Health conditons
what are some musculoskeletal & cardiovascular complications?
complication: loss of muscle strength & endurance, contractures & soft tissue changes, disuse osteoporosis, degenerative joint disease
Cardiovascular complications: increased HR, decreased cardiac reserve, orthostatic hypotension, venous thromboembolism
Respiratory complications
decreased ventilation, atelectasis, & pneumonia
metabolism affects
decreased BMR, increased diuresis, natiursis, nitrogen & calcium depletion
genitourinary problems
renal stones & more frequent UTI
Immobilization
- much easier to prevent than to treat
- affects almost every organ system
- glucose intolerance, anorexia, constipation & pressure sores may develop
- CNS changes could affect balnce and coordination
Cranial nerves
12 pairs connected to the undersurface of the brain
spinal nerves
31 pairs of nerves are attached to spinal cord
Function of spinal nerves
primary function is to make sensation & movements possible
nerve pathology
can be localized or diffuse & may be caused by acute or cummulative truama
mechanisms of nerve injury (7)
- excessive copression of a nerve from a number of different mechanisms
- nerve laceration can occur as result of contact with a sharp object
- inadequate blood supply (edema)
- exposture to excessive electric energy, heat, radiation
- single application of high force traction
- repeated application of lower levels of traction
- accidental injection
classification of perpheral nerve injury (3)
Neurapraxia- bruise of the nerve with full spontanous recovery within a few days or weeks
Axonotmesis- nerve fibers distal to the site of injury degenerate but internal organization of the nerve remains intact
Neurotmesis- complete laceration of the nerve
What is nerve degeneration and regeneration?
nerve recovery after complete nerve (neuromesis) occurs if there is no damage to the cell body
wallerian degeneration
occurs when a nerve fiber is cut resulting distal nerve segment degeneration. involves disintegration of the axoplasm & axolemma over a course of 1-12 weeks and degradation of the surrounding myelin
to successful regenerate a nerve, what are the four steps?
1. survival of the cell body
2. absence of barriers
3. accurate growth towards appropriate end-organs
4. accomodation of the central nervous system to reorganize mixed afferent signals (sensory)
diagnosis and assessment
musculoskeletal, neuromuscular, cranial & peripheral nerve integrity, function
evaluation, diagnosis & prognosis (nerve)
-impaired peripheral nerve integrity & muscle performance associeted with peripheral nerve injury
abnormal findings: loss of diminished strength, ROM, impaired sensation hyporeactive stretch reflexes
general rehab management (4)
- patient education
- therapeutic strengthening
- joint ROM and muscle stretching
- manual therapy techniques
occupational therapy (2)
- splinting and orthotics may be used to protect repaired nerves or insensate areas, rest limb segments to assist in resolving inflammaton, promote function or prevent disformity after nerve injury
- sensory retraining is intended to reduce hyperesthesia & promote reorganization of cortical representation of the involved limb
physiotherapy
electrotherapeutic modalities may be used to stimulate contraction of denervated muscle, to facilitate muscle contraction in weakened reinnervated muscle and for pain management
- includes: heat, cold, hydrotherapy, US, laser & light therapy
surgical management
surgical interventions are determined base on nature of the injury produces a closed or open wound, and the amount of time between injury and presentation
2 surgical nerve interventions
- end to end coaptation and nerve graft
- nerve graft may be used if there is a gap between the nerve endings
complications of nerve injuries (2)
- contractures, deformities, impaired motor & sensory function
- complex reguonal pain syndrome (CRPS), formly called reflex sympathetic dystrophy (RSD)
radial nerve
Motor: innervating extensory and supinator group of muscles of the wrist, thumb, and fingers
Sensory: posterior upper arm and the forearm, the dorsum of the thumb and the index and middle fingers and the radial half of the ring finger to the PIP joints
Median Nerve
Motor: innervating the flexors of the forearm, hand and thenar muscles
Sensory: considered the "eye of the hand" for providing sensory innervation
Ulnar nerve
Motor: responsible for innervating flexor carpi ulnaris, median half of the flexor digitorium profundus and intristic muscles of the hand
Sensory: innervates dorsal and volar surfaces of the little finger and the ulnar half of the dorsal and volar surface of the finger
How to test for all 3 nerves for motor function
1. ask patient to extend his/her wrist
2. abduct the fingers 3, 4, 5
3. make a ring (O) sign with thumb and index finger tips touching each other.
Cumulative Trauma Disorder (CTD)
can be many different things, including CNS damage from repeated concussions
CTD vs. RSI
CTD: condition due to the body's response to the truama
RSI: condition is the result of the body's response to the repetitive stress with the stress being the trauma
RSI- Repetitive Strain Injury
- pain from muscles, nerves and tendons
- overuse of muscles and tendons in the upper body
Types of RSI (2)
1. Doctor is able to diagnose based on symptoms (pain and imflammation of muscles and tendons)
2. Doctor is unable to diagnose from patient's symptoms (no symptoms besides pain)
Etiology of RSI
fatigue, limited rest opportunities, jobs or recreational activities that involve awkward postures and repetition localizing stress and/or fatigue
Primary Risk Factors for RSI
- Repetitive activities
- prolonged activities
- activities requiring high amount of force
- activities requiring awkward positioning
- cold temperatures & activites involving vibration are thought to increase risk of RSI
- stress
Symptoms of RSI (7)
- Mild to severe
- stiffness
- numbing
- cramping
- pain/tenderness
- throbbing
- weakness
Tests of RBI
Tests: Provocative tests: Tinel's and Phalens tests, neural tension tests, reflex integrity, sensory intregrity and testing, tactile gnosis testing, function
Differential Diagnosis/Related Conditions
- Tendonitis
- nerve compression
- myofascial pain
Carpal Tunnel Syndrome
-caused by compression on the median nerve at the wrist where the nerve passes through a tunnel
- repetitive wrist movements cause inflammation
DeQuervian's Tenosynovitis
- Caused by chronic, repetitive overuse of the wrist
- Disorder that affects the tendons on the radial side of the wrist
- Affects te extensor pollicis brevis and abductor pollicia longus
Tennis Elbow (known as "lateral epicondylitis")
- disorder that affect the common extensor tendon that has it's origin at the lateral epicondyle of the humerus.
- Caused by overuse/repetitive use of wrist extensors
Golfer's Elbow (known as "medial epicondyle")
- caused by overuse/repetitive use of wrist flexors
- less common tendon inflammatory condition
Trigger Finger
- Characterized as painful "locking" of the finger-digit becomes locked in a flexed position when person attempts to perform full AROM of a digit
- Creates a nodule in the tendon at the MCP joint level
- Caused by repetitive finger movements
General Treatment Approaches
- Anti-flammatory
- Steroids
- Heat/Cold modalities
- Job site evaluation, ergonomics consultation, posture re-education, strengthening problems, slow-stretching, brace or splint
Rehab Management (2)
- Early: splinting, strengthening job site, ergonomic
- PTA modalities & exercise course: slow- stretching, nerve-gliding exercise, soft tissue massage