question 4- cryotherapy
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55thth January 2011 January 2011
Question 4Question 4
Joyce sustained a fall where she fell on Joyce sustained a fall where she fell on her outstretched hand 2 days ago. her outstretched hand 2 days ago.
Her X-ray results were normal.Her X-ray results were normal. The Doctor referred her for The Doctor referred her for
physiotherapy.physiotherapy. On examination, her MCP and PIP joints On examination, her MCP and PIP joints
of the hand are swollen and restricted of the hand are swollen and restricted in movement.in movement.
The Patient is unable to close the hand The Patient is unable to close the hand fully and the grip is weak.fully and the grip is weak.
Subjective & Objective AssessmentSubjective & Objective AssessmentQuestions to ask JoyceQuestions to ask Joyce
Were you able to flex your fingers into a fist Were you able to flex your fingers into a fist beforebefore
the fall?the fall?
Were you able to lift/hold objects Were you able to lift/hold objects
(e.g. hook grip/princer grip etc) before the fall?(e.g. hook grip/princer grip etc) before the fall?
If yes to both questions, have you ever had If yes to both questions, have you ever had
difficulty in performing the above? difficulty in performing the above?
Possible Objective AssessmentPossible Objective Assessment
AROM & PROM MCP Flexion / ExtensionAROM & PROM MCP Flexion / Extension AROM & PROM PIP Flexion / ExtensionAROM & PROM PIP Flexion / Extension
MMT For MCP and PIP JointsMMT For MCP and PIP Joints
Main ProblemsMain Problems
Fell on her outstretched hand 2 days ago Fell on her outstretched hand 2 days ago ACUTEACUTE
MCP and PIP joints of the hand are swollen MCP and PIP joints of the hand are swollen and restricted in movement and restricted in movement Decreased Decreased in ROMin ROM
Unable to close the hand fully and the grip is Unable to close the hand fully and the grip is weak weak Decreased in Strength. Decreased in Strength.
SwellingSwelling of MCP and PIP Joints of MCP and PIP Joints
Subjective & Objective AssessmentSubjective & Objective AssessmentGoalsGoals
Short Term Goals – reduce pain and edema, Short Term Goals – reduce pain and edema, increases ROM (usually to accomplish within increases ROM (usually to accomplish within
2-3 sessions of Physiotherapy )2-3 sessions of Physiotherapy )
Long Term Goals – To be able to perform Long Term Goals – To be able to perform higher intensity functional tasks – e.g. higher intensity functional tasks – e.g. cleaning the house, lifting heavier objects, cleaning the house, lifting heavier objects, playing sports that require grip strength e.g. playing sports that require grip strength e.g. tennis, badminton, squash, golf etctennis, badminton, squash, golf etc
(Usually within 1 to 2 months of Physiotherapy)(Usually within 1 to 2 months of Physiotherapy)
Subjective & Objective AssessmentSubjective & Objective AssessmentPrecautions and contraindications of CryotherapyPrecautions and contraindications of Cryotherapy
Hypersensitivity to ColdHypersensitivity to Cold
Cardiac DiseaseCardiac Disease
Coronary ThrombosisCoronary Thrombosis
Vasoconstriction of coronary arteryVasoconstriction of coronary artery
Arterial Blood PressureArterial Blood Pressure
Cooling larger areas, e.g. limb segment may lead to transient Cooling larger areas, e.g. limb segment may lead to transient rise in B.P. rise in B.P.
Elderly or young children with no ability to give f/b or Elderly or young children with no ability to give f/b or reliable answers/ may not understand the potential reliable answers/ may not understand the potential dangers.dangers.
Patients lacking local thermal & painful sensationPatients lacking local thermal & painful sensation
RationaleRationalePhysiological Effects Why did I choose Cryotherapy?Physiological Effects Why did I choose Cryotherapy?
Vasoconstriction of cutaneous blood vessels Vasoconstriction of cutaneous blood vessels
reduce heat loss to body surface)reduce heat loss to body surface) Increasing blood viscosity, increasing resistance Increasing blood viscosity, increasing resistance
to blood flow to blood flow reduced bleeding reduced bleeding Intense cold reduces conduction velocity of Intense cold reduces conduction velocity of
peripheral nerves , delay synaptic transmission peripheral nerves , delay synaptic transmission
Reduce Pain Reduce Pain
alleviated by reducing the release of pain-alleviated by reducing the release of pain-inducing irritantsinducing irritants
Decrease rate of swellingDecrease rate of swelling Lowers metabolism rate Lowers metabolism rate
REST, ICE, COMPRESSION, ELEVATION
Treatment Treatment Possible electrotherapeutic modalitiesPossible electrotherapeutic modalities
Acute Stage Acute Stage
(up to 72hours)(up to 72hours)
Swelling Swelling hence do not use Heat hence do not use Heat
Paraffin WaxParaffin Wax
Before Treatment……….Before Treatment………. Hot/Cold Test (Test-tube) Hot/Cold Test (Test-tube) Sharp/Blunt Test – due to burning sensation Sharp/Blunt Test – due to burning sensation Ice-cube test – 3 minutesIce-cube test – 3 minutesContraindicated if a round, red/pink patch appearsContraindicated if a round, red/pink patch appears(skin hypersensitivity to ice)(skin hypersensitivity to ice) Position the patient's hand above the heart Position the patient's hand above the heart
Warning Prior to TreatmentWarning Prior to Treatment
While receiving ice treatment, you are expected to feel cold, While receiving ice treatment, you are expected to feel cold, burning, achy and numbness at the area of application. burning, achy and numbness at the area of application.
Should you feel any discomfort, press the bell and call your Should you feel any discomfort, press the bell and call your Physiotherapist immediately.Physiotherapist immediately.
Throughout the treatment, please do not touch any equipment or Throughout the treatment, please do not touch any equipment or move around. move around.
Should you have any doubts, please call your Physiotherapist for Should you have any doubts, please call your Physiotherapist for assistance.assistance.
Do you understand?Do you understand?
TreatmentTreatment
TreatmentTreatmentMethod of ApplicationMethod of Application
Home Programme/ExercisesHome Programme/Exercises
Exercises to increase ROM & Muscle Strength
Ice bath for 20minutes at home
Progression of treatmentProgression of treatment(Assuming improved condition)(Assuming improved condition)
Heat TherapyHeat Therapy
Only if localised temperature riseOnly if localised temperature rise subsides subsides
Timeline between Timeline between
Subacute and Chronic StageSubacute and Chronic Stage
Paraffin Wax
NOT TO BE USED DURING ACUTE STAGE!
Progression of treatmentProgression of treatmentHeat Therapy – Physiological EffectsHeat Therapy – Physiological Effects
Vasodilate local cutaneous blood vesselVasodilate local cutaneous blood vessel Increasing blood flowIncreasing blood flow Increasing metabolic rate (oxygen uptake)Increasing metabolic rate (oxygen uptake) Promotes HealingPromotes Healing Increasing ROM Increasing ROM Heat allows greater tolerance of stretchingHeat allows greater tolerance of stretching Viscosity of tissues reducedViscosity of tissues reduced Increased collagen extensibility at high Increased collagen extensibility at high
temperaturestemperatures
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