Orthopedic Tx 400 (Edema & Scar tissue -- lectures 2/3)

Question 1

Chronic edema

Answer 1

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

Question 2

pitted vs non-pitted edema

Answer 2

pitted edema indicates more complicated Systemic conditions

Question 3

acute stage duration?

Answer 3

0-3 days

Question 4

subacute (early and late)

Answer 4

..

Question 5

early subacute phase

Answer 5

2 weeks

10-14 days

Question 6

late subacute

Answer 6

up to 3 weeks

Question 7

what can modify duration of acute vs subacute

Answer 7

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)

Question 8

chronic

Answer 8

after 3 weeks (?)

Question 9

chronic tx strategies

Answer 9

anything is fair as long as patient consents

** important things to add
—> exercise/physical activity
—> adequate loading

misc:
Cross fibre frictions

stretching
joint mobilization

Question 9

acute tx strategies

Answer 9

ice

compensatory GSM (general swedish massage)

elevation

Diaphragmatic breathing

vibrations/tapotement

(?) visualization/meditation
(?) positional (Px) release

pain free motion (joint nutrition?)

Question 10

subacute

Answer 10

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

Question 11

note for PBA

Answer 11

can have one primary pathology (E.g. orthopedic)

—> but then patient description can also include other systemic conditions

Question 12

always remember to

Answer 12

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

Question 13

road rash, abrasion

Answer 13

superficial with ragged edges

scrape or tearing causing loss of skin

Question 14

laceration

Answer 14

increased tissue loss with ragged edges

Question 15

incision

Answer 15

clean, approximated edges, from a sharp object

generally induced by a surgeon in medical context

Question 16

puncture

Answer 16

clean edges with small entry

Question 17

animal bites

Answer 17

often a combo of crush, laceration, AND punture

ALSO OFTEN INFECTION

note importance of antibiotics

Question 18

burns

Answer 18

result of external thermal agent

E..g
boiling water
oil
chemicals
electrical burns
radiation (Even sun burn)

Question 19

burn degrees

Answer 19

They are categorized by degree;

First degree(superficial),

Second degree(partial thickness),

Third degree(full thickness), and

Fourth degree(also full thickness).

Question 20

first degree burns (superficial thickness)

Answer 20

Erythema, swelling, pain, skin blanches with pressure, only epidermis is affected, heals quickly, no scarring, eg; sunburn.

Question 21

second degree burn (partial thickness)

Answer 21

Affects epidermis and dermis, may result in scarring depending on severity, may require grafting, may leave permanent disfigurement, painful, erythema, superficial blistering.

Question 22

third degree burn (full thickness)

Answer 22

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.

Question 23

eschar

Answer 23

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.

Question 24

Fourth-Degree Burns (Full Thickness)

Answer 24

Damage to muscle, tendon, ligament, charring, catastrophic damage of the hypodermis, may result in compartment syndrome, grafting required if injury is not fatal.

Question 25

TYPES OF SCAR TISSUE

Answer 25

..

Question 26

contracture

Answer 26

shortening of CT

Can affect:
MM
tendon
joint capsule

Question 27

adhesion

Answer 27

reduced motion

—> leads to cross-links forming in collagen fibres

—> reduces ROM

Question 28

SCAR TISSUE adhesions

Answer 28

occur with injury or ACUTE inflammation

Collagen fibres allow adhesion and contracture to form IN RANDOM PATTERNS

Question 29

FIBROTIC adhesions

Answer 29

occurs with CHRONIC inflammation

Can cause moderate to severe restrictions in ROM

Difficult to resolve

Question 30

Proud Flesh

Answer 30

abnormally thick granulation tissue

does not re-epithelialize

raised, red, and susceptible to damage

Question 31

hypertrophic scar

Answer 31

and overgrowth of dermal tissue

remains within the wound boundaries

Question 32

avoid

Answer 32

avoid frictioning hypertrophic scars

Question 33

keloids

Answer 33

DO NOT WORK ON DIRECTLY

extends beyond original wound boundary

“accelerated growth of the scar”

Question 34

SCAR TISSUE CONTRAINDICATIONS

Answer 34

FRICTIONS CI’d —> ESP IF patient is taking anti-inflammatories

FRICTIONS CI’d / NOT RECOMMENDED for “Proud Flesh” and “Keloid Scars”

Question 35

HOPMNRS for Scars

Answer 35

..

Question 36

anecdote

Answer 36

numbness –> pain –> itchiness

Question 37

can you work at injury site?

Answer 37

not until closed and SHARP is reduced/removed

CAN work around the injury

Question 38

HOPMNRS for scars (OBSERVATION)

Answer 38

edema?

raised, red, avascular, no hair/glands, postural dysfunction ?

what type ?

infection?
fungus?

Question 39

HOPMNRS for scars (palpation)

Answer 39

tissue may be thick/hard

altered elasticity

cool to touch

may be decreased mm tone
—> D/t prolonged immobility

Question 40

treatment and homecare (scars)

Answer 40

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?

Question 41

Tx and homecare (cont) — ROM?

Answer 41

AROM
PROM
AAROM
(all within pain tolerance)

Question 42

prolonged passive stretching? (scars)

Answer 42

self stretching introduced in the late sub acute stage

Question 43

strengthening

Answer 43

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.