Integument Flashcards
What Does the Integument Tell Us?
- Determine the baseline status
- Determine the rate of healing/non-healing
- Determine the presence of edema/swelling/effusion
Edema/swelling/efussion
- Edema: accumulation of an excessive amount of watery fluid in cells, tissues or serous cavities (extravascular and interstitial tissue)
- Swelling: clinical manifestation of edema
- Effusion: escape of fluid from blood vessels or the lymphatics into tissue or cavity
Why Examine the Integument?
• Identify circulatory problems
o Altered temperature of an extremit
• Assist in locating the presence of adhesion formation
• Determine the location of pain/primary problem
• Location of eccymosis (bruising)
o Determine the acuteness or chronicity of the condition
What Will Elasticity of Integument Tell Us?
o Amount of drag or resistance to movement
o Use of fingers vs skin roll to assess the amount of motion in all directions
-localized = injury/trauma, systemic = bigger infection?
-Cold = circulatory issue
-Wet = systemic or sympathetic issue
Signs of Altered Skin Integrity
o Circumferential/diameter measure
o Areas of infection
o Areas of recent healing – implies weak tissue area
o Smell (if applicable) - indicates infections
o Size/color of eschar (scab)
o Amount/color of drainage – look at dressing Integumentary
Specific Integument Impairments
• Increased diaphoresis (sweating/clammy skin)
• Increased warmth/redness
• Coolness – circulation problems
o Location and dimension
What Does Myofascial Mean?
Pertaining to the sheet of fibrous tissue (connective tissue) that envelopes the body beneath the skin; also encloses muscles and muscle groups, and separates their several layers or groups
Indications for Examination
PT Impairments, Postural Imbalance, Swelling/Edema, Altered Skin Integrity
Postural Issues
Strength deficiencies in both muscles. Muscles lengthen, others tighten→muscles more prone to injury
Myofascial Tests and Measures
• Palpation
• Specific techniques
o Layer palpation and skin rolls
Muscle Spasm
• Increased muscle tension and shortness, which cannot be released voluntarily and which prevents lengthening of the muscles involved
• Responds to stretching
Occurs as a reaction to injury
Muscle Spasticity
Result of a neurological problem, loose inhibitory system and muscle contracts without any regulatory mechanism.
Triggger Points
Hyperirritable spots in skeletal muscles that are associated with palpable nodules and taut bands of muscle fibers. • Will refer pain and tenderness to another area of the body when pressure is applied – pattern of pain is reproducible
• Pattern of pain is specific to the muscle
Latent Trigger Points
Focus of hyperirritability in the muscle or its associated fascia, clinically only painful if palpated, can have referred pattern of pain
Trigger Points respond _______________ to stretching
Negatively
Muscle Spasms respons _______________ to stretching
Positively
If both muscle spasm and trigger points exists treat __________ first.
Trigger Point
Autonomic Signs that you should stop TP therapy
nausea, sweating, dizziness
TP Differential Diagnosis
- Passive or active ROM increases pain
- Strong contraction of muscle against resistance increases pain
- Direction and location of skin roll is limited
- Altered muscle/tendon/ligament integrity
More TP Differnetial Diagnosis
- Focal tenderness at TP, always present always reproducible
* Palpable taut band in muscle passing through the TP; muscle tissue in the vicinity feels dense to palpation
Exampls of Interventions for TPs
• Soft tissue mobilization (STM)/myofascial release (MFR)
o Targets superficial and deep layers
- Swedish massage
- Trigger Point Release
Mechanical Effects of Soft Tissue Mobilization and Myofascial Release
o Increased ROM, lymphatic flow, reduce scar tissue, helps with edema.
Metabolic Effects of Soft Tissue Mobilization and Myofascial Release
o Increase capillary dilation secondary to increase circulation
o Increase RBCs, platelets
o Prolonged effects - urine output, nitrogen excretion
o Intervention
Adverse Autonomic Effect of Soft Tissue Mobilization
- Seen with use in the thoracic area
- Increase in sweating, nausea, dizziness
- Stop treatment
Soft Tissue Contraindications
- Thrombophlebitis – blood clots
- Infection
- Open wound
- New scar tissue – weak tissue
- Edema secondary to kidney, heart, lymph obstruction – don’t want to push fluid to other parts of the body
- Fx site
- Acute injury
Benefits of STM
• Pain
o Decreases pain
• Neurological mechanism: Gate Control Theory of Pain:
• Psychological
o General relaxation and encourages confidence in patients
o Hands on effect”
STM is usedin conjuection with
o Therapeutic exercises
o Joint mobilization
o Electronic Muscle Techniques Stretching, PNF
STM Supplies to Decrease Friction
- Cold cream
- Massage cream/lotion
- Mineral oil
- Baby oil
- Cocoa butter and vitamin E oil*
- Bee’s wax*
For Deep Friction massage, should lotion should be used?
No
Why shouldn’t commercial rubs be used?
• Should not be used
• Superficial cutaneous fibers stimulated, may mask sensory input
• Increased chance of blistering
** Bengay is a skin irritant, thus that’s why there’s an increase in circulation
STM and Documentation
• Objective section under today’s treatment
o Should include patient position, treatment technique, time frame, supplies used
• Assessment section
o Interpret patient’s response to treatment
• Plan
o Any changes in treatment plan
