This site is helpful for both Physiotherapy students and Patients. This site contains physiotherapy diseases, management, treatment, details of physiotherapy equipments, rehabilitation, exercise technique, self exercise technique, manipulation, news, physiotherapy education etc.
29 April 2009
Management depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone.The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation or external fixation.
28 April 2009
- radial fracture in distal 2 cm
- +/- ulnar styloid fracture
- dorsal displacement of distal fragment
- "silver-fork" deformity
Causes of Colles fracture:
Wrist fractures occur most often in a fall or in a motor vehicle accident, but any sufficiently strong force on the hand can break the wrist. The wrist can be broken from a sudden force pushing the hand backwards.
A strong force pushing the hand into the forearm can also cause a Colles fracture, which often involves a break of the radius bone near its end. There is a natural weak spot in the radius where it widens.
If the pieces don't lock back together like a jigsaw puzzle, the pull of the forearm muscles can pull the larger end over the smaller like a sleeve, and the bone can shorten like a collapsible drinking cup.
Wrist arthritis may occur following a distal radius fracture. This can be the result of cartilage injury at the time of the break, or wear and tear from changes in the joint alignment after the bone is healed.
If the defect is minor, usually no treatment is necessary. If the defect is more serious, then surgery to repair it is often performed.
In cases where hydrocephalus is present, surgery is sometimes necessary to drain the cerebrospinal fluid that builds up. Normally, this fluid would flow from the brain down the spinal column before being absorbed into the bloodstream, but if the spinal cord is damaged it can't escape.
Physiotherapy helps with mobility. Regular use of a urinary catheter may be needed if there are difficulties passing urine normally. Emotional support is important, and special teaching may be necessary.
Taking a daily folic acid supplement from at least one month before conception through to the end of the 12th week of pregnancy can reduce the risk of spina bifida by up to 70 per cent.
It's recommended that women of child-bearing age take a 400mcg supplement of folic acid every day, in addition to a dietary intake of 200mcg folic acid a day.
Foods containing folic acid include:
- Fortified breakfast cereals
- Baked beans
- Green leafy vegetables
- Peas and chickpeas
Prevention of Spina Bifida:The United States Public Health Service since 1992 has recommended that all women of childbearing age who are capable of becoming pregnant should consume 0.4 mg (400 mcg) of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects. Folic acid is found in foods such as cereals, broccoli, spinach and other leafy green vegetables and citrus fruits. It is also available as a vitamin supplement. Folic acid can reduce by about 50 percent the risk of having a newborn with spina bifida. Unfortunately, most women do not eat enough folic acid-containing foods (such as leafy vegetables and citrus fruits). For this reason, the U.S. Food and Drug Administration requires that flour, breads, rolls, buns, corn meal and grits, farina, rice, macaroni, and noodle products should be fortified with folic acid. However, because prevention is so easy, it is now recommended that every woman of childbearing age take 40 mg (400 mcg) of folic acid as a vitamin supplement daily. Women should realize that it is important that they consume the vitamin every day, whether they are planning a pregnancy or not. Folic acid appears to work around the time of conception, so if women wait to start folic acid until they know they are pregnan
Spina bifida (Latin: "split spine") is a developmental birth defect involving the neural tube: incomplete closure of the embryonic neural tube results in an incompletely formed spinal cord. In addition, the vertebrae overlying the open portion of the spinal cord may not fully form and remain unfused and open. This allows the abnormal portion of the spinal cord to stick out through the opening in the bones. There may or may not be a fluid filled sac surrounding the open spinal cord. Other neural tube defects include anencephaly, a condition in which the portion of the neural tube which will become the cerebrum does not close, and encephalocele, which results when other parts of the brain remain unfused.
Different types of spina bifida:
There are four types of spina bifida:
- closed neural tube defects,
- meningocele, and
Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name "occulta," which means "hidden," indicates that the malformation, or opening in the spine, is covered by a layer of skin. This form of spina bifida rarely causes disability or symptoms.
Closed neural tube defects make up the second type of spina bifida. This form consists of a diverse group of spinal defects in which the spinal cord is marked by a malformation of fat, bone, or membranes. In some patients there are few or no symptoms; in others the malformation causes incomplete paralysis with urinary and bowel dysfunction.
In the third type, meningocele, the meninges protrude from the spinal opening, and the malformation may or may not be covered by a layer of skin. Some patients with meningocele may have few or no symptoms while others may experience symptoms similar to closed neural tube defects.
Myelomeningocele, the fourth form, is the most severe and occurs when the spinal cord is exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening. The paralysis may be so severe that the affected individual is unable to walk and may have urinary and bowel dysfunction.Symptoms of Spina bifida:
In spina bifida occulta, which affects up to one in ten people, there may be visible signs of a dimple or small hair growth on the back. Often people don’t even know that they have it and it is noticed on an xray that is taken for another reason. This is a mild form and rarely causes disability.
In spina bifida cystica there is a sac or cyst (like a blister) on the back, covered by a thin layer of skin. The sac contains tissues that cover the spinal cord, cerebrospinal fluid and sometimes even the nerves and tissues of the spinal cord itself.
There are two forms of spina bifida cystica:
Meningocele - the sac contains tissues that cover the spinal cord (meninges) and cerebrospinal fluid. Nerve damage is minimal, so there's often little disability.
Myelomeningocele - the sac contains tissue, cerebrospinal fluid, nerves and part of the spinal cord. Spinal cord damage or incomplete development always occurs, resulting in paralysis and sensation loss below the damaged region. Many lose the ability to walk as they grow.
There's often an accompanying condition called hydrocephalus (increased pressure in the fluid in the brain, which causes some very young children's heads to swell with the pressure), which can gradually damage brain function especially if untreated. Other problems include incontinence and urinary tract infections.
Myelomeningocele is more common and more serious than meningocele.
Complications of spina bifida:
Complications of spina bifida can range from minor physical problems to severe physical and mental disabilities. It is important to note, however, that most people with spina bifida are of normal intelligence. Severity is determined by the size and location of the malformation, whether or not skin covers it, whether or not spinal nerves protrude from it, and which spinal nerves are involved. Generally all nerves located below the malformation are affected. Therefore, the higher the malformation occurs on the back, the greater the amount of nerve damage and loss of muscle function and sensation.
In addition to loss of sensation and paralysis, another neurological complication associated with spina bifida is Chiari II malformation—a rare condition (but common in children with myelomeningocele) in which the brainstem and the cerebellum, or rear portion of the brain, protrude downward into the spinal canal or neck area. This condition can lead to compression of the spinal cord and cause a variety of symptoms including difficulties with feeding, swallowing, and breathing; choking; and arm stiffness.
Chiari II malformation may also result in a blockage of cerebrospinal fluid, causing a condition called hydrocephalus, which is an abnormal buildup of cerebrospinal fluid in the brain. Cerebrospinal fluid is a clear liquid that surrounds the brain and spinal cord. The buildup of fluid puts damaging pressure on the brain. Hydrocephalus is commonly treated by surgically implanting a shunt—a hollow tube—in the brain to drain the excess fluid into the abdomen.
Some newborns with myelomeningocele may develop meningitis, an infection in the meninges. Meningitis may cause brain injury and can be life-threatening.
Children with both myelomeningocele and hydrocephalus may have learning disabilities, including difficulty paying attention, problems with language and reading comprehension, and trouble learning math.
Causes and Risk Factors of Spina Bifida:The most important risk factor for spina bifida is poor nutrition, especially a diet deficient in folic acid.
There appears to be factors other than nutrition in the development of spina bifida. Genetics also seems to play a role. People of Northern European and Hungarian ancestry have the highest rates of the disease, and the condition tends to run in families, though not consistently. In fact, 90 to 95 percent of children with spina bifida are born to women who have no other children or anyone in the family with the defect.
27 April 2009
Spondylolisthesis is treated according to the Grade. Grades 1 and 2 generally respond to conservative treatment, including physical therapy, home exercises, stretching and the use a brace. Higher Grades of Spondylolisthesis may require surgery. This decision is best made with your physician.
Spondylolisthesis is the slipping forward of one vertebra, in relation to the vertebra beneath it. This slippage usually happens in the low back at the L5-S1 level.
Who Gets Spondylolisthesis:Children involved in sports such as gymnastics and diving have a high incidence of spondylolisthesis. These and other sports put a lot of stress on the back, especially the movement of hyperextension (bending backwards). Spondylolisthesis also occurs in adults after the age of 40, due to degeneration.
Causes of Spondylolisthesis:Spondylolysis is the most common cause of spondylolisthesis. Genetics may also be a factor. Sometimes children are born with weakened facet joints, predisposing them to spondylolisthesis. Infections and degeneration may also be causes of the condition. One of the biggest contributors to spondylolisthesis is the repititive hyperextension of the spine that comes with such sports as gymnastics, diving, weightlifting and football.
Grades of Spondylolisthesis:Spondylolisthesis is measured in grades (degrees) of slippage.There are 4 grades., each representing 25% slippage. So, for example, if a patient is measured to have a Grade 2 Spondylolisthesis, this means that the 2 adjacent vertebra maintain a 50% contact with one another. Grades are measured by taking a side view X-Ray. Other diagnostic methods, such as CT scans or MRIs might be used to determine the damage to surrounding tissues.
- Grade 1: 25% slippage
- Grade 2: 50% slippage.
- Grade 3: 75% slippage.
- Grade 4: 100% slippage.
An inflammatory arthritic disorder, primarily of the axial skeleton (sacroiliac joints and spine), but can affect hip and shoulder joints and infrequently the peripheral joints. It causes chronic back pain and leads to stiffness of the spine. Most of the affected individuals have the HLA-B27 gene.
Ultraviolet (UV) light is electromagnetic radiation with a wavelength shorter than that of visible light, but longer than x-rays, in the range 10 nm to 400 nm, and energies from 3 eV to 124 eV. It is so named because the spectrum consists of electromagnetic waves with frequencies higher than those that humans identify as the color violet.Though these waves are invisible to the human eye, some insects, like bumblebees, can see them!
Natural sources of Ultraviolet
The Sun emits ultraviolet radiation in the UVA, UVB, and UVC bands, but because of absorption in the atmosphere's ozone layer, 98.7% of the ultraviolet radiation that reaches the Earth's surface is UVA. (Some of the UVB and UVC radiation is responsible for the generation of the ozone layer.)
Ordinary glass is partially transparent to UVA but is opaque to shorter wavelengths while Silica or quartz glass, depending on quality, can be transparent even to vacuum UV wavelengths. Ordinary window glass passes about 90% of the light above 350 nm, but blocks over 90% of the light below 300 nm.
The onset of vacuum UV, 200 nm, is defined by the fact that ordinary air is opaque below this wavelength. This opacity is due to the strong absorption of light of these wavelengths by oxygen in the air. Pure nitrogen (less than about 10 ppm oxygen) is transparent to wavelengths in the range of about 150–200 nm. This has wide practical significance now that semiconductor manufacturing processes are using wavelengths shorter than 200 nm. By working in oxygen-free gas, the equipment does not have to be built to withstand the pressure differences required to work in a vacuum. Some other scientific instruments, such as circular dichroism spectrometers, are also commonly nitrogen purged and operate in this spectral region.
Extreme UV is characterized by a transition in the physics of interaction with matter: wavelengths longer than about 30 nm interact mainly with the chemical valence electrons of matter, while wavelengths shorter than that interact mainly with inner shell electrons and nuclei. The long end of the EUV/XUV spectrum is set by a prominent He+ spectral line at 30.4 nm. XUV is strongly absorbed by most known materials, but it is possible to synthesize multilayer optics that reflect up to about 50% of XUV radiation at normal incidence. This technology has been used to make telescopes for solar imaging; it was pioneered by the NIXT and MSSTA sounding rockets in the 1990s; (current examples are SOHO/EIT and TRACE) and for nanolithography (printing of traces and devices on microchips).
Rickets, a disease that affects the developing skeletal system of children and other young animals, is the result of the body's inability to absorb calcium and phosphate. The disease is characterized by soft, weak and deformed bones. Rickets also occurs in adults, but it is then called osteomalacia because the affected bones are already formed. In adults, osteomalacia causes the bones of the skeletal system to become weak and soft.
Rickets is usually the result of a Vitamin D deficiency. Vitamin D is consumed through a proper diet and produced by the body with adequate exposure to sunlight. This vitamin is very important to the body because it helps aid in the absorption of calcium and phosphate, the minerals responsible for the strength and hardness of the bones.
Malnutrition is a major cause of rickets which can develop at any time during life, including while a baby is still in the womb. A perpetual lack of sunlight can also cause rickets. One form of rickets, called vitamin D resistant rickets, is a hereditary disease that involves the kidneys' inability to retain proper phosphate levels in the body. Chronic kidney failure that is not inherited may also be an underlying cause of rickets. Other underlying diseases or problems with the bowels can result in rickets in both adults and children.
A person with rickets may have severely bowed legs, deformation of the spine, chest and pelvis, bones that break easily and severely stunted growth. In severe cases, the knees bulge or appear very large, and there may also be other visible bone deformations characterized by posture and gait.
Rickets is diagnosed by performing blood tests to measure calcium and phosphate levels, and by using x-rays to visually asses the bone condition. A person's dietary and lifestyle history is also assessed. For example, a person who is confined to their home is more likely to develop rickets. This history can help gauge risk factors and rule out other underlying causes.
When rickets is caused by malnutrition or lack of sunlight, it can be treated with vitamin D supplements and sun exposure. Rickets caused by underlying diseases can be corrected by treating the primary disease. Bone deformities in young children often correct themselves depending on their severity. Children and adults can also wear braces and maintain proper posture to counteract bowed legs and spinal complications. In severe cases, surgery may be the only way to correct deformities.
Rickets is not as common in the United States as it is in other countries that have limited food supplies or diets with little variety. However, it is still important to maintain a diet rich in vitamin D. Foods like vitamin fortified milk and cereals, fish and liver are rich in vitamin D.
24 April 2009
"If we were to design a drug that had perfect properties according to what we know about heart disease and associated risk factors, we couldn't improve on garlic," says Amanda McQuade-Crawford, herbalist and director of the Ojai Center of Phytotherapy in Ojai, Calif. Regular use of garlic is associated with the prevention of cardiovascular disease, she explains. Garlic raises protective HDLs (high-density lipoproteins), while it lowers harmful LDLs (low-density lipoproteins) and triglycerides (blood fats). Garlic is also known to help lower high blood pressure, she says. Garlic aids in cancer prevention by raising the body's level of glutathione transferase, a liver enzyme known to detoxify the body of carcinogens, says McQuade-Crawford. In China, researchers found gastric cancer was reduced where garlic intake was high. Other researchers have noted improved helper/suppressor ratios of T-cells in AIDS patients who take garlic. Proven to work against various micro-organisms including bacteria resistant to antibiotics, garlic is known to be antifungal and antiviral, she adds.
The berries of this flowering shrub are best used for the heart, says McQuade-Crawford. Hawthorn aids the heart's pumping action by opening the coronary arteries to nourish the heart muscle. The herb can also slow a rapid heart rate and strengthen a failing heart. Hawthorn usually lowers high blood pressure, especially a raised diastolic high blood pressure, and it benefits low blood pressure due to weak heart muscles with arrhythmia (irregular heart rhythm).
"Hawthorn takes a long time to do its best -- six months or longer. In the style of a true herbal tonic, it can be taken safely and effectively over time for its best effects," notes McQuade-Crawford.
Ginkgo Biloba extract from the ginkgo tree has been shown to benefit visual function by improving microcirculation to the eyes especially among patients suffering from senile macular degeneration, a common condition thought to involve free radical damage, says Steven Schechter, N.D., author of Fighting Radiation & Chemical Pollutants With Foods, Herbs &Vitamins (Vitality, Ink).
More than 280 scientific studies indicate standardized ginkgo extract prevents and/or benefits ailments such as vertigo, tinnitus, inner ear disturbances, memory impairment, ability to concentrate, anxiety, depression, neurological disorders, senility, circulatory disorders, edema and Raynaud's disease (a vascular disorder). Ginkgo extract improves the quality and increases the quantity of capillary circulation, thus increasing blood flow to the brain, heart and tissues in organs and glands, Schechter says. In addition, he notes, the flavonoids in ginkgo are potent free radical scavengers.
Also known in Chinese as ma huang, ephedra may be the world's oldest herb cultivated for medicinal purposes, dating back nearly 5,000 years, says McQuade-Crawford. It's commonly used in cold formulas as a decongestant.
"Ephedra is a great bronchial dilator," McQuade-Crawford says. It helps asthma sufferers by opening the sinus passages and has an antihistamine effect which aids chronic and acute allergies. Ephedra also acts as a circulatory stimulant to blood pressure and heart function; it elevates blood pressure. Ephedra's main constituent is ephedrine, which increases adrenaline secretion in our bodies. The boost you get from ephedra stimulates certain glands, muscles and tissue functions, while it suppresses others.
"In the long term, ephedra's adrenaline overdrive can lead to chronic stress and even to degenerative disease," warns McQuade-Crawford. She notes this is important for people using ephedra for dietary weight loss or "pep pill" purposes because the effects of ephedra linger in the body long after the herb is gone. "Ephedra shouldn't be used with drugs for the heart or for the lungs and never with antidepressant drugs. It's not for use with the weak or the ill and when used long term, dosages should be conservative," McQuade-Crawford cautions.
Licorice has been most recently researched as an antiviral and in the treatment of gastrointestinal ulceration, explains McQuade-Crawford. Its soothing, anti-inflammatory and relaxing actions help smooth muscles in the gastrointestinal tract on contact. "Licorice gets into a painful, contracted, tight digestive tract and coats the raw places, relaxes the clenched-up muscles and acts as a local anti-inflammatory," she says. Licorice also increases bile secretion. Licorice is indicated for any gastrointestinal ulcers, including mouth ulcers. The root is indicated for chronic coughs and bronchitis as a soothing decongestant. It's also indicated in small amounts to reduce sugar cravings.
The Chinese often use licorice to improve the taste and the effects of other herbs in complex formulas. Japanese research has shown licorice to decrease high testosterone levels in women with ovarian cysts and to increase their fertility. Large amounts of licorice or long-term use raises blood pressure in some people.
A strong antioxidant, bilberry benefits your circulatory system, eyes, heart and brain, and helps generate overall good health, says Schechter. Bilberry fruit contains a type of flavonoid called anthocyanosides, which are responsible for increasing flexibility of capillaries and increasing blood flow.
Research shows that standardized extract of bilberry can enlarge range of vision and improve sharpness of images, enhance ability to focus, and improve blurred vision, eyestrain and nearsightedness. Bilberry extract also helps strengthen coronary arteries and helps prevent atherosclerosis and venous insufficiency, which causes swollen ankles and feet. "Since adding bilberry to my own health program, I've noticed my muscles seem to recover slightly faster, I experience less muscular pain and my vision has improved from 20/100 to approximately 20/50," says Schechter.
Decades of research prove echinacea's value for aiding the immune system, Schechter explains. Studies have determined echinacea's ability to activate white blood cells and stimulate the regeneration of the cellular connective tissue and the epidermis. Schechter notes that echinacea's infection-fighting properties stem from its ability to neutralize a harmful enzyme involved in the infection process. Echinacea also increases two vital components of your immune system that consume and eliminate invading organisms and foreign particles.
German studies have shown echinacea extract contains proteins that help protect noninfected cells against viral infections, one reason why echinacea is regarded as an influenza preventor. Another German study found echinacea effective in allergy treatment because it helps prevent tissue inflammation due to harmful foreign toxins.
"I consider standardized milk thistle seed extract the most beneficial herbal product for liver detoxification, regeneration and protection, and, in general, one of the most universally necessary herbal products for the 1990s," says Schechter. He notes that the stress of toxins from chemical pollutants, pharmaceuticals, alcohol, tobacco smoke, drugs and different forms of radiation have cumulative side effects that need to be addressed.
More than 120 scientific studies have shown that milk thistle extract regenerates, regulates and strengthens liver functions. Because free radicals attack the liver, primarily the fat tissue in the liver, the antioxidant qualities of milk thistle are extremely beneficial. Milk thistle stimulates your body to produce superoxide dismutase, which is one of two primary antioxidants the body can manufacture.
Astragalus has been used as an immunity booster in China for nearly 4,000 years, according to Rob McCaleb, founder of the Herb Research Foundation in Boulder, Colo. Astragalus extracts can increase immune system efficiency by increasing immune activity. One study found that astragalus extracts could increase the impaired immune function of blood cells up to and sometimes beyond normal cell ability.
According to Planetary Herbology (Lotus Press) by Michael Tierra, N.D., astragalus helps strengthen digestion, raise metabolism, strengthen the immune system and promote wound healing. It can also treat chronic weakness of the lungs, shortness of breath, low energy, prolapse of internal organs, spontaneous sweating, chronic lesions and deficiency edema.
Ginseng is one of the most widely studied herbs, having been the subject of more than 3,000 scientific studies to investigate how ginseng helps improve a person's physical and/or mental performance, notes McCaleb. Studies have shown ginseng helps increase memory and learning by improving circulation. It's also been shown to reduce cholesterol and protect the liver from toxins. Ginseng, according to Tierra, is known to strengthen the lungs, nourish body fluids and calm the spirit. It may be used for shock, collapse and heart weakness, as well as for promoting longevity and increasing resistance to disease.
- Read a book or two - helps with relaxation and sleep.lay cards and do crosswords - keeps the brain active.
- Play cards and do crosswords - keeps the brain active.
- Sleep long and get up late - late risers have faster brains and lower stress levels.
- Go out into the fresh air as often as you can. Vitamin D‚ which is important for bones‚ teeth and happiness is boosted by sunlight (but keep the sunscreen on).
- Walk and keep physically active - it's good for the heart and lungs
- Sing - the breathing control needed from singing is good for combating stress
- Drink at least 6 to 8 cups of liquid a day - preferably water and fruit juices - to give the body a chance to deal with all the toxins we consume on a daily basis.
- Eat five portions of fruit and vegetables a day - this will make you enjoy better health and vitality which in turn can make life more enjoyable.
- Keep your home safe and free from hazards (floor surfaces‚ trailing flexes)‚ wear properly fitting slippers and increase the level of lighting everywhere - this will help you avoid slips‚ trips and broken hips.
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