Rehabilitation of people with haemophilia. Part II – Surgical treatment and rehabilitation procedure guidelines

Physiotherapy ◽  
2013 ◽  
Vol 21 (2) ◽  
Author(s):  
Izabela Jaszczur-Janus ◽  
Andrzej Janus ◽  
Zdzisława Wrzosek ◽  
Małgorzata Kuliszkiewicz-Janus

AbstractIn the first article of the series about the rehabilitation of haemophilic patients, the issues related to the aetiology of the disease, its clinical picture, changes in locomotor system, and substitution therapy have been discussed. In this paper the authors present the orthopaedic treatment methods and the guidelines for rehabilitation procedures after intraarticular and intramuscular haemorrhages. They also describe the physical examination and medical interview of a patient with plasmatic diathesis. Also, they point out the specificities of therapeutic procedure which has to take into account not only the changes in locomotor system but also haemostatic abnormalities and substitution therapy. The authors have divided the rehabilitation process into three phases, depending on the patient’s clinical status.

2020 ◽  
Vol 48 ◽  
Author(s):  
Maria Eduarda Dos Santos Lopes Fernandes ◽  
Luiza De Albuquerque Carvalho ◽  
Marina Galindo Chenard ◽  
Cícero Araújo Pitombo ◽  
Orlei Justen Dos Santos ◽  
...  

Background: Flexural deformities are anatomical deviations, in varying degrees, of one or more joints, and may have a congenital or acquired origin. Congenital contracture of the deep digital flexor tendon (DDFT) affects newborn calves and results in hyperflexion of the metacarpal-phalangeal joint, which in severe cases means that the animal must support its own weight on its fetlock joints. The aim of this study is to report the rapid and successful result of applying bilateral total tenotomy technique on a newborn bovine that had been diagnosed with severe bilateral DDFT contracture in the thoracic limbs.Case: A 3-week-old male bovine with a history of difficulty in maintaining a quadrupedal position was attended at the Veterinary Hospital of the Federal University of Tocantins. The animal had severe bilateral locomotor alterations in the thoracic members to the point that he walked on his fetlock joints. The physical examination revealed clinical parameters within the normal range. However, the locomotor system examination showed severe flexor deformity in the bilateral metacarpal-phalangeal joints, and the limbs were being supported on the dorsal face of the fetlock joints, which presented ulcerations, and was suggestive of a shortening of the DDFT. Based on the patient's history and clinical examination, as well as the severity of the tendon contractures, surgical treatment using the DDFT bilateral total tenotomy technique was decided upon. Postoperative treatment consisted of 2.5 mg/kg of enrofloxacin intramuscularly (IM), SID, for 5 days and 0.5 mg/kg meloxicam via IM, SID, for 3 days; as well as a dressing (cotton, medical bandage and a PVC mold) on the thoracic limbs to provide support and allow the animal to walk, until its complete recovery. One day after the surgery, the animal was able to walk with difficulty and some trembling; however, on the third day after the surgical procedure, it could stand up by itself, walk and graze normally. The surgical stitches were removed seven days after the operation, as the surgical wounds had healed adequately. The animal was followed-up for a one-month period after the total tenotomy, with no recurrence of any of the clinical signs, and the thoracic limbs had regained normal biomechanics.Discussion: Congenital flexural deformities are common in newborn calves of different breeds and their incidence is mainly in the thoracic limbs, especially in the carpal, distal interphalangeal and metacarpal-phalangeal joints as was reported in the animal in this study. The history and anamnesis of the animal, along with a thorough physical examination, in order to rule out any other congenital alterations, was extremely important in the diagnosis, and the classification of the severity of the deformity along with the choice of appropriate treatment in the present study. Although total tenotomy is rarely reported in the literature, and there are controversial results with calves, the surgical treatment was chosen in the present case due to the severity of the case. The DDFT bilateral total tenotomy surgical technique gave satisfactory results for the correction of severe bilateral flexor deformity in the thoracic limbs of the newborn crossbred calf. Complete recovery of the limb biomechanics was rapid, and there was no post-surgical complications, thus ensuring the animal could have a good and healthy life. Total DDFT tenotomy is considered a viable surgical procedure for calves with severe congenital flexor deformities; however, post-operative care is also important to ensure good final results.


Physiotherapy ◽  
2013 ◽  
Vol 21 (1) ◽  
Author(s):  
Izabela Jaszczur-Janus ◽  
Andrzej Janus ◽  
Zdzisława Wrzosek ◽  
Małgorzata Kuliszkiewicz-Janus

AbstractHaemophilia is one of the most frequent bleeding diatheses. Patients with it suffer from numerous changes in locomotor system. Although properly conducted rehabilitation is the main component of proper treatment, inadequate knowledge about haemophilia may lead to the use of inappropriate therapy and be a source of danger for the patient group under discussion. In the first part of the series of articles about the problems of rehabilitation of haemophilic patients, the authors describe the aetiology of the disease, its clinical picture, elucidate the emergence of changes in the joints, and bring information on the substitution therapy.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuji Nishizaki ◽  
Keigo Nozawa ◽  
Tomohiro Shinozaki ◽  
Taro Shimizu ◽  
Tomoya Okubo ◽  
...  

Abstract Background The general medicine in-training examination (GM-ITE) is designed to objectively evaluate the postgraduate clinical competencies (PGY) 1 and 2 residents in Japan. Although the total GM-ITE scores tended to be lower in PGY-1 and PGY-2 residents in university hospitals than those in community-based hospitals, the most divergent areas of essential clinical competencies have not yet been revealed. Methods We conducted a nationwide, multicenter, cross-sectional study in Japan, using the GM-ITE to compare university and community-based hospitals in the four areas of basic clinical knowledge“. Specifically, “medical interview and professionalism,” “symptomatology and clinical reasoning,” “physical examination and clinical procedures,” and “disease knowledge” were assessed. Results We found no significant difference in “medical interview and professionalism” scores between the community-based and university hospital residents. However, significant differences were found in the remaining three areas. A 1.28-point difference (95% confidence interval: 0.96–1.59) in “physical examination and clinical procedures” in PGY-1 residents was found; this area alone accounts for approximately half of the difference in total score. Conclusions The standardization of junior residency programs and the general clinical education programs in Japan should be promoted and will improve the overall training that our residents receive. This is especially needed in categories where university hospitals have low scores, such as “physical examination and clinical procedures.”


2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Karthik V. Hariharan ◽  
Michael G. Timko ◽  
Christopher G. Bise ◽  
Meenakshi Sundaram ◽  
Michael J. Schneider

Abstract Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.


2011 ◽  
Vol 139 (1-2) ◽  
pp. 58-63 ◽  
Author(s):  
Sonja Milasinovic

Introduction. Developmental dysplasia of the hip (DDH) represents one of common diseases of the locomotor system. Late discovery and inadequate healing of this defect leads to serious disability in the best years of human life. Objective. The aim of this study was to analyze the quality of functional and anatomic restitution of the diseased hip, depending on the age of the patient at the time of surgery. Methods. Our retrospective study was developed on 78 children surgically treated for DDH. The examiners were distributed in three groups according to age in which they had been operated. The data were produced on the basis of full-scale medical documents for each patient. Results. We analyzed and compared anatomic and functional results of surgeries treating DDH in the group of examiners. On examination, we got data that the most prevalent were distorted gait, inequality of the legs and positive Trendelendburg?s sign in the group of children who had been operated in the oldest age. The patients who were surgically treated in older age had worse postoperative results in aspect value angle of flexion and abduction in treated hip, higher frequency in manifesting pain and asymmetric gait. Better corrective results on aspect of dimension of the colodiaphyseal and Hilgenrainer?s angle will be obtained if DDH treatment is conducted in younger age of patients. In 94.95%, the patients were treated with Salter innominate osteotomy of pelvis with osteotomy of the femur involving its shortening and reverse rotation. Preoperative treatment with Pavliks harness was provided in 44.02% children, with abduction of Hilgenrainer?s apparatus in 2.6%, with abductions ?Niva? slips in 2.6% and preoperative extension in 28.2%. Conclusion. The surgical treatment of DDH in the observed patients done at the earlier age of growth resulted in the evidently better anatomical and functional results at postoperative observation.


Author(s):  
Igor Sergeevich Trifonov ◽  
Mikhail Vladimirovich Sinkin ◽  
Elena Vladimirovna Grigoryeva ◽  
Rashid Abdurakhmanovich Navruzov

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy is associated with some difficulties: particularly, the lack of stereotypical clinical picture in the same patient and controversial data on modern methods of diagnostics — all these statements make identifying epileptogenic zone more difficult and lack of clear criteria for the selection of patients for surgical treatment. In this review, issues of aetiology, pathogenesis, clinical manifestations and criteria for the selection for surgical treatment suggested by different authors are presented.


2013 ◽  
Author(s):  
Catherine M. Otto ◽  
David M Shavelle

The complete evaluation of the cardiovascular patient begins with a thorough history and a detailed physical examination. These two initial steps will often lead to the correct diagnosis and assist in excluding life-threatening conditions. The history and physical examination findings should be assessed in the overall clinical status of the patient, including the patient's specific complaints, lifestyle, comorbidities, and treatment expectations. This chapter discusses the cardiovascular conditions that frequently require evaluation: chest pain, dyspnea, palpitations, syncope, claudication, and cardiac murmurs; and reviews the background, history and physical examination, and diagnostic tests available for each. Diagnostic algorithms are provided, and the appropriate use of invasive and noninvasive cardiac testing for each condition is discussed. This review contains 8 highly rendered figures, 12 tables, and 52 references.


2017 ◽  
Vol 10 (1) ◽  
pp. 54-63
Author(s):  
Denis Vladimirovich Ilchenko ◽  
Andrey Aslanovich Kardanov ◽  
Aleksandr Sergeevich Karandin ◽  
Andrey Vadimovich Korolev

Background The issue of rehabilitation after surgical treatment of the foot deformities is not sufficiently covered in the contemporary literature. In spite of diversity of certain approaches used in the rehabilitation process, there is no consistency in their application. In addition, there is no consensus on the effectiveness of various techniques, on the quantity and quality of the procedures and the timing of their introduction in the rehabilitation process. The objective of this article is to analyze the effectiveness of the techniques used in the rehabilitation of patients after surgical treatment of the foot deformities. Methods The article describes methods that are, in our opinion, the most effective and well-established in the post-operative recovery of patients. The  principles of complex usage of conservative treatment methods, including lymph drainage massage, manual therapy and therapeutic physical training, are covered. Results The introduction of the protocols we have developed in the rehabilitation of patients after surgical treatment of the foot deformities helped to organize the recovery process, to clarify the timing of rehabilitation measures, to improve the final result of treatment. Conclusions The use of pathogenetically justified methods of rehabilitation, which include massage, manual therapy and therapeutic physical training, promotes the most rapid and complete recovery of motor functions in patients after surgical treatment of the foot deformities.  


2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Mukramin Amran

Osteoarthritis (OA) is a progressive and degenerative chronic musculoskeletal disease caused by thinning of the cartilage in the joint due to bone rubbing against each other. History of the patient's history, clinical picture of the physical examination and the results of the radiological examination are basic things to diagnose OA. Patient's complaints include joint pain which is a major complaint that brings the patient to the doctor, joint stiffness, crepitation, joint swelling, and changes in gait. Gait changes due to pain are found on a physical examination even though radiologically is still at an initial level. In addition it can be found that crepitus, swollen joints are often asymmetrical. The aim of this study was to determine clinical and radiological features by counselor and Lawrence of outpatient genotypes osteoarthritis patients in the rsu anutapura hammer orthopedic polyclinic in 2018. Descriptive research methods were conducted on 27 people with genital osteoarthritis who were treated at the orthopedic clinic in Anutapura Palu Public Hospital 2018. Consecutive sampling was used and data collection through interviews and observations in the form of pain, joint stiffness, crepitus, joint swelling and gait changes and radiological examinations based on Kellgren and Lawrence criteria. Data analysis using SPSS 25 with frequency distribution test. The results of the study were (1) based on the clinical picture in genu osteoarthritis patients pain (100%), pain accompanied by gait changes (70.37%), pain accompanied by joint stiffness (51.4%), pain accompanied by joint swelling (44, 4%), and pain with crepitus (37.0%). (2) based on radiology in patients with osteoarthritis genu with the highest grade 3 and 4 respectively (33.3%), grade 2 (29.6%), grade 1 (3.7%) and in grade 0 not found. Conclusion: found joint pain and a small portion of pain accompanied by crepitus, radiologists found in most grades 3 and 4 while grade 0 was not found.


Sign in / Sign up

Export Citation Format

Share Document