This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Aquatic therapy refers to treatment and exercise performed in the water for relaxation and other therapeutic benefits.Typically a qualified aquatic therapist gives constant attendance to person receiving treatment in a heated therapy pool
The document provides energy conservation techniques for individuals experiencing fatigue, back pain, aging, or other conditions affecting their energy levels. It discusses pacing oneself, prioritizing tasks, sitting when possible, simplifying tasks, and maintaining good posture. Specific examples are given for grooming, dressing, showering, housework, cooking, grocery shopping, and home safety. The overall goal is to preserve physical function and promote wellness by breaking tasks into smaller, more manageable units and alternating between activity and rest.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
1. The document outlines the general management of ataxia through relaxation techniques, strengthening exercises, and fatigue reduction measures.
2. The goals of general physical therapy for ataxia are to prevent complications, treat symptoms like hypotonicity and dysmetria, improve muscle strength and range of motion, and provide education to patients.
3. Specific techniques discussed include relaxation, strength and cardiovascular conditioning, pain management, functional training, and flexibility exercises. Patient education is also emphasized.
Muscle re-education aims to regain normal muscle function through therapeutic techniques. It involves developing motor awareness, voluntary control, strength, endurance and safe, acceptable movement patterns. Key techniques to activate denervated or weak muscles include passive motion, cutaneous stimulation, electrical stimulation and EMG biofeedback. A thorough patient evaluation is required to determine the appropriate re-education program based on factors like joint mobility, alignment and available motor and sensory pathways.
The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system.
It is named after Berta Bobath, a physiotherapist, and her husband Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.
Procedure: in a “trial & error” fashion in 1948.
Concept of compensatory training.
Neglects the potential of hemiplegic side.
It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.
Therapist should have:
Good posture & movement analysis skills.
PRINCIPLES
NDT THERAPY WORKS
ALWAYS TREAT THE PATIENT AS A WHOLE
WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
TEAMWORK IS CRITICAL FOR REHAB PURPOSES
UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
TRANSFERENCE OF TRAINING IN DAILY LIFE
HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Aquatic therapy refers to treatment and exercise performed in the water for relaxation and other therapeutic benefits.Typically a qualified aquatic therapist gives constant attendance to person receiving treatment in a heated therapy pool
The document provides energy conservation techniques for individuals experiencing fatigue, back pain, aging, or other conditions affecting their energy levels. It discusses pacing oneself, prioritizing tasks, sitting when possible, simplifying tasks, and maintaining good posture. Specific examples are given for grooming, dressing, showering, housework, cooking, grocery shopping, and home safety. The overall goal is to preserve physical function and promote wellness by breaking tasks into smaller, more manageable units and alternating between activity and rest.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceSusan Jose
Here we present a widely used neurophysiotherapeutic approch - NDT, exploring its current principles and throwing a glance at the historical development and why it is being so widely practice.
does it really have that evidance base?
Find more as you click on. Give a like if I helped you learn or clear concepts. Thankyou. Love you all. Lets learn more.
1. The document outlines the general management of ataxia through relaxation techniques, strengthening exercises, and fatigue reduction measures.
2. The goals of general physical therapy for ataxia are to prevent complications, treat symptoms like hypotonicity and dysmetria, improve muscle strength and range of motion, and provide education to patients.
3. Specific techniques discussed include relaxation, strength and cardiovascular conditioning, pain management, functional training, and flexibility exercises. Patient education is also emphasized.
Muscle re-education aims to regain normal muscle function through therapeutic techniques. It involves developing motor awareness, voluntary control, strength, endurance and safe, acceptable movement patterns. Key techniques to activate denervated or weak muscles include passive motion, cutaneous stimulation, electrical stimulation and EMG biofeedback. A thorough patient evaluation is required to determine the appropriate re-education program based on factors like joint mobility, alignment and available motor and sensory pathways.
The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system.
It is named after Berta Bobath, a physiotherapist, and her husband Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.
Procedure: in a “trial & error” fashion in 1948.
Concept of compensatory training.
Neglects the potential of hemiplegic side.
It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.
Therapist should have:
Good posture & movement analysis skills.
PRINCIPLES
NDT THERAPY WORKS
ALWAYS TREAT THE PATIENT AS A WHOLE
WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
TEAMWORK IS CRITICAL FOR REHAB PURPOSES
UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
TRANSFERENCE OF TRAINING IN DAILY LIFE
HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
Upper Limb Prosthetics - Dr Om Prakashmrinal joshi
This document provides information on upper limb prostheses. It discusses the history of prosthetics, levels of amputation, types of prosthetic systems (passive, body-powered, externally powered, hybrid), components (socket, suspension, control mechanisms, terminal devices), and considerations for prosthetic selection and use. The key points are that upper limb loss can be devastating, prosthetics can replace some hand functions but not sensation, and the appropriate prosthesis depends on the amputation level, expected use, and individual factors.
The intention of this Slideshow presentation is to show the therapists the benefit of adding this modality into a typical massage session. Define, benefits, techniques, and end results are shown and demonstrated.
This document provides an overview of physiotherapy for geriatric patients. It discusses assessing patients, setting goals, and therapeutic interventions. The assessment involves a full history, physical exam, and evaluation of functional status. Goals aim to improve mobility, strength, and quality of life. Therapeutic interventions may include range of motion, stretching, strengthening, aerobic exercise, and gait training exercises. Orthotics and reassessment are also discussed.
The TUG test (Timed Up and Go) to predict falls riskJames Brinton
Timed Up and Go (TUG) Test is a timed test of standing and walking that is a predictor of falls risk.
It is s gait-speed test used to assess a person's mobility and requires both static and dynamic balance.
It is very simple to perform, involves very little equipment and takes very little time. The results is a predictor of falls risk.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Adaptive equipment enhances independence and safety for aging individuals by allowing them to complete activities of daily living in their own home. As our population ages, the goal is to promote aging in place with supports instead of moving to long-term care facilities. Adaptive devices ease the physical and mental strain on family caregivers by providing independence. Occupational therapists and other medical professionals can assist with obtaining and teaching how to properly use adaptive equipment which is covered by Medicare or private insurance in many cases.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
The document discusses core stability and core muscles. The core, or lumbo-pelvic-hip complex, consists of 29 muscles including the abdominal muscles, back muscles, and hip muscles. It is the center of gravity and where all movement originates. Core training exercises like planks, bridges, and exercises using a Swiss ball can improve posture, muscle balance, stabilization, and prevent low back pain by developing efficient neuromuscular control since all movement originates from the core. Sample exercises described are planks, bridges, planks on a Swiss ball, Swiss ball curls, supermans, and more.
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
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Ap facilitatory and inhibitatory techniqueAnwesh Pradhan
This document discusses several sensory motor approaches used in neurophysiotherapy, including Rood's approach, PNF, neurodevelopmental approach, sensory integration, and Brunnstrom's movement therapy. It provides details on the theoretical basis, principles, techniques, and strategies of each approach. Rood's approach focuses on normalizing muscle tone through sensory stimulation to produce purposeful movement. PNF uses techniques like manual contacts, stretch, and traction to stimulate proprioceptors and facilitate desired movement. The neurodevelopmental approach was developed by Bobath and aims to modify abnormal movement patterns.
Arthroplasty is a reconstructive surgery to restore joint motion and function or relieve pain by replacing damaged bone and joint surfaces with prosthetic implants. The document discusses various types of arthroplasty including hip, knee, and shoulder arthroplasty. It describes the principles of arthroplasty, techniques, approaches, and potential complications for each type of joint replacement surgery.
This document provides guidance on prescribing wheelchairs. It outlines the parts of a wheelchair, important considerations in evaluating patients, and goals of prescription. A proper evaluation involves medical history, physical exam, and functional assessment. Prescriptions are developed using tools like the SEAT checklist to address safety, comfort, and accommodation of needs over time. The goals of prescription include normalization of tone, improved function and mobility, and increased comfort and skin integrity.
The document discusses the rotator cuff, which is made up of four muscles and tendons that hold the humerus in the shoulder joint. Rotator cuff tears are a common cause of shoulder pain and disability. Tears can be classified based on timing (acute or chronic) and depth (partial or complete). Treatment for acute tears is usually surgical repair, while chronic tears may be treated with rest, physical therapy, and surgery if conservative treatment fails. Rehabilitation after repair focuses on protecting the repair while regaining range of motion and strength over 3 phases lasting 3-6 months.
Assessment of shoulder injuries in primary care Monis Khan
1. The document discusses common shoulder injuries seen in primary care including AC joint separations, clavicular fractures, shoulder dislocations, and proximal humeral fractures.
2. It provides details on the mechanism of injury, physical exam findings, appropriate imaging, management guidelines, and potential complications for each condition.
3. Special tests are described to clinically assess the rotator cuff muscles and identify injuries to the supraspinatus, infraspinatus, teres minor, and subscapularis.
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
Upper Limb Prosthetics - Dr Om Prakashmrinal joshi
This document provides information on upper limb prostheses. It discusses the history of prosthetics, levels of amputation, types of prosthetic systems (passive, body-powered, externally powered, hybrid), components (socket, suspension, control mechanisms, terminal devices), and considerations for prosthetic selection and use. The key points are that upper limb loss can be devastating, prosthetics can replace some hand functions but not sensation, and the appropriate prosthesis depends on the amputation level, expected use, and individual factors.
The intention of this Slideshow presentation is to show the therapists the benefit of adding this modality into a typical massage session. Define, benefits, techniques, and end results are shown and demonstrated.
This document provides an overview of physiotherapy for geriatric patients. It discusses assessing patients, setting goals, and therapeutic interventions. The assessment involves a full history, physical exam, and evaluation of functional status. Goals aim to improve mobility, strength, and quality of life. Therapeutic interventions may include range of motion, stretching, strengthening, aerobic exercise, and gait training exercises. Orthotics and reassessment are also discussed.
The TUG test (Timed Up and Go) to predict falls riskJames Brinton
Timed Up and Go (TUG) Test is a timed test of standing and walking that is a predictor of falls risk.
It is s gait-speed test used to assess a person's mobility and requires both static and dynamic balance.
It is very simple to perform, involves very little equipment and takes very little time. The results is a predictor of falls risk.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Adaptive equipment enhances independence and safety for aging individuals by allowing them to complete activities of daily living in their own home. As our population ages, the goal is to promote aging in place with supports instead of moving to long-term care facilities. Adaptive devices ease the physical and mental strain on family caregivers by providing independence. Occupational therapists and other medical professionals can assist with obtaining and teaching how to properly use adaptive equipment which is covered by Medicare or private insurance in many cases.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
The document discusses core stability and core muscles. The core, or lumbo-pelvic-hip complex, consists of 29 muscles including the abdominal muscles, back muscles, and hip muscles. It is the center of gravity and where all movement originates. Core training exercises like planks, bridges, and exercises using a Swiss ball can improve posture, muscle balance, stabilization, and prevent low back pain by developing efficient neuromuscular control since all movement originates from the core. Sample exercises described are planks, bridges, planks on a Swiss ball, Swiss ball curls, supermans, and more.
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
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Ap facilitatory and inhibitatory techniqueAnwesh Pradhan
This document discusses several sensory motor approaches used in neurophysiotherapy, including Rood's approach, PNF, neurodevelopmental approach, sensory integration, and Brunnstrom's movement therapy. It provides details on the theoretical basis, principles, techniques, and strategies of each approach. Rood's approach focuses on normalizing muscle tone through sensory stimulation to produce purposeful movement. PNF uses techniques like manual contacts, stretch, and traction to stimulate proprioceptors and facilitate desired movement. The neurodevelopmental approach was developed by Bobath and aims to modify abnormal movement patterns.
Arthroplasty is a reconstructive surgery to restore joint motion and function or relieve pain by replacing damaged bone and joint surfaces with prosthetic implants. The document discusses various types of arthroplasty including hip, knee, and shoulder arthroplasty. It describes the principles of arthroplasty, techniques, approaches, and potential complications for each type of joint replacement surgery.
This document provides guidance on prescribing wheelchairs. It outlines the parts of a wheelchair, important considerations in evaluating patients, and goals of prescription. A proper evaluation involves medical history, physical exam, and functional assessment. Prescriptions are developed using tools like the SEAT checklist to address safety, comfort, and accommodation of needs over time. The goals of prescription include normalization of tone, improved function and mobility, and increased comfort and skin integrity.
The document discusses the rotator cuff, which is made up of four muscles and tendons that hold the humerus in the shoulder joint. Rotator cuff tears are a common cause of shoulder pain and disability. Tears can be classified based on timing (acute or chronic) and depth (partial or complete). Treatment for acute tears is usually surgical repair, while chronic tears may be treated with rest, physical therapy, and surgery if conservative treatment fails. Rehabilitation after repair focuses on protecting the repair while regaining range of motion and strength over 3 phases lasting 3-6 months.
Assessment of shoulder injuries in primary care Monis Khan
1. The document discusses common shoulder injuries seen in primary care including AC joint separations, clavicular fractures, shoulder dislocations, and proximal humeral fractures.
2. It provides details on the mechanism of injury, physical exam findings, appropriate imaging, management guidelines, and potential complications for each condition.
3. Special tests are described to clinically assess the rotator cuff muscles and identify injuries to the supraspinatus, infraspinatus, teres minor, and subscapularis.
The document discusses reverse total shoulder arthroplasty (rTSA), including:
- The procedure reverses the ball and socket of the shoulder joint.
- It was approved for use in the US in 2004.
- The new design moves the center of rotation medially and inferiorly, increasing deltoid tension and function as the primary shoulder elevator.
- Indications include severe rotator cuff deficiency or previous TSA failure. Contraindications include infection or inadequate bone stock. Potential complications range from minor issues like stiffness or hematoma to more serious problems like prosthesis loosening or nerve damage.
PHYSIOTHERAPY MANAGEMENT OF ROTATOR CUFF TENDINOPATHYismailabinji
MANAGEMENT OF ROTATOR CUFF TENDINOPATHY
INTRODUCTION.
The rotator cuff are group of muscles and tendons that surround the shoulder joint, keeping the humerus bone firmly within the shallow socket of the scapular. A rotator cuff tendinopathy can cause a dull ache pain in the shoulder that worsens at night.
Physiotherapists has a fundamental role in the management of rotator cuff pathology, whether the choice is conservative or surgical treatment, inform of exercises and use of therapeutic modalities.
Exercise therapy program is tailored to each patient's capabilities at a given session the physiotherapist adjust exercise intensity as determined by the patient's ability.
This document provides information about tennis elbow, including its anatomy, etiology, pathomechanics, pathophysiology, classification, assessment, management, and treatment. Tennis elbow, also known as lateral epicondylitis, is characterized by pain and tenderness at the common origin of the forearm extensor muscles. It is caused by repetitive overuse motions like heavy lifting or tennis strokes. Conservative treatment focuses on rest, anti-inflammatory drugs, splinting, and physical therapy like stretching and strengthening. Surgical treatment involves stripping the extensor muscles from their origin to relieve pain.
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
This document discusses the rehabilitation of reverse total shoulder replacements (rTSR). It notes that rTSR rehabilitation differs from traditional shoulder replacements by focusing initially on stability and deltoid rehabilitation, addressing scapular control, and emphasizing restoration of external rotation. Key points include immobilizing the shoulder initially, progressing to active-assisted then active range of motion, addressing movement deficits, and advancing to functional exercises while monitoring for complications like scapular notching. The goal is improved pain relief and movement, though some patients may have poor outcomes requiring additional support strategies.
Physiotherapy Rehab After Total Hip ReplacementMozammal Rabby
This document outlines the phases of rehabilitation following a total hip replacement surgery. It discusses examination of the patient, education provided, and four phases of rehabilitation: immobilization, maximum protection, moderate protection, and minimum protection. Each phase focuses on specific goals like regaining range of motion, strengthening muscles, improving gait, and resuming normal activities. Precautions are provided to prevent dislocation and protect the new hip joint at each stage of recovery.
This document discusses conservative treatment approaches for various knee injuries. It classifies knee injuries into internal derangements, external mechanism injuries, and fractures of the distal femur and proximal tibia. For many mild or stable injuries, conservative management including RICE, bracing, and graded exercise is recommended. Specific rehabilitation protocols are outlined for injuries like meniscal tears, ligament sprains, and patellar dislocations. Complications of both injuries and conservative treatments are also reviewed. The conclusion emphasizes that surgery is not always needed and proper conservative care with vigilance can achieve similar results.
This document provides an overview of assessment and management of shoulder injuries in physiotherapy practice. It discusses common shoulder presentations including pain, stiffness, instability and weakness. Common causes of shoulder pain are injuries to the glenohumeral joint, subacromial area, and AC joint. The document outlines techniques for assessing the shoulder through history, observation, range of motion testing, strength tests, and special tests like Neer's impingement test. Rehabilitation approaches are also reviewed, including exercises to improve mobility, strength, and functional ability. Outcome measures and when to consider referral are also addressed.
The document discusses hamstring tendon avulsion injuries, repair surgery, and rehabilitation. It describes the anatomy of the three main hamstring tendons - biceps femoris, semimembranosis, and semitendinosis. Hamstring injuries typically occur due to strong eccentric contractions when the knee is extended and hip is flexed. Surgical repair is recommended for complete avulsions. Post-surgical rehabilitation is divided into four phases, starting with non-weight bearing and progressing to running, cutting, and sport-specific drills over 3-6 months before returning to full activity.
Fractures of the humeral shaft are those that involve
the diaphysis or midshaft and do not involve the articular
or metaphyseal regions proximally or distally.It is useful to classify these fractures by anatomic
location because the effect of muscle forces causes different
displacement patterns depending on the level of
the fracture.Humeral fractures are further classified as closed or
open, transverse, oblique, spiral, segmental, or comminuted.
Additional classifications address nerve or
arterial injury and whether the fracture is through
pathologic bone.
The document discusses the treatment and rehabilitation of radial head fractures. Radial head fractures are challenging to treat due to the complex elbow anatomy. The goal of treatment is to restore anatomy and joint function while avoiding post-traumatic arthritis. Common symptoms include elbow pain, swelling, and limited range of motion. Rehabilitation is divided into three phases. Phase I focuses on range of motion exercises while avoiding stress on the joint. Phase II adds in supination and pronation exercises. Phase III aims to regain full pre-injury range of motion by 8 weeks.
S.I.C.K. Scapula with Clavicle Fractures Case Study Presentation (2013)ctoney
Each semester as an Athletic Training student we are required to take a clinical course. We are assigned to a clinical site and at the end of each semester we must present on an injury we encountered while working with athletes. Taking further interest into the injury we had to do research. I chose a clavicle fracture because working at a small high school I didn't see many injuries. Once evaluating my patient I realized he had S.I.C.K. Scapula (Scapular Malposition on rib cage, Inferior Medial Scapular Winging, Coracoid Tenderness, Scapular Dyskinesis). After realizing this I continued my research on this condition. I found it to be interesting because I hadn't learned about it in my classes at that point.
0004 AC, SC and ST joints dislocation-Copy.pdfeyobkaseye
This document discusses disorders of the acromioclavicular (AC), sternoclavicular (SC), and glenohumeral (GH) joints. It describes common conditions like AC joint dislocation and arthritis. It also discusses signs, risk factors, classifications systems, treatments, and physiotherapy management for AC joint disorders. For SC joint injuries, it outlines signs, causes, and treatments. Finally, it provides details on shoulder dislocation types, diagnostic procedures, conservative and surgical management, and physiotherapy rehabilitation protocols.
Physiotherapy in Reconstructive Surgery .pptxAhmedMufleh1
The document discusses physiotherapy for reconstructive hand surgery. It covers:
1. Pre-operative physiotherapy assessment and treatment including range of motion, strength, mobility and respiratory assessment.
2. Common hand surgeries like tendon repairs, amputations, and arthritis conditions. Flexor tendon injuries are classified into zones.
3. Post-operative rehabilitation protocols including immobilization, early passive motion, and early active motion. Exercises and progression of motion and strength over time are described for each protocol.
Physiotherapy in Reconstructive Surgery .pptxAhmedMufleh1
The document summarizes physiotherapy principles for reconstructive hand surgery. It discusses pre-operative assessment and mobility training. Post-operatively, it describes protocols for immobilization, early passive mobilization, and early active mobilization of flexor tendon injuries. Flexor tendon zones and factors affecting rehabilitation are also outlined. Treatment of post-surgical adhesions includes blocking exercises, gliding exercises, and myofascial release.
Positioning is fundamental to burn rehabilitation to prevent contractures and deformities. Key positions include shoulder retraction, elbow extension, wrist neutral, and hip abduction. Splinting maintains gained range of motion and positions limbs in elongation. Electrotherapeutic modalities like high volt pulsed galvanic stimulation and ultrasound therapy can assist wound healing by stimulating repair, destroying bacteria, and increasing circulation.
Pathophysiology of shoulder rotator cuff instability and repairdocortho Patel
sport injuries or trauma or dislocations of shoulder cause rotator cuff instabilty. here presenting detail about rotator cuff anatomy & treatment options.
The document discusses common muscle disorders in pediatrics and contracture deformities. It covers several genetic muscle disorders including Duchenne muscular dystrophy, spinal muscular atrophy, and different types of muscular dystrophy. It then focuses on contracture deformities, defined as stiffness or constriction in connective tissues that limits range of motion. Common causes in children include inactivity, injury, burns, and genetic disorders like muscular dystrophy or cerebral palsy. Physiotherapy is a primary treatment using exercises and stretches to improve mobility and prevent further contractures.
The document discusses various measurements used in epidemiology to measure mortality and morbidity. It defines key terms like incidence, prevalence, crude death rate, and standardized rates. It explains how to calculate different rates like crude death rate, specific death rate, case fatality rate, and proportional mortality rate. It also discusses the methods of direct standardization and indirect standardization to adjust rates. The learning objectives are to learn the basic measurements in epidemiology, how to select appropriate measurement tools, and how to measure and standardize mortality and morbidity rates.
This document provides information about basic nutrition and carbohydrates. It begins by outlining the objectives, which are to describe the functions of macronutrients, dietary fiber, and diseases associated with abnormal metabolisms. It then defines the six essential nutrients and explains that carbohydrates, proteins and fats are macronutrients that provide energy. Carbohydrates specifically are then discussed in more detail, including their classification, sources, and importance as the body's primary energy source. Overall, the document provides a high-level overview of basic nutrition with a focus on carbohydrates and their functions.
This document discusses cranial nerve disorders, nerve root lesions, nerve plexuses, and peripheral nerve lesions. It begins by covering trigeminal neuralgia, Bell's palsy, and cervical polyradiculopathy. For trigeminal neuralgia, the typical presentation, causes, diagnosis, and treatment including medications and microvascular decompression surgery are described. Bell's palsy is outlined as the most common type of facial paralysis. Cervical polyradiculopathy is then reviewed in terms of symptoms, common causes like spondylosis and disc herniation, evaluation, and initial treatment with conservative measures and epidural steroid injections.
This document provides an overview of the muscular system. It discusses the basic functions of muscles including body movement, maintenance of posture, heat production, and controlling openings. It describes the properties of muscular tissue including excitability, contractibility, extensibility, and elasticity. It details the three types of muscles - skeletal, cardiac, and smooth muscle - and their characteristics. The document also covers muscle naming conventions, attachments, arrangements of fascicles, and examples of muscles in different body regions like the head, neck, abdomen, and arm.
The document describes the major blood vessels in the human body. It discusses the structure and branches of the aorta, including the ascending aorta, aortic arch, and descending aorta. It also describes the major arteries and veins of the head, neck, upper limbs, thorax, abdomen, pelvis, and lower limbs. Additionally, it discusses arterial anastomoses, sites for compressing arteries to control bleeding, measuring blood pressure, thrombosis, and using saphenous veins for grafts.
Clean the site with an alcohol swab in a circular motion from the center outward. Allow to air dry.
8. Put on sterile gloves
9. Pick up the needle and hold it like a dart. Insert the needle at 10-15 degree angle into the vein.
10. Advance the needle into the vein until blood flashes back into the hub.
11. Advance the catheter over the needle into the vein until resistance is felt.
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Fractures.pptx
1. FRACTURES & SOFT TISSUE
INJURIES OF UPPER LIMB
DHEERAJ LAMBA (PHD)
HEAD & ASSOCIATE PROFESSOR
DEPARTMENT OF PHYSIOTHERAPY, JIMMA UNIVERSITY, JIMMA
2. FRACTURE CLAVICLE
INCIDENCE: THIS IS COMMON IN INFANTS
AND YOUNG CHILDREN. THIS IS ALSO ONE
OF THE COMMON BIRTH FRACTURES.
MOI: IT IS CAUSED BY A FALL ON THE
OUTSTRETCHED (FOOSH) HAND OR ON
THE POINT OF THE SHOULDER. IT MAY
OCCUR DURING EXTRACTION OF THE
HAND IN BREECH DELIVERY.
CLINICAL FEATURES: THE COMMON
SITE IS THE JUNCTION OF THE OUTER AND
MIDDLE THIRD OF THE BONE.
3. Treatment:
Infants and children: In children below 3 years, simple
strapping across the clavicle from the front backwards and a
cuff and collar
will be quite sufficient. The fracture unites in two or three weeks.
Older children and adults: There are numerous methods
described, but the simplest is the best. The principle is to lift the
outer fragment upwards and maintain its alignment with the
inner fragment by a firm figure of 8 bandage with paddings in
the axilla. The arm is supported in a sling. The fracture unites in
about 4 weeks.
4. Complications: Gross displacement can occasionally
endanger the brachial plexus and vessels and may need
surgical intervention and internal fixation. Stiff shoulder is
the commonest complication in older adults and is overcome
by early mobilisation by active exercises.
5. PHYSIOTHERAPY
OVERALL GOALS OF THE SURGICAL PROCEDURE AND
REHABILITATION ARE TO:
• CONTROL PAIN AND INFLAMMATION
• REGAIN NORMAL UPPER EXTREMITY STRENGTH AND ENDURANCE
• REGAIN NORMAL SHOULDER RANGE OF MOTION
• ACHIEVE THE LEVEL OF FUNCTION BASED ON THE ORTHOPEDIC
AND PATIENT GOALS
THE PHYSICAL THERAPY SHOULD BE INITIATED WITHIN THE FIRST
WEEK AND ONE HALF TO TWO FULL WEEKS POST-OP.
6. Goals:
Maintain elbow and wrist ROM, prevent shoulder stiffness, control pain and
swelling. Protect the repair.
Week 1
Sling.
May remove sling to do Pendulum exercises. No active shoulder motion.
Elbow and wrist ROM exercises, but no resisted exercises.
Goals:
Initiate shoulder ROM. Prevent pain. Protect the repair.
Weeks 2-3
Continue sling
Sling may be removed for exercises. May begin active-assisted motion. Continue
pendulum exercises. Rope/pulley exercises.
No lifting anything heavier than a glass in operative hand.
Weeks 4-5
May begin to wean from sling. If X-rays show no change in hardware, may begin
full active and passive motion.
No lifting anything heavier than a pencil.
7. GOALS OF PHASE:
• Full ROM
• Maximize upper extremity strength and endurance
• Maximize neuromuscular control
• Initiate sports specific training/functional training
Weeks 6- 8
If radiographs are showing signs of union, may begin to slowly incorporate resistance and
strengthening exercises. May now use arm to lift nothing heavier than a carton of milk.
Weeks 8-12
Once radiographs show union and 2 weeks of resistance exercises have been performed,
then may work on aggressive shoulder rehab to return to sports. Once painless shoulder
function has been achieved and strength has returned, and an athlete has completed the
return to play rehab, then an athlete may return to play.
STRENGTH
Progress strengthening program with increase in resistance and high speed repetition
Progress with eccentric strengthening of posterior cuff and scapular musculature
Progress rhythmic stabilization activities to include standing PNF patterns with tubing
for strength and endurance
Initiate military press, bench press, and lateral pull-downs
Initiate sport specific drills and functional activities
Initiate interval throwing program
Initiate light plyometric program
8. DISLOCATION OF THE
ACROMIO-CLAVICULAR JOINT:
THE ACROMIO-CLAVICULAR JOINT SUSTAINS SUBLUXATION OR
DISLOCATION DUE TO A FALL ON THE OUTER ASPECT OF THE
SHOULDER. PARTIAL RUPTURE OF THE CORACO-CLAVICULAR
LIGAMENTS RESULTS IN SUBLUXATION AND COMPLETE RUPTURE
RESULTS IN DISLOCATION .
CLINICALLY, THE PATIENT PRESENTS WITH ACUTE PAIN ON THE
TOP OF THE SHOULDER. THERE IS AN ELEVATION OF THE OUTER
END OF CLAVICLE AND TENDERNESS AT THAT SITE.
RADIOLOGY REVEALS THE DEGREE OF DISPLACEMENT AT THE
JOINT.
9. Mild and moderate
displacements are treated by
strapping. This goes around the
outer 1/3 of clavicle above and
the point of the elbow below with
the elbow kept at 90 degree
flexion. In cases of gross
displacements, open reduction
may be required. Repair of the
ruptured coraco clavicular
ligaments and internal fixation
with a vertical screw or
intramedullary pin gives good
results functionally and
cosmetically.
10. Acute Stage:
Type I Injury
Days 1-7
Ice
NSAID’s
Shoulder sling for 5-7 days– rest as needed
AROM fingers, wrist and elbow
Begin Pendulum Exercises – day 2 or 3
Shoulder isometrics trapezius and deltoid muscles
Days 7-10
Expect symptoms to subside
Discontinue sling
AROM and strengthening as symptoms allow
Type II Injury
Day 1
Ice for 24-48 hours
NSAID’s
Sling for comfort 1-2 weeks
Day 7 :Gentle ROM of shoulder
Allow use of arm for ADL
Discontinue sling at 7-14 days
Type III Injury – Non-operative
Ice for 24 hours
Sling – discontinue as symptoms
subside (1-4 weeks)
Leukotape - may increase
comfort and facilitate weaning
from sling and allow progression
of ROM and strengthening
exercises.
Begin ADL with arm at 3-4 days
Slowly progress functional
ROM, gentle PROM at 7 days
Type IV, V and VI injuries are
diagnosed by radiographs and
will need surgical consult.
Return to athletics and play
depends on healing and
restoration of near normal
strength and ROM.
11. After Acute Stage:
Type I and Type II injuries can progress to ROM and strength training as symptoms
permit. Type I can return to sport when nearly normal ROM and strength. No heavy
lifting, stresses, or contact sports until full painless ROM, and no point tenderness over
AC joint (usually by 2-3 weeks)
Type II injuries should avoid heavy lifting, pushing, pulling or contact sports for at least 6
weeks.
Type III injuries typically have full ROM at 2-3 weeks with gentle ROM exercises and return
to activity in 6-12 weeks with protection of AC joint.
Continue patient education
PROM, AAROM, AROM progression
Posture training
Strengthening of trapezius, deltoid, rotator cuff and scapular musculature
– may include isometrics, exercise bands, active progressing to resistive
forward flexion, side-lying external rotation, seated press-ups, push-ups plus Weight bearing
scapular stabilization using physio ball. Joint mobilization if glenohumeral joint limitations;
contraindicated at AC joint if hypermobility.
Modalities as needed– ice, electrical stimulation
Frequency & Duration
1-2 times per week for 2-4 weeks if Type I or II
1-2 times per week for 4-12 weeks if Type III, non-operative
12. FRACTURE SCAPULA
THIS IS NOT VERY COMMON. IT IS MOSTLY DUE TO DIRECT INJURY FROM
THE BACK.
THE FRACTURE SCAPULA MAY BE
A)FRACTURE NECK OF SCAPULA (25%)
B) FRACTURE BODY OF SCAPULA (50-60%)
C) FRACTURE ACROMION,
D) FRACTURE CORACOID.
DISPLACEMENT IS MINIMAL AS THE BONE IS WELL PADDED BY MUSCLES.
A CUFF AND COLLAR IS GIVEN FOR 2-3 WEEKS TILL THE SOFT TISSUE
INJURIES HEAL. ACTIVE MOVEMENTS ARE THEN ENCOURAGED TO OBTAIN
GOOD A FUNCTIONAL RECOVERY.
13. DISLOCATION OF THE SHOULDER
JOINT
CLASSIFICATIONS:
THE FOLLOWING CLINICAL TYPES SHOULD BE
RECOGNIZED.
1. ACUTE DISLOCATION.
A) ANTERIOR DISLOCATION -- COMMONEST TYPE.
B) POSTERIOR DISLOCATION -- THIS IS RARE.
C) INFERIOR DISLOCATION-- LUXATIO ERECTA.
2. OLD UNREDUCED DISLOCATION.
3. RECURRENT DISLOCATION.
15. ANTERIOR DISLOCATION
MECHANISM OF INJURY:
THE SHOULDER IS ONE OF THE JOINTS WHICH EASILY GETS
DISLOCATED BY TRAUMA. A FALL ON THE OUTSTRETCHED
HAND WITH THE ARM IN THE ABDUCTED AND EXTERNALLY
ROTATED POSITIONS CAUSES THE HEAD OF THE HUMERUS
TO SLIP ANTERIORLY.
Clinical features:
a. The absence of the head in its normal position leaving the
glenoid vacant.
b. The presence of the head in an abnormal position.
c. Positive (Dugas sign)
16. FIRST TIME DISLOCATORS:
MAY BE IMMOBILIZED FOR 4-6 WEEKS BEFORE
STARTING PHYSICAL THERAPY.
RECURRENT DISLOCATORS:
PHYSICAL THERAPY CAN BEGIN IMMEDIATELY
• PHASE I: 0-4 WEEKS
• GOALS:
• REST
• ESTABLISH FULL MOTION
• RETARD MUSCULAR ATROPHY
• DECREASE PAIN AND
INFLAMMATION
• ALLOW CAPSULAR HEALING
AAROM with wand to tolerance
Begin IR/ER at side, progress to 30degrees, 60 degrees then
90 degrees AB as pain subsides
Submax isometrics for all shoulder musculature
Gentle joint mobs & PROM
Modalities (ice) to decrease inflammation and pain
17. CONT…
PHASE II: 4-8 WEEKS
• GOALS:
• INCREASE DYNAMIC
STABILITY
• INCREASE STRENGTH
• MAINTAIN FULL MOTION
Isotonic Strengthening
Rotator Cuff
Scapular Stabilizers
Deltoid, Biceps, Triceps
Rhythmic Stabilization
Basic
Intermediate
Advanced
Phase III: 8-12
Goals:
Increase neuromuscular control
(especially in apprehension
position)
Progress dynamic stability
Increase overall strength
Continue to progress previous isotonic exercises
Begin dynamic stabilization
Basic
Intermediate
Advanced
Introduce basic plyometrics
*In Athletes begin to work ER/IR in 90 degrees AB
18. CONT…..
• PHASE IV: RETURN TO ACTIVITY
• GOALS:
• PROGRESSIVELY INCREASE
ACTIVITIES TO PATIENT FOR
FULL FUNCTIONAL RETURN
Continue previous isotonic
strengthening program
Advance plyometrics
Instruct in maintenance program prior
to discharge
19. POSTERIOR DISLOCATION:
THIS IS A RARE TYPE WHICH OCCURS DURING ATTACKS OF FITS OR ELECTRO CONVULSIVE
THERAPY. HERE THE HEAD IS DISPLACED POSTERIORLY AND THE ARM IS IN INTERNAL
ROTATION. THIS IS OFTEN MISSED AND NEEDS A SUPERO-INFERIOR VIEW RADIOGRAPH
ALSO.
OLD UNREDUCED DISLOCATION:
THE PATIENTS OFTEN PRESENT WITH A DISLOCATION UNREDUCED FOR SOME WEEKS.
MANIPULATION UNDER ANESTHESIA CAN BE TRIED FOR DISLOCATION UP TO 4 OR 6
WEEKS OLD. IT BECOMES IMPOSSIBLE TO REDUCE, IF IT IS OF LONGER DURATION DUE
TO SOFT TISSUE CONTRACTURE.
RECURRENT DISLOCATION SHOULDER:
THIS IS A CONDITION CHARACTERIZED BY REPEATED DISLOCATION OF THE SHOULDER
JOINT IN A PERSON, FOLLOWING ONE EPISODE OF ACUTE DISLOCATION. SUBSEQUENT
DISLOCATIONS REQUIRE LESS AND LESS VIOLENCE.
20. FRACTURE HUMERUS & ITS TYPE :
• EPIDEMIOLOGY
• MOST COMMON FRACTURE OF THE HUMERUS
• HIGHER INCIDENCE IN THE ELDERLY, THOUGHT TO BE RELATED TO
OSTEOPOROSIS
• FEMALES 2:1 GREATER INCIDENCE THAN MALES
• MECHANISM OF INJURY
• MOST COMMONLY A FALL ONTO AN OUTSTRETCHED ARM FROM
STANDING HEIGHT
• YOUNGER PATIENT TYPICALLY PRESENT AFTER HIGH ENERGY TRAUMA
SUCH AS MVA
Proximal Humerus Fractures
22. PROXIMAL HUMERUS FRACTURES
• NEER
CLASSIFICATION
:
• FOUR PARTS
• GREATER AND
LESSER
TUBEROSITIES
• HUMERAL
SHAFT
• HUMERAL
HEAD
• A PART IS
DISPLACED IF
>1 CM
DISPLACEMENT
23. REHABILITATION PROTOCOL FOR PROXIMAL
HUMERUS FRACTURES
Time Frame:0-6 weeks Phase-1
Immobilization: Sling / Immobilizer / Brace with 15 degrees abduction
x 6 weeks. Wear continuously except for therapy and hygiene /
bathing.
Restrictions: Avoid A/AA/PROM and strengthening with exception of
small, slow shoulder pendulums as pain allows.
Exercises:
Gripping exercises, elbow, wrist and finger ROM. Shoulder pendulums
(slow, small circles).
24. Time Frame: 6-10 weeks Phase-2
Immobilization: None
Restrictions: Add AROM, AAROM and PROM at 6 weeks unless advised otherwise
by surgeon.
Stretching should be gradual and in slow increments while avoiding pain. Do not
push past end point. If patient develops pain, drop back to early phase of
rehabilitation until pain free.
No strengthening.
Exercises: Gradually increase ROM exercises in line with restrictions.
Continue with modalities used as needed.
Time Frame: 10-14 weeks Phase-3
Immobilization: None
Restrictions:
Exercise advancement should be gradual and in slow increments while avoiding
pain. If patient develops pain, drop back to early phase of rehabilitation, until pain
free.
25. Exercises:
Continue with shoulder PROM, AAROM and AROM (Goal is 75% or greater of
normal PROM by 12 weeks). At 10 weeks begin shoulder isometric
strengthening with arms at side (IR, ER, scapular stabilization). At 12 weeks
add shoulder resistance strengthening exercises. Progression should be
gradual and in slow increments while avoiding pain.
Time Frame: 14+ weeks
Immobilization: None
Restrictions:
No specific restrictions. Patients ROM, strength and endurance should be
advanced progressively while avoiding pain.
Exercises:
ROM should be returning to normal; if not, continue to address with stretching.
Progressive upper body strengthening may be more aggressive after 16
weeks. Add exercises simulating work requirements or sport at 18 weeks as
part of return to work/ sport program.
Consider work conditioning program based on patients job requirements and
patient motivation at 6 months.
28. HUMERAL SHAFT FRACTURES
• MECHANISM OF INJURY
• DIRECT TRAUMA IS THE MOST COMMON ESPECIALLY MVA
• INDIRECT TRAUMA SUCH AS FALL ON AN OUTSTRETCHED HAND
• FRACTURE PATTERN DEPENDS ON STRESS APPLIED
• COMPRESSIVE- PROXIMAL OR DISTAL HUMERUS
• BENDING- TRANSVERSE FRACTURE OF THE SHAFT
• TORSIONAL- SPIRAL FRACTURE OF THE SHAFT
• TORSION AND BENDING- OBLIQUE FRACTURE USUALLY ASSOCIATED
WITH A BUTTERFLY FRAGMENT
29. HUMERAL SHAFT FRACTURES
• CLINICAL EVALUATION
• THOROUGH HISTORY AND PHYSICAL
• PATIENTS TYPICALLY PRESENT WITH
PAIN, SWELLING, AND DEFORMITY OF
THE UPPER ARM
• CAREFUL NV EXAM IMPORTANT AS THE
RADIAL NERVE IS IN CLOSE PROXIMITY
TO THE HUMERUS AND CAN BE
INJURED
30. HUMERAL SHAFT FRACTURES
Goal of treatment is to establish union with acceptable
alignment >90% of humeral shaft fractures heal with nonsurgical
management
31. REHABILITATION PROTOCOL
TIME FRAME: 0-4 WEEKS PHASE-1
• IMMOBILIZATION: SLING IMMOBILIZER / BRACE WITH 15 DEGREES
ABDUCTION X 4 WEEKS.
• WEAR CONTINUOUSLY EXCEPT FOR THERAPY AND HYGIENE /
BATHING.
• RESTRICTIONS: NO STRENGTHENING. AVOID AGGRESSIVE
STRETCHING AND ROTATIONAL STRESS. LIMIT ER TO NEUTRAL
AND IR TO CHEST.
• EXERCISES: GRIPPING EXERCISES, ELBOW, WRIST AND FINGER
ROM, SHOULDER PENDULUMS, PROM/AAROM/AROM FOR
SHOULDER SHOULD BE SLOW AND TO TOLERANCE.
• MODALITIES USED AS NEEDED.
32. Time Frame: 4-8weeks Phase-2
Immobilization: None
Restrictions: No strengthening until fracture healing. Avoid pain, stretch
to tolerable discomfort only.
Exercises: Gradually increases ROM exercises.
Stretching should continue to be slow and to tolerance while avoiding
pain.
Modalities used as needed.
Time Frame: 8-12weeks Phase-3
Immobilization: None
Restrictions: Exercise advancement should be gradual and in slow
increments
while avoiding pain. If patient develops pain, drop back to early phase of
rehabilitation, until pain free.
ROM restrictions: FF-none, ABD‐none, IR‐ 20°, ER 20°.
Exercises: Continue with shoulder PROM, AAROM and AROM. At
8weeks begin shoulder isometric strengthening with arms at side (IR,
ER, scapular stabilization). At 10weeks add shoulder resistance
33. Time Frame: 12-‐26 weeks Phase-4
Immobilization: None
Restrictions: No specific restrictions. Patients ROM, strength and endurance
should be advanced progressively while avoiding pain.
Exercises: ROM should be 85%normal or greater; if not, continue to address
with stretching Progressive upper-‐body strengthening may be more aggressive
after 16 weeks. Add plyometric training for athletes at 18 weeks.
Add exercises simulating work requirements at 18 weeks as part of return to
work program.
Time Frame: 26+weeks phase-5
Goal: Restore normal shoulder function and progress to return to sport or return
to work.
Restrictions: No specific restrictions. Advance progressively while avoiding
pain. If the patient develops pain they are to return to earlier stage of
rehabilitation.
Exercises: Aggressive upper‐body strengthening and with initiation of
plyometric training and sports or work specific training. Consider work
34. DISTAL HUMERUS FRACTURES
SUPRACONDYLAR FRACTURES, INTERCONDYLAR,
CONDYLAR AND EPICONDYLAR
SUPRACONDYLAR
FRACTURE
• MOST COMMON ELBOW FRACTURE IN
CHILDREN (60%)
• FRACTURE LINE EXTENDS
TRANSVERSELY OR OBLIQUELY
THROUGH DISTAL HUMERUS ABOVE
THE CONDYLES.
• DISTAL FRAGMENT USUALLY
DISPLACES
POSTERIORLY(EXTENSION TYPE)
COMMONEST TYPE.
35. INTERCONDYLAR FRACTURE
• FRACTURE LINE EXTENDS BETWEEN
MEDIAL AND LATERAL CONDYLES AND
EXTENDS TO SUPRACONDYLAR
REGION
• RESULTS AND T OR Y SHAPED
CONFIGURATION FOR FRACTURE
• CALLED TRANS-CONDYLAR IF IT
EXTENDS THROUGH BOTH CONDYLES
36. EPICONDYLAR FRACTURE
• USUALLY AVULSION FROM TRACTION
OF RESPECTIVE COMMON FLEXOR
(MEDIAL) OR EXTENSOR (LATERAL)
TENDONS
• MEDIAL EPICONDYLE AVULSION
COMMON IN SPORTS &
ADOLOCENTS WITH STRONG
THROWING MOTION. (FOOSH WITH
VALGUS INJURY) CHECK MEDIAN
NERVE
• FRACTURE LATERAL EPICONDYLE
COMMON IN CHILDERN CHECK
37. OLECRANON FRACTURE
• MECHANISM OF INJURY
• DIRECT TRAUMA : FALL ON POINT OF ELBOW
• INDIRECT TRAUMA : CONTRACTION OF TRICEPS PRODUCE
AVULSION FRACTURE
38. TREATMENT
TYPE I:
• ABOVE ELBOW PLASTER CAST WITH 30 OF ELBOW FLEXION
• MAINTAIN FOR 3 WEEKS
TYPE II:
• CLEAN BREAK FRACTURE WITH SEPARATION
• ORIF USING TENSION BAND WIRING (TBW)
TYPE III:
• COMMINUTED FRACTURE
• EXCISION OF OLECRANON &
• REATTACH THE TRICEPS TO PROXIMAL ULNA
39. REHABILITATION PROTOCOL
• AFTER REDUCTION, THE EXTENSION TYPE OF FRACTURE IS
IMMOBILIZED IN AN ABOVE ELBOW PLASTER SLAB WITH THE
ELBOW IN FLEXION. WHEREAS, THE FLEXION TYPE (LESS COMMON)
OF FRACTURE IS IMMOBILISED WITH THE ELBOW IN EXTENSION. IN
EITHER CASE THE PLASTER IS REMOVED AFTER 4 WEEKS.
• THE FRACTURE FRAGMENTS ARE FIXED INTERNALLY WITH THE
KIRSCHNER WIRES. POSTOPERATIVELY THE LIMB IS IMMOBILISED
IN A POSTERIOR SLAB WITH ELBOW IN FLEXION FOR 3 WEEKS. THE
K-WIRES ARE ALSO REMOVED AFTER 3 WEEKS AND THE ELBOW IS
MOBILISED.
• AFTER 3 WEEKS (MOBILIZATION) PHASE
• WAX THERAPY, ROLLER SKATES, NO PASSIVE
41. ELBOW DISLOCATIONS
• EPIDEMIOLOGY
• ACCOUNTS FOR 11-28% OF INJURIES TO THE ELBOW
• POSTERIOR DISLOCATIONS MOST COMMON
• HIGHEST INCIDENCE IN THE YOUNG 10-20 YEARS AND USUALLY
SPORTS INJURIES
• MECHANISM OF INJURY
• MOST COMMONLY DUE TO FALL ON OUTSTRETCHED HAND OR
ELBOW RESULTING IN FORCE TO UNLOCK THE OLECRANON FROM
THE TROCHLEA
• POSTERIOR DISLOCATION FOLLOWING HYPEREXTENSION, VALGUS
STRESS, ARM ABDUCTION, AND FOREARM SUPINATION (MORE
COMMON TYPE) 90%
• ANTERIOR DISLOCATION ENSUING FROM DIRECT FORCE TO THE
POSTERIOR FOREARM WITH ELBOW FLEXED (LESS COMMON) 10%
42. ELBOW FRACTURE/DISLOCATIONS
SURGICAL TREATMENT
• POSTERIOR DISLOCATION
• CLOSED REDUCTION UNDER SEDATION
• REDUCTION SHOULD BE PERFORMED WITH THE ELBOW FLEXED
WHILE PROVIDING DISTAL TRACTION
• POST REDUCTION MANAGEMENT INCLUDES A POSTERIOR
SPLINT WITH THE ELBOW AT 90 DEGREES
• OPEN REDUCITON FOR SEVERE SOFT TISSUE INJURIES OR
BONY ENTRAPMENT
• ANTERIOR DISLOCATION
• CLOSED REDUCTION UNDER SEDATION
• DISTAL TRACTION TO THE FLEXED FOREARM FOLLOWED BY
DORSALLY DIRECT PRESSURE ON THE VOLAR FOREARM WITH
ANTERIOR PRESSURE ON THE HUMERUS
43. Phase I: Weeks 1-4
Goals: Control edema and pain
Early full ROM
Protect injured tissues
Minimize deconditioning
Intervention:
• Continue to assess for neurovascular compromise
• Elevation and ice
• Gentle PROM - working to get full extension
• Splinting as needed
• General cardiovascular and muscular conditioning program
• Strengthen through ROM
• Soft tissue mobilization if indicated – especially assess the brachialis
myofascia
Phase II: Weeks 5-8
Goals: Control any residual symptoms of edema and pain
Full ROM
Minimize deconditioning
44. Intervention:
• Active range of motion (AROM) exercises, isometric exercises, progressing to
resisted
exercises using tubing or manual resistance or weights
• Incorporate sport specific exercises if indicated
• Joint mobilization, soft tissue mobilization, or passive stretching if indicated
• Continue to assess for neurovascular compromise
• Nerve mobility exercises if indicated
• Modify/progress cardiovascular and muscular conditioning program
Phase III: Weeks 9-16
Goals: Full range of motion and normal strength
Return to preinjury functional activities
Intervention:
• Interventions as above
• Modify/progress cardiovascular and muscular conditioning
• Progress sport specific or job specific training
45. FRACTURE OF HEAD OF RADIUS
• COMMON IN ADULTS
• NEVER IN CHILDREN, SINCE HEAD OSSIFIES AT THE AGE OF
5 YRS.
• MECHANISM OF INJURY
• FOOSH
• HAND FORCES ELBOW INTO VALGUS & PUSHES RADIAL
• HEAD AGAINST CAPITULUM
• RADIAL HEAD SPLIT & BROKEN
46. MASON CLASSIFICATION
• TYPE I : UNDISPLACED
• TYPE II : DISPLACED
• TYPE III : SEVERELY COMMINUTED
• TYPE IV : FRACTURE WITH DISLOCATION OF ELBOW
47. FRACTURE CAPITULUM
• COMMON IN ADULTS
• FRACTURE OCCURS AT CORONAL PLANE & FRAGMENT MOVES
UPWARDS.
MECHANISM OF INJURY
• FOOSH
• FALL ON ELBOW
48. PHYSIOTHERAPY PROTOCOL
2—4 WEEKS
• ACTIVE RANGE OF MOTION TO
DIGITS
• ACTIVE & ACTIVE ASSISTED
EXERCISES TO SHOULDER
• ISOMETRIC EXERCISE TO BICEPS,
TRICEPS & DELTOID
• ISOMETRICS TO FOREARM
MUSCLES
• BEGIN GRIP STRENGTHENING
EXERCISES (BALL , PUTTY)
4—6 WEEKS
• Stability is achieved
• Begin Supervised Elbow movements
• Continue Grip exercises
• Avoid PROM to elbow
• Teach Home program & advise about complications
8—12 WEEKS
• Continue active &Add PROM exercises to all joints
• Continue grip strengthening exercises
• Resistive exercises using weights
49. FOREARM FRACTURES
• FRACTURE OF THE RADIUS & ULNA
• FRACTURE OF RADIUS ALONE
• FRACTURE OF ULNA ALONE
• MONTEGGIA FRACTURE
• GALEAZZI FRACTURE
50. FRACTURE OF THE RADIUS & ULNA
• IN FOREARM WHEN ONE OF THE BONES IS FRACTURES & DISPLACED, THE OTHER
ALSO IS USUALLY FRACTURED.
• IF ONLY ONE BONE SHOWS A FRACTURE WITH DISPLACEMENT AND THE OTHER
SHAFT IS INTACT, ONE MUST EXPECT A DISPLACEMENT EITHER AT THE SUPERIOR OR
INFERIOR RADIO ULNAR JOINT.
• THE AXIS OF ROTATION OF THE FOREARM IS THE LINE JOINING THE SUPERIOR &
INFERIOR RADIOULNAR JOINT.
• THE RESTORATION OF THE INTEROSSEOUS SPACE BY PROPER CORRECTION OF
OVERRIDING, ANGULATIONS & ROTATION IS VERY IMPORTANT IN THE MANAGEMENT
OF THIS FRACTURE. IF IT IS NOT PROPERLY DONE THEN, IT RESTRICTS SUPINATION/
PRONATION
• ROTATIONAL DEFORMITY PRODUCED BY PULL OF MUSCLES ATTACHED TO RADIUS.
• BICEPS & SUPINATOR IN UPPER 1/3
• PRONATOR TERES IN MID 1/3
51. FRACTURE OF RADIUS
• VERY RARE
• IMMOBILIZED IN ABOVE ELBOW PLASTER CAST
• 3—6 WEEKS
52. MECHANISM OF INJURY
• FOOSH.
• DIRECT INJURY.
IN CHILDERN MANAGEMENT IS DONE BY LONG PLASTER CAST
FROM AXILLA TO METACARPAL
• HELPS TO CONTROL MOVEMENT
• CAST APPLIED WITH ELBOW 90° FLEXION
• SPLINT IS APPLIED FOR 6—8 WEEKS
• AVOID CONTACT SPORTS
• IF FRACTURE PROXIMAL TO PRONATOR TERES FOREARM IN
:SUPINATION
• IF FRACTURE DISTAL TO PRONATOR TERES FOREARM IN :
NEUTRAL.
53. Some surgeons keep Forearm in different positions
• For Upper 1/3 fracture — Supination
• For Mid 1/3 fracture — Mid Prone
• For Lower 1/3 fracture — Pronation
• Mid prone is prefer to facilitate Functional activity & Prevent Elbow stiffness
• POP for 3—6 weeks : children
• POP for 8—10 Weeks: Adult
COMPLICATION
• Non union
• VIC
• Mal union
• Cross union
• Compartmental Syndrome.
54. FRACTURE OF ULNA
• FRACTURE OF LOWER 1/3 IS VERY COMMON
MECHANISM:
• DIRECT TRAUMA
• TREATMENT:
• ABOVE ELBOW PLASTER SLAB
55. MONTEGGIA FRACTURE
DISLOCATION
• PROXIMAL THIRD OF THE ULNA WITH DISLOCATION OF THE HEAD OF THE
RADIUS.
• COMMON IN ADULTS
MECHANISM OF INJURY
• FOOSH—FALL WITH FORCIBLE PRONATION
• DIREST VIOLENCE ON POSTERIOR FOREARM.
56. BADO CLASSIFICATION
ANTERIOR TYPE
TYPE-I
• EXTENSION
TYPE
• COMMONEST
TYPE
• HEAD OF
RADIUS IS
DISLOCATED
ANTERIORLY &
• ULNA IS
FORWARD
ANGULATIONS
POSTERIOR
TYPE
TYPE II
• Flexion type
• Head of radius
is
dislocated
posteriorly
• Ulna is in
posterior
angulations.
LATERAL TYPE
Type III
• Adduction type
• Very rare
• Head of radius is
dislocated laterally
• Ulna is angulated
laterally
Type IV
• Proximal
3rd of both
bone forearm
fractured with
• Anterior
dislocation of
Head of
radius
58. PHYSIOTHERAPY PROTOCOL
• CAST/ SPLINTS
• IMMEDIATE TO ONE WEEK
• ACTIVE & PASSIVE ROM TO
SHOULDER
• AROM WRIST, FINGERS
• IF ISOLATED ULNA FRACTURE
• INITIATE ACTIVE, ACTIVE ASSISTED
ROM TO SHOULDER, ELBOW.
ONE TO TWO WEEKS:
• Active or Active Assisted ROM to digits
• Active or Active assisted ROM to shoulder
• Ulna fracture
• Elbow movements
• AROM or PROM to digits
FOUR TO SIX WEEKS:
• AROM or PROM to digits
• AROM or AAROM to shoulder
• Add gentle ROM to ELBOW
• Pronation / Supination added
• Ball squeeze
• Isometrics for Triceps, Biceps, Deltoid
59. EIGHT TO TWELVE WEEK:
• Full or Active or PROM to all joints
• Pronation / Supination continued
• Putty or Ball Squeeze
• Resisted exercises with weights
POST OPERATIVE PHYSIOTHERAPY MANAGEMENT
IMMEDIATE TO ONE WEEK:
• No cast with stable fixation
• Active & Passive ROM to Shoulder
• AROM wrist, Fingers
• AROM to elbow is initiated
• Pain free movements
TWO WEEKS:
• No cast with stable fracture
• Active & Passive ROM to Shoulder
• AROM wrist, Fingers
• AROM to elbow is initiated
• Pain free movements
60. FOUR TO SIX WEEKS:
• AROM to digits
• Ball squeeze
• AROM to shoulder, Elbow, Wrist.
• Pronation / Supination added
• Isometrics for Triceps, Biceps, Deltoid.
• No lifting or Weight bearing
• Gentle resistive exercises added.
• Functional activities encouraged ( Eat, Write)
EIGHT TO TWELVE WEEK:
• Full or Active or PROM to all joints
• Pronation / Supination continued
• Putty or Ball Squeeze
• Resisted exercises with weights.
61. SCAPHOID FRACTURE
• COMMON CARPAL BONE TO GET FRACTURED
• 75% OF ALL CARPAL INJURIES ARE INVOLVE SCAPHOID
• COMMON IN ADULTS
• RARE IN CHILDREN & ELDERS
MECHANISM OF INJURY: FALL ON DORSIFLEXION OF
HAND
62. Scaphoid has two nutrient arteries:
1) Entering the palmar surface of the Tubercle
2) Entering through Dorsal surface of the Body
Occasionally both the blood vessels pass through the tubercle or through the
distal half of the bone.
In such a case fracture may deprive the proximal half of the bone of its blood
supply leading to Avascular Necrosis
Commonly occur in middle third fracture. 30% TYPES
TYPES
Fracture occurs at Waist / Midline
Fracture occurs at Proximal Pole
Fracture occurs at Tubercle
Stable fracture
Unstable fracture
Unstable fracture displaces fragments and associated Carpal instability & dorsal
tilting of Lunates.
63. TREATMENT
CONSERVATIVE:
Scaphoid plaster cast
Wrist Slight flexion & Radial Deviation
Thumb in Glass Holding Position.
Tubercle Fracture: 3—4 Weeks of POP
Proximal pole fracture : 8—12 Weeks
Surgical:
ORIF
Screw fixation
64. COLLE’S FRACTURE
• THE INJURY WAS FIRST DESCRIBED BY ABRAHAM COLLES IN 1814.
• COMMON IN WOMEN
• HIGHER RATE ON INCIDENCE FOLLOWING POST MENOPAUSAL
• THIS IS A TRANSVERSE FRACTURE AT THE CORTICO-CANCELLOUS
JUNCTION OF THE DISTAL RADIUS OFTEN ASSOCIATED WITH A
FRACTURE OF THE ULNAR STYLOID PROCESS.
• IT COMMONLY OCCURS IN ELDERLY WOMEN
66. SMITHS FRACTURE
• ALSO CALLED AS REVERSE COLLE’S FRACTURE
• FRACTURE AT THE DISTAL END OF THE RADIUS WHERE THE
DISPLACEMENT OF THE DISTAL FRAGMENT IS THE OPPOSITE TO
THE COLLE’S.
• FRACTURE OCCURS SAME LEVEL AS LIKE COLLE’S.
• COMMON IN ADULTS
67. MECHANISM
• FALL ON FLEXED WRIST
• DIRECT VIOLENCE AT THE BACK OF WRIST
• DISTAL FRAGMENT DISPLACED PALMAR WARDS
MANAGEMENT
• AFTER REDUCTION
• WRIST IS IMMOBILIZED IN A BELOW ELBOW CAST
• 30° DORSI FLEXION POSITION
• FOREARM SUPINATED FOR 6 WEEKS
68. BARTON’S FRACTURE
• FRACTURE OF A DISTAL END OF RADIUS
• IT INVOLVES ARTICULAR SURFACE
• DISTAL END IS SPLIT VERTICALLY IN THE CORONAL PLANE WITH
• SMALL FRAGMENT GETTING DISPLACED ALONG WITH THE
• WRIST DORSAL WARD OR PALMAR WARD
TWO TYPES OF FRACTURE
• VOLAR BARTON’S
• DORSAL BARTON’S
69. BENNETT’S FRACTURE
• IT IS AN OBLIQUE INTRA ARTICULAR FRACTURE OF THE BASE OF THE FIRST
METACARPAL WITH SUBLUXATION OR DISLOCATION OF THE METACARPAL
MECHANISM OF INJURY
• DIRECT INJURY
• PUNCHING
TREATMENT
CONSERVATIVE:
• BELOW ELBOW PLASTER CAST WITH ABDUCTION & EXTENSION 4 WEEKS
SURGICAL:
• K—WIRE FIXATION
• SCREW FIXATION
70. ROLANDO’S FRACTURE
• EXTRA-ARTICULAR FRACTURE ACROSS THE BASE OF THE FIRST METACARAPAL.
• REDUCTION IS DONE WITH THUMB SPICA
• IMMOBILIZE FOR 3 WEEKS.
COMPLICATION:
• OA
71. LUNATE DISLOCATION
• LUNATE IS THE COMMONEST
CARPAL BONE TO BE
DISLOCATED.
MECHANISM OF INJURY
• HYPER EXTENSION
VIOLENCE
• BONE DISLOCATED TO THE
PALMAR WARDS
TWO TYPES:
Lunate dislocation:
Here Lunate dislocates
Anteriorly, Rest of carpal bones
remain in Position.
Peri-lunate dislocation:
Lunate remain in Position
Rest of the carpal bones
dislocated dorsally
72. PHYSIOTHERAPY PROTOCOL
DAY ONE TO ONE WEEK
• FULL ACTIVE ROM TO DIGITS
• FULL OPPOSITION OF THUMB
• ATTEMPT ISOMETRIC EXERCISE TO INTRINSIC MUSCLES OF HAND.
• USE UNINVOLVED HAND FOR SELF CARE & ADL
• NO WEIGHT BEARING ON AFFECTED SIDE.
PRECAUTIONS:
• NO SUPINATION/PRONATION
• NO ROM TO WRIST.
73. TWO WEEKS
• FULL ROM TO DIGITS,
• AROM TO WRIST IF IT IS IN ORIF OR EXTERNAL FIXATION.
• ISOMETRICS TO INTRINSICS, WRIST FLEXORS, EXTENSORS.
• ATTEMPT ACTIVITIES WITH UNINVOLVED LIMB.
• NO WEIGHT BEARING.
• NO SUPINATION/ PRONATION
• NO PROM TO WRIST ( ORIF & EF)
74. FOUR TO SIX WEEKS
• FULL AROM TO WRIST & FINGERS.
• SUPINATION / PRONATION ARE ENCOURAGED.
• ACTIVE ULNAR & RADIAL DEVIATIONS ARE DONE.
• GENTLE RESISTED EXERCISE TO DIGITS.
• ISOMETRICS TO FLEXORS, EXTENSORS, RADIAL/ ULNAR
DEVIATORS.
• GENTLE RESISTED EXERCISE IF TREATED BY ORIF OR EF.
• INVOLVED HAND USED AS A STABILIZER IN TWO HAND ACTIVITIES.
• INITIATE SELF CARE
• AVOID WEIGHT BEARING UP TO 6 WEEKS.
75. SIX TO EIGHT WEEKS
• FULL ROM TO ALL JOINTS OF UPPER EXTREMITY.
• STRESS SUPINATION / PRONATION & RADIAL / ULNAR DEVIATION.
• ACTIVE ASSISTED ROM TO PROM IS INITIATED.
• GENTLE RESISTIVE EXERCISES TO DIGITS & WRIST
• INVOLVED HAND USED FOR SELF CARE ACTIVITIES & ADL.
• IMPROVE POWER GRIP.
• WEIGHT BEARING TOLERATED
76. EIGHT TO TWELVE WEEKS
• FULL ROM ACTIVE OR PASSIVE IN ALL PLANES OF WRIST &
DIGITS.
• STRESS SUPINATION OR PRONATION.
• PRE
• SELF CARE ACTIVITIES.
• FULL WEIGHT BEARING AS TOLERATED.
77. METACARPAL FRACTURE
• FRACTURE OF THE METACRAPAL SHAFT IS VERY COMMON AT ALL
AGES.
• COMMONEST CAUSE IS FALL ON THE HAND
• BLOW ON THE KNUCKLES ( BOXING).
• CRUSHING HAND UNDER HEAVY OBJECTS.
78. CLASSIFICATION
• FRACTURE THROUGH THE BASE OF METACARPAL, USUALLY THROUGH
TRANSVERSE AND UNDISPLACED.
• FRACTURE THROUGH THE SHAFT—TRANSVERSE OR OBLIQUE
• USUALLY NOT MUCH DISPLACED
• DUE TO INTEROSSEI MUSCLES.
79. Neck of 5th Metacarpal fracture is due
to:
Boxing injury.
It is so called as Boxer’s Fracture.
Conservative management:
Splint
Cast
Surgical : ORIF—K-wire fixation
80. PHALANGES FRACTURE
• THESE ARE COMMON FRACTURES
MECHANISM:
• DIRECT INJURY
• INDIRECT TRAUMA
• BOTH DISPLACED & UNDISPLACED ARE SEEN.
82. MALLET FRACTURE
• AVULSION OF FRACTURE OF TERMINAL PHALANX
MECHANISM
• SUDDEN FLEXION OF DISTAL PHALANX IN CASE OF CRICKET,
• BASE BALL OR MAKING UP BED.
83. MANAGEMENT
• IMMOBILIZE THE FINGER IN POP WITH PROXIMAL INTERPHALANGEAL JOINT IN
FLEXION
• 3—4 WEEEKS
• SURGICAL
• ORIF
• K—WIRE ,
• ARTHRODESIS
84. PHYSIOTHERAPY PROTOCOL
DAY ONE TO ONE
WEEK:
• ROM OF DIGITS.
• GENTLE ROM OF
SHOULDER.
• ISOMETRICS TO
SHOULDER.
TWO WEEKS
• Active or Passive ROM to
Digits.
• AAROM to Shoulder.
Isometrics to Shoulder
FOUR TO SIX
WEEKS
• Continue AROM & PROM
to digits
• Active & AAROM to
Shoulder & Elbow.
Limit Supination /
Pronation
EIGHT TO
TWELVE WEEKS
• Gentle ROM to wrist.
Movements of Thumb
• Continue exes to
Shoulder & Elbow.
Gentle Supination/
Pronation Grip
exercises
TWELVE TO SIXTEEN
• ROM to all digits, Elbow, Shoulder.
• Grip strengthening exercises
• PRE Strengthening exercises for Biceps, Triceps,
Deltoid.
• Hydro therapy to reduce discomfort
86. SHOULDER
IMPINGEMENT SYNDROME
BICEPS TENDON DISORDERS
ROTATOR CUFF TEARS
PERI ARTHRITIS OF SHOULDER
THORACIC OUTLET SYNDROME(TOS)
ELBOW
LATERAL EPICONDYLITIS
MEDIAL EPICONDYLITIS
HAND AND WRIST
TRIGGER FINGER
CARPAL TUNNEL SYNDROME
DE QUERVAINS TENOSYNOVITIS
DUPUYTREN’S CONTRACTURE
87. TOS
COMPRESSION OF THE NEUROVASCULAR STRUCTURES AS THEY EXIT THROUGH THE THORACIC OUTLET
(CERVICOTHORACOBRACHIAL REGION). THE THORACIC OUTLET IS MARKED BY THE ANTERIOR SCALENE
MUSCLE ANTERIORLY, THE MIDDLE SCALENE POSTERIORLY, AND THE FIRST RIB INFERIORLY.
TOS AFFECTS APPROXIMATELY 8% OF THE POPULATION AND IS 3-4 TIMES AS FREQUENT IN WOMAN AS IN MEN
BETWEEN THE AGE OF 20 AND 50 YEARS.
CAUSE
CERVICAL RIBS ARE PRESENT IN APPROXIMATELY 0.5-0.6% OF THE POPULATION, 50-80% OF WHICH ARE
BILATERAL, AND 10-20% PRODUCE SYMPTOMS; THE FEMALE TO MALE RATIO IS 2:1.
CONGENITAL
• CERVICAL RIB
• PROLONGED TRANSVERSE PROCESS
• ANOMALOUS MUSCLES
• ABNORMALITIES OF THE INSERTION OF THE SCALENE MUSCLES
• FIBROUS MUSCULAR BANDS
• EXOSTOSIS (BENIGN GROWTH) OVER THE FIRST RIB
• CERVICODORSAL SCOLIOSIS
• CONGENITAL UNI- OR BILATERAL ELEVATED SCAPULA
88. ACQUIRED CONDITIONS
DROPPED SHOULDER CONDITION
WRONG WORK POSTURE (STANDING OR SITTING
WITHOUT PAYING ATTENTION TO THE
PHYSIOLOGICAL CURVATURE OF THE SPINE)
HEAVY MAMMARIES
TRAUMA
CLAVICLE FRACTURE
RIB FRACTURE
HYPEREXTENSION NECK INJURY, WHIPLASH
REPETITIVE STRESS INJURIES (REPETITIVE
INJURY MOST OFTEN FORM SITTING AT A
KEYBOARD FOR LONG HOURS)
89. MUSCULAR CAUSES
HYPERTROPHY OF THE SCALENE MUSCLES
DECREASE OF THE TONUS OF THE M.
TRAPEZIUS, M. LEVATOR SCAPULAE,
M.RHOMBOIDS
SHORTENING OF THE SCALENE MUSCLES,
M. TRAPEZIUS, M. LEVATOR SCAPULAE,
PECTORAL MUSCLES
90. CLINICAL PRESENTATION
PATIENTS WITH THORACIC OUTLET
SYNDROME WILL MOST LIKELY PRESENT
PAIN ANYWHERE BETWEEN THE NECK, FACE
AND OCCIPITAL REGION OR INTO THE
CHEST, SHOULDER AND UPPER EXTREMITY
AND PARESTHESIA IN THE UPPER
EXTREMITY. THE PATIENT MAY ALSO
COMPLAIN OF ALTERED OR ABSENT
SENSATION, WEAKNESS, FATIGUE, A
FEELING OF HEAVINESS IN THE ARM AND
HAND
91. WHEN THE ARM IS ABDUCTED OVERHEAD AND
EXTERNALLY ROTATED WITH THE HEAD ROTATED
TO THE SAME OR THE OPPOSITE SIDE. AS A RESULT
ACTIVITIES SUCH AS OVERHEAD THROWING,
SERVING A TENNIS BALL, PAINTING A CEILING,
DRIVING, OR TYPING MAY EXACERBATE SYMPTOMS.
WHEN THE UPPER PLEXUS (C5,6,7) IS INVOLVED
THERE IS A PAIN IN THE SIDE OF THE NECK AND
THIS PAIN MAY RADIATE TO THE EAR AND FACE.
OFTEN THE PAIN RADIATES FROM THE EAR
POSTERIORLY TO THE RHOMBOIDS AND
ANTERIORLY OVER THE CLAVICLE AND PECTORALIS
REGIONS. THE PAIN MAY MOVE LATERALLY DOWN
THE RADIAL NERVE AREA. HEADACHES ARE NOT
UNCOMMON WHEN THE UPPER PLEXUS IS
92. PATIENTS WITH LOWER PLEXUS (C8, T1)
INVOLVEMENT TYPICALLY HAVE
SYMPTOMS THAT ARE PRESENT IN THE
ANTERIOR AND POSTERIOR SHOULDER
REGION AND RADIATE DOWN THE
ULNAR SIDE OF THE FOREARM INTO
THE HAND, THE RING AND SMALL
FINGERS.
THERE ARE FOUR CATEGORIES OF
THORACIC OUTLET SYNDROME AND
EACH PRESENTS WITH UNIQUE SIGNS
AND SYMPTOMS
93. Arterial TOS Venous TOS True TOS Disputed Neurogenic
TOS
•Young adult
with vigorous arm activity
•Pain in the hand
•Claudication
•Pallor
•Cold intolerance
•Paresthesias
•S/s usually appear
spontaneously
•Younger men with
vigorous arm activity
•Cyanosis
•Feeling of heaviness
•Paresthesia in fingers
and hand (result of
oedema)
•Oedema of the arm
•Hx of neck trauma
•Pain, paresthesia,
numbness, and/or
weakness
•Occipital headaches
•S/s present-day and/or
night
•Loss of fine motor skills
•Cold intolerance
(possible Raynaud's
phenomenon)
•Objective weakness
•Compressors*: s/s
day>night
•Hx of neck trauma
•Pain, paresthesia, and
"feeling" of weakness
•Occipital headaches
•Nocturnal paresthesias
that often wake patient
•Loss of fine motor skills
•Cold intolerance
(possible Raynaud's
phenomenon)
•Subjective weakness
•Releasers*: s/s
night>day
94. SPECIAL TESTS
ADSON’S TEST
ELEVATED ARM STRESS/ ROOS TEST
PHYSIOTHERAPY MANAGEMENT
STRENGTHENING OF THE LEVATOR SCAPULAE, STERNOCLEIDOMASTOID AND
UPPER TRAPEZIUS (THIS GROUP OF MUSCLES OPEN THE THORACIC OUTLET BY
RAISING THE SHOULDER GIRDLE AND OPENING THE COSTOCLAVICULAR SPACE)
STRETCHING OF THE PECTORALIS, LOWER TRAPEZIUS AND SCALENE MUSCLES
(THESE MUSCLES CLOSE THE THORACIC OUTLET)
MOBILIZE FIRST RIB
POSTURAL CORRECTION EXERCISES
RELAXATION OF SHORTENED MUSCLES
MASSAGE
IF CONSERVATIVE MANAGEMENT FAILS: SURGERY
95. IMPINGEMENT SYNDROME IS A CLINICAL ENTITY IN
WHICH THE ROTATOR CUFF WAS
PATHOLOGICALLY COMPRESSED AGAINST THE
ANTERIOR STRUCTURES OF CORACOACROMIAL
ARCH, THE ANTERIOR THIRD OF THE
ACROMION,THE CORACOACROMIAL LIGAMENT,
AND THE AC JOINT.
CLINICAL FEATURES
SYMPTOMS USUALLY START GRADUALLY, IN THE
TOP-OUTER PORTION OF THE SHOULDER. THERE
MAY BE MILD PAIN ALL THE TIME, WITH SUDDEN
PAIN WHEN REACHING OVERHEAD AND PAIN
WHEN LOWERING THE ARM FROM AN OVERHEAD
POSITION. THERE MAY BE WEAKNESS OF THE
SHOULDER. IF NOT TREATED, THE CONDITION MAY
96. TREATMENT SURGICAL TREATMENT
FOR PRIMARY IMPINGEMENT SURGICAL
TREATMENT INVOLVES WIDENING THE
SUBACROMIAL OUTLET BY PERFORMING A
SUBACROMIAL DECOMPRESSION
(ACROMIOPLASTY)
FOR SECONDARY IMPINGEMENT THE SURGICAL
TREATMENT IS DIRECTED TOWARD THE ETIOLOGY
OF THE SYMPTOM
NON-OPERATIVE TREATMENT
THE INITIAL GOALS OF REHABILITATIVE PROCESS
ARE TO OBTAIN PAIN RELIEF TO REGAIN ROM
CRYOTHERAPY AND ULTRASOUND – TO RELIEVE
PAIN.
97. SUPRASPINATUS TENDINITIS
DEFINITION
INFLAMMATION OF SUPRASPINATUS TENDON
ANATOMY
ORIGIN: SUPRASPINOUS FOSSA
INSERTION GREATER TUBERCLE OF HUMERUS
MORE COMMON IN PITCHING IN BASEBALL, SWIMMING FREESTYLE, BUTTERFLY, OR
BACKSTROKE, LIFTING HEAVY WEIGHTS OVER THE SHOULDER
CAUSES
INJURY
OVER USE
PATHOLOGY
OVER USE
REPETITIVE STRESS
IRRITATION & INFLAMMATION
99. SPECIAL TESTS
SUPRASPINATUS TENDINITIS TEST
EMPTY CAN TEST
APLEY SCRATCH TEST
HAWKINS-KENNEDY IMPINGEMENT TEST
INVESTIGATIONS
X RAY MAY SHOW CALCIFICATION IN CALCIFIC
TENDINITIS.
101. ACUTE STAGE(0-7DAYS)
REST
CRYOTHERAPY
GRADE I MOBILISATION
SUB ACUTE STAGE (7DAYS-7WEEKS)
PULSED S W D
PULSED U S
LASER, IONTOPHORESIS
FRICTION MASSAGE
GRADE II &GRADE III MOBILISATION
PENDULAR EXERCISE
102. CHRONIC STAGE (ABOVE 7 WEEKS)
CONTINUOUS SWD
CONTINUOUS US
GRADE IV MOBILISATION TECHNIQUE
STRENGTHENING EXERCISES
(PROGRESSIVE RESISTED EXERCISE)
103. BICEPS TENDINITIS
DEFINITION
INFLAMMATION OF LONG HEAD OF THE BICEPS TENDON IN THE BICIPITAL GROOVE
ANATOMY
ORIGIN:
LONG HEAD: UPPER BORDER OF GLENOID CAVITY
SHORT HEAD: APEX OF CORACOID PROCESS
INSERTION: RADIAL TUBEROSITY
CAUSES
INJURY
OVER USE
PATHOLOGY
OVER USE
REPETITIVE STRESS
IRRITATION &INFLAMMATION
110. CAUSES
DEGENERATION OF ACROMIO CLAVICULAR JOINT
SUPRASPINATUS TENDONITIS
BICEPS TENDONITIS
PATHOLOGY
OVER USE
REPETITIVE STRESS
IRRITATION &INFLAMMATION
CLINICAL FEATURES
PAIN OVER THE SHOULDER
TENDERNESS AT THE TIP OF ACROMION
LIMITED ROM
WEAKNESS OF SUPRASPINATUS MUSCLE
111. SPECIAL TEST
SUB ACROMIAL PUSH BUTTON SIGN
DAWBARNS TEST
INVESTIGATION
X RAY SHOWS LOOSE RICE BODIES
112. PHYSIOTHERAPY MANAGEMENT
ACUTE STAGE
ICE THERAPY TO CONTROL PAIN AND
INFLAMMATION
SUB ACUTE STAGE
PULSED U S TO ANTERIOR PART OF
SHOULDER IN EXTENDED ARM POSITION
WHICH OPENS THE SUBACROMIAL SPACE.
PULSED S W D
113. CHRONIC STAGE
CONTINUOUS U S
CONTINUOUS S W D
STRENGTHENING OF SUPRASPINATUS
MUSCLE
SURGICAL MANAGEMENT
ACUTE-ASPIRATION OF SYNOVIAL FLUID
CHRONIC-ARTHROSCOPY
114. TREATMENT
ACUTE PHASE
THE INITIAL GOALS OF THE ACUTE PHASE OF
TREATMENT FOR BICIPITAL TENDINITIS ARE TO
REDUCE INFLAMMATION AND SWELLING.
PATIENTS SHOULD RESTRICT OVER-THE-
SHOULDER MOVEMENTS, REACHING, AND
LIFTING.
PATIENTS SHOULD APPLY ICE TO THE
AFFECTED AREA FOR 10-15 MINUTES, 2-3 TIMES
PER DAY FOR THE FIRST 48 HOURS
PHONOPHORESIS, IONOTOPHORESIS TO
RELIEVE PAIN AND INFLAMMATION.
115. PERIARTHRITIS SHOULDER
DEFINITION
IT INVOLVES THE PATHOLOGY IN THE PERI ARTICULAR STRUCTURES LEADING TO
ARTHRITIS OF
SHOULDER JOINT.
CAUSES
• SUPRASPINATUS TENDINITIS
• SUBACROMIAL BURSITIS
• BICEPETAL TENDINITIS
• O A OF ACROMIO CLAVICULAR JOINT
• ROTATOR CUFF INJURY
• HEMIPLEGIA
• DIABETES
• SURGERY ON THORAX –THOROCOPLASTY, MEDIAN STERNOTOMY
118. PATHOLOGY II
PROLONGED ACTIVITIES
WEAKNESS OF MUSCLE
ALTERED SCAPULO HUMERAL RHYTHM
MORE STRESS ON GLENO HUMERAL JOINT
INFLAMMATION OF TENDONS AND CAPSULE
LIMITATION OF R O M
119. CLINICAL FEATURES
PAINFUL STAGE
• PAIN WITH MOVEMENT
• GENERALIZED ACHE THAT IS DIFFICULT TO PINPOINT
• MUSCLE SPASM
• INCREASING PAIN AT NIGHT AND AT REST
• ADHESIVE STAGE
• LESS PAIN
• INCREASING STIFFNESS AND RESTRICTION OF MOVEMENT
• DECREASING PAIN AT NIGHT AND AT REST
• DISCOMFORT FELT AT EXTREME RANGES OF MOVEMENT
• RECOVERY STAGE
• DECREASED PAIN
• MARKED RESTRICTION WITH SLOW, GRADUAL INCREASE IN RANGE OF
MOTION
• RECOVERY IS SPONTANEOUS BUT FREQUENTLY INCOMPLETE
120. PHYSIOTHERAPY MANAGEMENT
PAINFUL STAGE
MOIST PACK
PULSED S W D
GRADE I OSCILLATORY MOBILIZATION TECHNIQUE
ADHESIVE STAGE
PULSED S W D
PULSED U S
GRADE II-GRADE III OSCILLATORY TECHNIQUE
PENDULAR EXERCISE
OVER HEAD PULLEY EXERCISE
121. RECOVERY STAGE
S W D
WAX THERAPY
PENDULAR EXERCISE
WALL LADDER EXERCISE
GRADE IV MOBILIZATION
STRENGTHENING EXERCISES FOR ROTATOR
CUFF MUSCLE
124. ROTATOR CUFF INJURIES
ACUTE TEAR
SUDDEN POWERFUL RAISING OF THE ARM AGAINST RESISTANCE, OFTEN IN
AN ATTEMPT TO CUSHION A FALL (EXAMPLES: HEAVY LIFTING, A FALL ON THE
SHOULDER)
INJURY USUALLY ASSOCIATED WITH A SIGNIFICANT AMOUNT OF FORCE IF
PERSON IS YOUNGER THAN 30 YEARS
CHRONIC TEAR
• FOUND AMONG PEOPLE IN OCCUPATIONS OR SPORTS REQUIRING EXCESSIVE
OVERHEAD ACTIVITY (EXAMPLES: PAINTERS, BASEBALL PITCHERS)
• VARIATIONS IN THE SHOULDER STRUCTURE CAUSING NARROWING UNDER
THE OUTER EDGE OF THE COLLAR BONE.
125. CLINICAL FEATURES OF ACUTE TEAR
SEVERE PAIN SHOOTING THROUGH THE ARM
MUSCLE SPASM
MOTION LIMITED BY PAIN
POINT TENDERNESS OVER THE SITE OF
RUPTURE
WITH LARGE TEARS, INABILITY TO RAISE THE
ARM OUT TO THE SIDE, ALTHOUGH THIS CAN
BE DONE WITH ASSISTANCE
126. CHRONIC TEAR
OCCUR MORE OFTEN IN A PERSON'S DOMINANT
ARM
MORE COMMONLY FOUND AMONG MEN OLDER
THAN 40 YEARS
PAIN USUALLY WORSE AT NIGHT AND INTERFERES
WITH SLEEP
WORSENING PAIN FOLLOWED BY GRADUAL
WEAKNESS
DECREASE IN ABILITY TO MOVE THE ARM,
ESPECIALLY OUT TO THE SIDE
ABLE TO USE ARM FOR MOST ACTIVITIES BUT
UNABLE TO USE THE INJURED ARM FOR ACTIVITIES
THAT ENTAIL LIFTING THE ARM AS HIGH OR HIGHER
127. PHYSIOTHERAPY MANAGEMENT
ACUTE STAGE
MOIST PACK
PULSED S W D
GRADE I OSCILLATORY MOBILIZATION TECHNIQUE
SUB ACUTE STAGE
PULSED S W D OR MWD
PULSED U S
GRADE II-GRADE III OSCILLATORY TECHNIQUE
PENDULAR EXERCISE
OVER HEAD PULLEY EXERCISE
SHOULDER WHEEL EXERCISES
WALL LADDER EXERCISES
128. CHRONIC STAGE
S W D/MWD
PENDULAR EXERCISE
WALL LADDER EXERCISE
GRADE IV MOBILIZATION
STRENGTHENING EXERCISES FOR ROTATOR
CUFF MUSCLE
130. LATERAL EPICONDYLITIS (TENNIS ELBOW)
PRIMARY INVOLVES DEGENERATION OF THE EXTENSOR CARPI RADIALIS BREVIS
TENDON 1 TO
2 CM DISTAL TO ITS ORIGIN AT THE LATERAL EPICONDYLE
CAUSES
GRIPPING ACTIVITIES (HAMMERING NAILS, PICKING UP HEAVY OBJECTS)
OVER USE OF THE MUSCLES OF THE FOREARM
CLINICAL FEATURES
PAIN
TENDERNESS
LIMITED R O M
MUSCLE WEAKNESS
DIFFICULTY IN DOING GRIPPING ACTIVITIES
131. SPECIAL TESTS
MILLS TEST
COZENS TEST
PHYSIOTHERAPY MANAGEMENT
ACUTE
PRICE PROTOCOL
WRIST COCK UP SPLINT AT 20 DEGREES MAY BE
USED TEMPORARILY(5-7 DAYS) ONLY AT NIGHT
SUB ACUTE
PULSED U S, LLLT
IONTOPHORESIS / PHONOPHORESIS
TRANSVERSE FRICTION MASSAGE
GENTLE ACTIVE ROM OF THE ELBOW, WRIST AND
HAND
LATERAL OR MEDIAL COUNTER BRACE
134. THE TRIANGULAR FIBROCARTILAGE COMPLEX
(TFCC)
LOAD-BEARING STRUCTURE BETWEEN THE LUNATE, TRIQUETRUM,
AND ULNAR HEAD. A TFCC TEAR IS A COMMON INJURY IN GOLF,
BOXING, TENNIS, WATER SKIING, GYMNASTICS, POLE VAULTING
AND HOCKEY.
FUNCTION: TO ACT AS A STABILIZER FOR THE ULNAR ASPECT OF
THE WRIST.
• TFCC IS AT RISK FOR EITHER ACUTE OR CHRONIC DEGENERATIVE
INJURY.
MOI: FORCED ULNAR DEVIATION
PATIENTS PRESENTS WITH ULNAR-SIDED WRIST PAIN THAT MAY
PRESENT WITH CLICKING OR POINT TENDERNESS BETWEEN THE
135. TFCC
DIAGNOSIS: MRI
ARTHROSCOPY IS THE DIAGNOSTIC GOLD STANDARD.
PROGNOSIS: GOOD
ETIOLOGY
OCCURS WITH COMPRESSIVE LOAD ON TFCC DURING MARKED
ULNAR DEVIATION
FORCED ULNAR DEVIANCE (I.E. SWINGING BAT, RACKET, ETC)
CAUSES INCREASED LOAD ON TFCC
CLINICAL PRESENTATION
PATIENTS COMPLAINS OF ULNAR-SIDED WRIST PAIN THAT OFTEN
GETS WORSE WITH ACTIVITY.
136. CLINICAL PRESENTATION
WEAKNESS IN THE GRIP, INSTABILITY, OR CLICKING SOUND
SPORTS INJURY LIKE BASEBALL PLAYERS: RESULT OF THE HEAVY
LOAD PLACED ON THE WRIST DURING THE SWING.
IN GYMNASTICS THE TFCC CAN BE INJURED THROUGH OVERUSE
INJURY.
ANY REPETITIVE WEIGHT BEARING ACTIVITIES (BOTH
COMPRESSIVE AND TENSILE).
SPECIAL TESTS
TFCC COMPRESSION TEST
TFCC STRESS TEST
PIANO KEY TEST
GRIND TEST
137. MANAGEMENT
CONSERVATIVE TREATMENT
• THE REHABILITATION PROGRAM SHOULD CONSIST OF REST,
ACTIVITY MODIFICATION TO REMOVE THE INCITING FORCE OF
INJURY, ICE APPLICATION AND SPLINT IMMOBILISATION FOR 3 TO 6
WEEKS
• AFTER THE IMMOBILISATION, THE PATIENT SHOULD RECEIVE
PHYSICAL THERAPY
SURGICAL
COMMON SURGICAL OPTIONS INCLUDE ARTHROSCOPIC REPAIR,
ARTHROSCOPIC DEBRIDEMENT (INDUCES BLEEDING TO
STIMULATE HEALING).
138. POST-OPERATIVE REHABILITATION
FOR TYPE 1 INJURIES
• WRIST WILL BE IMMOBILIZED FOR 1 WEEK AFTER THE
ARTHROSCOPY.
• AFTER ONE WEEK, RANGE OF MOTION EXERCISES CAN BE
STARTED.
• RETURN TO NORMAL SPORTS ACTIVITY IN 4 TO 6 WEEKS.
• WHEN THE SYMPTOMS REMAIN, ULNO-CARPAL
CORTICOSTEROID INJECTION CAN BE AN OPTION.
AFTER 4 WEEKS: THE WRIST IS PLACED IN A SHORT ARM SPLINT
WHICH ALLOWS PROGRESSIVE MOTION TO THE WRIST.
• THE IMMOBILIZATION WILL DECREASE THE WRIST PAIN AND
139. CONT.…
• PATIENTS CAN THEN START WITH RANGE OF MOTION AND GRIP-
STRENGTHENING EXERCISES.
• OTHER CO-ACTIVATION EXERCISES CAN ALSO BE INCLUDED TO
IMPROVE THE GLOBAL WRIST STABILITY.
AT 8 WEEKS POST OPERATIVE:
• ACTIVE MUSCLE TRAINING SHOULD BE STARTED
• A GRADED PAIN-FREE EXERCISE PROGRAM IS RECOMMENDED.
• PHYSIOTHERAPY MANAGEMENT SHOULD INCLUDE PATIENT
EDUCATION AND ACTIVITY MODIFICATION.
• ISOMETRIC EXERCISES SHOULD BE INCLUDED TO HELP
STRENGTHEN THE AREA AND REDUCE THE RISK OF INSTABILITY.
140. TRIGGER THUMB / FINGER
DEFINITION
TENOSYNOVITIS OF THE FLEXOR TENDON SHEATH OCCURRING AT THE LEVEL
OF THE METACARPO PHALANGEAL JOINTS.
CAUSES
OFTEN IDIOPATHIC
MAY BE CAUSED BY DIRECT TRAUMA
DIABETES
144. DUPUYTREN'S CONTRACTURE
DEFINITION
IT IS A CONTRACTURE OF THE PALMAR FASCIA OF THE RING AND LITTLE
FINGERS.
CAUSES
UNKNOWN. IN SOME PEOPLE THE CONDITION IS INHERITED
RISK FACTORS
AGE: 40 AND OVER
SEX: MALE > FEMALE
A PARENT WITH DUPUYTREN'S CONTRACTURE
DIABETES
145. PATHOLOGY
CHANGES IN THE PALMAR FASCIA
FIBRO PLASTIC PROLIFERATION
FIBROSIS
CONTRACTURE
CLINICAL FEATURES
SYMPTOMS ARE MILD BUT THEY BECOME
PROGRESSIVELY WORSE
RING FINGER IS USUALLY AFFECTED FIRST
FOLLOWED BY LITTLE
FINGER
NODULE PRESENT AT THE LEVEL OF METACARPO
PHALANGEAL JOINT
146. SURGICAL TREATMENT
MAKING SMALL INCISIONS IN THE
THICKENED TISSUE
REMOVING DISEASED TISSUE
REMOVING DISEASED TISSUE AND
OVERLYING DAMAGED SKIN, AND THEN
REPAIRING RESULTING GAPS IN SKIN WITH
SKIN GRAFTS
POST OPERATIVE SPLINTING AND
PHYSIOTHERAPY ARE VERY ESSENTIAL TO
PREVENT RECURRENCE.
147. DEQUERVAINS TENOSYNOVITIS
DEFINITION
INFLAMMATION OF THE TENDON SHEATH OF EXTENSOR POLLICIS BREVIS AND ABDUCTOR
POLLICIS LONGUS.
CAUSES
OVERUSE OF THE THUMB (PINCHING OR EXCESSIVE RADIAL DEVIATION)
EG- GOLFERS, SQUASH AND BADMINTON PLAYERS
CLINICAL FEATURES
INSIDIOUS ONSET
PAIN OVER THE FIRST DORSAL COMPARTMENT OF WRIST
SWELLING
TENDERNESS
LIMITED ROM
MUSCLE WEAKNESS OF APL AND EPB
148. SPECIAL TEST
FINKELSTEINS TEST
POSITIVE IF PAIN IS ELICITED OVER THE
FIRST DORSAL COMPARTMENT WHEN THE
THUMB IS HELD IN THE PALM AND WRIST IS
ULNARLY DEVIATED.
150. TO RELIEF PAIN
REST
ICE
ULTRA SOUND, LLLT
PHONOPHORESIS AND IONTOPHORESIS
TO REDUCE INFLAMMATION
MOIST HEAT
IONTOPHORESIS
SPLINTING
THUMB SPICA SPLINT, WITH THUMB IMMOBILIZED
IN ABDUCTION,
WRIST IN EXTENSION
151. TRANSVERSE FRICTION MASSAGE
TO INCREASE ROM
PAIN FREE ACTIVE ROM OF ENTIRE WRIST/THUMB
UNIT.
MODIFICATION OF ACTIVITY TO AVOID COMBINED
THUMB FLEXION AND ULNAR DEVIATION.
SURGICAL MANAGEMENT
THICKENING OF THE FIBRO-OSSEOUS CANAL
BECOME STENOTIC. RELEASE THE TIGHT
STRUCTURES.
152. GANGLION
The most common locations are the top
of the wrist the palm side of the wrist, the
base of the finger on the palm side, and
the top of the end joint of the finger.
The ganglion cyst often resembles a
water balloon on a stalk and is filled with
clear fluid or gel. The cause of these
cysts is unknown although they may form
in the presence of joint or tendon irritation
or mechanical changes. These cysts may
change in size or even disappear
completely, and they may or may not be
painful. These cysts are not cancerous
and will not spread to other areas
153. TREATMENT CAN OFTEN BE NON-SURGICAL. IN MANY CASES, THESE CYSTS
CAN SIMPLY BE
OBSERVED, ESPECIALLY IF THEY ARE PAINLESS. IF THE CYST BECOMES
PAINFUL, LIMITS ACTIVITY,
OR IS COSMETICALLY UNACCEPTABLE, OTHER TREATMENT OPTIONS ARE
AVAILABLE. THE USE OF
SPLINTS AND ANTI-INFLAMMATORY MEDICATION CAN BE PRESCRIBED IN
ORDER TO DECREASE
PAIN ASSOCIATED WITH ACTIVITIES. AN ASPIRATION CAN BE PERFORMED TO
REMOVE THE FLUID
FROM THE CYST AND DECOMPRESS IT. THIS REQUIRES PLACING A NEEDLE
INTO THE CYST,
WHICH CAN BE PERFORMED IN MOST OFFICE SETTINGS. IF NON-SURGICAL
OPTIONS FAIL TO
PROVIDE RELIEF OR IF THE CYST RECURS, SURGICAL ALTERNATIVES ARE
AVAILABLE. SURGERY
INVOLVES REMOVING THE CYST ALONG WITH A PORTION OF THE JOINT
CAPSULE OR TENDON
SHEATH IN THE CASE OF WRIST GANGLION CYSTS, BOTH TRADITIONAL OPEN
AND ARTHROSCOPIC TECHNIQUES MAY YIELD GOOD RESULTS. SURGICAL
TREATMENT IS GENERALLY SUCCESSFUL ALTHOUGH CYSTS MAY RECUR.