PT 670 Integument
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| Define Integument | pertaining to or composed of skin; protective covering
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| What is Integumentary Integrity? | 1. health of the skin 2. ability to serve as a barrier to the environment against parasites and bacteria
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| The purpose of integumentary test and measures is... | Assess the effects of a wide variety of problems that result in skin and subcutaneous changes
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| Integument changes occur due to ... | 1. pressure 2. venous and arterial problems 3. ulcers 4. burns and other traumas 5. number of other diseases
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| General determinations during the integumentary exam (3) | 1. Determine the baseline 2. Determine the rate of healing/ non-healing 3. Determine the presence of edema/swelling/effusion
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| Define edema | accumulation of an excessive amount of watery fluid in cells, tissues or serous cavities (extravascular and interstitial tissue)
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| Define swelling | clinical manifestation of edema
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| Define Effusion | escape of fluid from blood vessels or the lymphatics into tissue or cavity (i.e. knee sprain)
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| The general integumentary examination assists in what? | 1. identifying circulatory problems 2. locating the presence of adhesion formation 3. determine the location of primary pain/problem
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| What change of the integument might indicate a circulatory problem? | altered temperature of an extremity
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| Define eccymosis | bruise
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| Define inspection | visual evaluation of the skin
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| Palpation is used to test tissue ___________ | integrity
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| What are some changes in tissue integrity that can be detected? | 1. Temperature 2. Moisture 3. Elasticity
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| The evidence of sweating can indicate what? | peripheral circulatory efficiency, SNS activity, or the influence of the ambient environment
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| What can you visually see on the integument? | discoloration, presence of hair, swelling
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| Testing the elasticity test what? | Amount of drag or resistance to movement
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| What tactile examination techniques could be used to test elasticity? | Use of fingers vs skin roll to assess the amount of motion in all directions
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| Where should you begin palpation? | around the site of complaint
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| What places are important to know where you are, and what you are palpating? | bondy landmarks such as ligaments, capsule, joint, muscle, tendon
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| What determines the depth of palpation? | based on structures
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| What is the problem with palpating too heavy? | initially you may miss information from more superficial structures
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| The written descrition of impairments is located where? | Objective/ Examination section
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| The list of impairments is documented where? the considered where? | 1. Assessment/ Evaluation 2. considered in the Clinical Impression
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| Examples of impairments | 1. pain 2. decrease ROM 3. decrease strength 4. impaired balance 5. alteration in joint mobility 6. swelling 7. decrease in sensation
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| Specific impairments related to altered skin integrity. | Circumferential/diameter measure Areas of infection Areas of recent healing Smell (if applicable) Size/color of eschar (scab) Amount/color of drainage
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| Specific skin impairments post trauma/immobilization | Presence of atrophy Shiny/hairless skin Areas of eccymosis (indicate color, size and location )
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| What should you document about scars and incisions? | Dimension of the incision/scar Location of the incision/scar Presence of sutures/staples/steri-strips (list number) Presence of drainage: color/amount (area of non-healing: dimension and healing) Presence of keloid/adhesion formation
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| what is a keloid scar? | hypertrophic scar, larger than normal (African american have a higher rate of formation)
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| Written description of specific impairments | Increased diaphoresis (sweating/clammy skin) Increased warmth Coolness (location and dimension)
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| Define myofascial. | Pertaining to the sheet of fibrous tissue (connective tissue) that envelopes the body beneath the skin; also encloses muscles and muscle groups, and separates their several layers or groups
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| Myofascial Impairments | hypomobility Postural Imbalance swelling/ edema altered skin integrity
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| Hypomobility is usually secondary to... | immobilization/ inflammation
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| Postural imbalance is a causes a continuous cycle of what? | poor posture affects fascia with increase restriction which promotes the propagation of poor posture
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| Altered skin integrity could be due to... | scar formation poor tissue nutrition
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| What palpation techniques could be used to test myofascia? | layer palpation and skin rolls
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| What is recorded in Written documentation of integrity of soft tissue (myofascial tissue) | Size and location of muscle spasm and trigger points
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| Define muscle spasm | Increased muscle tension and shortness, which cannot be released voluntarily and which prevents lengthening of the muscles involved
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| Do muscle spasms respond to stretching? | yes
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| Latent trigger point is a focus of | hyperirritability in the muscle or its associated fascia clinically only painful if palpated
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| What are active trigger points? | hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers causing muscular pain
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| Pain from an active trigger point will or will not radiate? | radiate
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| The pattern of pain of an active trigger point is specific to what? | muscle
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| Name the characteristics of trigger points | Tender spots in muscles Decreased muscle stretch preventing the lengthening of muscle Referred pain with palpation Specific autonomic phenomena
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| Trigger points focal tenderness is always... | present and reproducable
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| What does a trigger point prent like in palpation? | Palpable taut band in muscle passing through the TP; muscle tissue in the vicinity feels dense to palpation
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| What can be elicited by pressure to the trigger point | twitch response
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| What will reproduce referred pain or increase the pain? limitations? | Gentle sustained pressure on the TP (10+ sec) Passive or active ROM increases pain Strong contraction of muscle against resistance increases pain Direction and location of skin roll is limited Altered muscle/tendon/ligament integrity
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| Myofascial Exam findings are best documented on what? | body chart
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| Examples of interventions | Soft tissue mobilization (STM)/myofascial release (MFR) (Targets superficial and deep layers) Swedish massage Trigger point release
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| Systematic and scientific manipulation of tissues effects what? | nervous, respiratory, musculoskeletal, circulatory systems
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| What are the mechanical effects of soft tissue mobilization | Assists in venous flow of blood Encourages lymphatic flow Reduce certain types of edema Produce gentle stretching of tissue Reduce subcutaneous scar tissue
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| Why does lymphatic flow need to increase? | due to increased pooling secondary to swelling, and massage redirects lymph in any direction
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| What are the metabolic effects of soft tissue massage? | Increase capillary dilation secondary to increase circulation decrease pain psychological PROLONGED EFFECTS Increased RBC Increased platelets Increased urine output Limited but definite increased O2 Increased nitrogen excretion
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| WHat is the neurological mechanism for decreased pain? | Gate Control Theory of Pain: the stimulation of large cutaneous fibers/receptors block pain, thus increased tactile stimulation will block pain
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| What is the autonomic effect of soft tissue massage? | ADVERSE Increase in sweating, nausea, dizziness
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| Contraindications of soft tissue massage? | Thrombophlebitis Infection Open wound New scar tissue Edema secondary to kidney, heart, lymph obstruction Fx site Acute injury (hemorrhage)
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| What is the progression of soft tissue massage? | Superficial to deep tissues
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| What is the applicaiton process of soft tissue massage? | Fingers, knuckles, elbows, palmar surfaces of hands and forearms
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| What other techniques coordinate with soft tissue massage? | Tissue elongation: muscle energy technique, stretching, PNF Joint mobilization Ther Ex Modalities
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| What is used to decrease friction | Cold cream Massage cream/lotion Mineral oil Baby oil Cocoa butter and vitamin E oil Bee’s wax
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| Important things to remember about patient position | Ensure relaxation Use of elevation for edema Body part should be exposed Use pillows for support Appropriately drape the patient
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| Important things to remember for physical therapists postion | Proper body mechanics Table height to increase comfort Wide BOS Weight shift vs UE movement helps decrease fatigue
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| what is recorded in the objective section | Should include patient position, treatment technique, time frame, supplies used
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| what information is put in the assessment section | Interpret patient’s response to treatment
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| What information is put in the Plan section | Any changes in treatment plan
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