Date post: | 01-Jun-2018 |
Category: |
Documents |
Upload: | hassan-jaleel |
View: | 218 times |
Download: | 1 times |
of 25
8/9/2019 Healing Process
1/25
Chapter 5Chapter 5
The Healing ProcessThe Healing Process
8/9/2019 Healing Process
2/25
OverviewOverview
Injuries to the musculoskeletalInjuries to the musculoskeletal
system can result from a widesystem can result from a wide
variety of causesvariety of causes.. Each of theEach of themajor components of themajor components of the
musculoskeletal systemmusculoskeletal systemhavehave
varying capacities to healvarying capacities to heal
8/9/2019 Healing Process
3/25
MusculoskeletalMusculoskeletal
InjuriesInjuries Injuries to the soft tissues can beInjuries to the soft tissues can be
classied as primary or secondaryclassied as primary or secondary
! PrimaryPrimary injuries can be self"in#icted$injuries can be self"in#icted$caused by another individual orcaused by another individual or
entity$ or caused by the environmententity$ or caused by the environment %cute%cute
&hronic&hronic
%cute on chronic%cute on chronic
8/9/2019 Healing Process
4/25
MusculoskeletalMusculoskeletal
InjuriesInjuries 'econdary'econdary injuries are essentiallyinjuries are essentially
the in#ammatory response thatthe in#ammatory response that
occurs with the primary injuryoccurs with the primary injury
8/9/2019 Healing Process
5/25
Wound healingWound healing
(ortunately$ the majority of soft tissue(ortunately$ the majority of soft tissue
injuries heal without complication in ainjuries heal without complication in a
predictable series of eventspredictable series of events However$ healing abnormalities canHowever$ healing abnormalities can
occur. These abnormalities can be dueoccur. These abnormalities can be due
to such complications asto such complications as
! InfectionInfection
! &ompromised circulation&ompromised circulation
! )europathy)europathy
8/9/2019 Healing Process
6/25
Wound healingWound healing
Three main phasesThree main phases
! In#ammatoryIn#ammatory
! ProliferativeProliferative
! *emodeling*emodeling
8/9/2019 Healing Process
7/25
Infammatory phaseInfammatory phase
The reaction that occursThe reaction that occurs
immediately after woundingimmediately after wounding
includes a series of defensiveincludes a series of defensiveevents that involves theevents that involves the
recognition of a pathogen and therecognition of a pathogen and the
mounting of a reaction against it.mounting of a reaction against it.This reaction involves bothThis reaction involves both
coagulation and in#ammationcoagulation and in#ammation
8/9/2019 Healing Process
8/25
Infammatory phaseInfammatory phase
&oagulation. %part from an initial period&oagulation. %part from an initial periodof vasoconstriction lasting for +",-of vasoconstriction lasting for +",-minutes$ tissue injury causesminutes$ tissue injury causesvasodilation$ the disruption of bloodvasodilation$ the disruption of bloodvessels and etravasation of bloodvessels and etravasation of bloodconstituents$ including plateletsconstituents$ including platelets
The main functions of the eudate are toThe main functions of the eudate are to
! Provide cells capable of tissue reconstructionProvide cells capable of tissue reconstruction! /ilute microbial toins/ilute microbial toins
! *emove contaminants present in the wound*emove contaminants present in the wound
8/9/2019 Healing Process
9/25
Infammatory phaseInfammatory phase
In#ammation. In#ammation is mediatedIn#ammation. In#ammation is mediated
by chemotactic substances$ includingby chemotactic substances$ including
anaphylatoinsanaphylatoins
$ which$ which
attract neutrophilsattract neutrophils
and monocytesand monocytes
! )eutrophils are white blood cells that bind to)eutrophils are white blood cells that bind to
microorganisms$ internali0e them$ and killmicroorganisms$ internali0e them$ and kill
themthem
! 1onocytes are white blood cells that develop1onocytes are white blood cells that develop
into macrophages$ and provide immunologicalinto macrophages$ and provide immunological
defences against many infectious organismsdefences against many infectious organisms
8/9/2019 Healing Process
10/25
Infammatory phaseInfammatory phase
The complete removal of theThe complete removal of the
wound debris marks the end ofwound debris marks the end of
the in#ammatory processthe in#ammatory processThis stage can last from ,"2 daysThis stage can last from ,"2 days
to longer than 2 monthsto longer than 2 months
8/9/2019 Healing Process
11/25
&ommon causes for a persistent chronic&ommon causes for a persistent chronicin#ammatory response includein#ammatory response include! Infectious agentsInfectious agents
! Persistent virusesPersistent viruses
! Hypertrophic scarringHypertrophic scarring
! Poor blood supplyPoor blood supply
! EdemaEdema
! *epeated direct trauma*epeated direct trauma
! Ecessive tension at the wound siteEcessive tension at the wound site
! Hypersensitivity reactionsHypersensitivity reactions
8/9/2019 Healing Process
12/25
Infammatory phaseInfammatory phase
&linically$ during the in#ammatory&linically$ during the in#ammatory
phase there is painphase there is pain
! %t rest%t rest! 3ith active motion3ith active motion
! 3hen specic stress is applied to the3hen specic stress is applied to the
injured structureinjured structure
The pain$ if severe enough$ can resultThe pain$ if severe enough$ can resultin muscle guarding$ and a loss ofin muscle guarding$ and a loss of
function.function.
8/9/2019 Healing Process
13/25
Prolierative phaseProlierative phase
&haracteristic changes during this&haracteristic changes during this
phase includephase include
! &apillary growth&apillary growth
! 4ranulation tissue formation4ranulation tissue formation
! (ibroblast proliferation with collagen(ibroblast proliferation with collagen
synthesis and increasedsynthesis and increasedmacrophage and mast cell activitymacrophage and mast cell activity
8/9/2019 Healing Process
14/25
Prolierative phaseProlierative phase
This phase lasts from + to ,+This phase lasts from + to ,+
days$ and often up to ,- weeksdays$ and often up to ,- weeks
depending on the type of tissue$depending on the type of tissue$and the etent of damage.and the etent of damage.
8/9/2019 Healing Process
15/25
emodeling phaseemodeling phase
The remodeling phase of woundThe remodeling phase of wound
healing involves a conversion ofhealing involves a conversion of
the initial healing tissue to scarthe initial healing tissue to scartissuetissue
This lengthy phase of contraction$This lengthy phase of contraction$
tissue remodeling and increasingtissue remodeling and increasingtensile strength in the wound laststensile strength in the wound lasts
for up to a yearfor up to a year
8/9/2019 Healing Process
16/25
emodeling phaseemodeling phase
Imbalances in collagen synthesis andImbalances in collagen synthesis anddegradation during this phase ofdegradation during this phase ofhealing may result in hypertrophichealing may result in hypertrophicscarring or keloid formationscarring or keloid formation
If left untreated$ the scar formed is lessIf left untreated$ the scar formed is lessthan 5-6 of its original si0ethan 5-6 of its original si0e
'carring that occurs parallel to the line'carring that occurs parallel to the lineof force of a structure is less vulnerableof force of a structure is less vulnerableto re"injury than a scar$ which isto re"injury than a scar$ which isperpendicular to those lines of forceperpendicular to those lines of force
8/9/2019 Healing Process
17/25
Muscle healingMuscle healing
The capacity of muscle forThe capacity of muscle for
regeneration is based primarily uponregeneration is based primarily upon
the type and etent of injurythe type and etent of injury 7roadly speaking$ there are three7roadly speaking$ there are three
phases in the healing process of anphases in the healing process of an
injured muscleinjured muscle
! The destruction phaseThe destruction phase
! The repair phaseThe repair phase
! The remodeling phaseThe remodeling phase
8/9/2019 Healing Process
18/25
!igament and tendon!igament and tendon
healinghealing Healing of ligaments and tendonsHealing of ligaments and tendons
generally can be broken downgenerally can be broken down
into four overlapping phasesinto four overlapping phases! I.I. HemorrhagicHemorrhagic
! II.II.In#ammatoryIn#ammatory
! III.III. ProliferationProliferation! I8.I8. *emodeling and maturation*emodeling and maturation
8/9/2019 Healing Process
19/25
"rticular cartilage"rticular cartilage
healinghealingThe capacity of articular cartilageThe capacity of articular cartilage
for repair is limitedfor repair is limited
The repair response of articularThe repair response of articularcartilage varies with the depth ofcartilage varies with the depth of
the injurythe injury
8/9/2019 Healing Process
20/25
"rticular cartilage"rticular cartilage
healinghealing Injuries of the articular cartilageInjuries of the articular cartilage
that do not penetrate thethat do not penetrate the
subchondral bone becomesubchondral bone becomenecrotic and do not healnecrotic and do not heal
These lesions usually progress toThese lesions usually progress to
the degeneration of the articularthe degeneration of the articularsurfacesurface
8/9/2019 Healing Process
21/25
"rticular cartilage"rticular cartilage
healinghealing Injuries that penetrate theInjuries that penetrate the
subchondral bone undergo repairsubchondral bone undergo repair
due to access to the bone9s blooddue to access to the bone9s bloodsupplysupplyThese repairs are usuallyThese repairs are usually
characteri0ed ascharacteri0ed as
! (ibrous(ibrous! (ibrocartilaginous(ibrocartilaginous
! Hyaline"like cartilaginousHyaline"like cartilaginous
8/9/2019 Healing Process
22/25
#one healing#one healing
The striking feature of boneThe striking feature of bone
healing$ compared to healing inhealing$ compared to healing in
other tissues$ is that repair is byother tissues$ is that repair is bythe original tissue$ not scar tissuethe original tissue$ not scar tissue
7one healing involves a7one healing involves a
combination of intramembranouscombination of intramembranousand endochondral ossicationand endochondral ossication
8/9/2019 Healing Process
23/25
#one healing#one healing
In classic histologic terms$In classic histologic terms$
fracture healing has been dividedfracture healing has been divided
into two broad phasesinto two broad phases! Primary fracture healingPrimary fracture healing
! 'econdary fracture healing'econdary fracture healing
8/9/2019 Healing Process
24/25
#one healing#one healing
Primary healing involves a directPrimary healing involves a direct
attempt by the corte toattempt by the corte to
reestablish itself once it hasreestablish itself once it hasbecome interruptedbecome interrupted
7one on one side of the corte7one on one side of the corte
must unite with bone on the othermust unite with bone on the otherside of the corte to reestablishside of the corte to reestablish
mechanical continuitymechanical continuity
8/9/2019 Healing Process
25/25
#one healing#one healing
'econdary healing involves'econdary healing involves
responses in the periosteum andresponses in the periosteum and
eternal soft tissues with theeternal soft tissues with thesubse:uent formation of a callussubse:uent formation of a callus
The majority of fractures heal byThe majority of fractures heal by
secondary fracture healingsecondary fracture healing