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
decreased ventilation, atelectasis, & pneumonia
decreased BMR, increased diuresis, natiursis, nitrogen & calcium depletion
renal stones & more frequent UTI
- 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
12 pairs connected to the undersurface of the brain
31 pairs of nerves are attached to spinal cord
primary function is to make sensation & movements possible
can be localized or diffuse & may be caused by acute or cummulative truama
- 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
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
nerve recovery after complete nerve (neuromesis) occurs if there is no damage to the cell body
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
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)
musculoskeletal, neuromuscular, cranial & peripheral nerve integrity, function
-impaired peripheral nerve integrity & muscle performance associeted with peripheral nerve injury
abnormal findings: loss of diminished strength, ROM, impaired sensation hyporeactive stretch reflexes
- patient education
- therapeutic strengthening
- joint ROM and muscle stretching
- manual therapy techniques
- 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
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 interventions are determined base on nature of the injury produces a closed or open wound, and the amount of time between injury and presentation
- end to end coaptation and nerve graft
- nerve graft may be used if there is a gap between the nerve endings
- contractures, deformities, impaired motor & sensory function
- complex reguonal pain syndrome (CRPS), formly called reflex sympathetic dystrophy (RSD)
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
Motor: innervating the flexors of the forearm, hand and thenar muscles
Sensory: considered the "eye of the hand" for providing sensory innervation
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
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.
can be many different things, including CNS damage from repeated concussions
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
- pain from muscles, nerves and tendons
- overuse of muscles and tendons in the upper body
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)
fatigue, limited rest opportunities, jobs or recreational activities that involve awkward postures and repetition localizing stress and/or fatigue
- 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
- Mild to severe
- stiffness
- numbing
- cramping
- pain/tenderness
- throbbing
- weakness
Tests: Provocative tests: Tinel's and Phalens tests, neural tension tests, reflex integrity, sensory intregrity and testing, tactile gnosis testing, function
- Tendonitis
- nerve compression
- myofascial pain
-caused by compression on the median nerve at the wrist where the nerve passes through a tunnel
- repetitive wrist movements cause inflammation
- 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
- 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
- caused by overuse/repetitive use of wrist flexors
- less common tendon inflammatory condition
- 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
- Anti-flammatory
- Steroids
- Heat/Cold modalities
- Job site evaluation, ergonomics consultation, posture re-education, strengthening problems, slow-stretching, brace or splint
- Early: splinting, strengthening job site, ergonomic
- PTA modalities & exercise course: slow- stretching, nerve-gliding exercise, soft tissue massage