Chapter 5 Notes
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This 3 page Class Notes was uploaded by Danielle Francy on Monday October 17, 2016. The Class Notes belongs to KNES 315 at Towson University taught by Gail Parr in Fall 2016. Since its upload, it has received 3 views. For similar materials see Care and Prevention of Athletic Injury in Kinesiology at Towson University.
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Date Created: 10/17/16
Chapter 5 Notes The Healing Process Soft Tissue Healing: ● Trauma or physical damage results in the destruction of tissues. ● Necrosis is the death of living cells. ○ Due to the disruption of the oxygen supply (hypoxia) to the involved area. ● The healing of destroyed soft tissues is a three-phase process involving: ○ Inflammation ○ Proliferation/Repair ○ Maturation ● Trauma: ○ Acute or chronic destruction of tissue Inflammatory Phase (0-6 days): ● Vasoconstriction: ○ Few seconds-10 minutes ○ Marks the beginning of coagulation which initiates clotting. ● Primary injury zone ○ Area of injured tissue prior to vasodilation ● Vasodilation ○ Slowing of blood flow; increase blood viscosity; stasis ○ Release of chemicals (e.g. heparin- anticoagulant and other chemicals) ■ Increase swelling ■ Increase capillary permeability ● Blood from ruptured tissues, broken blood vessels form a hematoma (pooling of blood) ● Edema (swelling) ○ Large amounts of fluid (plasma and water) and exudate (fluid with cellular debris and high protein content) in the interstitial spaces ○ Increase capillary permeability and increase in osmotic pressure ■ Becomes a continuous cycle of increased swelling ● Fibrin ○ Deposits an irregular meshwork of short fibers ○ Contains the area ○ Clot formation begins ○ Inelastic ○ Scar tissue ○ 30% weaker ● Phagocytosis ○ Activity encourages leukocytes to come into the area (white blood cells) ■ Margination/pavementing--leukocytes(WBCs) line up around the perimeter of the damaged area. ■ Diapedesis- movement of leukocytes (WBCs) into the damaged area ■ Phagocytosis- ingestion of cellular debris ● Neutrophils- destroy bacteria only ● Macrophages ○ Tolerate low oxygen conditions ○ Ingest dead neutrophils, cellular debris ■ Leukocytes then re-enter the bloodstream ● Secondary Injury Zone ○ Region of tissue damage following vasodilation Repair/Proliferative Phase (approx. 3 days following injury-6-8 weeks): ● Begins when the hematoma’s size decreases enough to permit room for growth of new tissue ● Fibroblasts ○ Immature connective tissue cells released into area by the exudate ■ Lay down collagen ■ Initial scare formation ● Angiogenesis/Capillary Budding ○ Increase in capillaries in the area ○ Increase in blood supply for healing ● By day 4-5, a weak, vascular connective tissue in area...low tensile strength ● *****Fibroblasts need to know where to lay down the collagen---movement provides natural tensions in the healing tissue, increasing strength. ● By 2-4 weeks, increase in tensile strength combines with a decrease in vascularity. ○ Recession of capillaries and fibroblasts ● Fibrous, inelastic, non-vascular scar tissue...relatively less tensile strength (30% less) than normal healthy tissue and less functional ○ Shortening of tissue yielding a decrease in flexibility Maturation/Remodeling Phase(up to 1+ years) ● Continued recession of fibroblasts ● Initial haphazard formation goes through modification...slow realignment of collagen fibers ○ Oriented to lines of stress ● Muscle fibers do not reproduce in response to injury but can regenerate some of the fibers ○ As such, adhesions develop within the muscles ○ Inhibits muscle fiber regeneration ○ Severe cases, may only regain 50% of pre-injury strength. ● Ligaments and tendons have minimal repair cells ○ As such, healing can take more than a year ○ Significant tensile force can cause elongation of fibers ○ In case of ligaments, this can be problematic ■ Lead to joint instability ● Concern: Immobilization ○ Atrophy, loss of strength, and decreased rate of healing if healing tissue is kept absolutely immobile, the resultant repair is weak
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