quiz-11/13/17 Flashcards
Distal Radius Fractures
One of the most common fractures in adults & usually from a fall on an outstretched hand (FOOSH)
Often associated with co-occurring injury
Radial fractures can cause shortening of the bone which can lead to ulnar abutment syndrome
Colles
Dorsal angulation
Smith
Volar angulation, less common than Colles
- falling with wrist in supination or flexion
Colles fractures- Fracture of the distal radius with DORSAL angulation
Surgical goal restore radial length and joint alignment to avoid ulnar abutment syndrome (compression of TFCC)
If fracture crosses the distal radial ulnar joint (DRUJ) or has involvement of the ulna then supination, pronation and radial/ulnar deviation will be affected
Closed reduction -
no incision made, the fracture is manipulated & realigned under X-ray fluoroscopy or just by feel and a cast is then usually applied.
Smith’s fracture
Volar angulation of distal fragment
Less common than Colles’
Smith’s and colles fracture can cause harm to what nerve?
Median Nerve
Non-articular fractures are easier to treat.
Can be treated non-operatively with immobilization.
Articular fractures involve the joint surface and usually require
external fixation to re-establish normal anatomical surfaces and alignment. If the joint surfaces are not preserved this will lead to pain, limitations in motion and arthritis from wear and tear.
Secondary complication- radius can shorten which causes ulnar abutment
If you have shortening- you get flattening of the incline because the radius is shorter
Positive for ulnar variance
the TFCC gets pinched- this creates ulnar sided wrist pain- supination makes it worse or if you add grip (shoves the ulna even farther in there)
- increases the load on the ulna
Ulnar Abutment Syndrome
-Ulnar sided wrist pain
Pain with supination (ulna migrates distally with supination. If a positive variance exists then more pressure on TFCC and carpals)
-Pain with weight beating and power grip secondary to change in load
-Normally a 22 degree incline between ulna and radius. Weight is distributed approximately 80% radius and 20% ulna.
Kienbock’s Disease
Avascular necrosis- death of the tissue because lack of blood flow
Surgical fixation methods for distal radius fractures
- Arthroscopic pinning
- Volar or dorsal plating and screws
- Cast applied two weeks the wrist control splint.
Percutaneous pinning
This can be added after reduction to provide additional stability
Pins for 6- 8 weeks
The superficial radial nerve is affected in up to 25%
External fixation used on:
Unstable Fractures
When the Fractures Extend Proximally up the Radius
Radiocarpal joint too smashed
Open and grossly contaminated fractures
The joint space has been compromised (not enough space or the articular surfaces don’t match up)
Open Reduction Internal Fixation
Volar plate fixation most common procedure but starting to see some dorsal.
Goal to restore close to normal anatomical position and joint surfaces.
Casted 2 weeks (performing tendon glides, AROM of digits, edema control) then thermoplastic wrist control splint is fabricated. Patient is instructed to remove splint to perform gentle ROM exercises 3 or 4 times a day.
Fracture Splint Following ORIF for distal radius fractures
Following a volar or dorsal plate procedure the wrist is immobilized 2 weeks then gentle AROM is allowed. A wrist control splint is fabricated and the patient can remove to perform exercises.
Management of carpal fractures
Carpal fractures are considerably less common than distal radius fractures.
Scaphoid fractures are the second most common wrist injury & most commonly fractured carpal bone.
Carpal fractures can be a diagnostic challenge
If the fracture is stable, immobilization by casting is the treatment of choice
Scaphoid
60-80% of carpal fractures involve this bone.
Forearm & thumb will have a thumb spica cast with IP free for 6 to 8 weeks.
Wrist immobilization with slight palmar flexion and radial deviation.
Splinting after cast removal is common.
Men are 10 times more likely to
fracture their scaphoid than women
This fracture is missed because:
- Feels like a sprain.
- Unlike the forearm, hand, and finger bones, fractures of the scaphoid rarely show any obvious deformity.
- Diagnosis delayed for weeks, months or even years
- The fracture may occasionally be invisible on the first x-ray, only to show up on an x-ray taken weeks or months later when bone re-absorption at the fracture site occurs
Scaphoid Fracture: Common Presentation is pain in snuffbox
Limited ROM due to pain (extension /RD)
Decreased grip strength
Painful grip and pinch
healing time for scaphoid fracture- Expected time to union for acute fractures is 6-24 weeks:
(1) Distal third = 6-8 weeks
(2) Middle third = 8-12 weeks
(3) Proximal third = 12-24 weeks
Scaphoid bloodflow
Proximal Pole fractures don’t heal well secondary to retrograde blood flow. These fractures must undergo ORIF of either screw or pinning and might require a bone graft.
Therapy for scaphoid fracture:
-A cast or splint is worn during fracture healing (6 to 8 weeks unless ORIF performed then they can move sooner)
-Encourage movement of digits & proximal joints, not
thumb
-Avoid heavy lifting, gripping, contact sports, & activities such as climbing ladders
-Initially in therapy the goal is to control the pain &
edema
Complications of scaphoid fractures:
- CTS
- Radial sensory n.
- Edema
- Pin infections
- Complex Regional Pain Syndrome (CRPS)
- Ligament injures
After a wrist injury: To be independent in most ADLS an individual should have the following
40 wrist extension
40 wrist flexion
50 forearm pronation
50 forearm supination
40 degree arc of ulnar and radial deviationKeep the patient’s focus on realistic goals for wrist injury
Keep the patient’s focus on realistic goals
-Goal is pain free functional range
The most important principle after distal radius fractures is to re-establish independent wrist extension .
Wrist extension required for functional grip strength (35 and 40 degrees).
Treatment while in cast for wrist fracture
AROM of elbow, shoulder, forearm, digits and thumb
Edema management: elevation, ice
Mirror Therapy (?)
Patient Education: Precautions and activity modification
Tendon glides
Therapy after casting or immobilization
Begin wrist AROM (supported on the table first and then against gravity)
Begin static progressive or dynamic splinting if stiff
Pain control: TENS, ice, E-stim for muscle re-ed
Functional activity / ADLs
Ultrasound for tightness or scar tissue
Pain Management for wrist fractures
Hot or Cold therapy
High volt electro-mesh glove
TENS
Modalities for wrist fractures
Heat and stretch
Cold
Fluidotherapy
Ultrasound or Iontophoresis
Joint Stiffness after wrist fracture
- Big problem after long term immobilization
- Joint mobilization (traction & dorsal/volar glide)
- Soft tissue mobilization
- PROM
- Heat and stretch
- Serial static splint
- Dynamic/static progressive splints
- Table top stretch/prayer stretch
Interventions for the stiff wrist
PROM Heat and stretch CPM Serial static splint Dynamic progressive splints Joint Mobilization Soft Tissue Mobilization
Considerations for wrist fractures:
As ROM exercises are initiated for wrist, be sure pt exercises while grasping an object. This allows pt to isolate wrist extensors from the Ex Digitorum Communis (EDC). (it thinks it can lift the wrist)
- marker or dowel to flex the EDC when extending and flexing the wrist
Fractures of the digits- closed and non-displaced
- Splint or cast
- Buddy tape
- Follow closely with x-ray
- Active motion permitted once pain and swelling resolve
Fractures of digits- closed displaced/angulated
- Manipulation/reduction of bone and external immobilization with cast or splint.
- Manipulation and percutaneous pinning
- Manipulation and application of an external fixator.
- Initiation of active motion will depend on stabilization technique and rate of fracture healing.
Fractures of the DigitsOpen, displaced, intra-articular, comminuted
-Open treatment involves exposure and direct manipulation of fracture
-K-wires
-Interosseous wires
-Plate a
Initiation of motion will depend on stability of fixation technique and rate of fracture healing.
radiographic evidence of healing.
- External fixation
- Intramedullary device
- Bone grafting
- Tension band technique
Fractures of digits- open, displaced
Initiation of motion will depend on stability of fixation technique and rate of fracture healing.
Rigid external fixation such as plate and screws allows for immediate AROM.
Semi-rigid Fixation- Begin motion based on resolution of pain, swelling and radiographic evidence of healing.
Metacarpal fracture
3-5 weeks
Proximal phalanx shaft fracture
5-7 weeks
Middle phalanx fracture
10-14 weeks
Distal phalanx fracture
3-4 weeks
Metacarpal fractures: 30-50% of hand fractures
- Fracture site more stable secondary to intrinsic muscles
- Most common fracture: Head or neck of the 5th metacarpal (boxer’s fracture).
- Metacarpal factures are characterized by excessive dorsal edema
-MP joint should be placed in 60 to 90 degrees of flexion
+++
- Fracture in dorsal angulation (interossei)
- Fourth and fifth digit can accept some angulation
- Second and third can not take beyond 15 degrees angulation.
What splint to use for metacarpal fracture- 5th metacarpal (boxer’s fracture)
Ulnar gutter
Proximal Phalanx fractures: (15-20%)
Common in thumb and index finger Proximal or mid-shaft area Spiral or oblique Proximal portion takes 3 to 5 weeks Mid-shaft takes: 7 to 8 weeks
Volar angulation of the fracture secondary to interossei attachment on the proximal piece and the central slip insertion on the distal portion.
Where is it bad for adhesions? Which fracture?
Proximal Phalanx Fractures
treat proximal phalanx
finger gutter splint and then you can use buddy tape
Middle phalanx fractures
Represent 8 to 12 % of hand fractures
Consolidation 10 to 14 weeks (takes the longest to heal)
Splinting as needed
Buddy strap
Distal phalanx fractures- 40-50%
- Crush injury
- Quick Healing (3 – 4 weeks)
- Very painful, hypersensitivity
- Nail matrix injury
- Tuft fracture is a comminuted fracture of the distal phalanx
- Soft tissue injuries such as Mallet and Jersey are avulsion fractures
Fractured thumb
- 4-6 weeks
- thumb spica splint
How to classify fractures?
Location in the bone * Angle of the fracture * Number of fragments Skin closed or open Stable or unstable Geometry: Transverse, oblique, spiral, comminuted, vertical Site: Base, shaft, neck, or head Deformity: Rotational, angular, or with shortening
Comminuted Fracture
involves shattering of bone into pieces; usually takes the longest to heal.
Compound/ Open Fx
bone pierces through skin
Incomplete Fractures
- Greenstick Fracture : characterized by a small crack and is most commonly found in children
- Hairline Fracture
Complete Fractures
Simple fracture: Transverse, oblique, spiral, impacted
Fractures can be angulated, displaced, distracted and pathological.
Growth plate fractures through the epiphyseal plate
should ultrasound be performed over growth plates?
NO
Clinical and radiographic healing
Clinical healing has occurred before it shows up on x-ray
Clinically healed means the bone can tolerate passive stress. It is determined by the MD.
Radiographic evidence of healing takes longer
What Is The Occupational Therapist’s Role in Fracture Management?
Splinting
Edema Control
Pain Control / Modalities
TENS, Cryotherapy, Hot packs, Ultrasound, NMES
Regain Range of Motion
Gentle AROM, AAROM, PROM, Stretching
- Regain Function/ADL and self care
- Regain sensation
- neuromuscular re-education
- Neuromuscular re-education
- Strengthening
Occupational Therapy Evaluation Acute Stage
Pain level Edema Associated soft tissue injury ROM in involved or adjacent joints depending on precautions Inspect for any deformity/mal-alignment
Goals after a fracture
Protect the fracture: Patient education, splinting
Edema & soft tissue swelling/inflammation reduction
Pain reduction
ROM / mobility improvement
Strength increased to functional level (LTG)
Ability to perform previous occupational tasks (LTG)
Inflammatory Phase : 1-2 weeks
Hematoma forms on the fracture site tissues come together to
begin bone repair
Regeneration Phase 2-6 weeks
Healing takes place- regrowth of bone & vascular tissue, soft callus
turns to hard callus & direct union
Remodeling Phase 6 weeks to a year
Strong bone tissue (ossification) is at the fracture
rigidity of callus dramatically improves between 6 to 8 weeks.
Complications Associated with Fractures; 1. Delayed Union or Non union caused by:
Infection
Poor blood supply
Fragments
Movement of parts after fixation, etc.
Complications Associated with Fractures: Malunion
rotation of spiral fracture or angulation- healing but at unusual angles. Fracture healed in the wrong position.
Choices for fracture fixation
-Fractures that are stable will often have closed methods of fixation such as a cast or splint.
Fractures that are displaced or unstable will require some form of internal fixation.
External fixation is used when traction is needed to hold a fracture out to length. Not seen as much with the development of the newer plate fixation techniques.
Fracture Immobilization
cast or external fixator
Internal Fixation
Screws Plates K-wires Tension bands Wire loop
Combination of fixation
splint with ORIF
Complications associated with fractures
Adherence of tendons resulting from edema, surgery or soft tissue injury over a fracture.
Joint stiffness and contracture after immobilization.
Occasionally, development of CRPS (complex regional pain syndrome)
The Unforgiving Elbow
High risk of contractures and motion loss following fractures and dislocations
Nerve injury often accompanies fractures of the elbow
High risk of the development of heterotopic ossification in the brachialis
Brachialis: Tone Issues and adhesions
The brachialis runs across the anterior joint capsule and will adhere to it which will lead to motion loss in both flexion and extension.
Facts about elbow injury
Loss of flexion is more limiting functionally
Extension loss is more common (-20)
Extension loss is more challenging
Treatment for Non-displaced Fracture
Sling for a few days
Elbow flexion and extension with forearm in neutral
Supination and pronation with elbow flexed at 90
Week 3 AROM as tolerated
No resistance for 8 to 10 weeks
Displaced Radial Head Fractures
Require fixation (Usually plates and screws) May or may not have a splint Gentle AROM Management depends on what other structures are involved
Splint to prevent full extension for elbow dislocation
Splinted at 90 degrees initially. Extension is gradually increased weekly. Full extension allowed at 6 weeks but is usually limited.
What is joint mobilization
Selective stretching of specific tissue around a joint without damaging adjacent tissue; Stretching a capsular structure in physiological planes.
Purpose of joint mobilization
Remodel connective tissue to improve extensibility and reduce stiffness
Reduce pain and encourage relaxation
Bathe the joint in synovial fluid and nourish joint structures.
Indications of joint mobilization
Stiff joints
To decrease pain
To prevent joint capsule tightening
Contraindications of joint mobilization
Joint replacements Fractures that are not healed Acute inflammatory or septic arthritis Bone disease Bacterial infection Malignancy Unstable joint
Osteokinematics:
Movements produced by 2 adjacent bones (flexion, extension, abduction etc). We can see/observe these motions.
These are the motions we are familiar with that occur in the cardinal planes. These include flexion, extension, abduction, adduction, internal and external rotation etc.
Arthrokinematics/Accessory:
essential movements that occur in joints as a result of physiologic (osteokinematic) motion but which cannot be produced my muscle action.
The motions occurring in the joint during motion. Spinning, rolling, gliding, sliding are necessary or impingement, compression, inflammation, stiffness and pain will occur.
Arthrokinematics/Accessory:
essential movements that occur in joints as a result of physiologic (osteokinematic) motion but which cannot be produced my muscle action.
The motions occurring in the joint during motion. Spinning, rolling, gliding, sliding are necessary or impingement, compression, inflammation, stiffness and pain will occur.
Concave
– hollowed or rounded inward like a “cave”.
Convex
curved or rounded outward
Ice cream cone
Convex moving on concave
Glide is to the opposite direction of movement. In other words The joint surface moves in the opposite direction the bone shaft is moving.
“Convex on Concave run the opposite way.”
ex) Glenohumeral joint
Concave moving on convex:
Glide in the same direction as movement of the bone shaft.
“Concave on convex like a wrench moves a hex.”
Ex) IP joints
Resting position
Maximum joint play - position in which joint capsule and ligaments are most relaxed
Evaluation and treatment position utilized with hypomobile joints
Loose-packed position
Articulating surfaces are maximally separated
Joint will exhibit greatest amount of joint play
Position used for both traction and joint mobilization
Close-packed position
Joint surfaces are in maximal contact to each other
General rule of joint positions
Extremes of joint motion are close-packed, & midrange positions are loose-packed.
Joint mobilization restores the accessory motions
(arthrokinematic motion) by gliding one joint surface on another, stretching peri-articular structures in the desired direction.
Importance of arthrokinematic motion
Essential to normal joint motion.
Loss of accessory motion can be clinically detected with joint assessment and at times might be the only pathology causing the pain or problem.
Restoration of accessory/arthrokinematic movement must accompany and usually proceeds restoration of movement in restricted joints.
Roll
A series of points on one articulating surface come into contact with a series of points on another surface
Rocking chair analogy; ball rolling on ground
Example: Femoral condyles rolling on tibial plateau
Roll occurs in direction of movement
Occurs on incongruent (unequal) surfaces
Usually occurs in combination with sliding or spinning
Spin
Occurs when one bone rotates around a stationary longitudinal mechanical axis
Same point on the moving surface creates an arc of a circle as the bone spins
Example: Radial head at the humeroradial joint during pronation/supination; shoulder flexion/extension; hip flexion/extension
Spin does not occur by itself during normal joint motion
Slide/Glide
Specific point on one surface comes into contact with a series of points on another surface
Surfaces are congruent
When a passive mobilization technique is applied to produce a slide in the joint – referred to as a GLIDE.
Combined rolling-sliding in a joint
Compression
Decrease in space between two joint surfaces
Adds stability to a joint
Normal reaction of a joint to muscle contraction
Distraction
Two surfaces are pulled apart
Often used in combination with joint mobilizations to increase stretch of capsule.
Structures being assessed
Capsular tightness
Joint surface
Congruency-greater contact more resistance to motion
Surface quality-rough verses smooth or loose bodies
Mobilization Techniques
Oscillations- to stimulate mechanoreceptors and inhibit nociceptors.
-pain relief
- low grade 1 and II
Roll/tilt
Glide
Spin/rotation
DistractionNeurophysiological effects –
Stimulates mechanoreceptors to pain
Affect muscle spasm & muscle guarding – nociceptive stimulation
Increase in awareness of position & motion because of afferent nerve impulses
Nutritional effects –
Distraction or small gliding movements – cause synovial fluid movement
Movement can improve nutrient exchange due to joint swelling & immobilization
Mechanical Effects
Improve mobility of hypomobile joints (adhesions & thickened CT from immobilization – loosens)
Maintains extensibility & tensile strength of articular tissues
Grades I and II - primarily used for pain
Pain must be treated prior to stiffness
Painful conditions can be treated daily
Small amplitude oscillations stimulate mechanoreceptors - limit pain perception.
Grades III and IV - primarily used to increase motion
Stiff or hypomobile joints should be treated 3-4 times per week – alternate with active motion exercises.
Joint Mobilization application
All joint mobilizations follow the convex-concave rule
Patient should be relaxed
Explain purpose of treatment & sensations to expect to patient
Evaluate BEFORE & AFTER treatment
Stop the treatment if it is too painful for the patient
Use proper body mechanics
Use gravity to assist the mobilization technique if possible
Begin & end treatments with Grade I or II oscillations
Positioning and stabilization
Patient & extremity should be positioned so that the patient can RELAX
Initial mobilization is performed in a loose-packed position
In some cases, the position to use is the one in which the joint is least painful
Firmly & comfortably stabilize one joint segment, usually the proximal bone
Hand, belt, assistant
Prevents unwanted stress & makes the stretch force more specific & effective
Patient response to joint mobilization
- May cause soreness
- Perform joint mobilizations on alternate days to allow soreness to decrease & tissue healing to occur
- Patient should perform ROM techniques
- Patient’s joint & ROM should be reassessed after treatment, & again before the next treatment
- Pain is always the guide
Superficial Thermal Agents
Fluidotherapy Hydrotherapy/whirlpool Cryotherapy (cold packs, ice) Hot packs Water (contrast baths) Paraffin Infrared Other commercially available heating or cooling technologies
Deep Thermal Agents
Ultrasound
Phonophoresis
Short-wave diathermy
Electrotherapeutic Agents
Use of electricity and electromagnetic spectrum to facilitate tissue healing, improve muscle strength and endurance, decrease edema, modulate pain, decrease the inflammatory process and modify the healing process.
- Neuro-muscular electrical stimulation (NMES)
- Functional stimulation (FES)
- High volt pulsed current (HVPC)
- Transcutaneous electrical stimulation (TENS)
- Interferential Current (IFC)
- Direct Current (DC)
- Iontophoresis
Mechanical Devices
Vasopneumatic devices (Edema) Continuous passive motion machines
Occupational Therapist must Demonstrate Verifiable Competence and Knowledge
Effects of the Modality:
-Biophysiological
-Neurophysiological
Electrophysiological
Safety in choosing to use a modality and in application:
- Knowledge of precautions
- Proper procedure and performance
Conduction
An exchange of heat when two surfaces come into contact with on another. Heat is transferred from the warm object to the cooler one (i.e. hot/cold packs, paraffin)
Convection
An exchange of thermal energy between and object and the fluid or substance moving past it (Fluidotherapy, whirlpool).
Conversion
Energy converted to heat. This form of heat is able to penetrate deeper into tissue (i.e. continuous ultrasound)
Analgesic/pain reduction
Alters nerve conduction
Decreases protective posturing, muscle guarding
Gate control theory/opiate mediated pain
TENS Effect (?)
Connective Tissue Effects
Increases tissue extensibility
Decreases joint stiffness
Temperature for therapeutic effectiveness must be at least 104 to 113 degrees to increase tissue pliability.
Effectiveness Depends on: Duration of heat Depth of penetration Degree of heating achieved Degree of stretch applied post heat The amount of tissue exposed
Metabolic and Vascular Effects
Vasodilation occurs with superficial heating
Indirectly effects sympathetic nervous system via spinal cord reflex
Cutaneous thermoreceptors carry afferent impulses to the spinal cord (feel the heat)
Heat stimulates the release of histamine which produces vasodilation
Heat with elevation aids venous return
Indications for the use of Heat
Decrease pain and muscle spasms To relax the patient To precondition tissue-increase softness and flexibility Increase blood flow and metabolism Stiff joints Adhesions and scar tissue Contractures
Indications for Heat
Chronic arthritis (paraffin)
Chronic and subacute inflammation: Heat decreases viscosity of the fluid making it easier to massage the swelling out following application.
Neuromas
Muscle spasms
Contraindications
Diminished sensation (Use caution). Absent sensation never use.
Very young or very old.
Nerve laceration with an insensate hand.
Impaired circulation (Use caution with diabetics)
Vascular instability (skin graft, replant)
Raynaud’s Disease- Vascular disease. Heat hardens arteries and causes damage.
Acute inflammation
Impaired cognition/mentation
Contraindications continued
Open wounds Over a malignant site Over rashes or skin conditions Bleeding tendencies/hemophelia Rheumatoid arthritis
Precautionary Use
Deep vein thrombosis (only under physicians order)
Infection (under physicians order)
Hot Packs
Uses Conduction through layers of towels as a method of heat delivery
Temperature of water in the hydroculator ranges from 160 to 180 degrees fahrenheit.
Never apply hot pack directly to skin.
If the tissue is being stretched with heat you must exercise more caution because blood flow is impaired.
Must have 6 to 8 layers with a small or cervical pack
One cover and two towels folded in half make 6 layers.
Paraffin wax
Heat Method: Conduction
-Liquid mixture of paraffin wax and mineral oil.
Usually comes pre-mixed in beads or blocks of paraffin.
Operating temperature: 125-130 degrees F.
Paraffin has a low specific heat, therefore the hotter temperature of 127 to 130 does not cause the tissue damage that a hot pack would at that same temperature. Specific heat is a measure of the heat required to raise the temperature of a given amount of a substance/tissue, one degree.
Paraffin wax bath benefits
Great for osteo and degenerative arthritis (not for rheumatoid).
Great for working on composite flexion of digits. Can have patient either actively flex to their max range or tape them in flexion (Can also be done with hot packs). Use caution when doing this. Blood flow might be affected with stretch which will reduce tissue tolerance to heat creating a more risk of injury.
Fluidotherapy
Heating Method: Convection
Uses dry heat and synthetic medium. Dry whirlpool More sanitary then water. Temperature easily adjusted. Agitation can be adjusted. Patient can move and perform exercises. Organic cellulose medium originally made of corn husks. Chatanooga manufactures both the units and the Cellex which is patented.
Fluidotherapy Recommended operating temperature
(115 to 116 degrees)
Rapid rate of heat transfer
Can use lesser temperatures for conditions such as CRPS or when you are focusing on desensitization.
Fluidotherapy precautions
Diminished sensibility
-Can cause edema secondary to the arm being in a dependent position.
Fluidotherapy Indications
Hypersensitivity Exercise with heat Exercise with resistance ROM in a painful extremity Heat with open wounds (use plastic bag)
Whirlpool
Heating mechanism conduction
Not used much anymore.
Heat source hot water
Temperature 90 to 120 degrees
Potential Dangers:
Cross contamination of open wounds
Advantages of whirlpool
Deep Tissue healing
Can exercise in the water
Facilitates debridement
Can adjust temperature
Contrast bath
Source:
-Hot and cold water basins
Heating Mechanism
-conduction
Indication:
-Pain and edema
Cold therapy
Decrease Inflammation-edema control
Pain control
Decrease spasticity
Decrease histamine through vasoconstriction
Decrease nerve conduction
Decrease muscle spasms
Cooling tissues after stretch helps maintain elongation of tissue.
Cold Therapy Contraindications
Some individuals are cold intolerant, thus not a candidate for cold modalities. Cold can cause a systemic response and vascular compromise.
Vascular insufficiency increases risk of frost bite.
Regenerating peripheral nerve
Blood clotting disorders
Over an area with peripheral vascular disease
Cold therapy precautions
Cognitively impaired Over an open wound unless using a whirlpool or water flushing modality. Hypertension Poor sensation The very young or the very old
Cold therapy adverse effects
Tissue damage < 54 degrees F.
Frostbite : 14 to 24 degrees F.
Nerve damage: Excessive exposure
Huntington’s reaction: Unwanted vasodilation with over 20 minutes exposure at consistent cold temperature (< 59 F).
Ice burns occur frequently secondary to people at home putting a cold pack either directly on skin or applying a pack and forgetting about it.
Indications for cold
Inflammation Swelling Pain Spasticity (time dependent) Muscle cooling after exercises Great for shoulders- Penetrates 10 cm beneath skin. Can reach the cuff.
Ice Massage indications
Pain, muscle cooling, localized inflammation and trigger points.
Treatment time varies based on location. Five to 10 minutes. Careful around boney prominences. Less time required to cool tissues
Infrared and light therapies
Infrared (IR) is invisible radiant energy, electromagnetic radiation with longer wavelengths than those of visible light, extending from the nominal red edge of the visible spectrum at 700 nanometers. Most of the thermal radiation emitted by objects near room temperature is infrared.
Infrared
Supposedly aids in circulation Used for diabetic neuropathy and pain. Various therapeutic delivery methods Hand held units Machines Anodyne
Other light therapy
Green Light to enhance Circadian Rhythm and help with sleep disorders.
Blue Light for skin cancer lesions
Both Green an blue have been used for cancer treatments and acne.
Laser Therapy (Low Level Laser Therapy or Cold Laser LLLT)
Low-level laser therapy (LLLT) refers to the use of a red-beam or near-infrared laser with a wave-length between 600 and 1000 nanometers and power from 5 to 500 milliwatts. Low-level lasers do not produce heat. In contrast, lasers used in surgery typically use 300 watts and burn the tissues they encounter.
Pain reduction, adhesion reduction and improve scar mobility.
