Supraspinatous Tendinitis.

What is Supraspinatus Tendinitis?
                                     

                      The tendon of the Supraspinatus muscle gets inflamed in this condition. This particular muscle is included in the rotator cuff muscles and the main action of this muscle is the abduction of the arm. The above muscle tendon passes between the acromion and the humeral head and sometimes results in friction. There is bursa to reduce the friction but owing to the overload the tendon gets inflamed.



Physiotherapy Management of Supraspinatus Tendinitis.

There are clinical tests to diagnose this 

1. Neer Test
2. Hawkins Kennedy Test
3. Empty Can Test.
4. Drop Arm Test.

   Apart from the clinical diagnosis, the imaging can be useful.

                                                                Calcified lesion view.


The main aim of Physical therapy management is in getting relief from Pain and inflammation, increasing range of motion, improving the muscle power and activity.

Modalities use:

1. CryoTherapy
                         
2. Ultrasound
             
3. Transcutaneous electrical nerve stimulation.

           



Tapping technique:
                

   


Exercises:

1. Mobility and Stretching:

Chest Strech                                     Supraspinatus Strech

Posterior Shoulder Strech  

                                                     

General Tips for Wheel Chair Caregivers

General Tips for Wheel Chair Caregivers.

                      These tips helps to develop the minimum skills and knowledge to the persons who involved in wheel chair service delivery.Wheel chair is a chair with wheels, used to move persons who cant walk. It can be operated either manually or with battery. Manual wheel chairs can be moved by a person or with your hands to push the scroll wheels. Other wheel chair has a battery powered electric motor to move the wheel chair.All basic wheel chairs can support 130 to 150 kg of weight.

Parts of a Wheel chair.

Tips for caregivers.

1. Check the wheelchair is properly working.

2.  Check the patient is in upright position or not.

         The patient back should touch the wheel chair back rest, hip, knee and ankle joints are in    90 degree.

3. Check the patient wears seat belt and foot straps.

4. Avoid speed because sudden changes in speed or direction can cause the wheelchair occupant to fall forward or to the side.

5. Always lift the patient- don't bump or drag- this could cause skin damage and lead to pressure sores.

6. Before assisting someone, make sure that you can support his/her  body weight.

7. Don't assist if you have a back problem.

8. Always position the patient limbs inside the wheel chair.

9. While turning the wheelchair in the vicinity of fixed objects, it is important to avoid catching a foot on the object to avoid injury to the foot or a twisting injury to the lower leg.

Wheelchair UP and DOWN through a kerb.

       At first you should practise with an empty wheelchair.Always inform the wheelchair user about what you are intending to do.When the occupant's feet are nearly touching the kerb, push down and forwards on the tipping lever with your foot and the same time pull back the wheelchair.This will help you to balance the wheelchair and its occupant on the rear wheels. Move the wheel chair forwards when the front wheels are clear the kerb and move until the casters rest on the floor.

                                While moving down make sure that the chair is lined at 90 degree to the kerb and slowly roll the back wheels down from the kerb. You should make sure that while rolling both the rear wheels touch the ground at the same time.If the casters reach the edge of the kerb use the same technique on the tipping lever what we used to move upwards in kerb. You can lower the front wheels to the floor when the wheelchair user's feet are clear the kerb.

Wheelchair UP and DOWN through a Ramp.

       

                           When going up if the patient is stable then give instructions to the patient to lean forward in the chair and this make it easier to ascend the ramp.

    To descend a ramp you should position yourself behind the wheelchair and slowly roll backwards.

Door that opens away and towards :

                         The caregiver should open the door and pull the wheelchair backwards through the doorway. The care giver should use his body to prevent the door from hit on the wheelchair. The caregiver should lock the lock when he moves the chair completely out the way.

                                         While moving a wheelchair through a door way that open towards to us the caregiver should leave enough space by open the door without striking the wheelchair. In this case also caregiver use his body to prevent the door from hitting to the wheelchair. After passing the doorway caregiver should lock the door.

How to transfer a patient from wheelchair to bed and bed to wheelchair.

         At first make sure that wheelchair is very close to the bed and both the bed and wheelchair is locked.Remove the armrest of the wheelchair on the transferring side.

If the patient is able to move give instructions to come on sitting otherwise assist the patient to come on sitting.One of your knee should interconnect with patient knees and use a gait belt to transfer. Some patients are able to bear weight but not in an ambulatory stage so in this case make a turn with the patient towards the wheelchair. 

        

                 

What is Whiplash Injury? Role of physiotherapist......

What is whiplash injury?

      This injury usually happens as a result of acceleration and deceleration forces on the neck.  

           

The most common cause is owing to the road traffic accidents and the other causes are roller-coasters,sports related injuries etc.  As a result of this injury may damage the bony and soft tissue such as in disc, ligaments,nerves.

                 The symptoms often takes sometimes to develop it may take 72hrs for the symptoms to appear.The common symptoms includes neck pain and swelling, stiffness and tenderness, headaches.

There are different grades for the whiplash injuries,

Grade 1- patient complains the neck pain with tenderness and swelling but no physical signs.
Grade 2- patient has neck problem and the range of motion is reduced with point tenderness.
Grade 3-  in this grade patient has musculoskeletal and neurological problems like reflex and sensory deficits. 
Grade 4- problems in the neck with fracture or dislocation.

How the Whiplash is diagnosed?

      After the examination the X-ray,C.T or M.R.I scan can rule out any serious injury or fracture.

Surgery is not need for most of the cases and  commonly the injuries are limited to only the muscles, ligaments and tendons. 

How can physiotherapy help in Whiplash injury?

   The most important principle is to prevent the condition from becoming chronic. The most common whiplash grades one and two requires immediate physiotherapy intervention.

Physiotherapist are highly skilled and supporting with neck problems and they may give you hands on treatments like manual therapy, massages.They will help you by giving advises for doing exercises, and the tips for prevent further problems. In physiotherapy there are both the active and passive treatment for the whiplash injuries. The ultimate aim of the physiotherapist is to change the treatment from passive to active.

Passive treatments for whiplash are deep tissue massage, hot and cold therapy, and electrotherapy. In the active treatment includes various exercises. The physiotherapist will teach you various exercises to improve the range of motion and  muscle strength.To conclude the physical therapy aim is to increase blood circulation ,reduce spasm and promote tissue healing.

Attention Scuba divers--- May leads to Paralysis and Death.

        Scuba Diving may leads to paralysis and the role of physiotherapy 
                                                                                    

              Decompression sickness,Diver's disease or caisson's disease is owing to the formation of bubbles in the blood and tissues. In the normal altitudes nitrogen and other gases exhaled or dissolves in the blood and tissues. Due to the altitude changes these gases don't dissolves and forms gas bubbles and these formation of bubbles make some obstruction in the blood circulation.

                              We can graded this disease according to the severity of the disease.In grade 1 there is only mild pain, swelling owing to the inflammation in the muscles and joints.The grade 2 affects the systems and the most severe forms will lead to paralysis even death.

 Treatment:

                     It is extremely important to take treatment right away.If treated early there is significantly higher chance of successful recovery.

 In the severe forms of this disease , especially the patients who has the spinal and  cerebral symptoms require long term of rehabilitation. In this case the rehabilitation is same as like stroke or spinal injury cases, although the outcome is usually better. 

As same as other cases physiotherapists are more concentrates to improve the mobility and muscle strength, relearning walking and balancing skills.

Patients who needs long term ventilator care, the therapist should do chest physio to clear the lungs of mucus. The treatment Frequency and Duration will depends upon the severity of injury.The major improvement in motor areas will occur after six to twelve months following the treatment. Depression and psychiatric problems are common in  the cases of spinal injuries patients so psychological -rehabilitation plays an important role in these cases.

                                       

What is De Quervains Syndrome? How to treat it?

What is De Quervains Syndrome?

                          De Quervains is a painful condition that affects the tendons of thumb and it will make discomfort when you turn the wrist or making a fist.

Etiology:

                   The etiology is idiopathic and mostly is seen in mothers of infants but some studies shows that it is caused by work activities.

Symptoms:

                    The most common symptom is pain in the back side of the thumb tendons.Swelling in  the same area of the thumb and it will be very hard to grasp or pinching things.

                           

Diagnosis:

                      Finkelstein test will help to rule out the dequevains disease,

 while doing this test you make a fist with the affected hand and move wrist to the side of little finger, in this movement if you feel pain you likely have De Quervains.

Physiotherapy Treatment:

There are various forms of physical therapy for the treatment of Dequervains. Mostly in the acute stage the ice packs are using to cease the edema and pain.Ultrasound is using to get a relief from local inflammation by means of iontophoresis and phonophoresis.

In the acute stage they provide splints for the support of hand and give advice in activities.

In the case of chronic Dequervains thermal modalities and massage can be given.The laser treatment also gives a good result from the pain and swelling. If the pain and swelling subsides the stretching and strengthening exercises can be started.

 

Physiotherapy is a good option for Low Back Pain.

Low Back ache is a common and serious problem, ranked as the highest contributor to disability in the

world.

Around five million people in Americans suffer from low back pain and the total expense of back pain treatments exceeds more than one billion a year.

Some interesting Facts about back pain:

This is one of the leading cause of disability globally. 

Back pain affects more than six hundred million people in world.

The average expense of treatment of back pain exceeds more than one billion a year in Australia.

Recent studies show that smoking increases the risk for back pain because nicotine decreases our circulation and blood flow. 

Do you want to prevent your back pain?

                     The people those who have back ache, try to do the following back stretching and strengthening exercises.Morning and night is a good time to do the back exercises often enough for them to be beneficial.These series of exercises helps to move back the bulging disc to the original position which will cease the pain and allow the spinal movement.

 

 

 Some recent research done in several countries shows that who suffer from  back pain have 14 percent increased risk of dying from any cause.
swaminathanpt@gmail.com

Cerebral Palsy and Physiotherapy.

What is Cerebral Palsy?

                          It is a non-progressive neuromotor disorder of cerebral origin.
The etiology of Cerebral palsy is owing to the brain damage, this damage caused by the brain injury or abnormal development  of brain.It oftenseems that the c.p is a congenital disease and it's very rarely gets after birth.There is no obvious reason why a child has cerebral palsy.The main causes include:
(1) Infection in early part of pregnancy. 
(2) Lack of oxygen to brain.
(3) Abnormal brain development.
                                                (4) A genetic link.

                                     1.Spastic C.P                                                                                                            2.Athetoid C.P
                              3.Ataxic C.P
                              4.Mixed C.P

SPASTIC CEREBRAL PALSY.

                               This is the commonest type of C.P and it's common signs are stiff muscles,joint tightness and involuntary jerky movements. In spastic c.p the most common injured area in brain is motor cortex. The motor cortex is the area in the brain in charge of all body movements. 

The different types of Spastic C.P are:
1.Spastic Monoplegia.
2.Spastic Diplegia.
3.Spastic Hemiplegia.
4.Spastic Triplegia.
5.Spastic Quadriplegia.

                                     In this type of c.p any muscle groups can be affected and the symptoms will vary in different people but there are some common symptoms they are stiff and tight muscles, contractures, abnormal gait, crossed knees, walking on tiptoes, abnormal reflexes.

ATHETOID CEREBRAL PALSY

                      Another name of this c.p is dyskinetic c.p and it is associated with movement disorder owing to the damage in developing brain especially in the basal ganglia. In this type of c.p both hypotonia and hypertonia are present.The symptoms will vary between patients some have minor problems but other have lot of problems and disabilities. The different forms of athetoid c.p are Dystonia, Chorea, Athetosis,Chorea Athetoid, Ataxia,  Dyskinesia.

ATAXIC CEREBRAL PALSY.

                       This is the least commonest type of c.p.In this typeof c.p children also have  problems in oral and speech.What ever problems they have, unfortunately we have no treatment to cure but we have some treatment that helps the children to cope up with their difficulties.

MIXED CEREBRAL PALSY.

               Around 10% of children suffering from c.p have a combination of two or more types.The most common form is spastic and athetoid c.p, the main cause is injury to both the pyramidal and extrapyramidal tracts of brain.
                        As with other forms of c.p mixed one is also non progressive and the condition doesn't worsen, the level of disability depends upon the severity of the injuries within the brain.

              

            The people who have c.p are challenging the common problems like posture, gait and coordination:- the physical therapy mainly concentrates on gait & coordination.The ultimate aim of physiotherapy is to achieve the body control and motor function.Along with the child physiotherapy the parents should get training the ways to keep the child muscles strong and joint flexible.

The physiotherapist again classified the c.p according to the Gross Motor Functional Classification System(G.M.F.C.S).

G.M.F.C.S Level 1 - Walks without limitations
G.M.F.C.S Level 2 - Walks with limitations
G.M.F.C.S Level 3 - Walks with adaptive equipment assistance.
G.M.F.C.S Level 4 - Self mobility with use of powered mobility                                                                                      assistance 
G.M.F.C.S Level 5 - Transported in a manual wheelchair.
                       The child should get intensive physiotherapy as soon as possible to achieve the maximum potential. This is a lifelong condition and the persons get benefits of physiotherapy throughout his life.