week 1 Flashcards

Question

Deep Heating examples

Answer 1

* ultrasound * shortwave diathermy (SWD) * microwave diathermy * occurs by conversion of another form of energy to heat * e.g.: energy in ultrasound waves produce heat in deeper tissues

Answer 2

* Provide a superficial moist heat * Stored in a thermostatically controlled hydrocollator * Wrap in 2-4 layers of towel for insulation before applying to the patient

Answer 3

* Ease of preparation and application * Variety of shapes and sizes * Moist, comfortable heat * Relatively inexpensive

Answer 4

* No method of temperature control once applied to patient * Do not conform to all body parts * Can be awkward to secure * Only retain heat for approx.20 minutes * Passive treatment * May be too heavy * Hot water hazard and spillages

Answer 5

* Efficient source of superficial heat due to its low melting point * Liquid state allows even distribution of wax * Often used in treatment of rheumatoid arthritis (RA)

Answer 6

* Even distribution * Adds moisture to skin * Can be used as exercise tool after treatment * Comfortable moist heat * Relatively inexpensive

Answer 7

* Can only be used for distal extremities (hands and feet) * No method of temperature control once applied to the patient * Only retains heat for approx. 20 minutes

Answer 8

a) Contraindications and Precautions b) Skin Tests c) Warnings given d) Monitoring during and after

Answer 9

* Circulatory insufficiency * Risk of dissemination * Exacerbation of existing conditions * To eyes or testes * Broken skin * DO NOT apply over transdermal drug patches or implants as may increase absorption of the drug which can be fatal (Fentanyl) Deep Vein Thrombosis (DVT): Heat application over an area with DVT could dislodge a thrombus, leading to a life-threatening embolism. Local Infection: Heat can exacerbate infection and promote bacterial growth in cases such as abscesses, osteomyelitis and septic arthritis Malignancy: Heat therapy can increase circulation, potentially accelerating cancer growth if applied near a tumour Severely Impaired Circulation: Heating ischaemic tissue could exacerbate tissue breakdown or cause burns due to impaired heat dissipation. Pregnancy: Whole-body heating is dangerous during pregnancy, and local heat (trunk, abdomen, pelvis) should be avoided over the foetal area Recently Radiated Tissue: Heat is contraindicated to an area if it has received radiation. Tissues may respond inadequately due to ‘tissue devitalisation’ for 3–6 months post radiotherapy Acute inflammatory skin disorders such as eczema and dermatitis as heat can exacerbate these conditions Inbuilt stimulators or metal implants: e.g., pacemakers is a CI in first 4 weeks of insertion

Answer 10

* Care using in conjunction with other modalities * Care if lying a patient on heat pack * May need more towels in application Metal Implants: Metal can concentrate heat, raising the risk of burns if heated Epilepsy: Though not directly contraindicated, practitioners should be cautious as thermal interventions may have unknown effects Photosensitivity: Some skin conditions and medications cause increased sensitivity to heat and UV exposure Over Open Wounds: Heat can delay wound healing and cause discomfort

Answer 11

* Tests the patient’s ability to discriminate hot from cold at the area to be treated * Done for ALL heat applications * Demonstrate on a non-affected area first * Typical items used are test tubes filled with warm and cool water * Care for spillages and dry or change linen immediately * Record the outcome

Answer 12

When having a heat treatment all you should feel is a mild, even, comfortable warmth. If you feel any more than this, or if heat concentrates in any particular spot or it starts to feel uncomfortable, please call me immediately otherwise you may be in danger of being burned. Please do not move or touch any of the equipment during the treatment. Do you understand this warning? Do you have any questions? Are you happy to proceed?

Answer 13

For hot packs, check skin immediately after application and again after 8 minutes and regularly thereafter * Observe skin and ask patient regarding the temperature of the pack * Look for even erythema, * Should be NO concentration of the sensation of heat * Bell/buzzer with patient

Answer 14

* Skin should be a nice even erythema after the application * Clean up immediately

Answer 15

Cryotherapy is the use of cold to treat injuries,

Answer 16

Ice packs, gel packs Cold Water Immersion

Answer 17

Reduces nerve conduction velocity, lowering pain perception. Blocks pain signals via mechanisms like the pain gate theory

Answer 18

Constricts blood vessels, reducing blood flow and inflammation Effects are greater in superficial tissues than deep muscles

Answer 19

Lowers white blood cell activity, reducing inflammation and tissue damage Minimises oxidative stress, preventing unnecessary tissue damage

Answer 20

Slows metabolism around the injury, limiting cell death and promoting healing

Answer 21

* Decreased skin temperature * Decreased muscle temperature * Decreased intra-articular temperature * Changes in blood flow * Decreased tissue metabolic rate * Decrease in nerve conduction velocity rapid locally and gradual deeper

Answer 22

* Blood flow decreases immediately during the first minutes of cold application due to vasoconstriction * Autonomic nervous system response triggered by stimulation of thermal receptors in skin * Increased blood viscosity and reduced blood flow * Reduced heat conduction to skin * After 5-10 minutes vasoconstriction gives way to vasodilation * This may last 15 minutes before being replaced by another episode of vasoconstriction

Answer 23

* Response in muscle to cooling is less dramatic * Decreased blood flow * Vasoconstriction * Increased viscosity of blood

Answer 24

* Metabolism is a series of chemical reactions * Cooling tissue will reduce the rate of these chemical reactions (Van’t Hoff’s Law) * Opposite to heating tissue * Limits likelihood of ischemia (secondary cell hypoxic damage)

Answer 25

* All nerve fibres are not equally affected by cooling * Myelinated nerves and smaller diameter fibres most affected * Smaller type A fibres are most affected * Fast pain, mechanoreceptors, cold receptors * C fibres (unmyelinated) are least affected * Chronic pain * Reduced motor skill * Reduced motor nerve conduction of afferent feedback

Answer 26

* Relief of pain * Treatment of acute injury * Secondary cell hypoxia * Effects on motor system * Relief of muscle spasm * Treatment of oedema * Treatment of chronic inflammatory conditions

Answer 27

* Decreased conduction velocity of pain receptors and neurons * Decreased release of pain- inducing irritants * Release of endorphins and encephalins * Also reduction of muscle spasm

Answer 28

* Immediate application of cold minimizes the extent of soft tissue damage (secondary cell hypoxia) and bleeding * Decreased metabolism * Decreasing the inflammatory response may limit oedema formation

Answer 29

* Long applications of ice reduces muscle strength * Short applications increase isometric muscle strength * Reduced motor skills & coordination * Due to slowed nerve conduction

Answer 30

* Reducing pain helps to reduce muscle spasm * Reducing muscle spasm allows increased range of movement

Answer 31

No indication that isolated use of ice alone increases function, reduces swelling and pain in acute LAS * Cryotherapy and exercise, greater effect on reducing swelling compared to heat

Answer 32

Cryotherapy may be beneficial in these conditions by relieving pain May also have a role in the management of acute inflammatory flare ups

Answer 33

* Involves placing part in mixture of cold water and flaked ice * Temperature can be controlled by varying the amount of ice that is added

Answer 34

* Self made using towel and ice flakes * Commercial cold packs * Commercial cold packs may be colder than ordinary ice packs * Potential to cause ice burns * Need to wrap in towel before application * Cold packs are applied for approximately 10-15 minutes (depth of target tissue)

Answer 35

* Towel placed in a mix of water and flaked ice and wrung out * Ice flakes will adhere to the cloth of the towel.

Answer 36

*Uses blocks of ice for direct massage *Ice is kept moving over the body part

Answer 37

* Cold water is applied to body parts via a sleeve which introduces compression at the same time as cooling. * Often used after orthopaedic surgery

Answer 38

* Can result in an ice burn * This is characterised by erythema and skin tenderness a few hours after treatment. * Cryotherapy can also cause injury to superficial peripheral nerves

Answer 39

* Circulatory insufficiency * Exacerbation of pre-existing conditions * Cold sensitivity ( e.g. Raynaud’s) * Cold urticaria * Cryoglobulinemia * Regions treated within 3-6 months by radiotherapy * Severe organ states Cold Hypersensitivity (Cold Urticaria): Can cause severe allergic reactions, including anaphylaxis Cryoglobulinemia: Cold exposure can lead to increased blood viscosity, causing blockages in small blood vessels Raynaud’s Disease/Phenomenon pregnancy

Answer 40

* Unable to communicate * Sensory loss * Note: * Extreme care required when icing near superficial nerve, neuropraxia can be a consequence Local Infection: While cryotherapy is generally safe, care should be taken when applied near infected tissue Recently Radiated Tissue: Radiated tissue may have altered circulation and sensation, increasing the risk of adverse reactions

Answer 41

* Cold feeling is noted very quickly * This is followed by burning/aching pain at around 2-7 minutes * Local anaesthesia/analgesia occurs at 5-12 minutes * Check after 5 minutes of application * Even redness during and after application * Shouldn’t be uneven/mottling of skin * Leave bell/buzzer with client

Answer 42

* This is an ice treatment. You will feel gradually increasing cold, which may be followed by a period of discomfort. The area should then go numb. If you feel any extreme discomfort or pain you must call me immediately as there is a danger of an ice burn. Please do not move or touch any of the equipment during treatment. * Do you understand? * Do you have any questions? * Are you happy for me to proceed with treatment?

Answer 43

 One of the most common injuries in sport  10% - 55% incidence  Types of acute injuries  Contusion  Strain/tear  Chronic/Overuse injuries  Focal thickening/fibrosis  Compartment syndrome  DOMS  Cramps?

Answer 44

A muscle contusion usually occurs when a muscle is subject to a sudden, heavy compressive force, e.g. direct blow to the muscle Overlying skin remains intact

Answer 45

 Muscle compression causes muscle fibre damage and rupture of microvessels  A large area of local hemorrhage (bleeding) is called a haematoma  Triggers an acute inflammatory response to remove the damaged tissue and initiating repair  Pain results from accumulating blood exerting pressure on nerve endings  Pain increases with movement or with pressure to area

Answer 46

extravasation of blood within intact muscle fascia results in increased intramuscular pressure, subsequently compresses & limits size of hematoma but can cause acute compartment syndrome.

Answer 47

develops if fascia surrounding muscle is torn & extravasated blood has access to spread into interstitial & interfascial spaces

Answer 48

 Occurs when hematoma calcifies within the muscle approx 3 wks post injury  Osteoblasts replace some of the fibroblasts in healing process

Answer 49

rebleed, inappropriate treatment eg heat or massage In case of thigh: knee effusion present, prone knee flexion < 45°

Answer 50

 Don’t improve in expected time frame  Improvements cease with subsequent deterioration  Ongoing signs of inflammation  Increase in morning pain & pain with activity  Night pain  Palpable lump

Answer 51

A muscle is strained or torn when some or all of the fibres fail to cope with the demands placed upon them e.g. excessive tensile force. it can be common in 2 jt muscles and during deceleration.

Answer 52

 Minor swelling  Minor discomfort  No or minimal loss of strength  No or minimal restriction of movement  Represents tear of few fibres

Answer 53

 Significant swelling  Significant discomfort,  Pain on contraction  Loss of strength  Restriction to movement  Represents tear of significant number of muscle fibres

Answer 54

 Complete tear of muscle,  Virtually complete loss of muscle function

Answer 55

 Skeletal muscle healing is a repair process (in contrast to bone which regenerates)  Heals with a scar which replaces the original tissue  3 phases of repair  - Inflammation (Destruction phase) - Proliferation (Repair phase) - Maturational (Remodelling phase)

Answer 56

 Initial trauma  Ruptured myofibres contract  Hematoma fills gap between myofibre stumps

Answer 57

Focal tissue thickening/fibrosis  Compartment syndrome  Delayed onset muscle soreness (DOMS)

Answer 58

 Repetitive microtrauma caused by overuse damages muscle fibres  Leads to adhesions between muscle fibres & formation of cross-linkages in fascia  Palpated as firm, taut, thickened bands arranged in the direction of stress  May present as large areas of increased muscle tone & thickening

Answer 59

 Exercise raises intracompartmental pressure & vicious cycle occurs  Muscle hypertrophy may be precipitation factor  Signs - Pain commences during activity, ceases with rest (does not ‘warm up’)  Diagnosis may involve compartment pressure testing

Answer 60

 Develops 24-48 hours after unaccustomed physical activity  Often more severe after eccentric exercise e.g. downhill running  Etiology unclear, theories proposed include:  Lactic acid  Muscle spasm  Torn tissue  Connective tissue  Enzyme efflux  Tissue fluid

Answer 61

A muscle cramp is a painful, involuntary muscle contraction that occurs suddenly & can be temporarily debilitating. Current theory: related to abnormal neuromuscular control at a spinal level in response to fatigue during or imediately after exercise

Answer 62

 3 stages of tendinopathy  Reactive, disrepair, degenerative  Degenerative = Collagen degeneration (disarray & separation)  Increased mucoid ground substance  Increased cells and vascular spaces +/-neovascularization  Absent inflammatory cells

Answer 63

 Pain sometime after exercise (next day)  Painful at rest, ‘warms up’ with use, then worsens in cool down  Local tenderness & thickening  Swelling or crepitus may be present

Answer 64

inflammation of the tendon

Answer 65

inflammation of outer layer of tendon, occurs when tendon rubs of bony prmoinces

Answer 66

 Acute oedema & hyperaemia  Infiltration of inflammatory cells  Rare occurrence  Signs - Crepitus (due to fibrinous exudate filling tendon sheath)  Difficult to differentiate from tendinosis

Answer 67

 Sudden onset of pain  Localised tenderness generally occurs at a site of least blood supply

Answer 68

 Inflammation (Destruction phase) - Necrosis predominates - Tenocytes migrate to area  Proliferation (Repair phase) - Synthesis of collagen  Maturational (Remodelling phase) - Repair tissue changes from cellular to fibrous - Alignment of collagen fibres in direction of stress

Answer 69

abnormal or excessive movement of the joint.

Answer 70

stretched fibres but normal ROM on stressing ligament

Answer 71

considerable proportion of fibres torn, stressing of ligament reveals increased laxity, but definite end point

Answer 72

complete tear of ligament with excessive joint laxity and no end point (be wary using pain as guide)

Answer 73

Initially hemostasis activated & fibrin clot formed then inflam response Formation of new tissue Remodelling

Answer 74

 Collagen disorganised  Smaller collagen fibres  Immature cross-links

Answer 75

The skin remains intact over the fracture site

Answer 76

The fractured bone disrupts skin integrity, creating a potential pathway for infection

Answer 77

pain, tenderness, swelling loss of function, nerve function loss, deformity of long bones, blood loss

Answer 78

reduction- restoration of a fractured bone to its normal postion immobilisation- prevents movement preservation- rehab exercises to restore function

Answer 79

capillaries continue to develop, tissue develops into granulation tissue, fibroblast produce a fibrocartilgous soft callus bridge (not strong enough to WB)

Answer 80

Occur when one side of the bone buckles while the opposite side fractures under tensile stress

Answer 81

Result from axial compressive loading, causing circumferential cortical bulging

Answer 82

Vulnerable sites in children and adolescents, commonly presenting as avulsion fractures when excessive tensile forces detach a portion of bone at the tendon or ligament insertion

Answer 83

malunion (inadequate alignment), delayed union (not in normal time frame), nonunion (failure for bone repair)

Answer 84

Haematoma Formation: Blood collects at the fracture site Fibrocartilaginous Callus Formation: Soft callus develops within a week Ossification: The soft callus is replaced by hard bone over several months Remodelling: The bone is reshaped to its original form, which may take years

Answer 85

Avascular Necrosis: Loss of blood supply leading to bone death Chronic Pain: Persistent discomfort post-healing Malunion: Abnormal healing alignment leading to secondary complications (e.g., osteoarthritis) Soft tissue injuries – Ligament, muscle, or tendon damage may result in long-term functional impairment.

Answer 86

Compartment Syndrome: Increased pressure within muscle compartments Infection: Especially in open fractures Acute compartment syndrome Neurovascular injury Deep vein thrombosis (DVT) / pulmonary embolism (PE)

week 1 Flashcards

(110 cards)