Integumentary System and Trigger Points Flashcards
what can we gain from examining the integument?
- circulatory problems (temperature)
- adhesions
- pain/primary problem location (eccymosis)
where do we document integumentary findings
under the systems review in examination (under objective section); the list of impairments documented go under assessment/evaluation and are considered in clinical impression
what information do you gather for your integumentary assessment
- determine baseline
- determine rate of healing
- determine presence of edema/swelling/effusion
what is edema
accumulation of excess fluid
what is swelling
clinical manifestation of edema
what is effusion
escape of fluid into a cavity
what do you inspect visually in your integument test
if post trauma/immobilization, look for atrophy, shiny, hairless skin, area of eccymosis
if scars/incisions, note dimension, location, number of sutures, presence of drainage (describe), presence of keloid/adhesion formation
what do you palpate for in integument test
tissue integrity: circumference/diameter; area of infection; area of healing; smell; size/color of eschar; amount/color of drainage
temperature: coolness (location, dimension); increased warmth
moisture: increased diaphoresis (sweating/clammy skin)
elasticity: use layer palpation/skin roll to assess
what are the steps for palpation
start around site of complaint
locate familiar bony landmarks
apply adequate pressure going from superficial to deep
what are indications for exam of myofascia
hypomobility
postural imbalance
swelling/edema
altered skin integrity (scar/poor nutrition)
what is a spasm
increased muscle tension and shortness which cannot be released voluntarily and prevents lengthening of muscles involved; responds to stretching
what is a trigger point
hyper irritable spots in skeletal muscles that are assc. with palpable nodules and taut bands of muscle fibers
what is a latent TP
is only painful if palpated, and the focus can be in muscle or associated fascia
can have referred pain pattern
what is an active TP
will refer pain and tenderness to another area with pressure
pattern of pain is specific to the muscle
differential diagnosis for TP
TP focal tenderness is always reproducible and pesent
local twitch can be elicited by pressure on TP
gentle sustained pressure on TP will reproduce referred pain
PROM/AROM increases pain
strong contraction against resistance creates pain
direction of skin roll is limited
altered muscle/tendon/ligament integrity
what are interventions for TP
manipulation of soft tissue
myofascial release
swedish massage
trigger point release
how does trigger point release decrease pain
through gate control theory (and general relaxation)
what are contraindications for TP
thrombophlebitis infection open wound new scar tissue edema 2dary to kidney, heart, lymph obstruction fx site acute injury, hemmorhage
what other interventions to use with TP
tissue elongation (stretching, PNF, muscle energy technique), joint mobilization, therex, modalities
what material to use with TP
cold cream, massage cream, etc. NOT commercial rubs
how do you document STM
in objective section: patient position, treatment technique, supplies used
assessment: patient response
plan: any changes in plan
