Deep Transverse fractures* Flashcards
how do we stress test ligaments (see that they are in tact)?
stretch the ligament and see that they are pain
how do we stress test tendon (see that they are in tact)?
resisted test - where the pain is helps differentiate between muscle and tendon.
how do we stress test muscle (see that they are in tact)?
resisted test - isometric contraction
deep transverse friction is a subclassification of
swedish remedial massage
definition of deep transverse friction
A repetitive, specific, non-gliding technique that produces movement between the fibres of dense connective tissue*; increasing tissue extensibility & promoting ordered alignment of collagen within the tissues
passive restraint
non contractile tissue stopping point at end of range guide joint motion connect bone to bone prevent excessive motion
dynamic restraint
connect muscle to bone
transmit tensile load to produce joint motion or maintain posture
upper limb synovial sheaths
between greater and lesser tubercle of humerus in intertubercular groove
major structural component of connective tissue
collagen
how is collagen aligned
oriented along axis of principal tensile physiological loading of CT
Roughly aligned in parallel bundles with scattered fibroblasts
elongation
straightening out of crimping
micro-failure
e.g. in cumulative overload
failure
(tearing): e.g. macrofailure or clinical strain / fracture
effects of injury and immobilisation on tendon
Irregular collagen arrangement Different collagen types Higher H2O content More random crosslinks between fibres, bundles & adjacent tissues Lower tensile stiffness Lower ultimate strength of CT
deep transverse friction analgesic effects
Counterirritant effect – stimulating (low-level) pain will activate body’s analgesic methods
Pressure / touch stimulus Pain gate effect via stimulating large diameter mechanoreceptors which inhibit transmission of pain impulses
Resorption of local irritating metabolites (by-products of healing process)
deep tissue friction effects - mobilisation
Mobilisation & remodelling of healing tissue reduced ‘stiffness’
Increase extensibility between tissue layers by producing a widthways stretching across fibres separating them and lengthening cross bridges between collagen fibres, thus restoring interfibre mobility
Increase extensibility between tissue and neighbouring surfaces e.g. Bone
Reduction in muscle tone
deep tissue friction effects - circulation
Local hyperaemia aiding the resolution of inflammation
Local ‘damage’ H substance released causing vasodilatation
stages of inflammation
acute inflammatory phase
proliferative phase
remodelling phase
acute inflammatory phase
vasodilation/constriction phagocytosis - neutrophil + monocytes 72 hrs - heat, swelling, redness pain tissue sensitivity altered chemical state
proliferative phase
fibroelastic infiltration
collagen formation producing granulation and scar tissue damage
remodelling phase
-contraction of scar
-vascularity reduces
-tensile strength of
collagen
-starts end of second
week – up to 1 year
deep tissue friction effects neurlogically
Neuromotor Excitability
Decrease in H-reflex (muscle tone) illustrating a reduction in neuromotor excitability when DTF applied to
mechanistic effects of deep transverse friction
reduced excitability
increased range of motion
increased supinator strength
contraindications of deep transverse friction
rheumatoid arthritis
calcification of soft tissue
over peripheral nerves- neuropraxia
why is rheumatoid arthritis a contraindication for deep transverse friction
Potential for collagenous weakening due to RA CI relevant to CT of affected joint(s) only e.g. ligt
why is calcification a contraindication for deep transverse friction
muscle or tendon e.g.
Myositis Ossificans (Quads)
Calcified SST
Pellegrini-Steida Lesion (MCL)
deep transverse friction technqiue
use area of hands to match target tissue size
apply accurately to site of tissue damage
apply at 90 degrees to tissue fibres
take tissues thu their full transverse sweep/ end feel
patients skin moves w/ finger over target tissue
warn patient it may be painful
pain must be within. patients pain tolerance
target tissue on stretch or shortened position
muscle tissue is in stretch or shortened position
shortened
tendon tissue is in stretch or shortened position
stretch
tendon-synovial sheath complex is in stretch or shortened position
stretch
deep transverse friction treatment parameters
depth of lesion
intensity - depends on stage of healing and pts pain tolerance
duration - 5-20 minutes
patient position - stretch or shortened position
when should deep transverse friction is used in a clinical setting
Ideal for small isolated musculo-tendinous or ligamentous lesion
Effects are both MECHANICAL & NEUROPHYSIOLOGICAL, but never used as sole treatment technique
