The document discusses crush injuries to the hand, including:
- The anatomy of the hand and the tissues that can be damaged in a crush injury.
- Common causes of crush injuries like machinery, accidents, and collapsed buildings.
- Signs and symptoms include bleeding, fractures, pain and loss of mobility.
- Treatment depends on severity but involves wound care, splinting, and possibly surgery to repair damaged tissues.
- Complications can include infection, impaired mobility, and systemic issues if crushing persists for over 4 hours.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
This document provides an overview of leprosy (Hansen's disease), including:
- It is caused by Mycobacterium leprae bacteria and primarily affects the nerves and skin.
- Symptoms include discolored skin lesions and loss of sensation which can lead to injuries.
- It is classified based on severity and can be diagnosed via skin biopsy or smear.
- Treatment involves long-term multi-drug antibiotic regimens.
- Surgical procedures and orthotic devices can help address deformities caused by nerve damage.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
Arthrodesis refers to the surgical fusion of a joint. It is indicated for pain and instability in the joint. With improvements in joint replacement surgery, arthrodesis is now less commonly performed. It permanently relieves pain by fusing the bones and eliminating joint movement, at the cost of stiffness. The optimal positions for fusing different joints are described. Common complications include malposition and nonunion.
The document defines orthotics and prosthetics and describes common devices used for each. Orthotics are devices that support or immobilize parts of the body, like splints or braces, while prosthetics replace missing body parts like limbs. It provides details on various static and dynamic orthoses, including examples like knee braces or back supports. For prosthetics, it outlines the components of lower and upper limb prostheses and different suspension, joint, and terminal device options. The ideal orthosis or prosthesis is described as functional, fitting well, light weight, easy to use, acceptable cosmetically, and easily maintained or repaired.
1) The document discusses arthroplasty and physiotherapy management for arthroplasty procedures like total hip replacement and total knee replacement.
2) It covers topics like indications, types, surgical approaches, complications and post-operative physiotherapy management for regaining range of motion, strength and ambulation abilities.
3) The goal of physiotherapy is to achieve a pain-free and stable joint to allow for lower extremity weight bearing and functional activities.
Amputation,Stump care, phantom limb pain and gait training in lower limbHarshita89
1) Phantom limb pain and sensations are perceptions ranging from slight tingling to sharp pain that amputees feel in a limb that is no longer physically attached. It is estimated to affect 49-83% of amputees.
2) There are two main types of pain after amputation - incisional stump pain localized around the scar, and phantom pain felt in the amputated limb itself. Phantom pain can be crushing or tearing.
3) While phantom sensations often occur right after amputation, phantom pain may affect 8-10% of amputees initially but can persist for years in some cases. Stump pain is usually described as pressing, throbbing or burning.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
This document provides an overview of leprosy (Hansen's disease), including:
- It is caused by Mycobacterium leprae bacteria and primarily affects the nerves and skin.
- Symptoms include discolored skin lesions and loss of sensation which can lead to injuries.
- It is classified based on severity and can be diagnosed via skin biopsy or smear.
- Treatment involves long-term multi-drug antibiotic regimens.
- Surgical procedures and orthotic devices can help address deformities caused by nerve damage.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
Arthrodesis refers to the surgical fusion of a joint. It is indicated for pain and instability in the joint. With improvements in joint replacement surgery, arthrodesis is now less commonly performed. It permanently relieves pain by fusing the bones and eliminating joint movement, at the cost of stiffness. The optimal positions for fusing different joints are described. Common complications include malposition and nonunion.
The document defines orthotics and prosthetics and describes common devices used for each. Orthotics are devices that support or immobilize parts of the body, like splints or braces, while prosthetics replace missing body parts like limbs. It provides details on various static and dynamic orthoses, including examples like knee braces or back supports. For prosthetics, it outlines the components of lower and upper limb prostheses and different suspension, joint, and terminal device options. The ideal orthosis or prosthesis is described as functional, fitting well, light weight, easy to use, acceptable cosmetically, and easily maintained or repaired.
1) The document discusses arthroplasty and physiotherapy management for arthroplasty procedures like total hip replacement and total knee replacement.
2) It covers topics like indications, types, surgical approaches, complications and post-operative physiotherapy management for regaining range of motion, strength and ambulation abilities.
3) The goal of physiotherapy is to achieve a pain-free and stable joint to allow for lower extremity weight bearing and functional activities.
Amputation,Stump care, phantom limb pain and gait training in lower limbHarshita89
1) Phantom limb pain and sensations are perceptions ranging from slight tingling to sharp pain that amputees feel in a limb that is no longer physically attached. It is estimated to affect 49-83% of amputees.
2) There are two main types of pain after amputation - incisional stump pain localized around the scar, and phantom pain felt in the amputated limb itself. Phantom pain can be crushing or tearing.
3) While phantom sensations often occur right after amputation, phantom pain may affect 8-10% of amputees initially but can persist for years in some cases. Stump pain is usually described as pressing, throbbing or burning.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
The document discusses congenital club foot (CCF), also known as congenital talipes equinovarus (CTEV). CCF is a deformity occurring in the ankle, subtaloid, and mid-tarsal joints. There are several theories for its causes, and its severity depends on the degree of displacement, while resistance to treatment depends on soft tissue rigidity. The deformity can be categorized into four components: cavus, adductus, varus, and equinus (CAVE). Treatment aims to fully correct the deformity early on through non-operative methods like serial casting or the Ponseti method, which involves weekly manipulation and casting. Education of parents on care and follow-up is
Osteotomy is a surgical procedure that cuts or divides bone to improve the function of a limb or provide stability to a joint. It involves three stages - dividing the bone, immobilizing it to allow correction and realignment, and physiotherapy to restore full function. Different types of osteotomies like closing wedge, opening wedge, and oblique cuts are used to correct various bone deformities and dysfunctions. Post-surgery physiotherapy focuses on reducing pain and swelling, maintaining stability, and gradually improving range of motion and strength. Complications can include under or overcorrection of deformity, nerve damage, compartment syndrome, and non-union of bone.
Mallet finger, or drop finger, is a deformity of the finger caused by damage to the extensor tendon below the DIP joint, preventing straightening of the fingertip. It most commonly occurs in the long, ring, or small finger of the dominant hand in young males after the fingertip is forcibly bent backwards. Treatment depends on the severity of the injury but generally involves splinting the finger to keep the DIP joint straight as the tendon heals, usually for 6-8 weeks. Surgery may be needed for open injuries, large bone fragments, or if non-surgical treatment is unsuccessful. Complications can include an extensor lag deformity or swan neck deformity if not properly
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
Amputation is the surgical removal of a limb or part of a limb. It has been performed for centuries as a treatment for trauma, infection, tumors, and other conditions. The procedure involves carefully marking the incision site, administering antibiotics, ligating blood vessels, and creating a conical stump for prosthesis fitting. Factors like adequate blood supply, joint mobility, and wound healing must be considered when determining the appropriate amputation level. With modern techniques, amputation allows many patients to regain mobility and independence through prosthetic devices.
Orthosis are devices used to support weak joints and correct deformities. They work by applying three point pressure and distributing weight across a wide surface area. Common orthosis include ankle foot orthosis (AFO) which support the ankle and foot, knee ankle foot orthosis (KAFO) which stabilize the knee and lower leg, and hip knee ankle foot orthosis (HKAFO) which provide support from the hip to the foot. Orthosis are made of plastic or metal and their design depends on the joints needing support and the individual's condition.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
This document discusses total knee replacement (TKR) and the physiotherapy rehabilitation process. It covers pre-surgical physiotherapy focusing on strength and mobility. Post-surgical physiotherapy is divided into phases focusing initially on range of motion and strengthening, then adding balance and proprioception training. The goals and key exercises of each phase are outlined in detail over 12 weeks of recovery. Complications of TKR like infection, loosening and failure are also mentioned.
Hammer toes is a condition where the toe is bent at the middle joint, causing it to resemble a hammer. There are two types - flexible and rigid. Risk factors include genetics and wearing tight shoes. Symptoms are pain at the bent joint from corns. Causes include tight shoes putting pressure on the toe tendon. Treatment depends on whether the toe is flexible or rigid - orthotics for flexible toes and surgery for rigid toes.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
This document discusses physiotherapy approaches for various abdominal surgeries including appendicectomy, hernia repair, nephrectomy, and operations on the small and large intestine. It outlines common indications, surgical procedures, complications, and post-operative physiotherapy protocols for mobilization and rehabilitation. The physiotherapy aims to safely progress exercises away from the incision site and address any postoperative problems like pain, reduced lung function, or risk of blood clots through techniques like chest physiotherapy, positioning, early mobilization, and pain relief measures.
Golfer elbow, also known as medial epicondylitis, is an overuse injury caused by repetitive motions that place stress on the tendons where the forearm muscles attach to the inner bump of the elbow. The condition causes pain on the inner elbow and difficulty with wrist movement. It commonly affects people over 30 years old who participate in sports like golf or tennis that involve swinging motions, or those with occupations requiring strong gripping. Conservative treatment includes rest, anti-inflammatory medications, physiotherapy, and bracing to decrease stress on the tendons.
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
The document discusses several hand deformities including mallet finger, swan neck deformity, and boutonniere deformity.
Mallet finger is an injury where the distal phalanx is forcibly flexed, rupturing the extensor tendon and preventing extension of the distal interphalangeal (DIP) joint. Treatment involves splinting the DIP joint in extension for 6-10 weeks.
Swan neck deformity involves hyperextension of the proximal interphalangeal (PIP) joint and flexion of the DIP joint. It can be caused by tendon injuries or ligament laxity. Treatment focuses on stretching intrinsics and splinting to balance extension.
The anterior cruciate ligament (ACL) is commonly ruptured in the knee. It occurs from a twisting force on a bent knee and often accompanies injuries to other knee ligaments and meniscus. The ACL attaches the femur to the tibia and prevents anterior tibial displacement. Diagnosis involves physical exams like the Lachman and pivot shift tests and MRI. Treatment options are conservative rehabilitation or surgical reconstruction, with surgery recommended for athletes or those with instability. Reconstruction uses grafts fixed in the knee with screws or buttons. Post-op rehabilitation is needed to regain strength and function.
Spinal stabilization involves surgical procedures to treat acute spinal injuries and conditions by restoring vertebral alignment and removing bone fragments. The degree of stabilization depends on the severity of the problem. Surgery involves inserting instruments like screws and plates in the back to stabilize the spine and facilitate fusion after decompression. Minimally invasive procedures perform stabilization through small incisions without damaging muscles. Recovery takes around six months with limited activity and physical therapy starting in the first week.
The document discusses total knee replacement (TKR). It begins with the anatomy of the knee joint, which consists of three bones and three compartments. It then defines TKR as a procedure done when conservative management of conditions like osteoarthritis and rheumatoid arthritis have failed to restore mobility or relieve pain. Common indications for TKR include increasing age, obesity, female sex, trauma, and repetitive occupational trauma. The document outlines the evaluation and management of TKR, including the history of the procedure and post-operative rehabilitation.
The document discusses crush injuries to the hand, describing the anatomy of the hand, tendons, and zones of injury. It outlines the mechanisms, signs and symptoms, complications, management, and nursing care for crush injuries. Prevention strategies and specific injuries like Jersey finger and trigger finger are also reviewed.
The document provides an overview of hand trauma, including mechanisms of injury, approaches to patients, and management of various structural injuries like cutaneous injuries, tendon injuries, nerve injuries, bone injuries, and amputation and replantation. It outlines the anatomy, typical presentations, and treatment approaches for each type of injury. For example, it describes that extensor tendon injuries are divided into zones and discusses the presentations and management depending on the zone. The document emphasizes the importance of thorough history, physical exam, and imaging to properly diagnose hand injuries and optimize outcomes through appropriate treatment.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
The document discusses congenital club foot (CCF), also known as congenital talipes equinovarus (CTEV). CCF is a deformity occurring in the ankle, subtaloid, and mid-tarsal joints. There are several theories for its causes, and its severity depends on the degree of displacement, while resistance to treatment depends on soft tissue rigidity. The deformity can be categorized into four components: cavus, adductus, varus, and equinus (CAVE). Treatment aims to fully correct the deformity early on through non-operative methods like serial casting or the Ponseti method, which involves weekly manipulation and casting. Education of parents on care and follow-up is
Osteotomy is a surgical procedure that cuts or divides bone to improve the function of a limb or provide stability to a joint. It involves three stages - dividing the bone, immobilizing it to allow correction and realignment, and physiotherapy to restore full function. Different types of osteotomies like closing wedge, opening wedge, and oblique cuts are used to correct various bone deformities and dysfunctions. Post-surgery physiotherapy focuses on reducing pain and swelling, maintaining stability, and gradually improving range of motion and strength. Complications can include under or overcorrection of deformity, nerve damage, compartment syndrome, and non-union of bone.
Mallet finger, or drop finger, is a deformity of the finger caused by damage to the extensor tendon below the DIP joint, preventing straightening of the fingertip. It most commonly occurs in the long, ring, or small finger of the dominant hand in young males after the fingertip is forcibly bent backwards. Treatment depends on the severity of the injury but generally involves splinting the finger to keep the DIP joint straight as the tendon heals, usually for 6-8 weeks. Surgery may be needed for open injuries, large bone fragments, or if non-surgical treatment is unsuccessful. Complications can include an extensor lag deformity or swan neck deformity if not properly
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
Amputation is the surgical removal of a limb or part of a limb. It has been performed for centuries as a treatment for trauma, infection, tumors, and other conditions. The procedure involves carefully marking the incision site, administering antibiotics, ligating blood vessels, and creating a conical stump for prosthesis fitting. Factors like adequate blood supply, joint mobility, and wound healing must be considered when determining the appropriate amputation level. With modern techniques, amputation allows many patients to regain mobility and independence through prosthetic devices.
Orthosis are devices used to support weak joints and correct deformities. They work by applying three point pressure and distributing weight across a wide surface area. Common orthosis include ankle foot orthosis (AFO) which support the ankle and foot, knee ankle foot orthosis (KAFO) which stabilize the knee and lower leg, and hip knee ankle foot orthosis (HKAFO) which provide support from the hip to the foot. Orthosis are made of plastic or metal and their design depends on the joints needing support and the individual's condition.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
This document discusses total knee replacement (TKR) and the physiotherapy rehabilitation process. It covers pre-surgical physiotherapy focusing on strength and mobility. Post-surgical physiotherapy is divided into phases focusing initially on range of motion and strengthening, then adding balance and proprioception training. The goals and key exercises of each phase are outlined in detail over 12 weeks of recovery. Complications of TKR like infection, loosening and failure are also mentioned.
Hammer toes is a condition where the toe is bent at the middle joint, causing it to resemble a hammer. There are two types - flexible and rigid. Risk factors include genetics and wearing tight shoes. Symptoms are pain at the bent joint from corns. Causes include tight shoes putting pressure on the toe tendon. Treatment depends on whether the toe is flexible or rigid - orthotics for flexible toes and surgery for rigid toes.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
This document discusses physiotherapy approaches for various abdominal surgeries including appendicectomy, hernia repair, nephrectomy, and operations on the small and large intestine. It outlines common indications, surgical procedures, complications, and post-operative physiotherapy protocols for mobilization and rehabilitation. The physiotherapy aims to safely progress exercises away from the incision site and address any postoperative problems like pain, reduced lung function, or risk of blood clots through techniques like chest physiotherapy, positioning, early mobilization, and pain relief measures.
Golfer elbow, also known as medial epicondylitis, is an overuse injury caused by repetitive motions that place stress on the tendons where the forearm muscles attach to the inner bump of the elbow. The condition causes pain on the inner elbow and difficulty with wrist movement. It commonly affects people over 30 years old who participate in sports like golf or tennis that involve swinging motions, or those with occupations requiring strong gripping. Conservative treatment includes rest, anti-inflammatory medications, physiotherapy, and bracing to decrease stress on the tendons.
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
The document discusses several hand deformities including mallet finger, swan neck deformity, and boutonniere deformity.
Mallet finger is an injury where the distal phalanx is forcibly flexed, rupturing the extensor tendon and preventing extension of the distal interphalangeal (DIP) joint. Treatment involves splinting the DIP joint in extension for 6-10 weeks.
Swan neck deformity involves hyperextension of the proximal interphalangeal (PIP) joint and flexion of the DIP joint. It can be caused by tendon injuries or ligament laxity. Treatment focuses on stretching intrinsics and splinting to balance extension.
The anterior cruciate ligament (ACL) is commonly ruptured in the knee. It occurs from a twisting force on a bent knee and often accompanies injuries to other knee ligaments and meniscus. The ACL attaches the femur to the tibia and prevents anterior tibial displacement. Diagnosis involves physical exams like the Lachman and pivot shift tests and MRI. Treatment options are conservative rehabilitation or surgical reconstruction, with surgery recommended for athletes or those with instability. Reconstruction uses grafts fixed in the knee with screws or buttons. Post-op rehabilitation is needed to regain strength and function.
Spinal stabilization involves surgical procedures to treat acute spinal injuries and conditions by restoring vertebral alignment and removing bone fragments. The degree of stabilization depends on the severity of the problem. Surgery involves inserting instruments like screws and plates in the back to stabilize the spine and facilitate fusion after decompression. Minimally invasive procedures perform stabilization through small incisions without damaging muscles. Recovery takes around six months with limited activity and physical therapy starting in the first week.
The document discusses total knee replacement (TKR). It begins with the anatomy of the knee joint, which consists of three bones and three compartments. It then defines TKR as a procedure done when conservative management of conditions like osteoarthritis and rheumatoid arthritis have failed to restore mobility or relieve pain. Common indications for TKR include increasing age, obesity, female sex, trauma, and repetitive occupational trauma. The document outlines the evaluation and management of TKR, including the history of the procedure and post-operative rehabilitation.
The document discusses crush injuries to the hand, describing the anatomy of the hand, tendons, and zones of injury. It outlines the mechanisms, signs and symptoms, complications, management, and nursing care for crush injuries. Prevention strategies and specific injuries like Jersey finger and trigger finger are also reviewed.
The document provides an overview of hand trauma, including mechanisms of injury, approaches to patients, and management of various structural injuries like cutaneous injuries, tendon injuries, nerve injuries, bone injuries, and amputation and replantation. It outlines the anatomy, typical presentations, and treatment approaches for each type of injury. For example, it describes that extensor tendon injuries are divided into zones and discusses the presentations and management depending on the zone. The document emphasizes the importance of thorough history, physical exam, and imaging to properly diagnose hand injuries and optimize outcomes through appropriate treatment.
This document discusses the management of hand injuries and associated infections. Some key points:
- Hand injuries are common, usually affecting young males, and are often caused by domestic or work-related accidents. Proper treatment is important to prevent stiffness.
- Evaluation of hand injuries involves assessing wound characteristics, neurovascular status, and underlying bone or tendon injuries. Management principles aim to preserve the hand and restore function.
- Treatment depends on wound type but typically involves debridement, irrigation, splinting, antibiotics, and reconstruction of tendons, nerves or bone as needed. Complications can include infection, stiffness if not managed properly.
- Specific injuries like bites, foreign bodies, fingertip injuries
This document summarizes a seminar presentation on flexor and extensor tendon injuries of the hand. It begins with an introduction to tendon anatomy and zones of injury. It then describes the specific anatomy and function of flexor and extensor tendons. Flexor tendon injuries are discussed based on their zone of injury, with details on clinical examination, repair techniques, and postoperative rehabilitation protocols. Complications and the use of tendon grafts are also summarized. The document concludes with sections on extensor tendon anatomy, testing, and associated structures like the sagittal bands.
Trauma refers to physical injury caused by transfer of kinetic energy. A standardized protocol called Advanced Trauma Life Support (ATLS) exists for evaluating and treating trauma patients. It involves primary, secondary, and tertiary surveys to address life threats and identify injuries in a systematic manner. Common musculoskeletal injuries include fractures, dislocations, amputations, and soft tissue injuries. Proper splinting and hemorrhage control are important initial steps in management.
1. The document discusses normal wound healing which occurs in three phases - inflammatory, proliferative, and remodeling. The inflammatory phase begins immediately after injury and lasts 2-3 days.
2. It also discusses abnormal wound healing such as delayed healing and discusses managing acute wounds which involves thorough debridement to remove all contaminated and devitalized tissue.
3. The document provides details on the classification of wounds as tidy or untidy and discusses various types of wounds like bites, puncture wounds, and degloving injuries as well as their management.
Amputation is the complete removal of an injured or deformed body part. It is indicated for conditions like peripheral vascular disease, infection, trauma, tumors and diabetes. The goals of amputation are to remove diseased tissue, reduce morbidity/mortality, and allow for maximum independent function with prosthetics. Determining the appropriate amputation level considers factors like circulation, soft tissues, bone/joint condition and infection control. Techniques aim to debride nonviable tissue, close wounds primarily or with flaps/grafts, smooth bone edges and allow for rapid rehabilitation. Complications include non-healing, infection, phantom pain/sensation and contractures.
This document discusses fractures, including their definition, causes, types, clinical manifestations, diagnosis, management, and complications. It defines a fracture as a break in the continuity of bone structure. Fractures can be caused by trauma or pathology and are classified as open or closed, complete or incomplete. The clinical signs of a fracture include pain, swelling, deformity, and loss of function. Diagnosis involves history, physical exam, x-rays, and sometimes CT or MRI. Management focuses on realignment, immobilization, and rehabilitation through various methods like casting, traction, or surgery. Potential complications include delayed healing, nonunion, malunion, and infection.
fracture is the breakdown in the continutity of the bone alignment this has many types as the fracure this topic include its definition , etiology, pathophysiology, clinical menisfestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from fracture and for learning for their examination and knowledge purpose
Amputation is the complete removal of an injured or deformed body part. It is performed to treat conditions such as peripheral vascular disease, trauma, infection, tumors, and congenital anomalies. The goals of amputation are to remove diseased tissue, reduce morbidity and mortality from severe conditions, and allow for reconstruction to produce a functional end organ. Various techniques are used depending on the condition and location of the amputation. Postoperative management focuses on wound healing, pain management, rehabilitation, and prevention of complications.
This document discusses the treatment of severe injuries to the upper extremities, known as mangled extremity injuries. The goals of treatment are to preserve life, tissue, function, and reconstruct the extremity and restore the patient's function. Key principles include a multidisciplinary team approach, careful evaluation, a reconstructive plan tailored to the patient's needs, debridement of all non-viable tissue, rigid skeletal fixation, soft tissue coverage, and rehabilitation. Various classification scoring systems exist to evaluate injury severity.
The document provides information about amputation, including definitions, types, causes, indications, and management. It discusses the epidemiology of amputation globally and regionally. It describes the diagnostic evaluation and various types of amputations, including closed and open amputations. Post-operative care involves pain management, wound care, exercise and rehabilitation to improve mobility and self-care abilities. Nursing focuses on managing pain, promoting mobility and self-esteem, and preventing complications like infection.
TORNIQUET and its applications over the different parts of bodyAryanKushSharma1
The document discusses tourniquets, which are compressing devices used to control blood flow to limbs during surgery. It defines tourniquets and describes their parts and types, including non-pneumatic, pneumatic automatic and non-automatic varieties. Guidelines are provided for safe tourniquet application and use, including appropriate pressures and time limits to avoid complications like nerve damage, compartment syndrome and post-tourniquet syndrome. Special considerations are discussed for pediatric patients due to anatomical and physiological differences.
This document discusses compartment syndrome, including its definition, relevant anatomy, causes, pathophysiology, diagnosis, and treatment. Compartment syndrome is an elevation of pressure within a closed muscle compartment that restricts blood flow. The most common causes are tibial and forearm fractures. Diagnosis is based on pain disproportionate to the injury that increases with stretch, and measurement of intracompartmental pressure over 30 mmHg. The only effective treatment is urgent surgical fasciotomy to release the fascial compartment and restore blood flow. Early diagnosis and treatment are important to prevent permanent muscle and nerve damage.
Fractures are breaks in bone continuity that can range from complete breaks to incomplete breaks. Globally in 2000, there were an estimated 9 million new fragility fractures, including over 1.6 million at the hip. Fractures are classified based on their anatomic features such as type, comminution, location, and displacement. Other classifications include the AO classification system for long bones, Salter-Harris classification for pediatric physeal fractures, and the Gustillo-Anderson classification for open fractures. Clinical presentation of fractures involves symptoms of pain, swelling, deformity, and loss of function as well as signs found on examination and imaging studies. Management principles involve stabilization, reduction, fixation, exercise, and physiotherapy.
Dupuytren's contracture is a condition causing the fingers to bend towards the palm. It is caused by a thickening of the fascia in the palm. The initial symptom is a nodule in the palm that develops into cords pulling the fingers into the palm. Surgery is the main treatment and involves excising the diseased tissue and splinting the fingers in extension post-operatively to prevent recurrence of contractures. Complications can include complex regional pain syndrome or recurrence of contractures if splinting is not continued long-term.
The document discusses disorders of the upper limb, including the shoulder, elbow, wrist, and hand. It provides details on anatomy, common conditions such as frozen shoulder, lateral epicondylitis, carpal tunnel syndrome, and treatments including injections, physical therapy, and surgery. It comprehensively covers the assessment and management of various musculoskeletal issues in the upper extremity.
This document discusses the assessment and management of extensor tendon injuries. It begins by describing the anatomy of the extensor tendon system. It then discusses the classification of extensor tendon injuries by zone. Zone I injuries, known as mallet fingers, involve disruption of the extensor tendon over the distal interphalangeal joint, often from forced flexion. Zone I injuries are generally treated conservatively with immobilization. Surgical repair is recommended for open injuries or injuries to higher zones. The document provides guidance on examination, repair techniques, and post-operative mobilization for different types of extensor tendon injuries.
This document discusses the management of extensor tendon injuries. It begins by describing the anatomy of the extensor tendon system. It then discusses that extensor tendon injuries are common and need to be properly treated to avoid impairment. The document outlines how to examine and assess extensor tendon injuries, including taking history and testing range of motion and strength. It describes the different zones where injuries can occur and provides guidelines for managing injuries in each zone, including splinting or surgical repair depending on the severity of the injury. The goal is to provide guidance to properly treat extensor tendon injuries.
1. Cleft lip and palate is a common congenital deformity resulting from incomplete fusion of tissues in the face and palate during early embryonic development between 4-8 weeks.
2. Risk factors for cleft lip and palate include family history, certain ethnicities being more susceptible, male sex, environmental exposures like smoking and medications during pregnancy, and advanced parental age.
3. Surgical repair of cleft lip is usually done by 6 months of age, with cleft palate repair by 12 months. Multiple surgeries may be needed. Nursing care focuses on adequate nutrition, positioning, and reducing family anxiety regarding the condition
This document defines communication and outlines its key elements and types. It describes the communication process, which involves a sender, message, channel, receiver, feedback, context, and environment. It also lists several potential barriers to effective communication, including physical conditions, use of jargon, lack of attention, perceptual differences, physical and emotional barriers, language and cultural differences, and information overload. The document aims to help students understand communication and potential issues that can interfere with the transmission of intended meanings.
Microdactyly, macrodactyly and hemangioma.pptAmina Rajah
This document discusses three conditions - macrodactyly, microdactyly, and hemangioma. Macrodactyly is an abnormal enlargement of one or more digits. It can be static or progressive. Microdactyly is an abnormal smallness of the fingers or toes. Hemangiomas are benign vascular tumors, most commonly seen as "strawberry marks" in infants, appearing on the skin at birth. Management of these conditions may include surgery, physical therapy, or medications depending on the specific condition.
This document discusses epispadias, a rare congenital malformation where the urethra opens abnormally on the dorsal surface of the penis in males or between the clitoris and labia in females. It defines epispadias as the failure of the urethral tube to form properly on the dorsal side. The incidence is about 1 in 117,000 newborn boys and 1 in 484,000 girls. Surgical repair aims to reconstruct the genitalia and urethra. Post-operative nursing care focuses on monitoring urine output, pain management, and preventing complications like infection.
Fournier's gangrene is a rare necrotizing soft tissue infection that affects the genital and perineal areas. It is usually caused by a polymicrobial infection following a break in the skin or mucosa. It progresses rapidly and can cause sepsis, multi-organ failure, and death if not promptly treated with aggressive surgical debridement and broad-spectrum intravenous antibiotics. Even with treatment, Fournier's gangrene has a high mortality rate of around 90% due to its severe complications. Risk factors include diabetes, immunosuppression, trauma, and perineal infections.
Colporrhaphy is a surgical procedure to repair pelvic organ prolapse such as cystocele or rectocele. It repairs defects in the anterior or posterior vaginal walls by plicating the fascia with sutures and using mesh to reinforce the repair. The procedure is performed under anesthesia, either general or regional. It aims to restore prolapsed organs and relieve symptoms like incontinence and pain. Success rates are high at 85-90%, though complications can include infection, recurrent prolapse or mesh erosion.
This document provides information on various congenital hand deformities, including camptodactyly, clinodactyly, and prominent ears. Camptodactyly is a flexion deformity of the PIP joint that most commonly affects the little finger. It is classified into three types based on presentation and severity. Clinodactyly is a deviation of the digit in the radial or ulnar direction, often affecting the small finger. Prominent ears are characterized by an abnormally protruding pinna due to underdeveloped antihelix and concha. Management involves splinting or surgery depending on severity and age of presentation.
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This document provides an overview of transport across the cell membrane. It begins with an introduction to the importance of transport for cellular function and maintenance. It then describes the key components and functions of the cell membrane. The document outlines the different mechanisms of transport, including passive transport mechanisms like diffusion, osmosis, and facilitated diffusion that do not require energy. It also discusses active transport mechanisms like primary active transport, endocytosis, and exocytosis that move molecules against their concentration gradient with the use of cellular energy. The objectives are to describe the cell membrane, explain the different transport processes, and discuss the clinical implications of transport across the cell membrane.
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2. The hand, more than any other body part, enables man to control and manipulate
his/her surroundings. Some of the functions of the hand include:
Grasping
For Identification i.e Fingerprint
Sensation
To form precise movements, e.g. writing and sewing.
A means of communication e.g. Sign Language for the deaf
Pinching
For forensic purposes
3. The hand contains 27 bones.
Each one belongs to one of three
regions: the carpals, (wrist), the
metacarpals, (the palm), and the
phalanges (the digits).
4. Muscles acting on the hand
include:
Adductor Pollicis
Palmaris Brevis
Interossei
Lumbricals
Thenar
Hypothenar Muscles
5.
6. Crush injury is defined as compression of extremities or other parts
of the body that causes muscle swelling and/or neurologic
disturbances in the affected areas of the body, usually the
extremities.
Crush syndrome is the systemic manifestation of breakdown of
muscle cells caused by the compression, provoking the releasing of
cell components (creatine kinase, lactic acid, myoglobin, and
potassium) into the extracellular fluid. This
causes hypovolemia, hyperkalemia, metabolic acidosis, renal
hypoperfusion, and ischemia resulting in acute renal failure (ARF).
7. Crush Injury of the hand is sustained when the fingers, hand or
wrist are caught between two surfaces (sharp, blunt, smooth or
irregular) forcibly producing damage to the skin and its enclosed
contents of soft tissues and bone.
The degree of damage is proportional to the amount of force applied
per square inch and the duration the compression is in place.
The tissues that will be likely affected include skin, muscle, tendons,
bone, blood vessels, fascia and nerves.
8. Machineries in the industries
RTA
Agricultural injuries
Fall of heavy objects
Building collapse
The hand being trapped in a door.
9. Bleeding
Soft tissue damage
Fracture
Laceration
Loss of vascular integrity
Pain
Numbness
Decrease range of motion (difficulty moving)
Weakness
Pallor (pale or bloodless)
10. Depending on the severity of the crush injury, symptoms will differ. For a minor
injury, there can be bruising, lacerations and moderate pain, while for a major
crush, there is often serious damage below the skin, including tissues, organs,
muscles and bones.
When a major crush injury occurs, energy is transferred from an offending object
into the tissues and the tissues are stretched.
When tissues are stretched beyond their normal tolerance, damage occurs.
If compression continues over an extended time (typically longer than 4 hrs), the
muscle tissue will actually begin to break down and may cause systemic problems
by releasing toxins into the blood stream. These toxins can cause cardiac problem,
a drop in blood pressure and renal failure.
11. As the tissue is compressed, it is deprived of blood flow and becomes ischemic,
eventually leading to cellular death.
The time to injury and cell death varies with the crushing force involved; however,
skeletal muscle can often tolerate ischemia for up to 2 hr without permanent
injury.
This results in hypovolemia by hemorrhagic volume loss and the rapid shift of
extracellular volume into the damaged tissues. Acute renal failure (ARF) is caused
by hypoperfusion of the kidneys.
Return of circulation to the injured and ischemic area after rescue also results in
injury, as reperfusion leads to increased neutrophil activity and the release of free
radicals.
A second effect from pressure and reperfusion is the release of debris from the
damaged cells into the circulation.
Another complication of reperfusion is the development of compartment
syndrome.
12.
13.
14. Scene safety
Extrication (Rescue)
ABC of resuscitation
Arrest Bleeding
Amputated parts should never be discarded, they should be brought to the
hospital
Remove rings as soon as possible, as they may become stuck if the hand swells.
Remove any foreign bodies.
Immobilize potential fractures.
Elevate the involved extremities
Use ice to reduce swelling and for pain control
15. Excision of all devitalised structures
Salvaging of the potentially viable structures.
Debridement
Skeletal stabilisation: External fixators should be planned such that they do not
obstruct flap coverage
Revascularisation
Skin grafting
Flap cover
Nerve and tendon repairs or grafting and reconstruction .
16. ABC of resuscitation
History: History should include the following: When, How , Where, Age, Co-
morbidities, hand dominance and occupational history.
Assessment:
Assess circulatory status of the hand (using Doppler’s device, arteriography and
checking distal pulse)
Sensory assessment of the radial nerve, the median nerve and the ulnar nerve using
two-point discrimination in three locations.
Motor assessment:
Assessing potential tendon injuries: Check for flexion and extension of each finger at
each joint.
17. Examination: The principle of Life before Limb should be Applied.
Amputated Parts: Amputated parts should be cleaned with saline, wrapped in a moist
gauze and placed in a dry plastic bag. The bag should be placed in a container with ice.
Fluid Resuscitation
X-ray of the limb up to the point of compression
Clinical Photograph
Blood Transfusion
Medication: Antibiotics, Analgesics
Tetanus
Rehabilitation: maintain joint mobility, prevent adhesions and contractures and
enhance scar maturation.
18. Primary prevention of crush injury might be possible only via industrial safety
regulations, building codes, and injury prevention programs.
Once a crush injury has occurred, secondary prevention of crush syndrome may be
possible with timely management at the scene of injury and carried on through
field care, pre-hospital transport, and initial hospital care.
19. Acute Pain related to crush injury of the hand evidenced by pain score of 10 out of
10.
Ineffective Tissue Perfusion (Peripheral) related to decreased peripheral blood
flow to the hand evidenced by pulselessness.
Impaired Skin Integrity
Self-Care Deficit
Risk for Infection
21. A tendon is a tough, high-tensile-strength band of dense
fibrous connective tissue that connects muscle to bone.
Tendons are similar to ligaments; both are made
of collagen. Ligaments connect one bone to another,
while tendons connect muscle to bone.
Tendons are strong cords that connect muscles to bone.
When muscles contract, their tendon(s) pull through
the attachments to bone and cause a joint to move.
22. Tendons are composed
of approximately 90% to
95% of tenoblasts and
tenocytes, with the
remaining 5-10%
consisting of
chrondrocytes at the
bone attachment.
23. Tendon Injuries are traumatic injuries to the tendons that can be caused by
laceration or trauma.
Stages of Tendon Injury Healing
1. Inflammatory stage (48–72 hours) – inflammatory cells move into the site of
injury. They increase vascular permeability, initiate angiogenesis and stimulate
proliferation of tenocytes.
2. Proliferation stage (5 days to 4 weeks) – fibroblastic and collagen-producing
cells enter and proliferate.
3. Remodelling stage (6 weeks onwards) – tissue repair and fibrosis occur. Over
time, the fibrous tissue is replaced by the scar-like tissue of the tendon.
24. FLEXOR TENDONS
Each finger has two flexor
tendons, the Flexor Digitorum
Profundus and the Flexor
Digitorum Superficialis and
the thumb has one (the Flexor
Pollicis Longus).
25. Zone I – distal to FDS insertion
Zone II – This extends from insertion of FDS up to
distal palmar crease. Zone II has been known as
“no man’s land” .
Zone III – Extends from distal palmar crease up to
flexor retinaculum.
Zone IV – This zone lies under flexor retinaculum
Zone V – Extends from proximal border of flexor
retinaculum to musculo-tendinous junction of
flexor muscles.
T 1 - distal to the interphalangeal joint (IP) in the
thumb
T 2 - between the metacarpophalangeal (MCP) and
interphalangeal (IP) joints
T 3 - proximal to the metacarpophalangeal (MCP)
to palmar flexion crease
26. Tendon Involved Deformity
Zone 1 FDP Jersey Finger
Zone 2 FDP and FDS Trigger Finger
Zone 3 neurovascular bundles Dupuytren’s Contracture
Zone 4 Carpal Tunnel and its contents (9 flexors
and Median Nerve)
Carpal Tunnel Syndrome
29. Zone 1 – DIP joint
Zone 2 – middle phalanx
Zone 3 – PIP joint
Zone 4 – proximal phalanx
Zone 5 – MCP joint
Zone 6 – metacarpal
Zone 7 – carpal and wrist joint
Zone 8 – distal forearm
Zone 9 – proximal forearm.
The anatomical zones in the thumb are:
Zone T1 – IP joint
Zone T2 – proximal phalanx
Zone T3 – MCP joint
Zone T4 – first metacarpal.
30. Mallet injuries (extensor zone I): Mallet fingers commonly result from closed
avulsion injuries.
31. Boutonniere deformity: zone 3
A Boutonniere deformity results from injury and disruption of the central slip at
the PIP joint.
32. Surgical repair is required if 60% or more of the flexor tendon is cut but,
deceptively, a tendon may be 70–90% lacerated and still functional.
Tendon repair is not an emergency; however, as time progresses the repair
becomes more difficult as the cut ends retract, tissue becomes more oedematous
and scarred, and the prognosis worsens.
Therefore, repair should ideally be carried out within 7 days of injury
The simplest repair technique is a two-strand approach called the Kessler
technique.
RICE
33. Patient education is critical in the management of tendon injuries.
Patients need to be aware of the necessary precautions. The wound needs to be
kept clean and dry.
The splint needs to stay on 24 hours a day, 7 days a week.
For a flexor injury, the patient needs to keep the fingers cupped with the wrist in
neutral if the splint is off. This position does not put any stretch or tension on the
tendons.
Therapy sessions are usually twice a week for the first two weeks post-surgery.
Thereafter, weekly sessions until around 10 weeks post-surgery.
34. Early complications – infection, pain, tendon rupture, pulley rupture and poor
tendon gliding.
Late complications – adhesions, stiffness, scarring and complex regional pain
syndrome.
35. NOVEMBER 2019, PAPER II
Mr. Onah, a 37 years old grinding machine operator and father of six (6) was rushed into
the emergency department with history of his right hand getting stuck in a moving
machine. He is obviously in extreme pain, and has an open wound. Diagnosis of crush
injury of the right hand is made after two (2) specific diagnostic procedures.
Define crush injury (1 mark)
Enumerate tissues that are likely to be affected in Mr. Onah’s hand (3 marks)
Explain two (2) possible diagnostic procedures that could aid the diagnosis of Mr. Onah
(3 marks)
Develop a nursing care plan to solve (3) nursing diagnoses of Mr. Onah (9 marks)
Highlight the advice to give Mr. Onah on discharge bearing in mind the nature of his job and
socioeconomic effect it will have on his family (4 marks)
36. Stewart, C. (2005). EMR textbook: Crush injuries. Retrieved February 4, 2007,
from http://www.wnysmart. org/References/Medical%20Subjects/Crush%20Injury.
Pdf
Tendon injuries: Basic science and new repair proposals. Available from:
https://www.researchgate.net/publication/318746365_Tendon_injuries_Basic_scien
ce_and_new_repair_proposals [accessed Feb 03 2022].
Griffin, M., Hindocha, S., Jordan, D., Saleh, M. & Khan, W. 2012. An overview of
the management of flexor tendon injuries. Open Orthop J, 6, 28–35.