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Glossary of Terms A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W
Achilles tendinosis Degenerative process of the Achilles tendon often caused by increased activity, overuse, improper footwear, or tight hamstrings Analgesia The relief of pain Analgesic A pain-relieving effect with no loss of consciousness Annulus fibrosus A region of the intervertebral disk that provides support for the nucleus. The outer ring of fibrous material surrounding the nucleus of the intervertebral disks. Antagonists Muscles that produce body movement in opposing directions Anterior surface Surface at the front of the body, facing the examiner Antinociceptive Reducing sensitivity to painful stimuli by impairing nociceptors’ ability to transmit nociceptive signals to the brain Aponeurosis A flat sheet of fibrotendinous, collagen-based tissue which forms the site of attachment of flat muscles or corresponds to a zone of separation between muscles Apophysis A cartilaginous structure at the insertion of major muscle groups into bone that may be susceptible to overuse syndromes Arthrography A procedure in which a contrast medium is injected into a joint to outline soft tissues such as the meniscus in the knee or a torn structure such as the rotator cuff in the shoulder Arthroplasty Procedure to replace or mobilize a joint, typically performed by removing the damaged surfaces and replacing them with an implant. Total joint arthroplasty is replacement of both sides of the joint. Hemiarthroplasty replaces only one side of a joint. Arthroscopy A minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopaedic conditions. Articular cartilage The surface that covers the ends of bones that articulate with each other to form a joint Athletic trainer A qualified allied healthcare provider who is educated in the management of healthcare problems of athletes Avascular necrosis A condition in which cells die as a result of inadequate blood supply Avulsion fracture A fracture that occurs when a ligament or tendon pulls its bony insertion Axons The neuron's tail-like "wire," a long (0.1 - 2,000 mm), spider thread thin portion of the neuron that carries voltages between the neuron's input sites (concentrated on cell body and dendritic tree) and the neuron's outputs B Back pain A pain in the cervical, thoracic, lumbar or lumbo-sacral regions of the back, varying in sharpness and intensity Baseball finger or mallet finger Rupture of the extensor tendon at or near its insertion on the terminal phalanx caused by a sudden flexion force on the distal interphalangeal joint while the finger is actively extended; also known as mallet finger Biceps tendinitis Inflammation of the biceps tendon in its subacromial location Biceps tendinosis Degenerative process of the biceps tendon usually resulting from overuse Biomechanics The study of external and internal forces applied to the body and their relationship to stability and motion Bipolar electrocoagulation Therapeutic use of a high-frequency electric current to induce the coagulation and ablation of tissue when the electrical current passes between two tips of a handpiece Bunion Prominence of the first metatarsal head often associated with lateral shift of the great toe (hallux valgus deformity) Bursa A sac formed by two layers of synovial tissue that is located where there is friction between tendon and bone or skin and bone Bursitis Inflammation of a bursa C Calcaneus Heel bone Callus A buildup of the keratin layer from repetitive friction or injury; frequently occurs on the plantar surface of the foot around the great toe Capillaries Small, thin-walled blood vessels that have close contact with individual cells of the body Capsule A collagenous structure that surrounds a joint like a sleeve. The capsule allows motion of joints and protects the articular cartilage. The capsule, along with ligaments, tendons, and bony structure, provides stability to the joint. Carpal tunnel syndrome Median nerve compression at the wrist that is characterized by pain, numbness, and weakness in the median nerve distribution of the hand Cartilage (articular) A low-friction cellular tissue that coats joint surfaces Cavus Excessive height of the longitudinal arch of the foot Cervicalgia Neck pain; diiscomfort or more intense forms of pain that are localized to the cervical region Cervical lordosis Forward curvature of the cervical spine Chondroblasts The cells that form cartilage Chondrocytes The cells in cartilage Chondromalacia Softening of the articular surface that results from exposure of normal cartilage to excessive pressure or shear Chronic Back pain Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine. Chronic rotator cuff tear Tear of the rotator cuff of the shoulder resulting from degeneration within the rotator cuff tendon Clavicle The collarbone Collagen A triple helix protein that is the major structural macromolecule of the extracellular matrix of articular cartilage; found also in bone, tendon, and ligament Collagen Denaturation Collagen can be denatured upon raising the temperature. When collagen is heated, the heat-labile intramolecular crosslinks are broken, and the protein undergoes a transition from a highly organized crystalline structure to a random, gel-like state (denaturation). The denaturation process is initiated through destruction of heat-labile hydrogen bonds. Conduction of Heat Transfer of heat from a warmer to a cooler object Condyle A rounded process at the end of a long bone Connective tissue Tissue that connects and supports the structures of the body Contusion Bruise; injury to soft tissue without a break in the skin Coracoacromial arch A structure formed by the acromion process and the coracoacromial ligament; comprises the anterolateral roof of the shoulder Coracobrachialis A muscle that assists in flexion and adduction of the shoulder Coronal plane A coronal plane is any plane of section in the anatomical position that passes vertically through the body and is perpendicular to the median plane. It divides the body into anterior and posterior sections. Cortical bone Dense bone that is responsible for skeletal homeostasis Corticosteroids Cortisone-like medicines that are used to provide relief for inflamed areas of the body. They lessen swelling, redness, itching, and allergic reactions. Short-term side effects are uncommon but include shrinkage (atrophy) and lightening of the color (depigmentation) of the skin at the injection site, introduction of bacterial infection into the body, local bleeding from broken blood vessels in the skin or muscle, soreness at the injection site, and aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (postinjection flare). Tendons can be weakened by corticosteroid injections in or near tendons. Tendon ruptures as a result have been reported. In people who have diabetes, cortisone injections can elevate the blood sugar. In patients with underlying infections, cortisone injections can suppress the body's ability to fight the infection and possibly worsen the infection or may mask the infection by suppressing the symptoms and signs of inflammation. Generally, cortisone injections are used with caution in people with diabetes and avoided in people with active infections. Cortisone injections are used cautiously in people with blood-clotting disorders. Long-term side effects of corticosteroid injections depend on the dose and frequency of the injections. With higher doses and frequent administration, potential side effects include thinning of the skin, easy bruising, weight gain, puffiness of the face, elevation of blood pressure, cataract formation, thinning of the bones (osteoporosis), and a rare but serious damage to the bones of the large joints (avascular necrosis). cRF Continuous Radiofrequency, a modality of RF in which energy is delivered without interruption with the objective of generating high/ablative temperatures in tissue, usually small nerve fibers. Denaturation The alteration of the basic nature or structure of a substance Diaphysis The shaft of a long bone Diathermy Therapeutic measure used in medicine to generate heat in the body tissues. Electrodes and other instruments are used to transmit electric current to surface structures and its effect is similar to those of heat-packs, infrared light, and therapeutic ultrasound Dislocation Complete disruption in the normal relationship of two bones forming a joint (ie, no contact of the articular surfaces) Distal Location in an extremity nearer the free end; location on the trunk farther from the midline or from the point of reference Dorsal Toward the posterior surface of the body Dorsal Root Ganglion (DRG) A swelling consisting of sensory neuron cell bodies whose axons constitute the dorsal root of a spinal nerve Ecchymosis Bruising or discoloration associated with bleeding within or under the skin Edema Condition in which fluid escapes into the tissues from vascular or lymphatic spaces and causes local or generalized swelling Effusion The presence of fluid within a joint Electrocoagulation Is the therapeutic use of a high-frequency electric current to induce the coagulation and ablation of tissue. Electrocoagulation is quickly followed by a wound healing response, which is, in many occasions, the desired outcome. Electromyography (EMG) A test that measures the electrical response of muscle contraction Epitenon A glistening, synovial-like membrane that envelops the tendon surface Erythema Redness of the skin Exostosis A spur or bony overgrowth Extension Movement of an extremity posterior to or behind the body Extensor A muscle, the contraction of which causes movement at a joint with the consequence that the limb or body assumes a more straight line, or so that the distance between the parts proximal and distal to the joint is increased or extended; the antagonist of a flexor External rotation Lateral rotation of an extremity relative to the body Extracorporeal Shock Wave Therapy (ESWT) A treatment developed to relieve the pain associated with calcifying tendinitis and heel spur; In the US, is only FDA approved as “indicated for the treatment of chronic proximal plantar fasciitis for patients 18 years of age or older with symptoms for 6 months or more and a history of unsuccessful conservative therapy” Facet joint Also known as the zygapophyseal joint; is the synovial joint between the articular processes (facets) of the vertebral bodies Fascia Sheet or band of tough fibrous connective tissue; lies deep under the skin and forms an outer layer for the muscles Fasciotomy Incision of the fascia Flexion Movement of an extremity anterior to or in front of the body Flexor A muscle the action of which is to flex or bend a joint Fluoroscopy A special type of radiograph that shows real time motion of the structure, such as neck motion Foramen The space between the pedicles of two adjacent vertebrae through which the nerve root exits at each level in the spine Fracture A disruption in the integrity of a bone Fracture-dislocation A fracture of bone associated with a dislocation of its adjacent joint Frozen shoulder A condition characterized by restricted shoulder movement G Gamekeeper's thumb Rupture of the ulnar collateral ligament of the thumb Ganglia A mass of nerve cell bodies usually found lying outside the central nervous system Genu (knee) Genu valgum is knock-knee deformity; genu varum is bowleg deformity Gerdy's tubercle The attachment site for the iliotibial band Glenohumeral dislocation (shoulder dislocation) Injury in which the humeral head may displace from the joint Glenohumeral instability Excessive shoulder laxity accompanied by pain or feelings of instability Greater trochanter Broad, flat process at the upper end of the lateral surface of the femur to which several muscles are attached H Hallux The great toe Hallux rigidus A painful loss of motion of the great toe metatarsophalangeal joint caused primarily by arthrosis Hallux valgus Deformity at the first metatarsophalangeal joint where the proximal phalanx deviates laterally; also known as a bunion Hammer toe Flexion deformity of the distal interphalangeal joint of the foot Hamstrings Three muscles in the posterior region of the buttock and thigh that provide an extension force at the hip and a flexion force at the knee Heat-shock Rapid, precise application of heat at the injured site Heat Shock Generator Alpha Orthopaedics' AT3 device Heat-Shock Proteins (HsPs) An intracellular protein that increases in concentration during metabolic stress, such as exposure to heat. HsPs affect protein assembly, folding, sorting, and uptake into organelles. There are various kinds of HsPs, each performing different functions. Heel Spur An abnormal growth in the heel bone (calcaneous) due to calcium deposits that form when the plantar fascia pulls away from the heel. Heel spurs are commonly associated with plantar fasciitis Hemarthrosis A collection of blood within a joint Hematoma A collection of blood resulting from injury Hemipelvis Bones located on each side of the sacrum; composed of the fused ilium, ischium, and pubis Hemiplegia Paralysis of one side of the body Heterotopic ossification The formation of bone in any nonosseous tissue; often occurs following trauma I Iliotibial band (ITB) syndrome An overuse injury where repetitive flexion and extension causes inflammation of the iliotibial band when it rubs over the lateral femoral condyle Impingement syndrome of the shoulder Shoulder pain caused by tendinosis of the rotator cuff tendon or irritation of the subacromial bursa. Inflammation A localized tissue response initiated by the injury of vascularized tissues Instability Looseness, unsteadiness, or an inability to withstand normal physiologic loading without mechanical deformation Internal rotation Medial rotation of an extremity relative to the body Interventional pain According to the American Society of Interventional Pain Physicians (ASIPP), interventional pain management is a "discipline of medicine devoted to the diagnosis and treatment of pain related disorders." Interventional pain medicine utilizes a multidisciplinary approach, in which a team of health care professionals works together, to provide a full range of treatments and services for patients suffering from chronic and/or acute pain. The goals of interventional pain management are to relieve, reduce, or manage pain and improve a patient's overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. Interventional pain management also strives to help patients return to their everyday activities quickly and without heavy reliance on medications. Intervertebral disk A fibrocartilaginous disk located between the bodies of each of the vertebrae Inversion injury of the ankle Ankle injury resulting from landing on the lateral aspect of the foot Ischemia Tissue deprived of a blood supply J Joint The junction between the ends of two adjacent bones Joint capsule A layer of collagen-based connective tissue that plays a crucial role in joint stability Jumper's knee Chronic tendinosis of the patellar tendon; frequently limited to the distal pole of the patella rather than being diffused throughout the tendon K Kyphosis Curvature of the spine that is convex posteriorly L Laminectomy A surgical decompression procedure in which part of the posterior arch of a vertebra is removed; allows access to the disk Lateral Lying away from the midline Lateral condyle Forms the lateral border of the upper surface of a joint Ligament A collagen-based tissue that connects two bones to stabilize a joint Longitudinal arch Arch along the long axis of the foot formed by the bones of the foot starting at the weight-bearing surface of the calcaneus and ending at the metatarsal heads Lordosis Curvature of the spine that is convex anteriorly M Mallet finger Rupture of the extensor tendon at or near its insertion on the terminal phalanx caused by a sudden flexion force on the distal interphalangeal joint while the finger is actively extended; also known as baseball finger mcRF Monopolar capacitive-coupled Radiofrequency, a modality of RF in which high-frequency energy is delivered through a capacitive coupled electrode. mcRF is capable of generating high temperatures in deep tissues that progressively may result in: initiating the inflammatory cascade as part of the wound healing response; deactivating (modulating) small nerve fibers (afferent nerves or nociceptors), coagulation of tissue. Medial Lying toward the midline Medial condyle Forms the medial border of the upper surface of a joint Medial epicondyle of the elbow A bony prominence located proximal and medial to the trochlea; serves as the attachment site for the flexor-pronator muscle group and the ulnar collateral ligament Meniscus A soft-tissue structure that lines some joints and provides load distribution, shock absorption, and lubrication Metacarpals The five bones of the hand that extend from the wrist to the fingers Metaphysis The broad portion of a long bone adjacent to a joint. In children, the broad portion of a long bone includes the epiphysis, the physis, and the metaphysis. Metatarsalgia Generalized pain in the forefoot Microtenotomy The procedure by which small incisions (via cut or coagulation of tissue) are made in a tendon with the objective of inducing an active wound healing response, a tendon release, and tendon lengthening among others Modalities Physical agents that can create an optimum environment for injury healing, while reducing pain and discomfort Monopolar electrocoagulation Therapeutic use of a high-frequency electric current to induce the coagulation and ablation of tissue when the electrical current passes from the active electrode to a return plate Morton's neuroma An interdigital neuroma of the foot causing pain, numbness, and tingling Muscles Contractile connective tissues that effect movement; a component of nearly all organs and body systems Myofascial pain syndrome A painful musculoskeletal condition Myofibers The fibers that constitute a muscle Myositis ossificans The formation of lamellar bone within muscle, often as a result of blunt trauma Myotomes The areas of muscle that are supplied by a particular nerve root N Nerve conduction studies Studies that test the speed by which motor, sensory, or mixed (combined motor and sensory) nerves transmit impulses Neuralgia Pain along the course of a nerve Neuropraxia A temporary loss of neural function Neuritis Inflammation or irritation of a nerve Neuroablation Destruction of nerve fibers Neurolysis Destruction or dissolution of nerve fibers Neuroma A tumor composed of nerve cells Neuromodulation Electrical stimulation of a peripheral nerve, the spinal cord, or the brain for pain relief Neuropathy An abnormal condition involving a peripheral nerve Neurotmesis Injury in which there is complete nerve disruption leading to the death of the distal axons Neurotoxic A substance poisonous to nerve tissue Nociceptive Pain-sensing Nonsteroidal anti-inflammatory drugs (NSAIDs) A broad group of chemically heterogeneous drugs that share important clinical and tissue effects: all have some analgesic, antipyretic, and anti-inflammatory activity. Includes aspirin, ibuprofen, indomethacin, naproxen, and others O Olecranon bursa Bursa in the elbow that separates the skin from the underlying ulna; allows the soft tissue to glide smoothly over the olecranon process Opiates A class of analgesic drugs that includes heroin, morphine, and codeine Origin The more fixed end or attachment of a muscle Osgood-Schlatter disease Partial avulsion of the tibial tubercle because the tubercle is subjected to traction forces by the patellar tendon insertion; also known as tibial osteochondrosis Osteoarthritis (OA) A deterioration of the weight-bearing surface of a joint distinguished by destruction of the hyaline cartilage and narrowing at the joint space Osteolysis Dissolution of bone, particularly as resulting from excessive resorption Osteomyelitis Infection of bone Osteophytes Overgrowth of bone, common in osteoarthritis and spinal stenosis Osteoporosis Deterioration of bone tissue resulting in an increased risk of fracture Overuse injury Any injury caused by repetitive sub-failure stress that surpasses the tissue's natural repair processes P Pain A sensory and emotional reaction precipitated by actual or anticipated injury Palmar The anterior surface of the forearm, wrist, and hand Paresthesias Abnormal sensations such as tingling, burning, or prickling Patella Kneecap Patellar tendinosis A condition that results in pain and deterioration of the patellar tendon without evidence of inflammation; a common problem in jumping sports Patellofemoral joint The joint between the patella and the femur Pelvis A bony ring, consisting of the sacrum, coccyx, and innominate bones, that connects the trunk to the lower extremities Periosteum A sleeve of connective tissue that surrounds the shaft of the bone and contributes to fracture healing Peripheral nerves Nerves throughout the body that carry information to and from the spinal cord Phalanges Bones making up the finger bones (three in each finger and two in the thumb) Physiatry Physical medicine and rehabilitation (PM&R), or physiatry, is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities Physiatrist A doctor of rehabilitation medicine who specializes in the comprehensive management of patients with impairments and disabilities and pain arising from neuromuscular, musculoskeletal, and vascular disorders Plantar The sole, or flexor surface, of the foot Plantar fasciosis Degenerative process of the plantar fascia, usually originated at its insertion on the plantar aspect of the calcaneous bone; a common cause of inferior heel pain Platelet Rich Plasma (PRP) An increase in the concentration of platelets (and their associated contents) in a given volume of plasma that is above the concentration found in whole blood Portable transcutaneous electrical nerve stimulation (TENS) unit A portable therapeutic modality that uses electrical stimulation to attempt to modulate pain, strengthen muscles, and enhance soft-tissue healing Posterior arch The posterior division of the vertebral column that includes the facet joints on either side of the arch and the spinous process pRF Pulsed Radiofrequency, a modality of RF in which energy is delivered with interruption of the energy cycle with the objective of exposing the target structure to neuro-modulating stimulus avoiding ablative temperatures Prolotherapy "Proliferative Injection Therapy" involves injecting an otherwise non-pharmacological and non-active irritant solution into the body (usually water), generally in the region of tendons or ligaments for the purpose of generating tissular healing responses Proprioception A sense or perception, usually at a subconscious level, of the movements and position of the body and especially its limbs, independent of vision; this sense is gained primarily from input from sensory nerve terminals in muscles and tendons (muscle spindles) and the fibrous capsule of joints combined with input from the vestibular apparatus Proximal Describes structures that are closer to the trunk Q Quadriceps tendinosis A condition that results in quadriceps tendon insertion pain just proximal to the patella; commonly occurs in running and jumping sports that involve changing directions R Radial styloid Bony prominence felt on the lateral (thumb) side of the wrist Radiculopathy Disease of the nerve roots Radiofrequency Radio-frequency energy is a form of electromagnetic energy. When applied to tissues, rapidly oscillating electromagnetic fields cause movement of charged particles within the tissue, and the resultant molecular motion generates heat Range of motion (ROM) The amount of movement available at a joint Recalcitrant Stubbornly resistant to treatment Referred pain Pain that is perceived in a different location from the location of pathology Reflex Fairly fixed pattern of response or behavior similar for any given stimulus; does not involve a conscious action Regeneration The production of tissue that is structurally and functionally identical to tissue damaged by injury Rehabilitation Restoration, following disease, illness, or injury, of the ability to function in a normal or near-normal manner Repair The replacement of damaged or lost cells and matrix with new cells and matrix that are not necessarily identical in structure and function to normal tissue RF Radiofrequency RICE A method of treatment of acute injury that is used to counteract the body's initial response to injury; RICE is an acronym for rest, ice, compression, and elevation Rotator cuff The rotator cuff is made up of four muscles and their tendons. These combine to form a "cuff" over the head of the humerus. The four muscles are supraspinatus, infraspinatus, subscapularis, and teres minor Sacroiliac joint The joint formed by the iliac and sacral bones as part of the pelvic ring Sacrum One of the three bones (sacrum and two pelvic bones) that make up the pelvic ring Scoliosis Lateral curvature of the spine Shin splints An overuse syndrome that results from cyclical loading at the posterior tibial and soleus muscle attachments onto the tibia; also known as posterior tibial stress syndrome Spinal cord Extension of the brain, composed of virtually all the nerves carrying messages between the brain and the rest of the body. It lies inside of and is protected by the vertebrae and the spinal column Spinal pain Back pain Spinal stenosis Narrowing of the canal housing the spinal cord; commonly caused by encroachment of bone Spine Column of 33 vertebrae extending from the base of the skull to the tip of the coccyx Scapular notch A structure formed by the convergence of the scapular spine with the glenoid and the coracoid processes; also known as the greater scapular notch Spinous process That part of each vertebra that can be palpated, as it lies just under the skin in the midline of the back Splint Device used to immobilize part of the body Sports medicine The practice of medicine that physicians, athletic trainers, paramedics, and other allied health professionals provide to athletes Sprain Partial or complete tear of a ligament Spur formation Degenerative and age-related changes in an attempt to auto-stabilize motion Sternum Breastbone Strain Partial tear of a muscle Strength The force or tension a muscle or muscle group can exert against a resistance in one maximal effort. Subcutaneous fat The layer of skin that insulates and protects the body Symptom Evidence of change in body functions apparent to the patient and expressed to the examiner on questioning Synovial fluid A fluid that has a very low coefficient of friction and provides lubrication and nutrients for joint chondrocytes T Team physician The physician who is the leader of the sports medicine team and oversees all aspects of the sports medicine program Tendinitis Any injury that produces an inflammatory response within the tendon substance Tendinopathy A pathological process impacting a tendon Tendinosis Tendinosis is an accumulation over time of small injuries that don't heal properly due to a failed wound healing response Tendinosis lesion Asymptomatic tendon degeneration caused either by aging or by cumulative microtrauma without inflammation Tendon A specialized type of collagen-based tissue that attaches muscle to bone. Tendons transmit forces of muscular contraction to cause motion across a joint Tennis elbow Tendinosis of muscle origins at the lateral epicondyle; also called lateral epicondylosis Thermal Shrinkage of Collagen Collagen shrinkage occurs through the cumulative effect of the unwinding of collagen’s triple helix, due to the destruction of the heat-labile intramolecular cross-links, and the residual tension of the heat-stable intermolecular cross-links Thermofascioplasty Alpha Orthopaedics AT2 System noninvasive electrocoagulation’s impact on fascias Thermomyoplasty Alpha Orthopaedics AT2 System noninvasive electrocoagulation’s impact on muscles Thermoplasty Alpha Orthopaedics AT2 System noninvasive electrocoagulation’s impact on tissue Thermotenoplasty Alpha Orthopaedics AT2 System noninvasive electrocoagulation’s impact on tendons Transcutaneous electric nerve stimulation (TENS or TeNS) Application of electrical current through the skin for pain control. The unit is usually connected to the skin using two or more electrodes Transverse plane Horizontal section of the body U Ultrasound (Ultrasonography) An imaging modality in which images are created from high-frequency sound waves V Valgus Angulation of a distal bone away from the midline in relation to its proximal partner. Genu valgum is a knock-knee deformity, with abduction of the tibia in relation to the femur. Can also be used to describe angulation of fractures or bony deformities. Varus Angulation of a distal bone toward the midline in relation to its proximal partner. Genu varum is a bowleg deformity, with adduction of the tibia in relation to the femur. Can also be used to describe angulation of fractures or bony deformities. Vertebral arch Part of the vertebra composed of the right and left pedicles and the right and left laminae; also called neural arch Vertebral column Segmented spinal column composed of 24 movable vertebrae, 5 fixed sacral vertebrae, and 4 fixed coccygeal vertebrae Visceral Pertaining to the inner abdominal structure and organs Visual Analog Scores (VAS) A measurement instrument that tries to measure a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured. For example, the amount of pain that a patient feels ranges across a continuum from none to an extreme amount of pain. From the patient's perspective this spectrum appears continuous; their pain does not take discrete jumps, as a categorization of none, mild, moderate and severe would suggest. It was to capture this idea of an underlying continuum that the VAS was devised. Operationally a VAS is usually a horizontal line, 100 mm in length; anchored by word descriptors at each end, the patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks. Volar Toward the anterior surface of the body Wound A wound is a disruption in the continuity of cells—anything that causes cells that would normally be connected to become separated. Wound healing is the restoration of that continuity Wound Healing Response (WHR) Wound healing is a biological process that looks to repair tissular damage. The WHR evolves in three distinct phases inflammation, proliferation, and remodeling. The inflammatory response is the cornerstone of the process and is dependent on the ability of the host to recognize the injury. The characteristics of the inflammatory phase include the appearance of neutrophils. If inflammation is delayed or stopped, the subsequent events are delayed or may not happen at all. The proliferative phase is the second phase of repair and is anabolic in nature. The proliferative phase generates granulation tissue. In this process, acute inflammation releases cytokines, promoting fibroblast infiltration of the wound site, then creating a high density of cells. Collagen is the major connective tissue protein produced and released by fibroblasts. The connective tissue physically supports the new blood vessels that form and endothelial cells promote ingrowth of new vessels. These new blood vessels are necessary to meet the nutritional needs of the wound healing process. The process of wound healing continues with remodeling or maturation phase and is the third phase in healing. After the third week, the wound undergoes constant alterations, known as remodeling, which can last for years after the initial injury occurred. Collagen is degraded and deposited in an equilibrium-producing fashion, resulting in no change in the amount of collagen present in the wound. The collagen deposition in normal wound healing reaches a peak by the third week after the wound is created. Contraction of the wound is an ongoing process resulting in part from the proliferation of specialized fibroblasts. Maximal tensile strength of the wound is achieved by the 12th week. |