Class 12 Flashcards
What are Burger’s Disease (Clinical Presentation - Acute Inflammation Episodes)?
• flare-ups of acute angiitis affecting primarily medium-sized arteries & veins of leg (distal to knee) & possibly forearm
• intensely painful – pain from blood vessels, nearby tissues & supply tissues
• S/S of acute inflammation
• very high thromboembolism risk
• flare-up & remission pattern with varying frequency
What are Burger’s Disease (Clinical Presentation - Ongoing Problems)?
• with each attack, additional b.v. wall damage occurs, especially stenotic scarring
• ongoing thrombosis related risks
▪ very high risk of pulmonary & brain embolism
• ischemic & infarctive states in supplied tissue, e.g., ulceration
▪ very high risk of gangrene
• other sequelae of stenotic vessels, e.g. tissue dystrophy, edema, intermittent claudication
• risk of b.v. rupture
If individual stops smoking condition arrests without
further flare-ups; Residual damage is largely permanent.
What are Burger’s Disease (RMT Concerns)?
- RMT must look on this condition as often precluding massage therapy, especially when person is smoking & condition is active. Medical consultation is important.
Massaging unaffected body parts may be reasonable as long as risk of promoting problems from systemic increase in circulation is evaluated.
- Modified relaxation work & lightweight cool/cold applications may be beneficial during flare-up.
- Meds: Anti-inflammatories, anticoagulants, analgesics, muscle relaxants all possible.
- Often reduced sensation in affected body parts d/t reduced perfusion of local peripheral nerves.
- If medically cleared to massage during remission/inactive condition, RMT must be conscious of tissue fragility & other aspects of reduced perfusion & drainage. Massage & hydrotherapy approaches should avoid mobilizing large volumes of blood that damaged vessels may not be able to handle – may worsen congestion/edema & could promote gangrene. Very important to evaluate efficacy of ‘pumping’ modalities like contrast bathing or muscle squeezing in view of residual thrombus risk. More passive approaches like elevation & Buerger’s Exercise are probably better suited.
- Use person’s ADLs re: exercise tolerance & common hydro practices (as well as MD restriction info) to help set your guideline for acceptable levels of stimulus during treatment. Introduce modalities cautiously, e.g., hydro patch test.
- Exercise prescription should emphasize gently improving CV fitness & de-emphasize leg work (forearm if involved). Strenuous exercise should be avoided. Prolonged post exercise tenderness is common – needs appropriate mild warm-up and cool down. Buerger’s Exercise daily at home is excellent.
Raynaud’s conditions are characterized by?
• ‘attacks’ of arteriolar spasm
• typically affect hands; may involve the feet, nose, ears
• during attack affected part blanches & may become cyanotic
• ischemic pain
• episodes may last from a few minutes to a few days, varies greatly
• appears to be irritation or over-reaction of sympathetic innervation
What is Raynaud’s Disease?
• idiopathic, affecting otherwise healthy individuals
• typical sufferer is somewhat more likely to be female
• attacks are not associated with development of thrombosis or ongoing b.v. or tissue damage
• generally not treated medically – person may take analgesic during attack
What is Raynaud’s Phenomenon?
• associated with a known cause:
• occupational use of vibrating equipment like hydraulic drills/jackhammers
In this context often called ‘white hand.’ Avoidance requires compliance with strict limits of time spent on such equipment.
• secondary to autoimmune conditions like SLE and sometimes to cancer
In this context why an individual does or does not get Raynaud’s Phenomenon as complication of condition is not always clear, but predictable percentage do.
• attacks are typically more severe & frequently associated with ongoing b.v. damage; thrombosis may be present & trophic changes in supply tissue may occur
• treatment often related to managing causative condition where possible; anti-inflammatory & anticoagulant meds may be used, as well as analgesics
Raynaud’s Disease, Raynaud’s Phenomenon - what are some RMT Considerations?
- Check with each patient for attack triggers:
→ Cold exposure is most common attack trigger. Can be checked out with patient – most should not have their affected body parts treated with cold hydro or allowed to get cold.
→ Stress is next most common precipitator. Some patients, sympathetic activating stimuli (e.g. pain, heavy tapotement) may need to be avoided.
→ A small percentage have attacks when exposed to allergen, e.g. cigarette smoke, airborne chemicals. - Adapt to meds as necessary.
- If patient is an individual with Raynaud’s Phenomenon that causes b.v. damage, carefully assess tissue status & thrombosis status. Risk of damaging tissue, promoting gangrene, creating infarctions in body part.
- During an attack:
• No massage on site
• No direct application of heat or pressure
What are Varicose Veins (Varicosities)?
Result from valvular incompetence in veins.
Usually seen in lower limbs, but can also occur:
• in vicinity of old injuries
• anal varicosities called hemorrhoids
• esophageal varicosities are potentially dangerous complication of liver problems, e.g., alcoholics
What are Causes Varicose Veins (Varicosities)?
Three main categories:
- Mechanical factors chronically elevated hydrostatic pressure in the vein
• hypertension
• pregnancy
• injury (scar tissue proximally)
• prolonged standing
• tight clothing
• beer gut
• something going wrong with right atrium
- General Factors: Inheritance, Aging, Obesity
Tendency to varicosities does run in families, perhaps from weaker or less ideally formed vein valves structures? Bit more statistically common in males. - Direct damage – trauma, surgery, post phlebitis, disease states that affect veins
What are anal varicosities?
hemorrhoids
What are esophageal varicosities?
Potentially dangerous complication of liver problems, e.g., with alcoholics
What are the 5 Types of varicose veins (less severe to more severe)
• vascular asterisks
• reticular veins
• varicose veins
• venous insufficiency
• tropic ulcers
What is the Clinical Presentation of Varicose Veins?
• Vein becomes progressively elevated, tortuous, ‘lumpy’
• Bluish segments indicate static blood/thrombosis
• Achy pain
• Tired, ‘heavy’ feeling in limb
• May be itchy, burning sensation in local tissue
• May be night-time cramps in local mm.
• Local tissue develops dystrophic changes, fragility
• Ulcerations in severe cases
• May be significant distal edema
What are RMT Considerations of Varicose Veins?
- Slow-developing layered type of thrombosis that develops, exceptionally stable, almost never gives off emboli – good news for RMT, who should nonetheless avoid direct penetrating manipulations on-site. It’s not necessary to avoid massaging the limb, just aggressive on-site work.
- Avoid overloading or traumatizing vessel.
- Maintain awareness of local tissue fragility – assess tissues around & deep to varicosities before deciding on treatment approach. More advanced cases involve more careful adaptation of treatment approach.
- There are multiple treatment options for varicose veins, all of which are quick outpatient procedures. These treatment options share same end goal: to destroy target vein so that body can re-route blood to healthier vessels.
Patients will typically wear compression stockings for 1-2 weeks post-treatment, are encouraged to walk several times per day. For couple weeks (depending on the size of treated vein),
patients should avoid:
• Strenuous activity
• Hot showers, hot baths
• Swimming
• Overloading local venous circulation
(e.g., massage - especially deep, long strokes to region)
When in doubt, check with MD’s office for time frame to avoid local therapy.
What is the Varicose Veins Treatment (Laser (AKA Endovenous Laser Treatment/Therapy/Ablation)?
Laser closes proximal point of diseased vessel
Typically used for smaller veins; topical anesthetic required
