Orthopedic Tx 400 (Edema & Scar tissue -- lectures 2/3) Flashcards
Chronic edema
can begin working @ area of edema
can start experimenting with techniques
important to start at this point, b/c need to avoid scar tissue formation
pitted vs non-pitted edema
pitted edema indicates more complicated Systemic conditions
acute stage duration?
0-3 days
subacute (early and late)
..
early subacute phase
2 weeks
10-14 days
late subacute
up to 3 weeks
what can modify duration of acute vs subacute
site/tissue/severity of injury
—> How vascular is the tissue?
age of patient
& overall health status
nutrition/sleep of patient
underlying conditions or medications
reinjury
injury/recovery management
socioeconomic status (having to work despite injury)
chronic
after 3 weeks (?)
chronic tx strategies
anything is fair as long as patient consents
** important things to add
—> exercise/physical activity
—> adequate loading
misc:
Cross fibre frictions
stretching
joint mobilization
acute tx strategies
ice
compensatory GSM (general swedish massage)
elevation
Diaphragmatic breathing
vibrations/tapotement
(?) visualization/meditation
(?) positional (Px) release
pain free motion (joint nutrition?)
subacute
contrast therapy
no circulatory work (unless maybe in late subacute stage
general swedish (maybe not directly on site, esp early subacute)
Joint mobilization:
Lower grades at earlier subacute
Higher grades at later subacute
stretching/strengthening
—> referring to personal trainer, physiotherapist
note for PBA
can have one primary pathology (E.g. orthopedic)
—> but then patient description can also include other systemic conditions
always remember to
adjust treatment based on patient preference
even if something is indicated, it is not appropriate if patient doesn’t prefer it, or doesn’t consent
road rash, abrasion
superficial with ragged edges
scrape or tearing causing loss of skin
laceration
increased tissue loss with ragged edges
incision
clean, approximated edges, from a sharp object
generally induced by a surgeon in medical context
puncture
clean edges with small entry
animal bites
often a combo of crush, laceration, AND punture
ALSO OFTEN INFECTION
note importance of antibiotics
burns
result of external thermal agent
E..g
boiling water
oil
chemicals
electrical burns
radiation (Even sun burn)
burn degrees
They are categorized by degree;
First degree(superficial),
Second degree(partial thickness),
Third degree(full thickness), and
Fourth degree(also full thickness).
first degree burns (superficial thickness)
Erythema, swelling, pain, skin blanches with pressure, only epidermis is affected, heals quickly, no scarring, eg; sunburn.
second degree burn (partial thickness)
Affects epidermis and dermis, may result in scarring depending on severity, may require grafting, may leave permanent disfigurement, painful, erythema, superficial blistering.
third degree burn (full thickness)
Extends down to the hypodermis or subcutaneous tissue.
May affect bone, tendons, nerves, not generally painful, partial thickness areas are painful, requires surgery, grafting,
may result in permanent disfigurement, risk of infection, life threatening if extensive, charring and eschar can be present.
eschar
a dry, dark scab or falling away of dead skin, typically caused by a burn, or by the bite of a mite, or as a result of anthrax infection.
Fourth-Degree Burns (Full Thickness)
Damage to muscle, tendon, ligament, charring, catastrophic damage of the hypodermis, may result in compartment syndrome, grafting required if injury is not fatal.
TYPES OF SCAR TISSUE
..
contracture
shortening of CT
Can affect:
MM
tendon
joint capsule
adhesion
reduced motion
—> leads to cross-links forming in collagen fibres
—> reduces ROM
SCAR TISSUE adhesions
occur with injury or ACUTE inflammation
Collagen fibres allow adhesion and contracture to form IN RANDOM PATTERNS
FIBROTIC adhesions
occurs with CHRONIC inflammation
Can cause moderate to severe restrictions in ROM
Difficult to resolve
Proud Flesh
abnormally thick granulation tissue
does not re-epithelialize
raised, red, and susceptible to damage
hypertrophic scar
and overgrowth of dermal tissue
remains within the wound boundaries
avoid
avoid frictioning hypertrophic scars
keloids
DO NOT WORK ON DIRECTLY
extends beyond original wound boundary
“accelerated growth of the scar”
SCAR TISSUE CONTRAINDICATIONS
FRICTIONS CI’d —> ESP IF patient is taking anti-inflammatories
FRICTIONS CI’d / NOT RECOMMENDED for “Proud Flesh” and “Keloid Scars”
HOPMNRS for Scars
..
anecdote
numbness –> pain –> itchiness
can you work at injury site?
not until closed and SHARP is reduced/removed
CAN work around the injury
HOPMNRS for scars (OBSERVATION)
edema?
raised, red, avascular, no hair/glands, postural dysfunction ?
what type ?
infection?
fungus?
HOPMNRS for scars (palpation)
tissue may be thick/hard
altered elasticity
cool to touch
may be decreased mm tone
—> D/t prolonged immobility
treatment and homecare (scars)
promote mobile/functional scar
–> increase ciuclation
increase edema
adress compensatory strutures
TREAT THE PERIPHERY FIRST***
H2O –> heat is used as pre Tx on maturing Scar tissue
Techniques
MFR
MLD (lymph drainage)
skin rolling
S/C bowing (GTR)
Cross fibre frictions (OI technique?)
followed by passive stretch (TO PREVENT ADHESIONS)
H2O –> Cold is applied post treatment (?????)
—> Why?
Tx and homecare (cont) — ROM?
AROM
PROM
AAROM
(all within pain tolerance)
prolonged passive stretching? (scars)
self stretching introduced in the late sub acute stage
strengthening
Strengthening begins with submaximal isometric contractions in early(?) sub acute stage, increasing as the scar matures. Next, isotonic is introduced.
Strengthening the antagonist will help prevent contractures in the agonist.
Eg;
injury to the forearm flexors, strengthening the extensors will decrease a tendency for the wrist to be drawn into flexion as the scar tissue contracts.
