Erb’s paralysis :

Erb’s paralysis And Physiotherapy Treatment :

Symptom-Erb'sPalsy
Erb’s Palsy And Position Of Hand

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.

ErbsPalsyInjury2
Cause Of Erb’s Palsy

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.

Erb's-Palsy
Brachial Plexus And Erb’s Palsy

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 “.

ExerciseInErb'sPalsy
Examination Of Erb’s Palsy

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.

Cause :

Intrinsic

Dystocia ( Difficult ChildBirth-Labor)

Break At Clavicle to Neonates.

Any age following injury to the head and shoulder.

Finding :

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.

Treatment :

ExerciseErb'sPalsy
Exercise In Erb’s Palsy

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.

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TRAPEZIUS MUSCLE:-

In human anatomy, the trapezius is a large superficial muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae and laterally to the spine of the scapula (shoulder blade). Its functions are to move the scapulae and support the arm.

The trapezius has three functional regions: the superior region (descending part), which supports the weight of the arm; the intermediate region (transverse part), which retracts the scapulae; and the inferior region (ascending part), which medially rotates and depresses the scapulae.Structure

STRUCTURE:-

The trapezius muscle resembles a trapezium (trapezoid in American English), or diamond-shaped quadrilateral. The word “spinotrapezius” refers to the human trapezius, although it is not commonly used in modern texts. In other mammals, it refers to a portion of the analogous muscle.

Position of trapezius and its parts.

  Superior fibers of the trapezius

  Middle fibers of the trapezius

  Inferior fibers of the trapezius

The superior or upper (or descending) fibers of the trapezius are formed from the external occipital protuberance, the medial third of the superior nuchal line of the occipital bone (both in the back of the head), the ligamentum nuchae, and the spinous processes of C1-C7. From this origin they proceed downward and laterally to be inserted into the posterior border of the lateral third of the clavicle.

The middle fibers, or transverse of the trapezius arise from the spinous process of the seventh cervical (both in the back of the neck), and the spinous processes of the first, second, and third thoracic vertebrae. They are inserted into the medial margin of the acromion, and into the superior lip of the posterior border of the spine of the scapula.

The inferior or lower (or ascending) fibers of the trapezius arise from the spinous processes of the remaining thoracic vertebrae (T4-T12). From this origin they proceed upward and laterally to converge near the scapula and end in an aponeurosis, which glides over the smooth triangular surface on the medial end of the spine, to be inserted into a tubercle at the apex of this smooth triangular surface.

At its occipital origin, the trapezius is connected to the bone by a thin fibrous lamina, firmly adherent to the skin. The superficial and deep epimysia are continuous with an investing deep fascia that encircles the neck and also contains both sternocleidomastoid muscles.

At the middle, the muscle is connected to the spinous processes by a broad semi-elliptical aponeurosis, which reaches from the sixth cervical to the third thoracic vertebræ and forms, with that of the opposite muscle, a tendinous ellipse. The rest of the muscle arises by numerous short tendinous fibers.

Origin:- external occipital protuberance, nuchal ligament, medial superior nuchal line, spinous processes of vertebrae C7-T12
Insertion:-posterior border of the lateral third of the clavicle, acromion process, and spine of scapula
Artery:-
superficial branch of transverse cervical artery or superficial cervical artery
Nerve:-
accessory nerve (motor)
cervical spinal nerves C3 and C4 (motor and sensation)
Actions:-     rotation, retraction, elevation, and depression of scapula

sternoclaidomastoid muscle

The sternocleidomastoid  muscle:-

In human anatomy, the sternocleidomastoid muscle also known as sternomastoid and commonly abbreviated as SCM, is a paired muscle in the superficial layers of the anterior portion of the neck; it is one of the largest and most superficial cervical muscles.

Structure:-The sternocleidomastoid passes obliquely across the side of the neck.

It is thick and narrow at its central part, but broader and thinner at either end.

    The medial or sternal head is a rounded fasciculus, tendinous in front, fleshy behind, which arises from the upper part of the anterior surface of the manubrium sterni, and is directed superiorly, laterally, and posteriorly.

    The lateral or clavicular head, composed of fleshy and aponeurotic fibers, arises from the superior border and anterior surface of the medial third of the clavicle; it is directed almost vertically upward.

The two heads are separated from one another at their origins by a triangular interval (supraclavicular fossa) but gradually blend, below the middle of the neck, into a thick, rounded muscle which is inserted, by a strong tendon, into the lateral surface of the mastoid process, from its apex to its superior border, and by a thin aponeurosis into the lateral half of the superior nuchal line of the occipital bone.usculus sternocleidomastoideus

Origin:-

    Manubrium sterni and medial portion of the clavicle
 

   Insertion:-

    Mastoid process of the temporal bone, superior nuchal line

Artery:-

    Occipital artery and the superior thyroid artery

Nerve:-    Motor: accessory nerve

                       sensory: cervical plexus

Actions:-     Unilaterally; cervical rotation to opposite side, cervical lateral flexion to same side
Bilaterally; cervical flexion, raises the sternum and assists in forced inspiration.

Subclavius muscle:-The subclavius is a small triangular muscle, placed between the clavicle and the first rib. Along with the pectoralis major and pectoralis minor muscles, the subclavius muscle makes up the anterior wall of the axilla.

Structure:-It arises by a short, thick tendon from the first rib and its cartilage at their junction, in front of the costoclavicular ligament.

The fleshy fibers proceed obliquely superolaterally, to be inserted into the groove on the under surface of the clavicle between the trapezoid ligament and conoid ligaments, which collectively form the coracoclavicular ligament.
 

Innervation:-The nerve to subclavius (or subclavian nerve), which arises from the point of junction of the fifth and sixth cervical nerves, where is called the upper trunk of brachial plexus, innervates the muscle .
Variation:-

Insertion into coracoid process instead of clavicle or into both clavicle and coracoid process. Sternoscapular fasciculus to the upper border of scapula. Sternoclavicularis from manubrium to clavicle between pectoralis major and coracoclavicular fascia.
 

Function:-

The subclavius depresses the shoulder, carrying it downward and forward. It draws the clavicle inferiorly as well as anteriorly.

The subclavius protects the underlying brachial plexus and subclavian vessels from a broken clavicle – the most frequently broken long bone.

Origin:-
first rib and cartilage

Insertion:-
subclavian groove of clavicle (inferior surface of middle third of clavicle)

Artery:-
thoracoacromial trunk, clavicular branch
 

Nerve:-
nerve to subclavius

Actions:-     depression of clavicle

ACL TEAR & PHYSIOTHERAPY MANAGEMENT :

ACL TEAR & PHYSIOTHERAPY MANAGEMENT :Anterior Cruciate Ligament (ACL) InjuriesOne of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes suffer from this injury the most
If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anatomy :


Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.
Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.

Description:

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.Injured ligaments are considered “sprains” and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

 Cause :





Acl injury

The anterior cruciate ligament can be injured in several ways:


  •     Changing direction rapidly
  •     Stopping suddenly
  •     Slowing down while running
  •     Landing from a jump incorrectly
  •     Direct contact or collision, such as a football tackle



Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.



symptoms:

Symptoms of a severe and sudden (acute) anterior cruciate ligament (ACL) injury include:

  •     Feeling or hearing a “pop” in the knee at the time of injury.
  •     Sudden instability in the knee. …
  •     Pain on the outside and back of the knee.
  •     Knee swelling within the first few hours of the injury.
  •     Limited knee movement because of swelling and/or pain.
  • Knee Giving Out/Instability


After an acute injury, you will almost always have to stop the activity you are doing, but you may be able to walk.
special tests:Abnormal Examination:
Your doctor can assess the ligaments of your knee with specific tests. The most commonly used tests to determine the presence of an ACL tear include:

  •     Lachman Test:    The Lachman test is performed to evaluate abnormal forward movement of the tibia. By pulling the tibia forward, your surgeon can feel for an ACL tear.
  •     Pivot Shift Maneuver:    The pivot shift is difficult to perform in the office, it is usually more helpful in the operating room with a patient under anesthesia. The pivot shift maneuver detects abnormal motion of the knee joint when there is an ACL tear present.

Test Results:
Your physician will also evaluate x-rays of the knee to assess for any possible fractures, and a MRI may be ordered to evaluate for ligament or cartilage damage. However, MRI studies may not be needed to diagnose an ACL tear. In fact, the physical examination and history are just as good as a MRI in diagnosing an ACL tear!

Nonsurgical Treatment:Nonsurgical management of isolated ACL tears is likely to be successful or may be indicated in patients:

  •     With partial tears and no instability symptoms
  •     With complete tears and no symptoms of knee instability during low-demand sports who are willing to give up high-demand sports
  •     Who do light manual work or live sedentary lifestyles


    •     Whose growth plates are still open (children)


    •  


    • EXERCISES AFTER INJURY TO THE ANTERIOR CRUCIATE LIGAMENT (ACL) OF THE KNEE:


    •  
      HEEL SLIDES:
      to regain the bend (flexion) of the knee.


    •  QUADRICEPS SETTING
      to maintain muscle tone in the thigh (quadriceps)muscles and straighten the knee.


    • HEEL PROP
      to straighten extend the knee


    • STRAIGHT LEG LIFT
      The quality of the muscle contraction in this exercise
      is what counts the most, not just the ability to
      lift the leg!  


    • stationary bicycle


    •  


    • standing hamstring curl :


    • hip abduction:




    • standing toe raise: 


    •  


    • wall slides:


 

Samarpan Physiotherapy Clinic :

VASTRAL  PHYSIOTHERAPY  CLINIC.: 

vastral physiotherapy clinic

Samarpan Physiotherapy Clinic : has started in march-2008 with a simple vision: To provide first class physiotherapy care & treatment at right place, right cost & to be the organization of choice and a motto: to treat others as you would expect to be treated yourself. Today, the clinic has quickly developed in to one of ahmedabad’s premier physical therapy and rehabilitation center.

The SAMARPAN  Physiotherapy Clinic is run by highly specialized physiotherapist in  AHMEDABAD,GUJARAT. who has extensive experience in the assessment and treatment of musculo-skeletal, neurological, gynecological and life style management cases. 

WHAT DO WE TREAT ?

    Orthopaedic conditions: like , joint problems, Backache, arthritis, Post knee/hip replacement ,ligament sprains,etc Special program for arthritis
    Neurological conditions: like stroke/ paralysis,parkinsonism,cerebral palsy(cp), spinal trauma, balance disorder,etc
    Gynecological Condition:   Pregnancy exercises, breathing techniques for delivery and post delivery exercises, Weight care exercise,Menopausal problems: like incontinence, osteoporosis,etc.
     Geriatrics Condition:  Old age problems: like arthritis, falls, walking problems,etc

    Work related physical disorders: like backache, neck pain, etc
    Vascular conditions: like varicose veins, atherosclerosis, swollen limbs after surgery, etc.

 

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