Mechanical Flashcards
1
Q
Edema Formation
A
- Edema composed mostly of blood plasma moves into the tissues in reaction to:
~ Increased blood vessel permeability.
~ Vasodilation
~ Altered Concentration Gradient
> Usually no or little difference is
present.
> With injury concentration
gradient shifts causing fluid to
flow into the tissues.
2
Q
Venous and Lymphatic Return
A
- Reduces Edema
~ Transports fluid (venous) and more
solid wastes/fluid (lymphatic) out of
the tissues and away from injury site - Arterial Pressure (heart) > Venous
Pressure - Lymphatic > Venous
3
Q
Venous and Lymphatic Return Mechanisms: Skeletal Muscle Contraction
A
- Veins and lymph vessels have one-
way valves.
~ Permit flow toward the heart
and prevent back-flow. - Vessel compression increases the
pressure which closes upstream
valves and opens downstream valves - Contraction forces blood and lymph
forward in the vessels
4
Q
Venous and Lymphatic Return Mechanisms: Respiratory Activity
A
- Both venous and lymphatic systems empty into the right atrium (RA).
~ Lymphatic fluid enters the venous
blood just prior to venous blood
entering the RA - Pressure in the RA is dependent on thoracic chamber pressure.
~ During Inspiration chest wall
expands and the diaphragm
descends causing a fall in thoracic
chamber pressure that leads to
expansion of the lungs, cardiac
chambers.
5
Q
Venous and Lymphatic Return Mechanisms: RA Pressure
A
- Expansion causes a decrease in RA pressure
~ A decrease in RA pressure alters the
pressure gradient causing increased
flow into the RA
6
Q
Venous and Lymphatic Return Mechanisms: Lymph Vessels are also Muscular
A
- When the vessels fill, pressure is exerted on the vessel wall causing a reflexive contraction of the musculature
7
Q
RICE: Compression
A
- Increases fluid pressure in tissues
~ Decreases flow of fluid into the
tissues
~ Encourages flow of fluid into the
vessels - Compression can take place of muscle contraction
- Prevents secondary damage, pain, and further damage
- RICE modifies concentration gradient
8
Q
RICE: Elevation
A
- Placing the limb in a nondependent position (elevated)
- Decreases fluid pressure in the vessels by decreasing fluid volume
~ Decreases flow of fluid into the
tissues.
~ Encourages flow of fluid into the
vessels.
~ Most effective when limb is at 90
degrees.
> Should at least be above level
of heart.
9
Q
Intermittent Compression
A
- Body part enclosed by a sleeve or appliance that’s filled with air or water
10
Q
Intermittent Compression: Circumferential
A
- Equal amount of pressure applied to all parts of the body part
~ Jobst Pump, Gameready
11
Q
Intermittent Compression: Sequential
A
- Compartments within the sleeve or appliance fill distal to proximal
~ Cryopress, Normatec
12
Q
Intermittent Compression: Mechanisms for Edema Management
A
- Increases pressure inside the tissues.
~ Changes pressure gradient. - Forces fluid forward in the venous and lymphatic systems.
~ Requires duty cycle or sequential
pressure for re-filling of venous and
lymphatic vessels.
13
Q
Intermittent Compression: Indications
A
- Edema
- Prevention of DVT (clotting)
14
Q
Intermittent Compression: Contraindications
A
- Fracture
- DVT
- Edema caused by congestive heart failure
- Dermatitis
- Thrombophlebitis (inflamed vein = clotting)
- Gangrene
- Compartment Syndrome
15
Q
General Procedures for Pressure
A
- Maximal pressure should not exceed diastolic BP
~ Blood wouldn’t be able to return to
heart if too high - Duty cycle of 3:1 (45s:15s) are commonly used
~ Can be modified
~ Cycle not well researched
~ Some off time required for pumping
action or sequential changes
16
Q
Traction
A
- Application of a longitudinal force to the spine distracting the vertebrae.
- Mechanical, Manual, Positional
- Traction is not a solution but a temporary pain reliever
17
Q
Traction: Indications
A
- Spinal Nerve Compression
- Disc Bulging/Herniation
- Facet Joint Pathology
- Muscle Spasm
18
Q
Traction Indication: Spinal Nerve Compression
A
- Pressure on the spinal nerve root.
- Result of bony abnormality (arthritic, anatomical), disc bulge/herniation or swelling mechanically impinging on the spinal nerve root as it passes through the intervertebral foramen.
- Separation of the vertebrae causes opening of the intervertebral foremen
~ Increased foremen can decrease
pressure on the spinal nerves
~ Different movements can make
foremen bigger/smaller which is very
important during rehab
19
Q
Traction Indication: Disc Bulging/Herniation
A
- Encourages the nucleus to migrate to the center
~ Removes compression on the disc
~ Elongates the annulus and causes
negative pressure
~ Puts tension on the posterior
longitudinal ligament - Disc Herniation typically goes posteriolateral due to bending forward being the most common MOI and the lack of ligament support in this direction
20
Q
Traction Indication: Facet Joint Pathology
A
- Facet joint pain due to arthritis, compression of facet surfaces or impingement of synovial membrane or oteochondral fragments.
- Flexion opens facet joints
- Extension closes facet joints
- Traction Effects
~ Decreases impingement
~ Allows synovial fluid exchange to
nourish the cartilage
21
Q
Traction Indication: Muscle Spasm
A
- Can relieve spasm caused by spinal nerve root compression
~ Can stretch/relax the paraspinals by
activating the GTO
~ Can reduce pain by activating
ascending pain mechanisms
22
Q
Traction Contraindications
A
- Acute Injury
- Unstable Spine
- Meningitis (coating that cover CNS)
- Vertebral Fractures
- Vascular Insufficiency
~ Arteries supplying the brain are
narrowed - Osteoporosis
~ Less density in bones = breaks
23
Q
Cervical Traction: Tension
A
- Least amount of force that reduces symptoms should be used
- Generally, a force = 20% of body weight will cause vertebral separation (supine)
~ More force needed in a seated
position due to gravity
