1
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2
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3
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- Cardinal signs of inflammation
- Swelling (tumor)
- Heat (calor)
- Redness (rubor)
- Pain (dolor)
- Loss of function
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4
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- Inflammation is good, swelling is bad.
- Common causes of inflammation:
- Trauma (Sprains)
- Bone Fractures
- Foreign bodies (Splinter)
- Bacterial invasions
- Decreased blood supply
- Bacteria & fungi
- Burns
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5
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- Inflammatory- Response Phase
- Fibroblastic-Repair Phase
- Maturation-Remodeling Phase
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6
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7
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8
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9
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- Symptoms Include Swelling, Pain, Warmth, and Crepitus
- Direct Destruction Of Soft Tissue Cells
- Vascular Reaction
- Cellular Reaction
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10
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11
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12
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- Histamine Vasodilation
& Cell Permeability
- Leucotaxin Margination (Leukocytes
Line Cell Wall) & Cell Permeability Forming Exudate
- Necrosin Turns On Phagocytes
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13
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14
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- Injured Area Is Walled-Off
- Leukocytes Phagocytize Foreign Debris
- Sets Stage For Fibroblastic-Repair Phase
- Lasts 2-4 Days After Initial Injury
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15
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- Occurs When Acute Response Does Not Eliminate Injuring Agent
- Leukocytes Replaced By Macrophages, Lymphocytes, and Plasma Cells
- Specific Mechanism Which Causes Conversion Is Unknown
- Overuse or Overload With Cumulative Repetitive Microtrauma
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16
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17
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- Proliferative, Regenerative Activity Which Leads To A Period Of Scar
Formation (Fibroplasia) And Repair Of Injured Tissue
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18
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- Begins Within The First Few Hours Following Injury
- Signs Of Inflammation Subside
- Pain and Tenderness To Touch
- May Last 4-6 Weeks
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19
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- Growth of Endothelial Capillary Buds Into the Area
- (Stimulated By Lack of Oxygen)
- Increased Blood Flow
- Increased delivery of Essential Nutrients for Tissue Regeneration
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20
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- Breakdown of Fibrin Clot
- Formation of Granulation Tissue
- (Fibroblasts,Collagen,Capillaries)
- Fibroblasts Accumulate Along Capillary Beds
- Synthesizes Extracellular Matrix
- (Collagen,Elastin,Ground Substance)
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21
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- Fibroblasts Begin Producing Collagen Which Is Deposited Randomly
Throughout the Scar
- Tensile Strength Increases Proportionally To Collagen Synthesis
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22
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- Formation of Minimal Scar
- Increase in Tensile Strength and a Decrease in the Number of Fibroblasts
Signals the Beginning of the Maturation-Remodeling Phase
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23
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- Persistent Inflammatory Response Causes Extended Fibroplasia and
Fibrogenesis
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24
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- Realignment of Collagen Fibers Along Lines of Tensile Force
- Ongoing Breakdown/Synthesis of Collagen
- Increase in Tensile Strength of Scar Matrix
- At 3-weeks a Contracted, Non-vascular Scar Exists
- May Require Several Years To Complete
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25
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- Wolff’s Law - Bone and Soft Tissue Will Respond to the Physical Demands
Placed on Them Causing Them to Remodel Along Lines of Tensile Force
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26
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27
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- Decreases Scar Formation
- Increases Revascularization
- Facilitates Muscle Regeneration
- Reorientation of Muscle and Ligament Fibers
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28
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29
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- Use Aggressive Active ROM Exercises
- Use Pain and Increased Swelling as Guides
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30
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- Atrophy
- Corticosteroids
- Keloids and Hypertrophic Scars
- Infection
- Humidity, Climate
- Age, Health, Nutrition
- Extent of Injury
- Edema
- Hemorrhage
- Poor Vascular Supply
- Separation of Tissue
- Muscle Spasm
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31
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32
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33
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- Controlling Edema
- Modulating Pain
- Facilitating Healing
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34
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35
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36
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- Protection
- Restricted Activity
- Ice
- Compression
- Elevation
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37
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- Protect From Additional Injury By Applying Appropriate Splints, Pads,
Braces, or Other Immobilization Devices
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38
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- Allow the Inflammatory-Response Phase to Do What It Is Supposed To
Without Interfering
- Rest Does Not Mean Do Nothing!
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39
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- Decreases metabolism To Control Secondary Hypoxic Injury
- Analgesia
- Possibly Cause Vasoconstriction
- Use for 20 Minutes - 1 Hour
- Use Ice Bags, Ice Packs, Cryocuff
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40
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- Mechanically Reduces Space For Swelling To Accumulate
- Use An Elastic Wrap and Compression Dressing For At Least 72 Hours
- Use Intermittent Compression, Cryocuff, Elastic Wraps
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41
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- Reduces Pooling of Blood in the Extremities
- Facilitates Venous and Lymphatic Drainage
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42
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- Cold Can Be Used For Analgesia
- Electrical Stimulating Currents May Also Be Used
- Low-Power LASER Has Been Recommended For Pain Modulation
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43
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- Low Intensity Ultrasound Can Be Effective In Facilitating The Healing
Process and Can Be Used Safely Immediately Following Injury
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44
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- As with First Aid Management, modalities should be used to control pain
and reduce swelling
- Cryotherapy should still be used to reduce likelihood of swelling
- Ice bags, cold packs, or ice
massages provide analgesic effects
- Heating an injury too soon is a bigger mistake than using ice on an injury for too
long
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45
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- Intermittent compression can decrease swelling by facilitating resorption
of the by-products of inflammatory process by lymphatic system
- Electrical stimulating currents and low-power laser can be used to help reduce
pain
- Incorporate active and passive ROM exercise
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46
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- Treatments may change from cold to heat
- Thermotherapy techniques may include
- hydrocollator packs, paraffin, warm whirlpool to increase circulation to the
injured area to promote healing
- Heat modalities can also produce some degree of analgesia.
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47
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- Intermittent compression can facilitate removal of injury by-products
- Electrical stimulating currents
assist process by
eliciting a muscle contraction inducing a muscle pumping action
- Electrical currents can be used for modulation of pain, as can
stimulation of trigger points with low-powered laser
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48
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- Continue to stress importance of ROM and strengthening exercises and
progress them appropriately during this phase
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49
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- Heating modalities are beneficial to healing
- Deep-heating modalities, ultrasound, shortwave and microwave diathermy used
to increase circulation
to deeper tissues
- Superficial heating modalities are less effective
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50
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- Electrical stimulating currents used both in pain modulation and to
stimulate muscle contractions
for increasing both ROM and strength
- Low-power laser used to modulate pain
- Role of controlled mobility
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51
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- Assist the Natural Healing Processes of the Body While Doing No Harm
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52
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