Contraindications to ultrasound

DOC-P (2's and 3) MINS-U (1's)

D1 - Deficient sensation (will be unaware if unstable cavitation is occuring resulting in burns)
D2 - DVT in treatment area (could become dislodged and cause pulmonary embelism)
O1 - Over spinal cord after recent spinal surgery (unstable cavitation in CSF)
O2 - Over pelvis or abdomen during menstruation or pregnancy
C1 - Compromised circulation (vessels can't deal with excess demand)
C2 - Cancer (irradiated tumours grow larger and heavier)
P1 - Physio untrained
P2 - Peripheral vascular disease (tissues can't cope with excess metabolic demand)
P3 - Previous deep x-ray therapy (radiotherapy)

M - Metal or plastic implants (cause more standing waves)
I - Infection in treatment area
N - No consent
S - S.E.G Skull, eyes, gonads
U - Unknown diagnosis

ULTT1

ULTT1 - all 3 major upper limb nerves are stretched with a median bias

• Stabilise scapula by depressing shoulder
• Abduct shoulder 1st
• Supinate
• Extend wrist and fingers
• Laterally rotate
• Extend elbow

Apply each one fully and check if the patient's alright before progressing to the next movement.

Be aware of your posture and ELITE

Inform the patient of what you're looking for, for them to not adjust their position as it will effect the results of the test and may produce a false positive and to inform you if they feel any pain or parasthesia

No pillows

Make sure patient is positioned properly on plinth so arm doesn't fall into horizontal extension or not enough room for abduction

ANT - Adverse Neural Tension

Also known as AND (adverse neurodynamics) and AMT (adverse mechanical tension) but all basically mean the same thing.

They all describe the process whereby neural tissue is compromised and looses its ability to fully lengthen leading it to be unable to conform to changes in limb and or trunk position.

The 3 mechanisms nerves conform to positions are:

1) Sliding across mechanical interface (bone, muscle, fascia etc)

2) Unwinding of a nerve

3) Becoming stretched and therefore increasing their internal and external tension

In a nutshell, if mechanism 1 and 2 become compromised, mechanism 3 is greatly increased!

• ANT can be used to both diagnositcally test (assess) and treat neural problem

Carpal tunnel syndrome

Carpal tunnel syndrome, or median neuropathy at the wrist, is a condition where the median nerve is compressed at the wrist. This leads to paresthesias (pins & needles) and muscle weakness in the hand. Night symptoms and getting woken up is also something that from your subjective assessment would be ringing bells to test for carpel tunnel syndrome. But what are these "tests" you speak of??

The median nerve sits between flexor digitorum profundus and flexor digitorum superficialis

Phalen's Test

This position reduces the size of the carpal tunnel, so if you did

have it, the symptoms would be aggravated temporarily. A +ve

test would reproduce pain, numbness or tingling.

Tinnel's Test

Uses a tapping movements over the line of the median

nerve over the flexor retinaculum area.

You're looking for setting off the sensations of pin's and needles

Peripheral Vascular disease (PVD)

Peripheral vascular disease or PVD is a broad 'umbrella' term used to describe any disease (or pathology) which involves compromised circulation of the large arteries to the arms or legs due to obstruction.

It can result from:
- atherosclerosis
- embolism
- thrombus formation

Causes either acute or chronic ischemia to arms or legs

Beat frequency

"The beat frequency is the resulting low frequency at the cross over point of 2 medium frequency currents"

E.g. If the current at at electrode A is set at 4100 Hz and 4000 Hz at electrode B'

the beat frequency will be 100 Hz and therefore target Abeta fibres (high frequency, low intensity)

Hyperalgesia & Hyperesthesia

Hyperalgesia = An increased sensitivity to pain, may be caused by damage to nociceptors or peripheral nerves. Hyperalgesia also occurs as part of the evolved response to infection and as part of sickness behaviour

Hyperesthesia = a condition that involves an abnormal increase in sensitive stimuli of the senses (hear,touch,taste etc). Increased touch sensitivity is known as 'tactile hyperesthesia' and increased sound sensitivity is known as 'auditory hyperesthesia'.

Aetiologies leading to GH impingement

Well for starters let's remind ourselves that aetiology is 'the study of the causes'!

Aetiologies for glenohumeral impingement can be divided into primary (direct cause) or secondary (indirect cause)

Primary

• Subacromial bursal thickening
• Increased subacromial loading
• Trauma (direct macrotrauma/repetetive microtrauma)
• Excessive overhead activity (too much waving to someone)
• Acromioclavicular arthrosis (osteophytes)

Secondary

• GH laxity/instability (note: laxity may be normal for some people)
• Muscle imbalance
• Scapula dyskinesia (difficulty or distortion in performing voluntary movements)
• Glenoid labrum lesions (joint will be less stable if the socket depth is decreased)

Arthroscopy?

A minimally invasive surgery used to either examine and/or treat the damage the interior of a joint, performed using an arthroscope.

Arthroscopic procedures can be used to evaluate or to treat many orthopaedic conditions such as: floating cartilage, torn surface cartilage, ACL reconstruction, trimming damaged cartilage.

'RESPIM' a sure fire way to stimulate Abeta fibres ;)

'R' is for

Rub

'E' is for ...

Exercise (high intensity cardiovascular exercise/that stimulates proprioceptors)

'S' is for

Sweeping...synovial sweeping that is

'P' is for Passive movements / accessory

movements

'I' is for

Interferential treatment














'M' is for


Massage

Pseudo & True Winging which causes which?

PSEUDO WINGING = Tight pec minor / weak LF traps

TRUE WINGING = Weak serratus anterior

"Oh and thanks Colonel Sanders...too bad most of it's pigeons with aids"

Grimsby's 3 stage program - instability rehab

Stage 1 - low speed, high reps, minimum resistance, beginning and middle range

- to increase muscle endurance and circulation whilst avoiding overexertion

Stage 2 - increasing resistance, add in isometrics in inner ranges

- designed to increase strength and sensitivity to stretch

Stage 3 - Continue to increase resistance (usually 80% 1RM) and add isometrics through a full but not maximal range

Barkark or Bankart lesion?

An injury of the anterior glenoid labrum due to repeated anterior shoulder dislocation.

It's an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head

Tennis elbow

A condition characterized by pain and tenderness on the outside of the elbow and in the back of the forearm. Its medical name is lateral epicondylitis.

Tennis elbow is caused by inflammation of the tendon that attaches the extensor muscles (in this case the muscles that straighten the fingers and wrist) to the humerus. The condition results from overuse of these muscles, causing constant tugging of the tendon at its point of attachment to the humerus.

Causes

Tennis elbow may be caused by playing tennis or other raquet sports with a faulty grip, but more commonly due to other activities such as gardening, manual labour (screwdriving).

Treatment

- Ultrasound

- RICE

- NSAIDS

- corticosteroid injection

- surgery to release the tendon

If it keeps recurring it's wise to take a break for a couple of weeks from raquet sports to see if that's definately what's causing it and then if it is seek professional advice is playing technique and equipment.

Tenosynovitis

Inflammation of the thin inner lining of the sheath that surrounds a tendon. Tenosynovitis is usually caused by excessive friction due to overuse; it is often brought on by working in an awkward position to do a job that involves repetitive movements. A reare cause is bacterial infection. Tendons in the hand and wrist are most commonly affected.

Symptoms

- Pain

- Tenderness

- Swelling over the tendon

- Occasionally crepitus

- Persistent recurrent tenosynovitis may lead to restricted movement as a result of the formation of adhesions (fibrous bands) between the tendon and its sheath.

Treatment

If infection is the cause, antibiotic drugs. Otherwise, treatment is usually NSAIDS, corticosteroid drug injection around the tendon. The hand and wrist may need to be immobilised in a splint for a few weeks. If the condition does not improve, surgery may be required to release adhesions.

Contraindications to massage

1. Open wounds

2. Muscle ruptures

(In the acute stage these may still be bleeding. Massage will increase bleeding and tissue damage at this stage and prolong recovery. After the initial 0-72 hrs of acute phase massage may be possible but depends on extent of injury)

3. Tendon ruptures

(Complete ruptures will require surgery not massage. The above also applies)

4. Contusions

(These are impact injuries within the muscle - intramuscular - Massage to a contusion may cause further damage and possibly bone growth within the muscle aka myositis ossificans)

5. Burns, chillblains and broken bones

6. RA and gout

(These are active inflammatory conditions, so massage may cause further inflammation)

7. Bursitis

8. Myositis Ossificans

9. Infections of skin and soft tissue

(Bacterial, viral, fungal infections can be spread to other areas of the body)

10. DVT (thrombosis)

(If dislodged can lead to pulmonary embelism, heart attack, stroke)

11. Artificial blood vessels

(Implanted through surgery should be avoided)

12. Bleeding disorders such as heamophillia

(May cause tissue damage and further bleeding)

13. Tumors

14. Anything else you're not sure of!