proteins activated by antigen-antibody complexes, bacteria, and foreign material that participates in the inflammatory response through cell lysis, opsonization, and attraction of leukocytes by chemotaxis
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| connective tissues | tissues consisting of fibroblasts, ground substance, and fibrous strands that provide the structure for other tissues
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| Contractures | Permanent shortening of muscle or scar tissue that produces deformity or distortion.
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| Corticosteroids | Drugs that decrease the inflammatory response through many mechanisms involving many cell types.
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| Diapedesis | The process by which leukocytes squeeze through intact blood vessel walls; a part of the process of extravasation.
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| Edema | Swelling that results from accumulation of fluid in the interstitial space.
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| Emigration | The process by which leukocytes migrate from blood vessels into perivascular tissues; a part of the process of extravasation.
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| Epithelial cells | Cells that form the epidermis of the skin and the covering of mucous and serous membranes.
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| Epithelialization | Healing by growth of epithelium over a denuded surface, thus reestablishing the epidermis.
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| Erythrocytes | Red blood cells.
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| Extravasation | The movement of leukocytes from inside a blood vessel to tissue outside the blood vessel.
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| Exudate | Wound fluid composed of serum with a high content of protein and white blood cells or solid materials from cells.
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| Fibroblasts | Cells in many tissues, particularly in wounds, that are the primary producers of collagen.
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| Fibroplasia | Fibroblast growth.
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| Granulation tissue | Tissue composed of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fills an open wound when it starts to heal; typically appears deep pink or red with an irregular, berry-like surface.
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| Healing by delayed primary intention | Healing in which wound contraction is reduced by delayed approximation of wound edges with sutures or application of skin grafts.
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| Healing by primary intention | Healing without wound contraction that occurs when wounds are rapidly closed with sutures with minimal loss of tissue and minimal bacterial contamination.
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| Healing by secondary intention | Healing with wound contraction that occurs when significant loss of tissue or bacterial contamination is present and wound edges are not approximated.
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| Hemarthrosis | Bloody fluid present in a joint.
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| Hematoma | The accumulation of blood in a tissue or organ.
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| Humoral mediators | Antibodies, hormones, cytokines, and a variety of other soluble proteins and chemicals that contribute to the inflammatory process.
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| Hyperemia | An excess of blood in a given area that causes redness and temperature increase in the area.
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| Impaction | Dissipation of energy resulting from an insult to bone.
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| Induction | The stage of bone healing when cells with osteogenic capabilities are activated.
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| Inflammation | The body’s first response to tissue damage, characterized by heat, redness, swelling, pain, and often loss of function.
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| Inflammation phase | The first phase of healing after tissue damage.
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| Leukocytes | White blood cells.
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| Ligaments | Bands of fibrous tissue that connect bone to bone or cartilage to bone, supporting or strengthening a joint at the extremes of motion.
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| Macrophages | Phagocytic cells derived from monocytes and important for attracting other immune cells to a site of inflammation.
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| Margination | A part of the process of extravasation in which leukocytes line the walls of blood vessels.
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| Maturation phase | The final phase of tissue healing in which scar tissue is modified into its mature form.
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| Monocytes | Leukocytes that are larger than polymorphonucleocytes (PMNs), have a single nucleus, and become macrophages when in connective tissue and outside the bloodstream.
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| Myofibroblasts | Cells similar to fibroblasts that have the contractile properties of smooth muscles and are responsible for wound contraction.
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| Neovascularization | The development of a new blood supply to an injured area.
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| Neural mediators | Nerve-related contributions to the inflammatory process.
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| Neutrophils | White blood cells present early in inflammation that have the properties of chemotaxis and phagocytosis.
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| Opsonization | The coating of bacteria with protein that makes them more susceptible to phagocytosis.
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| Pavementing | A part of the process of extravasation in which leukocytes lay in layers inside the blood vessel.
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| Phagocytosis | Ingestion and digestion of bacteria and particles by a cell.
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| Plasma | The acellular, fluid portion of blood.
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| Platelet-derived growth factor | A protein produced by platelets that stimulates cell growth and division and is involved in normal wound healing.
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| Platelets | Small, anuclear cells in the blood that assist in clotting.
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| Polymorphonucleocytes (PMNs) | Leukocytes whose nuclei have several lobes and contain cytoplasmic granules and that include neutrophils, basophils, and eosinophils.
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| Proliferation phase | The second phase of tissue healing during which damaged structures are rebuilt and the wound is strengthened.
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| Pus | Opaque wound fluid that is thicker than exudate and contains white blood cells, tissue debris, and microorganisms. Also called suppurative exudate.
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| Subacute inflammation | An inflammatory process that has continued for longer than 4 weeks.
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| Tendon | Fibrous band of tissue that connects muscle with bone.
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| Transudate | Thin, clear wound fluid composed primarily of serum.
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| Type I collagen | The most abundant form of collagen, found in skin, bone, tendons, and most organs.
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| Type II collagen | The predominant collagen in cartilage.
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| Type III collagen | A thin, weak-structured collagen with no consistent organization, initially produced by fibroblasts after tissue damage.
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| Wound contraction | The pulling together of the edges of an injured site to accelerate repair.
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| Ultimate goal of repair and inflammation is | to restore function
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| Rehab professionals treat inflammatory conditions resulting from: | trauma, surgical procedures, problematic healing
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| Tissue repair is characterized as: | proliferation of new blood vessels and formation of new growth tissue
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| Chondroblasts grow? | cartilage
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| Osteoblasts grow? | bone
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| Fibroblasts grow? | connective tissue
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| satellite cells grow? | precursor to skeletal muscle cells
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| Schwann cells grow? | myeline sheath around a nerve
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| Tissue will not improve without | some stress (do it in a protective way)
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| Induction theory | tissue will lay down or repair similar to original structures
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| tension theory (wolf's law) | bone laid down in response to stress, amount and direction of stress affects healing
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| 3 stages of inflammation and healing are | inflammation, proliferation and maturation
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| Inflammation phase | prepares wound for healing days 1-6
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| proliferation phase | rebuilds damaged structures and strengthens the wound, days 3-20
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| maturation phase | modifies the scar tissue into its mature form, days 9 onward
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| The vascular response includes: | swelling and redness, mediated by histamine, kinins, and prostaglandins
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| the immune response includes: | activates neutrophils and other infection fighting cells, complement system
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| What type of cell rids the site of bacteria and debris by phagocytosis? | neutrophils
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| What type of cell is first on the scene and most abundant | neutrophils
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| What type of cell converts to macrophages? | monocytes
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| Fibroblasts align how compared to the capillaries | perpendicular
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| What type of collagen is found in bone, skin, tendon and mature scars? | Type 1
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| What type of collagen is found in cartilage | Type 2
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| What type of collagen is found in gastrointestinal track, uterus, blood vessels, and is the first type to deposit in healing? | Type 3
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| Which theory states that healing tissue mimics the tissue around it? Dense induces dense, pliable = loose scar | induction theory
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| Which theory states external and internal stresses during maturation phase, determines final tissue structure | Tension theory
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| What are local factors affecting the healing process? | type, size, and location of injury; infection; vascular supply
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| What are the external factors affecting the healing process? | therapeutic use of physical agents
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| What are the systemic factors affecting the healing process? | age, disease, medications and nutrition
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| What is the timeframe for acute inflammation? | no more than 2 weeks
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| what is the timeframe for sub acute inflammation? | more than 4 wks
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| what is the timeframe for chronic inflammation? | months or years
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| What factors affect collagen structures? | muscle tension, joint movement, soft tissue loading and unloading, fascial gliding, temperature changes, mobilizations
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| Active mobilization of muscle when tendon repaired needs to be when? | more than 6 wks out
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| ligaments are still 30-50% weaker after repair, what does this mean? | early controlled movement is recommended
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| What are the influences of healing of a ligament? | type of ligament, size of defect, and amount of loading applied
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| What are the four stages of bone healing? | inflammation, soft callus, hard callus, bone remodeling
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