19 September 2023
16 June 2010
29- بروتوكول علاج طبيعي تأهيلي لحالة تعديل اصبع سبابة يد مريض مكان اصبع الابهام المفقود______________________________________Physical therapy & rehabilitation program after pollicization surgery
What is the pollicization surgery?
Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers.
How it is done?
During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollex"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement.
The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint.
Case study..
This guy was 21 years old & working in a factory, so restoring the hand function is the main target.I started a physical therapy program depending on the problems he had.
Examination..
By looking to the movements, flextion is better than the extension, so extensor lag happened.
As a test for the function, he was asked to pick up a pen & write with the left hand (the affected hand) i found that he can grasp a pen but he can not control it to write.
Then he was asked to let it down but it was not easy to open his hand.
Some movements are missed like adduction & abduction .And by examining the joints, PIP, DIP & MP i found PIP stiffness while the DIP has normal range of motion with passive movement test & lake of extension by active movement test.
But the MP joint i ignored testing it as this is not a real/normal joint.
The skin also play a very important role in the movement, as it gives more ranges to the joints to move further more so, paying attention to this factor is very important.
By examination, i found that the skin appears adherent on the dorsal surface & by testing its flexibility using my hand it was found rigid.
This adherence affecting the flexibility of the movement toward the flexion.
While the anterior surface is less adherence but still not permitting the normal flexibility.
No pain appear untill pressing on the metacarpophalangeal joint toward the flexion.
The program..
Exercises
Starting with strengthening exercises for the long flexors of the index and facilitating the extension using maximum resistance to the extensors to fire more fibers & neurons which improve the extension.
Starting with strengthening exercises for the long flexors of the index and facilitating the extension using maximum resistance to the extensors to fire more fibers & neurons which improve the extension.
In addition , the functional exercises were done for improving the synchronization between all groups of the muscles and restore the function as quickly as possible.
Writing is very important as in this action we can get very specific feedback, as the action of writing linked with the perceptual & cognitive activities of the brain which improve the out put of the motor action.
Writing is very important as in this action we can get very specific feedback, as the action of writing linked with the perceptual & cognitive activities of the brain which improve the out put of the motor action.
Stretching exercises for the hand flexors, by opening the hand widely and extending the wrist to the middle range of wrist extension as we can not do full extension because the surgeon took a bone graft from the carpal bone.
Orthoses
As a way to overcome the extensor lag, using a splint to hold the DIP & PIP joints in extension for long time during the day.
Manual techniques
One of the big problems was the PIP stiffness that affecting the function of the transfered finger so, mobilization techniques are used to increase the limited range of motion.
One of the big problems was the PIP stiffness that affecting the function of the transfered finger so, mobilization techniques are used to increase the limited range of motion.
Now the movement became smoother and easier but the skin stiffness was limiting the movement so, for the stiff skin over the dorsal surface, myofacial release & massage were used.
Also both were donefor the anterior surface adding the vibrator machine, ultrasonic waves & short wave to them.
Electrotherapy
Ultrasonic waves was used as it creates micro-massage which break down the adhesions if used in form of pulsed waves.
Deep heating generated by the short wave which used in form of continuous waves helps in gaining the flexibility.In addition hot packs & sometimes paraffin wax.
Every session i was using the vibrator as the shaking waves generated by this machine have the ability to release the adhesion mechanically & generating the heat in those tissues as a result of the friction and the shaking action of the vibrator.
Using faradic stimulation in the form of titanic contraction was done to the extensors of the fingers to facilitate the extension by firing more muscle fibers and more neurons.
The results
For three months of rehabilitaion, he can touch the little finger with the tip of the index (the O position), the DIP restored a good range allowing the hand to restore most of its functions & the skin was flexible enough at the anterior surface while the dorsal surface did not achieve more results.
Extensor lag decreased but still appear there.He can use the left hand well in his job without any barrier.I advised him to keep exercising the fingers using tools like pinch grip or flexible ball.
For three months of rehabilitaion, he can touch the little finger with the tip of the index (the O position), the DIP restored a good range allowing the hand to restore most of its functions & the skin was flexible enough at the anterior surface while the dorsal surface did not achieve more results.
Extensor lag decreased but still appear there.He can use the left hand well in his job without any barrier.I advised him to keep exercising the fingers using tools like pinch grip or flexible ball.
28 December 2007
28- Strain-Counterstrain Technique ..?!! _______ طريقة د.جونز للعلاج اليدوي كجزء من علم الاستيوباثي
Jones Strain and Counterstrain
Strain Counterstrain is an Osteopathic manual medicine technique. It emphasizes correction of abnormal neuromuscular reflexes rather than simply addressing painful, postural or structural problems. Counterstrain recognizes that these structural, postural and painful problems are a result of the abnormal reflexes. Until these abnormal neuromuscular reflexes are addressed significant healing is difficult
So, what in the world is strain and counterstrain anyway? Counterstrain is a form of manual manipulative therapy that uses an indirect means of passively positioning a painful or restricted joint or muscle to relieve pain and mechanical dysfunction.
That is an over simplified definition, but it captures the essence of the technique. Technically speaking, counterstrain is “A passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction. In addition, it is a mild overstretching applied in a direction opposite to the false and continuing message of strain from which the body is suffering.
This is one of the most gentle and powerful manual techniques that are currently employed in the field of rehabilitation. The reliability and effectiveness of this manual technique are rapidly becoming legendary, because they work so well!
Not only do the techniques work, they are applicable to a large range of musculoskeletal dysfunctions.
What is tenderpoints mean!!
Tenderpoints are manifestations of somatic dysfunction much as are the other TART changes. TART changes are seen as tissue Texture changes, Asymmetry, altered Range of motion, and Tenderness. The tenderpoint is a discrete pea sized area of tenderness that is uniquely a part of a somatic dysfunction. Each tenderpoint is a manifestation of a specific abnormal reflex that allows the practitioner to fashion a specific treatment for each patient.
How it works – The basics of physiology
Muscle origin and insertion
All muscles have a starting point on a bone (origin) and an ending point on a bone (insertion). Muscles are attached to the bone by a tendon. Think of a chicken drumstick. When you pull the meat away from the bone, it is adhered at the end by a clear or whitish tough cord. This is the tendon. A therapist can move a muscle into a lengthened position (stretch) or shortened position by knowing the origin and insertion of that particular muscle. By moving the bones, muscles can be put into a fully lengthened position, a shortened position or anywhere in between.
Sensory Input and Motor Output
All muscles communicate to the spinal cord and brain (central nervous system) via sensory nerves and receptors located in the tendon. These receptors called golgi tendon organs and muscle spindle fibers, relay information about the length of the muscles and how fast and in what direction the muscle is moving the bones and joints. They also communicate what state of contraction the muscle is in at rest (muscle tone). This is a part of our sensory feedback system which the nervous system uses to decide how to instruct the muscle what to do next (motor output). Our sensory system is highly sophisticated and sensitive. It provides our nervous system with the information to make rapid decisions to plot a course of action based on the desired activity of the brain while also avoiding injury.
Muscle Tone
Our central nervous system supplies a certain amount of constant output to each of our muscles. This is called the muscles’ tone. Without any input the muscle is flaccid (abnormal state) as seen in a stroke. With too much output a muscle is spastic and can make lengthening movement of a muscle nearly impossible. In between flaccid and spastic is a resting state for normal that varies with the individual.
Muscle tone continuum
l_______l______l_______l_________l______l________l________l
FLACCID RELAXED NORMAL TENSE SPASM SPASTIC(ABNORMAL) (ABNORMAL)
Muscle spasm – A vicious cycle.
A protective mechanism of the body based on these principles is called a muscle spasm. When the body perceives danger to a joint, the nervous system instructs the muscle to contract strongly to prevent movement that may cause damage. The muscle can stay in this state for a few minutes or a few days. It can become chronic and then this mechanism rarely serves to help or protect the body any longer and can become detrimental.
A vicious cycle is developed with pain, muscle guarding and muscle spasm.
A muscle in spasm is constantly sending signals to the nervous system, much like listening to music that is too loud. The nervous system reacts by sending strong signals right back. This is how a muscle can get into a vicious circle with the nervous system.
How it works – the technique
Dr. Jones developed a whole system based on understanding the tenderpoint. It is a unique finding with Strain/Counterstrain that the tenderpoint is found in the shortened muscle group, not in the muscle groups that most commonly present with pain. The treatment is achieved by placing a mild over stretching on the painful muscle thereby shortening the truly dysfunctional muscle group allowing for a reset of this abnormal reflex to a normal level.
-The therapist identifies the muscle in spasm.
-The muscle can be in visible or palpable spasm or can be identified by “tender points”. The therapist positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissues surrounding muscles and organs. More about this will be explained in future articles.)
-The therapist monitors tissue change and waits for optimum improvement to occur.
Strain Counterstrain is an Osteopathic manual medicine technique. It emphasizes correction of abnormal neuromuscular reflexes rather than simply addressing painful, postural or structural problems. Counterstrain recognizes that these structural, postural and painful problems are a result of the abnormal reflexes. Until these abnormal neuromuscular reflexes are addressed significant healing is difficult
So, what in the world is strain and counterstrain anyway? Counterstrain is a form of manual manipulative therapy that uses an indirect means of passively positioning a painful or restricted joint or muscle to relieve pain and mechanical dysfunction.
That is an over simplified definition, but it captures the essence of the technique. Technically speaking, counterstrain is “A passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction. In addition, it is a mild overstretching applied in a direction opposite to the false and continuing message of strain from which the body is suffering.
This is one of the most gentle and powerful manual techniques that are currently employed in the field of rehabilitation. The reliability and effectiveness of this manual technique are rapidly becoming legendary, because they work so well!
Not only do the techniques work, they are applicable to a large range of musculoskeletal dysfunctions.
What is tenderpoints mean!!
Tenderpoints are manifestations of somatic dysfunction much as are the other TART changes. TART changes are seen as tissue Texture changes, Asymmetry, altered Range of motion, and Tenderness. The tenderpoint is a discrete pea sized area of tenderness that is uniquely a part of a somatic dysfunction. Each tenderpoint is a manifestation of a specific abnormal reflex that allows the practitioner to fashion a specific treatment for each patient.
How it works – The basics of physiology
Muscle origin and insertion
All muscles have a starting point on a bone (origin) and an ending point on a bone (insertion). Muscles are attached to the bone by a tendon. Think of a chicken drumstick. When you pull the meat away from the bone, it is adhered at the end by a clear or whitish tough cord. This is the tendon. A therapist can move a muscle into a lengthened position (stretch) or shortened position by knowing the origin and insertion of that particular muscle. By moving the bones, muscles can be put into a fully lengthened position, a shortened position or anywhere in between.
Sensory Input and Motor Output
All muscles communicate to the spinal cord and brain (central nervous system) via sensory nerves and receptors located in the tendon. These receptors called golgi tendon organs and muscle spindle fibers, relay information about the length of the muscles and how fast and in what direction the muscle is moving the bones and joints. They also communicate what state of contraction the muscle is in at rest (muscle tone). This is a part of our sensory feedback system which the nervous system uses to decide how to instruct the muscle what to do next (motor output). Our sensory system is highly sophisticated and sensitive. It provides our nervous system with the information to make rapid decisions to plot a course of action based on the desired activity of the brain while also avoiding injury.
Muscle Tone
Our central nervous system supplies a certain amount of constant output to each of our muscles. This is called the muscles’ tone. Without any input the muscle is flaccid (abnormal state) as seen in a stroke. With too much output a muscle is spastic and can make lengthening movement of a muscle nearly impossible. In between flaccid and spastic is a resting state for normal that varies with the individual.
Muscle tone continuum
l_______l______l_______l_________l______l________l________l
FLACCID RELAXED NORMAL TENSE SPASM SPASTIC(ABNORMAL) (ABNORMAL)
Muscle spasm – A vicious cycle.
A protective mechanism of the body based on these principles is called a muscle spasm. When the body perceives danger to a joint, the nervous system instructs the muscle to contract strongly to prevent movement that may cause damage. The muscle can stay in this state for a few minutes or a few days. It can become chronic and then this mechanism rarely serves to help or protect the body any longer and can become detrimental.
A vicious cycle is developed with pain, muscle guarding and muscle spasm.
A muscle in spasm is constantly sending signals to the nervous system, much like listening to music that is too loud. The nervous system reacts by sending strong signals right back. This is how a muscle can get into a vicious circle with the nervous system.
How it works – the technique
Dr. Jones developed a whole system based on understanding the tenderpoint. It is a unique finding with Strain/Counterstrain that the tenderpoint is found in the shortened muscle group, not in the muscle groups that most commonly present with pain. The treatment is achieved by placing a mild over stretching on the painful muscle thereby shortening the truly dysfunctional muscle group allowing for a reset of this abnormal reflex to a normal level.
-The therapist identifies the muscle in spasm.
-The muscle can be in visible or palpable spasm or can be identified by “tender points”. The therapist positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissues surrounding muscles and organs. More about this will be explained in future articles.)
-The therapist monitors tissue change and waits for optimum improvement to occur.
The shortened position of a muscle is a non-threatening position for a muscle in spasm. The communication from the muscle to the nervous system at this time is one of relaxation. The nervous system no longer receives the excessive feedback from the muscle and instructs the muscle tone to change from spasm to a resting tone. Relief and restoration of motion is often immediate. By disarming muscle spasm in major muscle groups the body is able to return to pain free function and pain free movement can be restored and built upon with exercise.
This technique lays the groundwork for rehabilitation of any painful condition. This technique is best used for:
-Spasm in any area of the body
-Post surgery in any area of the body
-Restoring more upright posture (tightened muscles can pull you into poor posture)
-Chronic pain
-Spasm in any area of the body
-Post surgery in any area of the body
-Restoring more upright posture (tightened muscles can pull you into poor posture)
-Chronic pain
Can a muscle be in spasm (hypertonic) without a person knowing it?
Yes! People experience decreased mobility, tightness, or nothing at all if another muscle is compensating for it.
Advanced strain-counterstrain techniques have been pioneered by Sharon Weiselfish, PT, and PH.D. to release the muscle contained in the arteries, veins, lymph vessels and lining of some internal organs. These techniques relax the skeletal muscles of the immediate area surrounding the structure and sometimes can improve in a limited way the function of the structure released.
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