Myositis ossificans (MO) occurs when bone or bone-like tissue grows where it’s not supposed to. It most commonly happens in your muscle after an injury — like when you get hit hard in the thigh during a soccer game or maybe after a car or bicycle accident.Myositis ossificans comprises two syndromes characterized by heterotopic ossification (calcification) of muscle.About 80 percent of the time, these bony growths develop in the muscles of your thigh or upper arm.
In the first, and by far most common type, nonhereditary myositis ossificans, calcifications occur at the site of injured muscle, most commonly in the arms or in the quadriceps of the thighs.
The term myositis ossificans traumatica is sometimes used when the condition is due to trauma. Also known as Myositis ossificans circumscripta is another synonym of myositis ossificans traumatica refers to the new extraosseous bone that appears after trauma.
The second condition, myositis ossificans progressiva (also referred to as fibrodysplasia ossificans progressiva) is an inherited affliction, autosomal dominant pattern, in which the ossification can occur without injury, and typically grows in a predictable pattern. Although this disorder can be passed to offspring by those afflicted with FOP, it is also classified as nonhereditary, as it is most often attributed to a spontaneous genetic mutation upon conception.
Myositis ossificans usually occurs where a person has experienced a single traumatic injury, such as sustaining a hit while playing football or soccer that causes a deep muscle bruise.
It can also happen when there is a repetitive injury to the same area, such as in the thighs of horseback riders.
Sports injuries or accidents usually initiate MO. Adolescents and young adults in their 20s are most likely to develop MO. It’s rare for children age of 10 and under to get the condition. People who have paraplegia are also prone to develope MO, but usually with no evidence of trauma.
SIGNS & SYMPTOMS
Unlike other typical muscle strains or injuries, people with myositis ossificans may notice that their pain worsens with time instead of getting better.
Someone with this condition may also notice changes in the affected muscle, including:
A lump or bump
Decreased range of motion
If it has been at least 2–3 weeks since the pain or other symptoms started, the doctor may order some imaging tests to look for evidence of bone growth in the soft tissue.
Your doctor may also order other imaging tests. These may include a diagnostic ultrasound, MRI, CT, or bone scan.
X-ray: It can be difficult to diagnose myositis ossificans in the early stages with just an X-ray. Most X-rays will not show up any abnormalities in the first 2–3 weeks following the injury but will show changes after 3–4 weeks.
Ultrasound: Ultrasounds use sound waves to look at the soft tissues. They are one early diagnostic test that can be used to look for the changes associated with myositis ossificans. Ultrasonography depends on the ability of the person reading the scans, so many doctors do not often recommend it as the first test.
CT scan: Doctors can usually see the early development of bone tissue in soft tissues. However, it is not 100 percent reliable, and if a doctor suspects that someone has myositis ossificans, they may carry out additional testing to make the diagnosis.
Magnetic resonance imaging (MRI): An MRI is a preferred method of looking at soft tissue growths. A doctor may still order additional tests to compare and confirm a diagnosis.
A biopsy of the growth may also be taken and evaluated in a lab.
Myositis ossificans usually resolves on its own.You may be able to prevent MO by properly taking care of your injury in the first two weeks. You can reduce inflammation by immobilizing the affected muscle with slight compression, icing, and elevation.
Rest: You don’t have to just lie there, but don’t stress the muscle too much.
Ice: Apply for 15 to 20 minutes at a time.
Compression: Wrap an elastic bandage firmly around your injury to minimize swelling and keep the area stable.
Elevation: Raise your injured limb above the level of your heart to help drain excess fluid from the area.
Non-painful stretching and strengthening: Gently stretch the affected muscle and start doing strengthening exercises when your doctor says it’s OK. Don’t perform any movements to the point of pain.
Medications and orthotics
You can take nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) or naproxen (Aleve) to reduce pain and swelling. Topical treatments like Biofreeze or Tiger Balm can also helps to ease pain.
When your pain and movement allow you to get back to sports, wear some padding or other protection on the injured muscle to prevent additional damage.
Physiotherapy management of myositis ossificans includes
Icing the injury
Pulsed Ultra sound and phonophoresis
Maintain available range of motion but avoid stretching and massage, until maturation.
Passive range of motion and mobilization: This is when a person or machine moves your body parts for you.
Active range of motion and mobilization: This is when you use your own strength to move your body parts.
Iontophoresis with 2 % acetic acid solution.
Extra corporeal shock wave therapy
Growth should not be removed in premature stage as it will likely reoccur. The ossification becomes exuberant, infiltrates beyond the original site, and compresses the soft tissues around beyond hope of repair. When after serial x-rays the mass is dense, well delineated, and at a stand still, it may be safely removed. It may be possible to prevent myositis by aspirating the original haematoma.
While it can be difficult to predict who will get myositis ossificans, it is important to treat every injury promptly using the R.I.C.E. method. This is:
An athlete who sustains an injury may need to leave the game or event, especially if there is significant swelling or bruising.
Gentle stretching and range of motion exercises are also essential after an injury; myositis ossificans is more likely to affect a muscle that is not being used.
Doing too much too soon can worsen MO. But not working to recover your range of motion when the doctor says it’s safe may make your pain and stiffness last longer.
FRENKLE ‘S CO-ORDINATION EXERCISE FOR CEREBELLER ATAXIA
Definition of coordination Exercises:
It is the ability to execute smooth, accurate, controlled motor responses (optimal interaction of muscle function).
Coordination is the ability to select the right muscle at the right time with proper intensity to achieve proper action.
Coordinated movement is characterized by appropriate speed, distance, direction, timing and muscular tension.
It is the process that results in activation of motor units of multiple muscles with simultaneous inhibition of all other muscles in order to carry out a desired activity
Importance of the cerebellum in coordination ;
The cerebellum is the primary center in the brain for coordination of movement.
Components of coordinated movement:
Volition: is the ability to initiate,maintain or stop an activity or motion.
Perception:in tact proprioception and subcortical centres to integrate motor impulses and the sensory feedback. When proprioception is affected it is compensated with visual feedback.
Engramformation:is the neurologica lmuscular activity developed in the extrapyramidal system. Research proved that high repetitions of precise performance must be performed in order to develop an engram
Types of coordination:
1) Fine motor skills:
Require coordinated movement of small muscles (hands, face).
Examples: include writing, drawing, buttoning a shirt, blowing bubbles
2) Gross motor skills:
Require coordinated movement of large muscles or groups of muscles (trunk, extremities).
Examples: include walking, running, lifting activities.
The ability of the visual system to coordinate visual information. Received and then control or direct the hands in the accomplishment of a task .
Examples : include catching a ball,sewing,computer mouse use.
Causes of coordination impairments , Causes of Ataxia
Degeneration, damage or loss of nerve cells in the cerebellum, which is that part of the brain that controls muscle coordination, causes ataxia. The cerebellum comprises of two small ball-shaped folded tissues present at the base of the brain near the brainstem. Diseases which damage the spinal cord and peripheral nerves which connect the cerebellum to the muscles can also cause ataxia
Other causes of ataxia include:
Stroke is a condition where the blood supply to a part of the brain gets severely diminished or interrupted, which deprives the brain tissue of oxygen and other nutrients resulting in death of brain cells.
Trauma or injury to the head, which causes damage to the brain or spinal cord, can cause sudden-onset ataxia (acute cerebellar ataxia).
Chickenpox can result in a complication in the form of Ataxia; although this is not common. Ataxia can appear during the healing stages of the infection and persist for days to weeks and gradually resolve over the time.
Transient ischemic attack (TIA) is caused by a temporary reduction in blood supply to a part of the brain. Majority of the TIAs last only for a few minutes. Some of the symptoms of TIA include ataxia, which is temporary.
Multiple sclerosis is a chronic, potentially debilitating medical condition, which affects the central nervous system.
Cerebral palsy consists of a group of disorders, which occurs as a result of damage to a child’s brain during its early development. It can be before, during or shortly after birth. It affects the ability to coordinate movements of the body.
Paraneoplastic syndromes are rare, degenerative disorders, which are triggered by the response of the immune system to a tumor or neoplasm. This tumor is commonly in the lungs, ovaries, lymph nodes or breast. Patient can experience ataxia many months or years before cancer is actually diagnosed.
Toxic reaction to some medications can also cause ataxia. Medicines, especially barbiturates and certain sedatives, like benzodiazepine, can cause ataxia as a side effect. Other things, which could cause toxic reactions, are heavy metal poisoning, alcohol and drug intoxication and solvent poisoning.
Any type of growth on the brain, either cancerous or noncancerous, can damage cerebellum and cause ataxia.
Deficiency of vitamin E or B-12 can also lead to ataxia.
No specific cause can be found for some adults who develop sporadic ataxia, also known as sporadic degenerative ataxia, which can be of many types, such as multiple system atrophy which is a progressive and degenerative disorder.
Examples of coordination tests:
1) In the upper limb:
A) Finger-to-nose test
The shoulder is abducted to 90o with the elbow extended, the patient is asked to bring tip of the index finger to the tip of nose.Finger to therapist finger: the patient and the therapist site opposite to each other, the therapist index finger is held in front of the patient, the patient is asked to touch the tip of the index finger to the therapist index finger.
B) Finger-to-finger test
Both shoulders are abducted to bring both the elbow extended, the patient is asked to bring both the hand toward the midline and approximate the index finger from opposing hand
C) Finger-to-doctor’s finger test
the patient alternately touch the tip of the nose and the tip of the therapist’s finger with the index finger.
D) Adiadokokinesia or dysdiadokokinesia:
The patient asked to do rapidly alternating movement e.g. forearm supination and pronation, hand tapping.
E) Rebound phenomena:
The patient with his elbow fixed, flex it against resistance. When the resistance is suddenly released the patient’s forearm flies upward and may hit his face or shoulder.
F) Buttoning and unbuttoning test.
In any of the previous tests, we may find:
Intention tremors and Decomposition of movements
Dysmetria: in the form of hypermetria or hypometria
2) In the lower limb
A) Heel-to-knee test
B) Walking along a straight line. Foot close to foot:In case of cerebellar lesion, there is deviation of gait
C) Rom-berg test: Ask the patient to stand with heels together. Swaying or loss of balance occurs while his eyes are open or closed.
General principles of coordination exercises involve:
Constant repetition of a few motor activities
Use of sensory cues (tactile, visual,proprioceptive) to enhance motor performance
Increase of speed of the activity over time
Activities are broken down into components that are simple enough to be performed correctly.
Assistance is provided when ever necessary.
The patient there fore should have a short rest after two or three repetitions,to avoid fatigue.
High repetition of precise performance must be performed for the engram to form.
When ever a new movement is trained, various inputs are given, like instruction(auditory), sensory stimulation(touch) ,or positions in which the patient can view the movement (visual stimulation) to enhance motor performance.
Therapeutic exercises used to improve coordination:
Frenkel aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinaesthetic sensation.
The process of learning this alternative method of control is similar to that required to learn any new exercise,
the essentials being: Concentration of the attention, Precision and Repetition
The ultimate aim is to establish control of movement so that the patient is able and confident in his ability to carry out these activities which are essential for independence in everyday life.
They are a system of slow repetitious exercises. They increase in difficulty over the time of the program. The patient watches his hand or arm movements (for example) and corrects them as needed.
Although the technique is simple, needs virtually no exercise equipment, and can be done on one’s own, concentration and some degree of perseverance is required. Research has shown that 20,000 to 30,000 repetitions may be required to produce results. A simple calculation will show that this can be achieved by doing 60 repetitions every hour for six weeks in a 16-hour daily waking period. The repetitions will take just a few minutes every hour.
The brain as a whole learns to compensate for motor deficits in the cerebellum (or the spinal cord where applicable). If the ataxia affects say, head movements, the patient can use a mirror or combination of mirrors to watch their own head movements.
Frenkel Exercises are a series of motions of increasing difficulty performed by ataxic patients to facilitate the restoration of coordination. Frenkel’s exercises are used to bring back the rhythmic, smooth and coordinated movements.
Dr. H S Frenkel was a physician from Switzerland who aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinaesthetic sensation.
Frenkel Exercises were originally developed in 1889 to treat patients of tabes dorsalis and problems of sensory ataxia owing to loss of proprioception. These exercises have been applied in the treatment of individuals with ataxia, in particular cerebellar ataxia. The exercises are performed in supine, sitting, standing and walking. Each activity is performed slowly with the patient using vision to carefully guide correct movement. These exercises require a high degree of mental concentration and effort. For those patients with the prerequisite abilities, they may be helpful in regaining control of movement through cognitive compensation strategies. Patients with partial sensation can progress to practicing exercises with eyes closed. The main principles of Frenkel exercises are the following:
Concentration or attention
This program consists of a planned series of exercises designed to help patient compensate for the inability to tell where the arms and legs are- in space without looking.
1. Exercises are designed primarily for coordination; they are not intended for strengthening.
2. Commands should be given in an event, slow voice; the exercises should be done to counting.
3. It is important that the area is well lit and that patients are positioned so that they can watch the movement of their legs.
4. Avoid fatigue. Perform each exercise not more than four times. Rest between each exercise.
5. Exercises should be done within normal range of motion to avoid over-stretching of muscles.
6. The ?rst simple exercises should be adequately performed before progressing to more dif?cult patterns.
General Instructions for frenkel exercises
Exercises can be performed with the part supported or unsupported, unilaterally or bilaterally.
They should be practiced as smooth, timed movements, performed at a slow, even tempo by counting out loud.
Consistency of performance is stressed and a specified target can be used to determine range.
Four basic positions are used: lying, sitting, standing and walking.
The exercises progress from postures of greatest stability (lying, sitting) to postures of greatest challenge (standing, walking).
As voluntary control improves, the exercises progress to stopping and starting on command, increasing the range and performing the same exercises with eyes closed.
Concentration and repetition are the keys to success.
Frenkel exercises for lower limb
Exercises for the legs in lying
Flex and extend one leg by the heel sliding down a straight line on the table.
Abduct and adduct hip smoothly with knee bent and heel on the table.
Abduct and adduct leg with knee and hip extended by sliding the whole leg on the table.
Flex and extend hip and knee with heel off the table.
Flex and extend both the legs together with the heel sliding on the table.
Flex one leg while extending the other.
Flex and extend one leg while taking the other leg into abduction and adduction.
Heel of one limb to opposite leg (toes, ankle, shin, patella).
Heel of one limb to opposite knee, sliding down crest of tibia to ankle.
Whether the patient slides the heels or lifts it off the bed he has to touch it to the marks indicated by the patient on the plinth. The patient may also be told to place the heel of one leg on various points of the opposite leg under the guidance of the therapist.
Exercises for the legs in Sitting
One leg is stretched to slide the heel to a position indicated by a mark on the floor.
The alternate leg is lifted to place the heel on the marked point.
From stride sitting posture patient is asked to stand and then sit.
Rise and sit with knees together.
Sitting hip abduction and adduction.
Exercises for the legs in Standing
In stride standing weight is transferred from one foot to other.
Place foot forward and backward on a straight line.
Walk along a winding strip.
Walk between two parallel lines
Walk sideways by placing feet on the marked point.
Walk and turn around
Walk and change direction to avoid obstacles.
Frenkel exercises for upper limb :
Similar exercises can be devised for the upper limb wherein the patient may be directed to place the hand on the various points marked on the table or wall board to improve coordination of all the movements in the upper limb.
Some examples of Frankel exercises of upper limb in sitting position
Have patient sit in front of a table and place a number of objects on the table. The patient then touches each object with the right hand and then the left hand.
The patient flexes the right shoulder to 90 degree with elbow and wrist extended. The patient then takes his or her right index finger and touches the tip of his or her nose. This exercise is then repeated with the left hand. The exercise is performed alternating right and left index finger.
The patient taps bilateral hands on bilateral thighs while alternating palmer and dorsal surfaces as fast as possible.
Certain diversional activities such as building with toy bricks or drawing on a black board, buttoning, combing, writing, typing are some of the activities that also improves the coordination.
The knee joint is one of the strongest and most important joints in the human body. It allows the lower leg to move relative to the thigh while supporting the body’s weight. Movements at the knee joint are essential to many everyday activities, including walking, running, sitting and standing.
The knee, also known as the tibiofemoral joint, is a synovial hinge joint formed between three bones: the femur, tibia, and patella. Two rounded, convex processes (known as condyles) on the distal end of the femur meet two rounded, concave condyles at the proximal end of the tibia.
The patella lies in front of the femur on the anterior surface of the knee with its smooth joint-forming processes on its posterior surface facing the femur.
The joint-forming surfaces of each bone are covered in a thin layer of hyaline cartilage that gives them an extremely smooth surface and protects the underlying bone from damage. Between the femur and tibia is a figure-eight-shaped layer of tough, rubbery fibrocartilage known as the meniscus. The meniscus acts as a shock absorber inside the knee to prevent the collision of the leg bones during strenuous activities such as running and jumping.
As with all synovial joints, a joint capsule surrounds the bones of the knee to provide strength and lubrication. The outer layer of the capsule is made of fibrous connective tissue continuous with the ligaments of the knee to hold the joint in place. Oily synovial fluid is produced by the synovial membrane that lines the joint capsule and fills the hollow space between the bones, lubricating the knee to reduce friction and wear.
Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:
The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
The medial and lateral collateral ligaments prevent the femur from sliding side to side.
Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.
Numerous bursae, or fluid-filled sacs, help the knee move smoothly
The femur (thigh bone), tibia (shin bone), and patella (kneecap) make up the bones of the knee. The knee joint keeps these bones in place.
The patella is a small, triangle shaped bone that sits at the front of the knee, within the quadriceps muscle. It is lined with the thickest layer of cartilage in the body because it endures a great deal of force.
There are two types of cartilage in the knee:
Meniscus: these are crescent-shaped discs that act as a cushion, or “shock absorber” so that the bones of the knee can move through their range of motion without rubbing directly against each other. The menisci also contain nerves that help improve balance and stability and ensure the correct weight distribution between the femur and tibia.
The knee has two menisci:
medial – on the inner side of the knee, this is largest of the two
lateral – on the outer side of the knee
Articular cartilage: found on the femur, the top of the tibia, and the back of the patella; it is a thin, shiny layer of cartilage. It acts as a shock absorber and helps bones move smoothly over one another.
Ligaments are tough and fibrous tissues; they act like strong ropes to connect bones to other bones, preventing too much motion and promoting stability. The knee has four:
ACL (anterior cruciate ligament) – prevents the femur from sliding backward on the tibia, and the tibia from sliding forward on the femur.
PCL (posterior cruciate ligament) – prevents the femur from sliding forward on the tibia, or the tibia from sliding backward on the femur.
MCL (medial collateral ligament) – prevents side to side movement of the femur.
LCL (lateral collateral ligament) – prevents side to side movement of the femur.
These tough bands of soft tissue provide stability to the joint. They are similar to ligaments, but instead of linking bone to bone, they connect bone to muscle. The largest tendon in the knee is the patellar tendon, which covers the kneecap, runs up the thigh, and attaches to the quadriceps.
Although they are not technically part of the knee joint, the hamstrings and quadriceps are the muscles that strengthen the leg and help flex the knee.
The quadriceps are four muscles that straighten the knee. The hamstrings are three muscles at the back of the thigh that bend the knee.
The gluteal muscles – gluteus medius and minimus – also known as the glutes are in the buttocks; these are also important in positioning the knee.
The joint capsule is a membrane bag that surrounds the knee joint. It is filled with a liquid called synovial fluid, which lubricates and nourishes the joint.
There are approximately 14 of these small fluid-filled sacs within the knee joint. They reduce friction between the tissues of the knee and prevent inflammation.
* Knee Conditions:-
(1)Chondromalacia patella (also called patellofemoral syndrome): Irritation of the cartilage on the underside of the kneecap (patella), causing knee pain. This is a common cause of knee pain in young people.
(2)Knee osteoarthritis: Osteoarthritis is the most common form of arthritis, and often affects the knees. Caused by aging and wear and tear of cartilage, osteoarthritis symptoms may include knee pain, stiffness, and swelling.
(3)Knee effusion: Fluid buildup inside the knee, usually from inflammation. Any form of arthritis or injury may cause a knee effusion.
(4)Meniscal tear: Damage to a meniscus, the cartilage that cushions the knee, often occurs with twisting the knee. Large tears may cause the knee to lock.
(5)ACL (anterior cruciate ligament) strain or tear: The ACL is responsible for a large part of the knee’s stability. An ACL tear often leads to the knee “giving out,” and may require surgical repair.
(6)PCL (posterior cruciate ligament) strain or tear: PCL tears can cause pain, swelling, and knee instability. These injuries are less common than ACL tears, and physical therapy (rather than surgery) is usually the best option.
(7)MCL (medial collateral ligament) strain or tear: This injury may cause pain and possible instability to the inner side of the knee.
(8)Patellar subluxation: The kneecap slides abnormally or dislocates along the thigh bone during activity. Knee pain around the kneecap results.
(9)Patellar tendonitis: Inflammation of the tendon connecting the kneecap (patella) to the shin bone. This occurs mostly in athletes from repeated jumping.
(10)Knee bursitis: Pain, swelling, and warmth in any of the bursae of the knee. Bursitis often occurs from overuse or injury.
(11)Baker’s cyst: Collection of fluid in the back of the knee. Baker’s cysts usually develop from a persistent effusion as in conditions such as arthritis.
(12)Rheumatoid arthritis: An autoimmune condition that can cause arthritis in any joint, including the knees. If untreated, rheumatoid arthritis can cause permanent joint damage.
(13)Gout: A form of arthritis caused by buildup of uric acid crystals in a joint. The knees may be affected, causing episodes of severe pain and swelling.
(14)Pseudogout: A form of arthritis similar to gout, caused by calcium pyrophosphate crystals depositing in the knee or other joints.
(15)Septic arthritis: An infection caused by bacteria, a virus, or fungus inside the knee can cause inflammation, pain, swelling, and difficulty moving the knee. Although uncommon, septic arthritis is a serious condition that usually gets worse quickly without treatment.
* Prevention of knee injuries:-
The following tips may help prevent common knee injuries:
Warm up by walking and stretching gently before and after playing sports.
Keep the leg muscles strong by using stairs, riding a stationary bicycle, or working out with weights.
Avoid sudden changes in the intensity of exercise.
Replace worn out shoes. Choose ones that fit properly and provide good traction.
Maintain a healthy weight to avoid added pressure on the knees.
Always wear a seatbelt.
Use knee guards in sports where knees could get injured.
Maintaining strong, flexible leg muscles and seeking prompt medical attention for all knee injuries is essential to assure accurate diagnosis and appropriate treatment of the injury. Additionally, keeping the supporting leg muscles strong and practicing injury prevention will help keep the knee healthy across the lifespan.
(1)Mini or partial squats with a chair or at a counter (quadriceps):
Holding on to a chair or stable surface, with knees about shoulder width apart and pointing forward, slightly bend hips and knees as if sitting down onto a chair, and then slowly stand back up. Repeat 10 to 12 times.
(2)Standing hamstring curls (hamstrings):
Holding on to the back of a chair or stationary surface, without moving hip, bend knee as far as possible, bringing your heel up towards your buttocks. Do 10 to 12 reps on each leg.
(3)Marching in place (hip flexors and a good balance exercise):
On your own or while holding on to the back of a chair or stationary object, take alternating steps in place, bringing knee up to a comfortable height. Strive for 60 seconds of marching.
(4)Heel raises (calf muscle):
Holding on to back of a chair or stable surface, rise up on toes, lifting heels off ground and then slowly lower back down. Do 10 to 12 reps.
This simple exercise may be done on the floor with or without a pillow under your knee. Sit with your legs out in front of you and your knees completely straight (lean against a wall or back on your hands). Focus on contracting your quadriceps muscle and holding it as tight as possible for several seconds; relax and repeat 10 times. Repeat several times a day if your knees actively ache.
(6)Straight leg raises:
In the same starting position as the quad sets, sit with your right leg (do one at a time) straight in front of you with your toes pulled towards the knee. (If this is too difficult you may also do these lying on your back to start.) Keep your left leg bent with your foot on the floor. Contract your quads on your right leg, lift your foot about 12 inches off the ground and hold it up for 5 seconds; slowly lower it back down and repeat 10 times. Switch legs.
(7)Wall slides with ball squeeze:
Stand with your back against the wall and your feet shoulder width apart. Hold a small (soccer ball size) inflated ball between your knees. Slowly slide down the wall by bending your knees and lowering yourself (knees should form a right angle with quads parallel to the floor and shins perpendicular to the floor). Hold 5 to 10 seconds and slowly return to starting position. Repeat 10 or more times.
Lie on your side with your hip and knee bent to approximately a 90-degree angle, with feet together. While keeping your ankles together, raise your top knee up about 12 inches from the other in a clamshell type motion. Repeat 10 to 25 times and switch sides.
Lie on your back with both knees bent at about a 90-degree angle with your feet on the floor. Tighten your buttocks as you lift your bottom off the floor as high as you can without arching your back; shoulders, hips and knees should align. Hold this position as you extend one leg up while keeping knees aligned; hold 3 to 5 seconds and lower. Repeat on the opposite side. Perform 10 to 25 reps per side.
Include one or more of these exercises along with or instead of your usual leg routine two to three times a week for stronger legs and healthier, pain-free knees.
* famous surgery for knee joint :-
In a knee arthroscopy, a surgeon will look inside the knee joint, repair torn ligaments and remove damaged parts. Two or three very small incisions are made on the front of the knee. A fiber optic camera is inserted through one incision. A surgical instrument is inserted through the other incision.
The surgeon can then examine and repair the knee. Knee scopes are most often performed for meniscal tears (torn cartilage). A degenerative tear can be debrided (cleaned up) during the arthroscopy. A traumatic sports-related tear can be debrided or repaired via arthroplasty.
Because of the minimal soft tissue damage resulting from from an arthroscopy, recovery is relatively quick. It is a relatively easy surgery and most patients go home immediately after the scope. Patients will typically be able to resume normal activity and return to work within two or three weeks. The knee will be swollen for less than a week.
Knee osteotomy is a surgical procedure in which the surgeon removes or adds a wedge of bone to the top of your tibia (shinbone) or the bottom of your femur (thighbone). This provides a less worn area of articular cartilage to the weight bearing part of the joint.
Osteotomy is typically recommended for those with arthritis damage in just one area of the knee. Arthritis on just one side of the knee can cause the knee to bow inward (valgus deformity) or outward (varus deformity). This can be corrected by the removal or addition of a wedge of bone. (Traumatic injury or even birth defects can also cause misalignment for which osteotomy is an appropriate surgical intervention.)
Many patients who undergo knee osteotomy will eventually need a total knee replacement. The osteotomy will buy them a varying amount of time before the need for total joint replacement becomes necessary.
* importance of knee joint :-
We need our knees to run, walk, squat. With research suggesting our bones are weaker than those of Westerners, here’s a quiz to test how well you are caring for your ‘hinges’
Walking, running, climbing, dancing — the knees bear the brunt of every move we make throughout our lives. The main hinge between the ground and the body, knees bring together the femur (thigh bone), tibia (shin bone), fibula (next to tibia) and kneecap, and work as wheels that keep you going.
We use knee joint daily But We Do Not Take Care Of This Joint That’s Why Osteoarthritis is more commmon in india , Here we give basic detail of knee joint and exercise of knee joint, common knee surgeries and Overview and Related Muscle Detail
Oral submucous fibrosis is characterized as the unending, tricky ailment influencing the oral pit and here and there pharynx, albeit at times went before or potentially connected with vesicle arrangement and is constantly connected with juxtaepithelial fiery response took after by fibro versatile changes in the lamina propria with epithelial decay prompting firmness of oral pit prompting trismus and powerlessness to eat.
Oral submucous fibrosis is an interminable crippling and an all around perceived possibly threatening condition related with areca nut biting, an element of betel quid and is pervasive in South Asian populace. Pathogenesis isn’t yet settled however is accepted to be because of multifactorial causes; consequently the treatment of oral submucous fibrosis proposes a noteworthy test for oral doctors.
ETIOLOGY AND PATHOPHYSIOLOGY:
The pathogenesis of the illness isn’t entrenched, however the reason for OSF is accepted to be multifactorial.
Various variables may trigger the infection procedure by causing a juxtaepithelial fiery response in the oral mucosa. Components incorporate are areca nut biting, ingestion of chilies, hereditary and immunologic procedures, wholesome inadequacies and different variables.
Areca Nut (Betel Nut) Chewing:
The areca nut segment of betel quid assumes a noteworthy part in the pathogenesis of OSF 15. Betel nut is much of the time utilized as a psychotropic and antihelminthic operator and utilized as an after feast digestant which is taken to ease stomach inconvenience.
Smoking and liquor utilization alone, propensities basic to areca nut chewers, have been found to have no impact in the advancement of OSF. The most grounded confirm in regards to the etiology of OSF is with the propensity for areca nut biting.
Areca nut shape might be accessible in thefollowing structure:
Supari + Tobacco
Supari + Pan+ Tobacco
Supari + Pan + Pan masala
Skillet Parag/Pan masala
Supari + Pan + Lime
Supari-Roasted/Raw Areca nut
Part of areca nut in pathogenesis of OSF:
Arecoline, a dynamic alkaloid found in betel nuts. Animates fibroblasts to build creation of collagen by 150%.
To lift the mRNA and protein articulation of cystatin C, a nonglycosylated fundamental protein reliably up-directed the assortment of fibrotic illnesses, in a measurement subordinate way in people with OSF.
Areca nuts have likewise been appeared to have a high copper substance, and biting areca nuts for 5-30 minutes altogether increments solvent copper levels in oral liquids. This expanded level of solvent copper underpins the speculation as a starting element in people with OSF.
Press insufficiency frailty, vitamin B complex inadequacy and lack of healthy sustenance are advancing variables that unsettle the repair of the excited oral mucosa, prompting damaged recuperating and resultant scarring.
The resultant atrophic oral mucosa is more defenseless to the impacts of chilies and betel nuts. Mucosal changes like those in vitamin B and iron insufficiency are found in oral sub mucosal fibrosis.
The part of chillies ingestion in the pathogenesis of OSF is disputable.
A touchiness response to chilies is accepted to add to OSF.
Hereditary and Immunologic Processes:
A hereditary segment is thought to be engaged with OSF Patients with expanded recurrence of HLA-A10, HLA-B7, and HLA-DR3.
Fibrosis happens in cracked vesicles and ulcers when they mend, which is the sign of this stage.
Early sores show whitening of the oral mucosa.
More established sores incorporate vertical and round unmistakable sinewy groups in the buccal mucosa and around the mouth opening or lips, bringing about a mottled, marble like appearance of the mucosa in view of the vertical, thick, stringy groups running in a whitening mucosa. Particular discoveries incorporate the accompanying:
Decrease of the mouth opening (trismus).
Solid and little tongue.
Whitened and rough floor of the mouth.
Fibrotic and depigmented gingiva.
Rubbery delicate sense of taste with diminished portability.
Whitened and atrophic tonsils.
Contracted budlike uvula.
Sinking of the cheeks, not comparable with age or nutritious status.
Screech of OSF are as per the following:
Leukoplakia is precancerous and is found in over 25% of people with OSF.
Discourse and hearing deficiencies may happen in view of inclusion of the tongue and the eustachian tubes.
Torment in the ear or deafness.
Nasal pitch of voice.
Confinement of the development of the delicate sense of taste.
Diminishing and hardening of the lips.
Pigmentation of the oral mucosa.
Dryness of the mouth and consuming sensation.
Diminished mouth opening and tongue bulge.
Outrageous climatic conditions.
Delayed insufficiency to iron and vitamins in the eating regimen.
Oral appearances of scleroderma
Oral appearances of Plummer Vinson disorder (Iron lack Anemia).
Toludine blue test
Biopsy :- Incisional biopsy
a) Direct b) Indirect
Administration AND PREVENTION:
The treatment of patients with OSF relies upon the level of clinical contribution. On the off chance that the malady is identified at a beginning period, suspension of the propensity is adequate. Most patients with OSMF give moderateto-serious arranging. Direct to-serious arranging of OSF is irreversible. Medicinal treatment is symptomatic and gone for enhancing mouth developments.
Not to devour areca nut and other incessant aggravation, for example, hot and zesty sustenance including chiles.
Guidance green verdant vegetables.
Organization of Vit. A, B complex and high protein consume less calories.
Organization of Antoxid OD for 6 – two months.
Organization of Lycored OD for 6 two months.
Keeping up legitimate oral cleanliness.
Supplementing the eating regimen with nourishments rich in vitamins A, B complex, and C and iron.
Swearing off hot liquids like tea, espresso.
Swearing off liquor.
Utilizing a dental specialist to round off sharp teeth and concentrate third molars.
Surgical treatment is shown in patients with extreme conditions. These incorporate:-
Basic extraction of the stringy groups: Excision can bring about contracture of the tissue and intensification of the condition.
Split-thickness skin joining following respective temporalis myotomy or coronoidectomy: Trismus related with OSF might be because of changes in the temporalis ligament auxiliary to OSF; subsequently, skin unions may assuage.
Nasolabial folds and lingual pedicle folds: Surgery performed just in patients with OSF in whom the tongue isn’t included.
Muscle extending practices for the mouth might be useful to anticipate advance restrictions of mouth opening strong mouth opening has been attempted with mouth choke and non-cyclic surgical screw.
Diathermy: Microwave diathermy appear to be better than short wave, in light of the fact that specific warming of juxtaepitheliel connective tissue is conceivable it acts by physio fibrinolysis of groups.
Ultrasound: Ultra sound selectivity bring the temperature up in some all around aggregated territories. Ultrasound turns out to be an effective profound warming methodology.
Trigeminal neuralgia is a ceaseless torment condition that influences the trigeminal nerve, which conveys sensation from your face to your mind. In the event that you have trigeminal neuralgia, even mellow incitement of your face —, for example, from brushing your teeth or putting on cosmetics — may trigger a jar of unbearable agony.
You may at first experience short, mellow assaults. Yet, trigeminal neuralgia can advance and cause longer, more-visit episodes of burning agony. Trigeminal neuralgia influences ladies more frequently than men, and it will probably happen in individuals who are more established than 50.
On account of the assortment of treatment alternatives accessible, having trigeminal neuralgia doesn’t really mean you’re bound to an existence of agony. Specialists for the most part can adequately oversee trigeminal neuralgia with drugs, infusions or surgey
Representation indicating branches of the trigeminal nerve
Trigeminal neuralgia manifestations may incorporate at least one of these examples:
(1)Episodes of serious, shooting or Tabbing torment that may feel like an electric stun
(2)Spontaneous assaults of torment or assaults activated by things, for example, touching the face, biting, talking or brushing teeth
Episodes of torment enduring from a couple of moments to a few minutes
(3)Episodes of a few assaults enduring days, weeks, months or longer — a few people have periods when they encounter no torment
Consistent hurting, consuming feeling that may happen before it advances into the fit like torment of trigeminal neuralgia
(4)Pain in territories provided by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less frequently the eye and brow
Torment influencing one side of the face at any given moment, however may once in a while influence the two sides of the face
(5)Pain centered in one spot or spread in a more extensive example
In trigeminal neuralgia, likewise called tic douloureux, the trigeminal nerve’s capacity is upset. For the most part, the issue is contact between an ordinary vein — for this situation, a supply route or a vein — and the trigeminal nerve at the base of your mind. This contact puts weight on the nerve and makes it glitch.
Trigeminal neuralgia can happen because of maturing, or it can be identified with different sclerosis or a comparable issue that harms the myelin sheath securing certain nerves. Trigeminal neuralgia can likewise be caused by a tumor packing the trigeminal nerve.
A few people may encounter trigeminal neuralgia because of a mind sore or different anomalies. In different cases, surgical wounds, stroke or facial injury might be in charge of trigeminal neuralgia.
The principal line of treatment is prescription.
The medication of decision is carbamazepine (Tegretol™), which disposes of or gets worthy torment help 69 percent of patients.
Baclofen (Lioresal™) is the second medication of decision and might be more viable if utilized with low-dosage carbamazepine.
Different medicines that might be compelling incorporate pimozide, phenytoin (Dilantin™), capsaicin, clonazepam (Klonopin™) and amitriptyline (Elavil™).
Erb’s paralysis likewise called Erb’s Duchenne paralysis is a loss of motion of the arm(Upper Limb). This damage is caused for the most part Due to damage to the upper gathering of the arm’s principle nerves, Mainly the damage of the upper trunk C5– C6 nerves root. These Nerve Root shape some portion of the brachial plexus, Forming the ventral rami of spinal nerves C5– C8 and One thoracic nerve T1. These wounds Occurs most normally, however not solely, from bear dystocia amid a troublesome birth. Contingent upon the idea of the harm, the loss of motion can either resolve alone finished a time of months, essential Physiotherapy Treatment or Severe Injury May require surgical Intervention.
The loss of motion can be halfway or finish; the harm to each nerve can go from wounding to Complete Tear. The most ordinarily included Nerve root is C5 (otherwise known as Erb’s point: the union of C5 – C6 roots) as this is mechanically the uttermost point from the power of footing, in this manner, the principal/most influenced Nerve Root. Erb– Duchenne paralysis introduces as a lower engine neuron Injury with sensibility Loss and vegetative marvels.
The most ordinarily included nerves are the suprascapular nerve, musculocutaneous nerve, and the axillary nerve.
The indications of Erb’s Palsy incorporate loss of sensation in the arm and loss of motion or wekness of the deltoid, biceps, and brachialis muscles. “The position of the appendage, under such conditions, is by : the arm hangs by the adducted and is turn inside ; the lower arm is in pronation and exntension position. Sholder Abduction, elbow Flexion And Supination is lost Mainly. The subsequent Condition Look’s Like Postion Also Called “server’s tip Hand “.
On the off chance that this damage happens at early age May Leads to influence improvement (e.g. as a neonate or newborn child), it frequently leaves the patient with Delayed development in the influenced arm including the shoulder through to the fingertips littler than Compare to Normal arm. This likewise leaves the patient with Delayed solid, Nervous and circulatory improvement. The Delayed of muscule improvement May prompts the arm being significantly weaker than a Normal one, and less enunciation, with numerous patients unfit to lift the arm above shoulder tallness, and additionally leaving numerous with a Muscle contracture.
Dystocia ( Difficult ChildBirth-Labor)
Break At Clavicle to Neonates.
Any age following injury to the head and shoulder.
Look at The Patient’s Arm Position Like Adducted From Sholder, Extended From Eblob Joint And Pronated Position With Weakness or Paralysis Of Deltoid, Brachialis,Biceps Most Commonly.
Facilitate Investigation Is By EMG/NCV Reports Or By MRI Accordingly.
A few infants recoup on Gradually With Physiotherapy Treatment be that as it may, Patient some may require authority mediation or Surgical Procedure According To Injury.
Neonatal/pediatric neurosurgery is frequently required for separation Injury. Injuries may recuperate Naturally Over Time and capacity Gradually come back With Help Of Exercise Therapy.
Physiotherapy Treatment is required Mainly to reestablish muscle Function. In spite of the fact that scope of movement is recouped in numerous youngsters under one year in age, people who have not yet recuperated after this point will once in a while increase full capacity in their arm and may create Deformity.
The three most regular medications for Unrecovered Erb’s Palsy are:
1. Nerve exchanges (as a rule from the contrary arm or appendage)
2. Sub Scapularis discharges and Latissimus Dorsi Tendon Transfers.
Physiotherapy Treatment :
Evaluation Of Patient Mainly Muscle Chart Of Whole Upper Limb And Range Of Motion And RD Test.
As needs be Design Treatment Plan And Monitoring Progress Report With SD Curve At Every 10 Days Helps Recovery Process Going On.
As indicated by Muscle Chart Strenthening Exercise, Electrical Stimulation, Passive Movement Or Active Assited Exercise Are Design.
Home Exercise Are Teached To Patient’s Relative And Deformity Correction Position And Splinting Training Are Also Required.
Predominantly Airplane Splint Commonly Used But It May Be Vary According To Condition.
Parkinsonism is a clinical disorder portrayed by tremor, bradykinesia, inflexibility, and postural shakiness.
Parkinsonism is any condition that causes a mix of the development anomalies found in Parkinson’s ailment —, for example, tremor, moderate development, debilitated discourse or muscle firmness — particularly coming about because of the loss of dopamine-containing nerve cells (neurons).
Parkinsonism illness (PD) is a degenerative, dynamic issue that influences nerve cells in profound parts of the cerebrum called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra create the neurotransmitter dopamine and are in charge of handing-off messages that arrangement and control body development. For reasons not yet comprehended, the dopamine-delivering nerve cells of the substantia nigra start to cease to exist in a few people. At the point when 80 percent of dopamine is lost, PD side effects, for example, tremor, gradualness of development, solidness, and adjust issues happen.
Body development is controlled by an unpredictable chain of choices including between associated gatherings of nerve cells called ganglia. Data goes to a focal region of the cerebrum called the striatum, which works with the substantia nigra to send motivations forward and backward from the spinal rope to the mind. The basal ganglia and cerebellum are in charge of guaranteeing that development is done in a smooth, liquid way.
Phases OF PARKINSONISM :-
STAGE ONE – A Person as a rule has mellow manifestations, for example, tremors or shaking in a limb.Change, for example, poor stance, loss of balance,and strange outward appearances.
STAGE TWO – Symptoms influence the two appendages and the two sides of the body. The individual has for the most part has issue strolling or adjusting, and the failure to finish physical errands turns out to be more clear.
STAGE THREE – Symptoms can be extreme and incorporate the powerlessness to walk straight or stand. there is a detectable abating of physical developments.
STAGE FOUR – The capacity to walk is regularly restricted
STAGE FIVE – tHE PERSON is regularly unfit to deal with herself and will most likely be unable to stand or walk .she may require consistent one on one nursing care.
Diffuse Lewy body ailment (a kind of dementia)
Numerous framework decay
Dynamic supranuclear paralysis
Different reasons for auxiliary parkinsonism include:
Cerebrum harm caused by anesthesia drugs, (for example, amid surgery)
Carbon monoxide harming
Certain medications used to treat mental scatters or queasiness
Mercury harming and other compound poisonings
Overdoses of opiates
MPTP (a contaminant in some road drugs)
Indications of Parkinson’s ailment contrast from individual to individual. They additionally change as the illness advances.
Indications ordinarily start showing up between the ages of 50 and 60. They grow gradually and regularly go unnoticed by family, companions, and even the individual who has them.
The most widely recognized one is tremor.
Tremor. A tremor, or shaking, as a rule starts in an appendage, regularly your hand or fingers. You may see a forward and backward rubbing of your thumb and index finger, known as a pill-moving tremor. One normal for Parkinson’s infection is a tremor of your hand when it is casual (very still).
Impeded development (bradykinesia). After some time, Parkinson’s sickness may lessen your capacity to move and moderate your development, making basic assignments troublesome and tedious. Your means may end up plainly shorter when you walk, or you may think that its hard to escape a seat. Additionally, you may stall as you endeavor to walk, making it hard to move.
Unbending muscles. Muscle firmness may happen in any piece of your body. The hardened muscles can restrain your scope of movement and cause you torment.
Debilitated stance and adjust. Your stance may wind up plainly stooped, or you may have adjust issues because of Parkinson’s malady.
Loss of programmed developments. In Parkinson’s malady, you may have a diminished capacity to perform oblivious developments, including flickering, grinning or swinging your arms when you walk.
Discourse changes. You may have discourse issues because of Parkinson’s illness. You may talk delicately, rapidly, slur or waver before talking. Your discourse might be all the more a monotone as opposed to with the standard articulations.
Composing changes. It might turn out to be difficult to compose, and you’re composing may seem little.
Registered tomography (CT) sweeps of individuals with PD typically seem ordinary.
X-ray has turned out to be more precise in conclusion of the ailment after some time, particularly through iron-delicate T2* and SWI groupings at an attractive field quality of no less than 3T, both of which can exhibit nonattendance of the trademark ‘swallow tail’ imaging design in the dorsolateral substantia nigra.
Catechol-O-methyltransferase (COMT) inhibitors.
Point OF PHYSIOTHERAPY-
Keep up and enhance levels of capacity and autonomy, which will enhance a man’s personal satisfaction
Utilize exercise and development techniques to enhance portability
Rectify and enhance anomalous development examples and stance, where conceivable
Boost muscle quality and joint adaptability
Rectify and enhance stance and adjust, and limit dangers of falls
Keep up a decent breathing example and compelling hack
Instruct the individual with Parkinson’s and their carer or relatives
Upgrade the impacts of medication treatment.
Visual prompting – a concentration point to venture over and start step; portions of tape on the floor to start or keep strolling through regions that reason moderating or solidifying
Sound-related prompting – tallying 1-2-3 to start strolling; venturing to the beat of a metronome or particular music at a predefined rhythm to proceed with the cadence of a walk
Consideration – Thinking about making a major stride; influencing a more extensive curve to turn
Proprioceptive prompting – shaking from side to side prepared to start a stage; making one stride in reverse as a sign prepared to then walk advances.
Hallux valgus is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected and is often accompanied by significant functional disability and foot pain.
Bunions are a widespread foot ailment that can be caused by a number of factors including genetics
Excess weight gain,
Activity level, and
Other less common causes of bunions include trauma to the
MTP joint (sprains, fractures, and nerve injuries),
Some studies report that bunions tend to occur ten times more frequently in women than in men, primarily as the result of wearing narrow, pointy, tight fitting, and/or high-heeled shoes over a significant period of time. Repetitive stresses to the foot can also cause bunions.
Your big toe points toward your second toe, or your second toe overlaps your big toe
A prominent bump on the inside of the MTP or big toe joint
Pain on the inside of your foot at the big toe joint when wearing any kind of shoe
Pain each time the big toe flexes when walking
Redness, swelling , or thickening of the skin on the inside of the big toe joint
Radiographic exmatination show the angle formed between longitudinal bisection of the 1st Metatarsal and proximal phalanx.
A big toe position with an angle of up to 10° is still considered normal.
A minor hallux valgus defect is 16-20°.
A moderate hallux valgus deformity has a deviation of 16-40°.
A severe hallux valgus deformity has a deviation of over 40°.
Magnetic resonance imaging (MRI) will detect cartilage damage, trapped soft tissue and bone damage.
Adjusted footwear with wider and deeper tip
Increase extension of MTP joint
Relieve weight-bearing stresses (orthosis)
Sesamoid Mobilization:The physical therapist performs grade III joint mobilizations on the medial and lateral sesamoid of the affected first MPJ. One thumb is placed on the proximal aspect of the sesamoid and is used to apply a force from proximal to distal that causes the sesamoid to reach the end range of motion (distal glides). These are performed with large-amplitude rhythmic oscillations. No greater than 20° of movement of the MPJ should be allowed during the technique.
Strengthening of peroneus longus
Electrotherapy Modalities – Ultrasound, ice, electrical stimulation, MTJ mobilizations and exercises. This is more effective than physical therapy alone. The combination will result in a increase in ROM of the MTP joint, strength and function, and also a decrease in pain .
Pain is the main reason that patients seek treatment for a bunion. Inflammation is best eased using ice therapy, techniques (e.g. soft tissue massage, acupuncture, unloading taping techniques) or exercises that unload the inflamed structures. Anti-inflammatory medications may help. Orthotics can also be used to offload the bunion.
For Restoring the Normal Joint Of Motion –
Joint mobilisation (abduction and flexion) and alignment techniques (between the first and the second metatarsal)
Muscle and joint stretches
Bunion splint or orthotics
bunion stretch and soft tissue release.
For Strenghting Of Muscles –
Towel curls The patient spreads out a small towel on the floor, curling his/her toes around it and pulling the towel towards them.
The ends of the band are either held by an assistant or secured against an immovable object (e.g. a table leg). The patient then dorsiflexes the ankle, pulling “towards their nose,” working against the resistance of the band.
Deltoid Muscle :In human anatomy, the deltoid muscle is the muscle forming the rounded contour of the shoulder.
Anatomically, it appears to be made up of three distinct sets of fibers though electromyography suggests that it consists of at least seven groups that can be independently coordinated by the central nervous system.
It was previously called the deltoideus (plural deltoidei) and the name is still used by some anatomists. It is called so because it is in the shape of the Greek letter Delta (triangle). It is also known as the common shoulder muscle, particularly in lower animals (e.g., in domestic cats). Deltoid is also further shortened in slang as “delt”.
A study of 30 shoulders revealed an average mass of 191.9 grams (6.77 oz) (range 84 grams (3.0 oz)–366 grams (12.9 oz)) in humans.
Deltoid Muscle (proximal attachments)
a. Anterior head: anterior surface of the lateral clavicle.
b. Middle head: acromion process and spine of the scapula.
a. Deltoid tuberosity of the humerus.
a. Flexes the arm at the shoulder.
b. Medially rotates the arm at the shoulder.
a. Abducts the arm at the shoulder.
a. Nerve: Axillary nerve
b. Nerve roots: C5 and C6
Applied Anatomy :
Rupture of the deltoid muscle
Diagnosis: RUPTURE OF THE DELTOID MUSCLE
Anatomy: The large Deltoid muscle (M Deltoideus) is a thick triangular muscle, emanating around the shoulder, covering the shoulder joint and forming the rounding of the shoulder. The muscle is fastened on the humerus. The various parts of the deltoid muscle take part in nearly all movements of the shoulder joint.
SHOULDER AND UPPER ARM MUSCLES FROM THE FRONT
Cause: When a muscle is subjected to a load beyond the strength of the muscle (butterfly swimming, weight training, weight lifting) a rupture occurs. Most ruptures in athletes are partial ruptures. The rupture can be located both in the front and the back as well as at the attachment to the upper arm (humerus).
Symptoms: In light cases a localised tenderness can be felt following the load (“muscle strain”, “imminent pulled muscle”). In more severe cases sudden shooting pains in the muscle can be felt (“partial muscle rupture”) and in the worst cases a sudden snap is felt, rendering the muscle unusable (“total muscle rupture”) this is very rare, and is almost only seen in conjunction with other damage in the shoulder. With muscle injuries the following three symptoms are characteristic: pain upon pressure, stretching and activating against resistance.
Acute treatment: Acute treatment starts as quickly as possible after the injury has been incurred. The objective of the acute treatment is primarily to prevent additional injury and reduce bleeding as much as possible. Effective acute treatment will reduce bleeding, formation of scar tissue, the number of complications, which can arise, and the rehabilitation period. Treatment follows the so-called “RICE” principles: R;- Continued sports activity is immediatel stopped(Rest) B:-As soon as is possible, Ice should be placed on the injured area. The cold ice makes the blood vessels contract, thereby stopping the bleeding. Cold spray has no effect in such circumstances. The ice must not come into direct contact with the skin, which should be covered with a thin layer of, for example, elastic bandage. Ice treatment should be given for twenty minutes in each of the first three hours after injury.
I:- As far as is possible the treatment should furthermore comprise:
C-: A Compression bandage should be applied, however, must not be so tight as to prevent the blood flow. The compression bandage should be removed at night, but applied again each morning until the swelling goes down. The effect of the compression can be enhanced if a piece of felt, for example, of approx. one cm. thickness is placed under the bandage and directly above the haemorrhaging.
E:- The injured area is kept as high as possible, and preferably above the heart (Elevation). The haemorrhaging will stop when it comes above the level of the heart. Elevation of the affected area should be performed as much as possible as long as swelling is in evidence.
Examination: Light cases with only minimal tenderness and no discomfort when using the arm do not necessarily require medical examination. The extent of the tenderness is, however, not always a mark of the degree of the injury. In case of more pronounced tenderness medical examination is advised with the aim of securing a correct diagnosis and treatment. Pain will be present when pressure is applied to the damaged muscle, which will be aggravated when the muscle is activated against resistance and when the muscle is stretched. Ultrasound is well suited to ensure the diagnosis.
Treatment: The treatment primarily involves relief, discontinuance of the injury inducing activity, stretching and increasing fitness training.
Rehabilitation: INSTRUCTION GENERAL STEP1 STEP2 STEP3 STEP4 Complications: If satisfactory progress is not made, a physician should be consulted to ensure that the diagnosis is correct and that no complications have arisen. Amongst others the following should be considered:
Rupture of the upper shoulder blade muscle Inflammation of the upper shoulder blade muscle Rupture of the lower shoulder blade muscle Tendon sheath inflammation of the biceps Luxation in the joint between the shoulder blade and the collarbone Partial luxation in the shoulder joint Frozen shoulder Muscle infiltrations Sprained shoulder (distorsio art. humeroscapularis) Meniscus lesion in the shoulder (laesio labrum glenoidale) Impingement Nerve entrapment on the back of the shoulder blade