Soft Tissue Injury Mechanics and Healing Quiz

Soft Tissue Healing

• Soft tissue healing is a multi-stage process involves different phases
• The presentation discusses the phases of soft tissue healing: inflammatory, proliferative, and remodeling
• The presentation also covers the various soft tissue lesions and the different grades of sprains and strains
• Healing times vary depending on the tissue and grade: muscles (0-3 days to 3-12 weeks), tendons (3-7 weeks to 3-6 months), ligaments and sprains (2-8 weeks to 6-12 months), meniscus/labrum (3-12 months), and fractures (6-8 weeks)

Objectives

• Students should understand different types of soft tissue lesions
• Students should know the different phases of soft tissue healing, in order to provide appropriate treatment recommendations for each phase
• Students should understand the PEACE acronym for managing soft tissue injuries
• The acronym PEACE stands for Protection, Elevation, Avoid anti-inflammatories, Compression, and Educaiton

Soft Tissue Lesions

• Stain: Damage to the musculotendinous unit
• Sprain: Damage to joint capsule or ligaments
• Dislocation: Complete displacement of a joint
• Subluxation: Partial displacement of a joint
• Tendinopathy: Damage to the tendon caused by repeated mechanical stress
• Synovitis: Inflammation of the synovial membrane
• Hemarthrosis: Bleeding into a joint
• Bursitis: Inflammation of the bursa
• Contusion: Bruising caused by trauma

Grades of Sprain/Strain

• Grade 1: Stretching or microscopic tears; minimal swelling, localized pain, and almost normal range of motion (ROM)
• Grade 2: Partial tear; moderate swelling, bruising, loss of ROM, and significant pain
• Grade 3: Complete tear; severe pain, swelling, bruising, and loss of ROM

Healing Times by Grade

• A chart specifying tissue type, what caused the injury (exercises, tendonitis etc), and how long healing will take for each grade

Soft Tissue Repair

• Inflammatory Phase: Assess the damage, clear damaged tissue, and lasts 4-6 days to 2 weeks
• Proliferative Phase: Begin repairs, limited circulation (4-24 days, up to 6 weeks in e.g. tendons) lasts 3 weeks to 2 years depending on tissue and damage grade.
• Remodeling Phase: Maturation of scar tissue, contracture of scar tissue, remodeling from Type III to Type I collagen, collagen aligns to stress, and no inflammation signs

Stages of Wound Healing

• The presentation includes an image of a graph visually representing different phases of healing: inflammation (4-6 days), proliferation (4-24 days), and remodeling (21 days to 2 years)

Inflammatory Phase

• Tissue response includes chemical signals (e.g., histamine, bradykinin) that induce changes in the blood vessels and create an edema
• Include chemotaxis where immune cells travel to the injury site
• Phagocytosis which involves the removal of tissue debris and pathogens
• Clinical signs may involve redness, swelling, heat, pain, and reduced movement because of pain

Inflammatory Phase Management Considerations

• Control stress to the injured tissue, using i.e. Protection
• Reduce swelling and control inflammation but do not interfere with the natural inflammatory response.
• Pain assessment for treatment plan and guidance
• Use PEACE guidance to provide an outline for managing the injury

PEACE

• Protection – Avoid actions that increase pain
• Elevation – Elevate injured limb above the heart
• Avoid anti-inflammatories– Do not use anti-inflammatories as they impede healing
• Compression – Use elastic wraps or bandages
• Education - Let the body heal itself

Proliferative Phase

• Capillary bed growth, collagen formation (Type III) and granulation tissue formation
• Pain occurs in correlation to tissue resistance as healing progresses.
• Tissue healing proceeds as inflammation reduces.
• LOVE acronym is used to aid in considerations during this phase: Load, Optimism, Vascularisation, Exercise

LOVE

• Load – increase stress to tissues based on pain tolerance guides your gradual return to normal activities
• Optimism – promotes recovery by being confident and positive
• Vascularisation –Choose activities to increase blood flow
• Exercise –Restore mobility, strength, and proprioception

Remodeling Phase

• Maturation of scar tissue, contracture of scar tissue, remodeling of Type III to Type I collagen and the collagen aligning to stress
• No inflammation
• Pain is end-range resistance
• Managing the remodeling phase involves progressive stress/increase in load, intensity and frequency of activities and movements

Factors Affecting Healing

• Lifestyle factors (diet, activity levels, stress, and smoking/alcohol usage)
• Comorbidities (e.g., age, obesity, diabetes, and immunocompromised conditions)

Application

• Cases provided in presentation will involve the use of appropriate phases/grades and recommendations
• Presentation discusses identifying phases of healing for each case.