Cervical Fracture

The cervical spine is a highly mobile segment of the axial skeleton that allows a large range of motion in flexion, extension and rotation. It is vulnerable to injury because is unprotected and is composed of seven cervical (C1 – C7). An injury to one of its cervicals is extremely dangerous due to the function exercised by each one with regard to the movement. A blow to this area may incapacitate the patient, while in other cases, can cause death. Urgent care is vital to patient recovery and development (mostly young and adults in full working capacity).

After a trauma, the patient may have some of these symptoms: pain in suboccipital region, neck stiffness, limited movement and if there are medullary affection, can be felt from altered sensation and mobility to the patient's death depending on the degree of damage and affected segment. Fractures in the spine are classified according to trauma stability (stable or unstable) and by the affected cervical (upper or lower). An unstable fracture is considered one that presents neurological damage, ligament damage and significant displacement of the vertebral body. Moreover, a higher trauma are those involving the C1, C2 or C3, while a lower trauma goes from C3 to C7.

To determine the patient's diagnosis, radiography, MRI and CT are used. In cervical injuries, the first therapeutic element to consider is the provisional immobilization collar and referral of the patient to the hospital. The primary goal of treatment for stable fractures without neurological injury, is to reduce displacement and stabilize the spine. These fractures have an orthopedic treatment. There are different devices to do this, among them we can find: occipital cervical brace with adjustable support and mental, immobilizer sterno-occipital-mandibular, cervical traction metal bracket, orthotics cervical Halo type, among other devices. Furthermore, unstable fractures were treated with traction and cranial surgical stabilization (these fractures have surgical treatment). Treatment depends on whether the injury occurs in the anterior or posterior region of the cervical vertebrae.

Like most of the fractures that occur around the human body, physical therapy is, in some cases, the main treatment for these traumas. As for cervical trauma, the purpose is to help the patient regain mobility through analgesics, anti-inflammatory and through physical therapy. Among the services and techniques that offer physical therapy to patients with cervical trauma is: education and advice given by the physiotherapist, home exercise, massage and thermotherapy, electrotherapy, among other things.

Bibliography:

Alday, R., et al. "Traumatismos cervicales." Neurocirugia (1995): 22-31.

Vera García, Marta, et al. "Fracturas Cervicales." Fisioterapia Vol. 3 (n.d.).

                    

                                        

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is a common condition, constituting one of the leading causes of death in the pediatric population and young adults. It is a global health problem that produces motor disabilities, behavioral or cognitive sphere. These traumas are the leading cause of death in children over one year old and is also the cause of mental retardation, epilepsy and physical disabilities. It also represents one of the most frequent causes of death and disability in young people in our society. It requires immediate medical treatment and, sometimes, it requires surgical treatment. Approximately 50% of all deaths are associated with this trauma and this increases to 60% when it is for a vehicular accident.

Diagnosis, treatment and prognosis of these injuries has been modified in recent years based on the introduction of new techniques. The aim of urgent attention to TBI, regardless of severity, is to prevent secondary brain damage and identify intracranial abnormalities requiring emergency surgery. The pathophysiology of brain injury is classified into three types of injuries: primary, secondary and tertiary injury. The primary lesion is the direct damage caused by the impact of the trauma or the acceleration-deceleration mechanism, secondary develops as a consequence of the primary lesion, developing bleeding, edema, hyperemia, thrombosis and other secondary pathophysiologic processes and finally the tertiary injury is the late expression of progressive damage or caused by primary and secondary injury (causes neuronal death).

The pathophysiology of traumatic brain injury helps to have a better understanding of the different clinical manifestations of this type of trauma and its consequences in the short, medium and long term, in order to develop an appropriate therapeutic management of these patients. The diagnosis requires studies such as x-rays of the spine and skull, monitoring of intracranial pressure (ICP), computed tomography (CT), cerebral angiography, among other studies.

The general treatment for an injury in the brain skull can lead any of the following treatments: infusion of crystalloid solutions, maintaining a normal mean arterial pressure, apply pressure to sites of active bleeding, emergency surgery, if is necessary, reinforce cerebral perfusion and prevent secondary brain damage, among other treatments. To conclude, the medical care it is very important.

Bibliography:

Cruz Benítez, Luis and Francisco Javier Ramírez Amezcua. "Estrategias de diagnóstico y tratamiento para el manejo del traumatismo craneoencefálico en adultos." Trauma Vol. 10.No. 2 (2007): 46-57.

Guzmán, Francisco. "Fisiopatología del trauma craneoencefálico." Colombia Médica Vol. 39.No. 3 (2008): 78-84.

Ortega, Jorge Eduardo. ""Trauma Cráneo Encefálico: Actualización en el Manejo Médico"." Revista Medica Hondureña 66.4 (1998): 147-153.

  

Physical Therapy: A Treatment Option for Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed at the carpal tunnel of the wrist (formed by the flexor retinaculum and the carpal bones). This painful disorder typically occurs in association with activities that place repetitive stress through the flexor tendons. When this tension is excessive due to too much repetition or high force, damage to the tendons may occur. This results in swelling and inflammation of the tendons, thereby reducing the dimensions of the carpal tunnel, compressing the median nerve (responsible for supplying some sensation and motor control to the hand). This syndrome is associated with repetitive occupational trauma, rheumatoid arthritis, pregnancy, acromegaly, wrist fractures, and other conditions.

Some of the Carpal Tunnel Syndrome (CTS) sufferers will usually experience the following symptoms in their hand or fingers: hand pain or aching, pins and needles, numbness at night, burning, weakness or cramping and swelling. The incidence of carpal tunnel syndrome is located from 0.1 to over 10 percent. Although carpal tunnel syndrome can occur at any age, it is commonly seen in patients greater than 50 (is more common in women). The diagnosis of the carpal tunnel syndrome is based on an analysis of a physiotherapist, or general doctor, about the symptoms. They usually use various tests such as Phalen’s test, Tinel’s test or the wrist flexion/median nerve compression test.

Most cases of carpal tunnel syndrome are usually treated with the appropriate physiotherapy. This includes careful assessment by the physiotherapist to determine which factors have contributed to the development of the condition. The physiotherapist will address: carpal bone mobilization and flexor retinaculum stretching to open the carpal tunnel, nerve and tendon gliding exercises to ensure full unrestricted nerve motion is available, muscle and soft tissue extensibility, cervicothoracic spine to correct any referral or double crush syndromes, grip and pinch, thumb abduction and forearm strengthening in later phases, comprehensive upper limb, wrist and hand ROM strengthening and endurance exercises and posture, fine motor and hand dexterity exercises. The treatment of this syndrome includes: ultrasound, traction, splints, medication, electrical stimulation, ice or heat treatment, gliding exercises and manual therapy. During recovery, the patient should follow the RICE protocol (rest, ice, compression and elevation). A surgery may be required to decompress the median nerve.

To conclude, it is very important to take this condition seriously. This syndrome can cause loss of independence.

Bibliography:
Carpal Tunnel Syndrome. s.f. <http://www.physioadvisor.com.au/9250550/carpal-tunnel-syndrome-symptoms-diagnosis-trea.htm>.

Gómez Conesa, Antonia and Gisbert Serrano. "Carpal Tunnel Syndrome." Fisioterapia (2004): 170-185.

Miller, John. Physio Works. March 22, 2015. <http://physioworks.com.au/injuries-conditions-1/carpal-tunnel-syndrome>.

Mishock, John R. Mishock Physical Therapy and Associates. 2014. <http://www.mishockpt.com/physical-therapy-a-treatment-option-for-carpal-tunnel-syndrome/>

 
      

Ankles Fractures

Ankle fractures are the most common type of fractures treated by orthopedic surgeons (account for 9% of fractures). The ankle consists of the articular surfaces of the talus, tibia and fibula, as well as its binding ligaments and capsule. The tibia is the shinbone and is located on the inner, or medial, side of the leg, the fibula is located on the outer, or lateral, side of the leg and the talus is a small bone that sits between the heel bone (calcaneus) and the tibia and fibula. The distal ends of the tibia and fibula bones are also known as the medial and lateral malleoli, respectively. Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward.

The contribution of the articular surfaces, ligaments, capsular and ligamentous structures and the ankle function and stability are influenced by changes in load characteristics and joint position and altered in response to injury. Doctors classify ankle fractures according to the area of bone that is broken. The ankle fractures can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both. These fractures can be caused by a car accident, one false move, diseases such as imperfect osteogenesis (failure in the bone development) and rheumatoid arthritis (inflammation of the joints) and by sports injuries, such as basketball or football. An ankle fracture is accompanied by one or all of these signs and symptoms: immediate and severe pain, significant swelling, bruising, inability to walk, cannot put any weight on the injured foot, and change in the appearance of the ankle so that it differs from the other ankle.

The goals of treatment are the fracture healing and the recuperation of the ankle's movement and function. The treatment will depend of the diagnosis which can be done by an arthrogram, bone scan, computed tomography (CT), x-joint (radiography of articulation) or with a MRI (magnetic resonance imaging). Treatment of ankle fractures depends upon the type and severity of the injury (lateral malleolus fracture, medial malleolus fracture, posterior malleolus fracture, bimalleolar fractures or bimalleolar equivalent fractures, trimalleolar fractures or syndesmotic injury). For some ankle fractures, surgery is needed to repair the fracture and other soft tissue related injuries. No matter if it is broken or not, it's important to follow the "RICE" protocol (rest, ice, compression and elevation). Also, immobilization and medication can be needed. Obviously, physical therapy plays an important role in recovery. 

To conclude, it is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.

Bibliography: 

American College of Foot and Ankle Surgeons. (n.d). Ankle Fractures. Retrieved from ACFAS: http://www.foothealthfacts.org/footankleinfo/ankle-fracture.htm

American College of Foot and Ankle Surgeons. (2006). Ankle Fractures. ACFAS, 1-2.

American Orthopaedic Foot & Ankle Society. (2015). Ankle Fracture. Retrieved from AOFAS: http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Ankle-Fracture.aspx

Crist, B., Dunbar, R. P., & Fischer, S. J. (March, 2013). Ankle Fracture. Retrieved from Ortho Info: http://orthoinfo.aaos.org/topic.cfm?topic=a00391

Cunha, J. P. (March 13, 2015). Broken Ankle (Ankle Fracture). Retrieved from Emedicine Health: http://www.emedicinehealth.com/ankle_fracture/article_em.htm#broken_ankle_ankle_fracture_overview

Education for ABC Health Program. (n.d.). "Fractura de Tobillo". 1-3.

Varela, B., Federico, C., Rainero, V., Salvo, J. N., Ventura, E. A., & J. I. (n.d.). "Fracturas de Tobillo" . 1-20.

             

IDD Therapy Disc Treatment

The IDD Therapy - Intervertebral Differential Dynamics Therapy - is a proven treatment for the relief of lower back pain. With a significant success rate, thousands of patients have experienced dramatic pain relief and healing. This treatment is non-surgical, non-invasive, and typically does not involve pain medications. The treatment is safe and painless, also comfortable and relaxing. The therapy includes approximately 20 treatment sessions and is completed in about 35 days. The IDD Therapy treatment can reduce pressure on the vertebral joints, promote retraction of herniated discs, and promote self-healing and rehabilitation of damaged discs, thereby relieving low back pain.

Intervertebral discs are the spongy shock absorbers between the vertebrae bones in our spines, and patients with long term disc problems have limited treatment options available to them. The most important thing for good spinal health and disc health is movement.  Thus when there is muscle spasm and pain, mobility in the spine is lost. When it comes to treating discs, the purpose is to help restore movement in the spinal segments. To achieve this, doctors and therapists works to change posture, to restore muscle balance, releasing muscle tension and a variety of other interlinked problems. These are the reasons why other methods and techniques are used.

The IDD Therapy disc treatment tool is a mechanical advancement which uses computer controlled pulling forces to open and mobilize targeted spinal segments where there is an injured disc. IDD Therapy allows clinicians to take pressure off the targeted disc and other spinal structures to relieve pain. The combination of IDD Therapy with other manual therapy interventions provides us with a complete programmed of care for our disc patients and in particular those with long term problems.

To conclude, the degeneration of vertebral discs can cause spinal structures to pinch nerve roots, thereby causing pain. It is extremely important to address these complications quickly due to their effects. The IDD therapy provides an effective solution to this condition.

Bibliography:

Stefaan. (2015, January 15). NEW HOPE FOR DISC PAIN PROBLEMS. Retrieved from Core Warwick: 

http://www.chiropractorswarwick.co.uk/index.php/2015/01/15/new-hope-for-disc-pain-problems/

What is IDD Theraphy? (n.d.). Retrieved from Crissman Family Practice: http://www.crissmanfamilypractice.com/index.cfm/fuseaction/site.content/mode/dtl/type/83688/post/58505.cfm