Efficacy Of Dynamic Splinting Health And Social Care Essay

Efficacy Of high-powered Splinting Health And loving C atomic number 18 EssayThe procedure has proven to both reliable and durable. A successful arrive stifle transposition allows diligent to resume roughly all activities of daily living with minimal difficulty. In most cases patients no longer require external aids or chronic medications. conclusion total human genu joint joint substitute helps patients to maintain their overall self esteem. quantity stifle replacement is indicated when there is unremitting bleak pain in the stifle with or without deformity. The pain/ deformity may be payable to osteoarthritis, screaky arthritis and various non specific arthritis. It relieves pain, provides mobility and correct deformity. trumpow genu joint joint replacement is a surgical procedure in which injured or shamed part of the articulatio genus joint are replaced with artificial separate. The procedure is performed by sepe military rank the heftinesss and ligamen ts around the knee to expose the knee capsule. The knee capsule is opened, opened the inside of the joint. The end of the femoris and shinb championl are removed. The artificial parts are cemented into place. The knee will consist of metal shell at the end of the femoris, a metal and plastic trough on the shinbone and if needed a plastic button in the cap. In a way this could be more appropriately called a human knee resurfacing operation.The habitual pathology for total knee replacement is knee fold contracture.DEFINITION prosody contracture is defined as the shortening of the connective tissue paper thereby rigidification the joint. It is repayable to tightening of the posterior capsule combined with the tightening of biceps femoris and col squint-eyed ligaments.Hence rehabilitation program should be undertaken soon after(prenominal) TKA to maintain joint govern of bowel movement.In particular this shoot examined the prise of propelling care foring in increasing effigy of transaction and reducing the crimp contracture. Dynamic splinting utilizes the biomechanical adaptation of keeping the joint at end- jog to achieve a physiological change of molecular realignment to elon entry the connective tissue. This protocol of low-load, prolonged-duration carry with dynamic tension continually decocts the contracture.ANATOMY OF genu voiceThe knee joint is the largest and most complex joint in the consistence. It is synovial modified hinge joint. It is formed by fusion and median(a) tibio- femoral and genus Patella- femoral joint.ARTICULAR SURFACESIt is comprised theFemoral condyles distal end of femur shinl condyles proximal end of shin.Patellar facetes posterior break through of patella.Femoral condylesThe articular turn ups of femur are pulley shaped. The femoral condyles are convex in both planes. They are extended interiorly by the pulley shaped patellar get alongs. The bang of the pulley is represented priorly by the central gr oove on the patellar surface and posteriorly by the intercondylar notch.111 shin bonel condyleThe shinl surfaces are mutually curved and comprises two curved and concave parallel gutters which are marooned by a blunt eminence running antero- posteriorly eminence lodges the two intercondylar tubercles.Tibio-femoral jointsThe tibial condyles condition to the femoral condyles while the inter condylar tibial tubercles come to within the femoral intercondylar notch, these surfaces constitute useally the tibio-femoral joint.Femero-patellar jointsThe facets of patella correspond to the patellar surface of the femur while the vertical ridge of the patella fits into the central groove of the femur.LIGAMENTS OF knee JOINTMedial collateral ligamentIt is planate band rhomboidal in outine. It is attached above to the average epicondyle of femur, at a lower place to the medial margin and the adjoining medial surface of tibia.Function define valgus rotationLateral collateral ligamentFunct ionrestrain varus rotation and spurn internal rotationkneeanat foregoing symmetrical ligamentIt is attached below to the introductory part of the intercondylar area of tibia between the anterior ends of lateral and medial semilunar cartilages. Above it is attached to the posterior part of the medial surface of lateral femoral condyle.FunctionTo resist anterior displacement of the tibia on the femur when the knee is flexedTo resist varus or valgus rotation of the tibia, oddly in the absence of the collateral ligamentsResists internal rotation of the tibia. stakeserior cruciate ligamentIt is attached below to the posterior part of intercondylar area of tibia, posterior to the wing of posterior end of medial semilunar cartilage. Above it is attached to the anterior part of lateral surface of the medial condyle of femur.FunctionTo allow femoral rollback in flexionResist posterior translation of the tibia relative to the femurControls external rotation of the tibia with increasing knee flexion.Retention of the PCL in total knee replacement has been shown biomechanically to provide average kinematic rollback of the femur on the tibia. This also is of the essence(predicate) for improving the jimmy arm of the quadriceps mechanism with flexion of the knee.MUSCLES OF articulatio genus JOINT quadruplet femorisPopliteusSemitendinosusSemimembranousSartoriusBiceps femorisGastrocnemiusPlantarisBURSAE AROUND THE KNEE JOINTAnteriorlyThe suprapatellar bursaThe prepatellar bursaSuperficial intrapatellar bursaDeep infrapatellar bursaLaterallyA bursa between lateral collateral ligament and biceps heftinessA bursa between lateral collateral ligament and popliteus tendonPopliteus bursa lies between the popliteus and lateral condyle of femur.MediallyThe tibial inter tendinous bursa( invertebrate foot anserine bursa)A bursa between medial collateral ligament and semimembranous tendonA bursa between semimembranous tendon and tibia.PosteriorlyA bursa between lateral head of gastrocnemius muscle and capsule.Semimembranous bursa(brodies bursa)NERVE SUPPLYFemoral plaqueSciatic nerveObturator nerveBLOOD SUPPLYThe arterial supply to knee joint, is from the branches ofPopliteal arterial blood vesselFemoral arteriaTibial arteryTIBIO-FEMORAL ARTHROKINEMATICSViewed in the sagittal plane, the femurs articulating surface is convex while the tibias in concave. We can predict arthrokinematics based on the rules of concavity and convexityDuring stifle ExtensionDuring Knee plication rough chain disagreeable ChainOpen ChainClosed ChainTibia Glides Anteriorly On femorisFemur Glides Posteriorly On TibiaTibia Glides Posteriorly On FemurFemur Glides Anteriorly On Tibiafrom 20o knee flexion to full accompanimentfrom full knee extension to 20o flexionTibia rotates externallyFemur rotates internally on unchangeable tibiaTibia rotates internallyFemur rotates externally on abiding tibiaTHE SCREW-HOME MECHANISMRotation between the tibia and femur occurs mechanically be tween full extension (0o) and 20o of knee flexion. These figures illustrate the pinnacle of the redress tibial plateau as we look down on it during knee bowel movement. steer of tibial plateautop of tibial plateautop of tibial plateauDuring Knee Extension, the tibia semivowels anteriorly on the femur.During the last 20 degrees of knee extension, anterior tibial glide persists on the tibias medial condyle because its articular surface is longer in that dimension than the lateral condyles. lengthy anterior glide on the medial side produces external tibial rotation, the screw-home mechanism.THE SCREW-HOME MECHANISM REVERSES DURING KNEE FLEXIONtop of tibial plateautop of tibial plateautop of tibial plateauWhen the knee begins to flex from a position of full extension, posterior tibial glide begins out countersink on the longer medial condyle.Between 0 deg. extension and 20 deg. of flexion, posterior glide on the medial side produces relative tibial internal rotation, a reversal of the screw-home mechanism.TOTAL KNEE REPLACEMENTTotal knee replacement is indicated when there is unremitting severe pain in the knee with or without deformity. The pain/ deformity may e due to osteoarthritis, Rheumatoid arthritis and various non specific arthritis. It relieves pain, provides mobility and correct deformity.Total knee replacement is a surgical procedure in which injured or change parts of the knee joint are replaced with artificial parts. The procedure is performed by seperating the muscles and ligaments around the knee to expose the knee capsule. The knee capsule is opened, assailable the inside of the joint. The end of the femur and tibial are removed. The artificial parts are cemented into place. The knee will consist of metal shell at the end of the femur, a metal and plastic trough on the tibia and if needed a plastic button in the cap. In a way this could be more appropriately called a Knee resurfacing operation.ENew FolderNAGU PROJECTimAGESTotal-Knee-Replace ment.jpgThe total knee replacement can beUnicompartmental arthroplasty The articulary surface of femur and tibia, either the medial or lateral compartment of the knee are replaced by an implant. Eg osteoathritis.Bicomprtmental arthroplasty In bicompartmental arthroplasty, the articular surface of tibia and femur of both medial and lateral compartments of the knee joints are replaced by an implant. The tertiary compartment i.e.., the patellofemoral joint is however left intact.Tricomprtmental arthroplasty the articular surface of the lower femur, upper berth tibia and patella are replaced by prosthetic device. Most commonly performed arthroplsty.The prosthesis consists of a tibial component, a metal femoral component and a high molecular weight polyethylene button for articular surface of the patella.TKA GOALSRestore mechanical alignment neutral tibiofemoral alignment =4-6 of anatomic valgus,horizontal joint line,Soft tissue balance (ligament),(Patella tracking (Q-angle)INDICATIONO teoarthritisRheumatoid arthritisHemophilic arthritisTraumatic arthritisSero negative arthridesCrystal deposition diseasePigmented villonoular synovitisavascular necrosisBone dysplasiasAsymmetric arthritsCONTRA INDICATIONAbsolute contraindicationsRecent or curren joint infectionSepsis or brassatic infectionNeuropathic arthropathyPainful upstanding knee fusionRelative contraindicationsSevere osteoporosisDebilated poor healthNon functioning extensor mechanismPainless, well functioning arthrodesisSignificant peripheral vascular diseasesTKA ComplicationsDeath 0.53%Periprosthetic Infection 0.71%Pulmonary emboli 0.41%Patella fractureComponent shittingTibial tray shamPeroneal Nerve Palsy 0.3% to 2%Periprosthetic Femur FracturePeriprosthetic Tibial FractureWound Complications / Skin slough noble-mindedPatellar Clunk Syndrome rarePatellofemoral Instability 0.5%-29%DVTInstabilityPopliteal artery injury 0.05%Quadriceps Tendon good luck 0.1%Patellar Tendon Rupture StiffnessFat EmbolismMCL ruptureNEED AND SIGNIFICANCE OF understandNeed of the studyTo reduce flexion contractureTo improve range of motionTo improve functional activitySignificance of the studyThis study is to guess the efficacy of dynamic splinting for knee flexion contracture quest a total knee arthroplasty.Statement of the problemTo study the efficacy of dynamic splinting for knee flexion contracture following a total knee arthroplasty.Hence the study is entitled as efficacy of dynamic splinting for knee flexion contracture following a total knee arthroplasty.ObjectivesTo reduce flexion contractureTo improve range of motionTo analyze the effect of dynamic knee splint nugatory supposalThe null hypothesis can be stated as follows there is no monumental dissimilitude in knee flexion contracture after the application of dynamic knee splint.Alternate hypothesisThe hypothesis can be stated as follows there is evidentiary difference in knee flexion contracture after the application of dynamic knee spli nt.2. REVIEW OF LITERATURE1. TOTAL KNEE ARTHROPLASTYSimon H Palmer, MD, Consultant sawbones Sep 21, 2010 Osteoarthritis destruction of the knee is the most common tenability for total knee replacement.Jayant joshi, prakash kotwal says that total knee replacement relieves pain, provides mobility corrects deformity.2. FLEXION CONTRACTUREJ. Ilyas A.H. Deakin C. Brege and F. Picard Flexion contracture is a common deformity encountered in patients requiring total knee arthroplasty (TKA). segment of orthopaedics, golden jubilee national hospital, clydebank, glasgow, g81 4hx, uk. One hundred and four free burning TKA were perfect by a single consultant development the OrthoPilot (BBraun, Aesculap) navigation corpse and Columbus implants. Seventy-four knees had preoperative flexion contracture (including neutral knees) while 30 were in hyperextension.Ouellet D, Moffet H. Arthritis Rheum October 2002 Large movement deficits are present, especially in single-limb support pre-op and 2 mo nths following TKA.Huei-Ming Chai, PHD. November 24, 2008 total knee arthroplasty limits range of motion3. DYNAMIC SPLINTDennis l armstrong, m.d. Buck willis, phd evaluates the efficacy of dynamic knee extension splinting for knee flexion contracture following TKA.FingerE, WillisFB Health tangible Education, Recreation, Texas State University, Cases journal 2008, Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch.Finger E, Willis B 29Dec2008 Dynasplint offers extension musical arrangements to aid in rehabilitation and recovery from flexion contracture.Clinical studies fix demonstrated grea shield average reduction in rehabilitation judgment of conviction and speak to with the use of Dynasplint Systems in conjunction with physiologic therapy.Willis FB Biomechanics.2008 Jan 15 afterwards surgery, a patient is often left with shortened connective tissue and may shoot a difficult ti me go commonly again. Wearing a dynamic knee splint will postpone and remodel the tissue to restore range of motion.McClure P, Blackburn L, Dusold C Ideally, wearing your Dynasplint for 6-8 continuous hours yields the best go outs as it allows a safe, long lasting remodeling of the round the bend tissue.Cliffordr.Wheeless, Iii, Md.December3, 2008. The manipulation of this report is to review the use of external fixator for the gradual correction of severe knee flexion contractures that limit patient function.James f. Mooney iii, md, l. Andrew koman Posted 05/01/2001 second-rate preoperative flexion contracture was 80.5. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures4. CONVENTIONAL PHYSICAL THERAPY FOR KNEE ARTHRITISJan.K.Richardson, Pt, Phd, Ocs Said that arthritis is a degenerative disease of the cartilage and bones that results in pain and stiffness in affected joi nt. There is no regain for arthritis, but physical therapy can make living easier and less painful.Brigham And Womens hospital Department of Rehabilitation Services Physical Therapy .ROM along with proper soft tissue balance is required to ensure proper biomechanics in the knee joint. Aggressive post-operative PT has been shown to be effective in improving patient outcomes and shortening length of stayBalint G And Sz Ebenyl.B Showed that therapeutic exercises decreases pain, growings muscle play out and range of motion as well as improve resolution and aerobic capacity. Weight reduction is proven in obese patients with OA of knee. redress heat and cold, electrotherapy, acupuncture are widely apply.Dr. Margriet van baar reported that significant beneficial effectuate from exercise therapy including improvements in self reported pain, disability, walking ability and overall sense of well being.Dorr LD. J Arthroplasty June 2002 CPM helps achieve knee range of motion quicker in first post-op weeks but at final follow-ups, no difference in final range of motionByrne, et al. Clin Biomech October 2002 Deficits in knee enduringness balanced by increased articulatio coxae extensor work rehab should optimize bilateral hip and knee function after TKAMcManus et al 2006, Jorge et al 2006 the higher frequencies (90-130Hz) to stimulate the pain gate mechanisms thereby mask the pain symptoms.Ozcan et al, 2004 Low frequency nerve excitant is physiologically effective (as with TENS and NMES) and this is the key to IFT intervention.Adedoyin, R. A., et al. (2002).IFT acts primarily on the excitable (nerve) tissues, the strongest effects are likely to be those which are a direct result of such stimulation (i.e. pain relief and muscle stimulation).National chinaware University Hospital, November 2008 PNF stretching techniques has been used frequently for patients with total knee arthroplasty in clinical practice to increase range of motion effectively and reduced knee p ain during exercise.Huei-Ming Chai, PHD November 24, 2008 PNF stretching technique is a therapeutic technique utilize the PNF concept to the related muslces either to increase neuro-inhibition mechanism for releasing muscle spasm and elongating muscle length, or to increase neuro-excitation mechanism for enhancing muscle strengthHarold B. James H. Beaty, MD Range-of-motion exercises, muscle strengthening, rate training, and instruction in performing activities of daily living are important.5. GONIOMETRIC MEASURENT FOR ROMCarlos Lavernia, MD, Range of motion estimate through direct observation without a goniometer provides inaccurate findings.Mark D. Rossi, PhD, PT, CSCS The Journal of Arthroplasty Vol. 23 No. 6 Suppl. 1 2008 Measured write ups utilize a goniometer provided an improved degree of accuracy, but results appear to be pendent on the clinician performing the measurement.Richard l. Gajdosik Associate Professor Physical therapists may take away most knee goniometric m easurements as clinically valid, and the evidence indicates that most of these measurements are reliable.6. KNEE SOCIETY SCOREGil Scuderi, MD-Chair Jim Benjamin, MD Jess Lonner, MD Bob Bourne, MD and Norm Scott, MD, 2007,The Knee Society rating system (KSS) was first create in CORR in 1989 and has get down the precedent clinical evaluation system for reporting results for patients undergoing Total Knee Replacement.John N. Insall, MD, Lawrence D. Dorr, Scott, MD Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 NovThe Knee Society has proposed this new rating system to be simple but more exacting and more objective.MD, Richard D. Scott, MD, and W. Norman It is hoped the knee club rating system will become universally accepted and will be adopted by all authors, even if they wish to report results using a customary hit method as well.3. MATERIALS AND METHODOLOGYMATERIALSEvaluation toolGoniometryKnee society scoreOutcome measureRange of motionKnee s coreFunction scoreMaterial usedDynamic knee splintMETHODOLOGY(A) Study design30 subjects with flexion contracture following biased TKA assigned in two groups. concourse A15 subjects Dynamic Splint Along With naturalized Physiotherapy.GROUP B15 subjects Conventional Physiotherapy.(B) Study settingThis study was carried out in the department of physical medicine and rehabilitation, Sri Ramakrishna hospital, Coimbatore.(C) Study durationThis study was carried out for a dot of 6 months.(D) SamplingRandom sampling.INCLUSION CRITERIAAge 45 to 70 years.Both sexFlexion contracture 20 12 deg (post operatively)Unilateral TKA reduce flexibility in AROM of knee extensionPain that is worsened by bending over while legs are straightImpaired gait patternAbility to understand informed consent and experiment responsibilitiescensure CRITERIAFracturesBilateral TKATKA Knee sepsisOsteomyelitis or whatever orthopedic infection extensor mechanism dysfunctionPsoriasisKnee joint neuropathyPrevious Str oke or Brain InjurySTATISTICS TOOLThe data collected was analyzed using independent t-test. The test was carried out between two groups. Independentt test was used to compare the effectiveness of treatment between the groups.t =S =X1 = diversion between pretest and posttest determine of meeting IX2 = Difference between pretest and posttest values of theme II= entertain difference of convention I= inculpate difference of Group IIn1 = No. of samples in Group In2 = No. of samples in Group IIS = Combined standard deviationTREATMENTDynamic knee Extension splintThe taunt Effecthttp//www.dynasplint.com/uploads/user-uploads/rebound2.gif53% Average Reduction in Time and follow Associated with ROM RehabilitationHigh-force, short-duration stretching favors recoverable, elastic tissue deformation, whereas low-force, long-duration stretching enhances immutable plastic deformation. In the clinical setting, high force application has a greater risk of causing pain and possibly ruptures o f tissue. Dynasplint Systems improve range of motion by creating permanent, non-traumatic tissue elongation and remodeling, thus virtually eliminating the range of motion rebound effect often observed in the clinical setting.RangerKnee2Features BenefitsLLPS (Low-Load, Prolonged-Duration Stretch) technology has been proven to successfully treat joint stiffness and restrict range of motion.Early application can reduce time and cost associated with range of motion rehabilitationSimple, adjustable and reproducible bilateral tensioning SystemAvailable for rent or purchaseBiomechanically correctComfortable to wearEach Dynasplint System is recycled to reduce waste and help the environmentA Dynasplint Systems consultant will fit your patients and oversee their treatment to ensure the best possible resultsOver a quarter of a million patients mystify been successfully treated with Dynasplint SystemsConveniently labeled and easy to use uncomplaining Wearing ProtocolPlease review the tension your Dynasplint consultant set for you initially.In the beginning, the splint should be worn for 2-4 hours.Do not increase the tension until you can tolerate overnight wear. Time is the most important factor and your first goal should be 6-8 hours of pain free wear. subsequently achieving this time goal, when you take the splint off if you have less than 1 hour of post-wear stiffness, turn tension up by one on both sides.However if you are unable to wear the splint for a prolonged period of time, decrease the tension by a one-half to one full turn.During the process of regaining your range of motion, if you have any question or concerns contact your Dynasplint consultant.http//www.wheelessonline.com/images/i1/imk11.jpgCONVENTIONAL TREATMENTMODALITIES FOR PAIN CONTROL, dropsy REDUCTIONMoist HeatFunctional electrical stimulation transdermic electrical stimulationIce therapyInterferential therapyGalvanic StimulationJOINT militarisationFlexion restraintPosition patient seatedPosterio r glide of tibia on femur-grade 3 Oscillation with 30 second hold, recurrent 5 times with patellar mobilization of inferior glides (5 mins)Extension restrictionPosition patient prone with patella off of tableAnterior glide of tibia on femur- grade 3 oscillation and atmospheric static hold (10 secs in 3 repetitions) with patellar mobilization superior glides (5 mins) reading PROGRAMClosed and open kinetic chain strengthening exercisesproprioceptive/balance exercises targeting the trunk and lower extremity musculaturePartial body weighted squatsGait trainingRange of motion exercisesHeel slide (supine sitting)Stretching (prone/supine) to increase knee extension ROMGAIT provisionForward WalkingSidesteppingBackward or Retro-WalkingFUNCTIONAL TRAINING stand upTransfer ActivitiesLiftingCarryingPushing or PullingSquatting or CrouchingReturn-to-Work Tasks courage TRAININGUpper body exercise.Ambulation activitiesOne-leg cycling, using non-operative leg with resistance to motion. respite/PR OPRIOCEPTION TRAININGTandem WalkingLateral Stepping over/around objectsWeight-Shifting ActivitiesClosed Kinetic Chain Activities5. DATA ANALYSIS AND INTERPRETATIONKNEE annexe ROM GROUP IPre test(Two months after TKA)Post test(conventional PT with SPLINT)DifferenceX1160161611516214162141641214014140141411314113142121201212012121111211112111Mean=12.93PRE screen AND POST KNEE EXTENSION ROM GROUP IKNEE EXTENSION ROM GROUP IIPre test(Two months after TKA)Post test(conventional PT without splint)DifferenceX21871118612186121861218414167916791641216412164121431114410144121421214212Mean=11.46t=2.82s.dev=1.42degrees of freedom = 28The probability of this result, assuming the null hypothesis, is 0.009PRE sieve AND POST KNEE EXTENSION ROM GROUP IIKNEE SCORE AND FUNCTION SCORES.No.ParametersGroupsMeanS.D.Valuet Value1.Knee ScoresGroup A184.473.06Group B132.Function ScoreGroup A35.64.983.01Group B30.1 lowly DIFFERENCE BETWEENKNEE SCORE AND FUNCTION SCOREdemographic DATATHE AGE OF THE SAMPLES B ETWEEN 45 -70 YEARS IN all(prenominal) GROUPAge (years)No. of SamplesTotalGroup AGroup B45-5043750-5554955-6025760-6522465-70213TOTAL NUMBER OF MALES AND FEMALES IN EACH GROUPSexNo. of SamplesTotalGroup AGroup BMale81018Females7512TOTAL NUMBER OF RIGHT AND LEFT SIDE INVOLVEMENT IN EACH GROUPSide of involvementNo. of SamplesTotalGroup AGroup BRight11819Left47115. DISCUSSIONTotal knee arthroplasty (TKA) is considered the treatment of choice for patients with intractable pain and substantial functional disabilities who have not had acceptable relief and functional improvement after cautious treatment. Knee flexion contracture is a common pathology following TKA affecting up to 61% of these patients.The purpose of the study is to determine the effectiveness of dynamic splinting in treating patients with flexion contracture following Unilateral TKA.Literature review states that there is significant difference between dynamic splinting and conventional physiotherapy management in reduci ng flexion contracture following Unilateral TKA.A total of thirty patients with unilateral TKA were selected under inclusive criteria and were randomly allocated into an experimental group and pull strings group as Group A and group B respectively. In each group 15 Individuals were allottedIn Group A, dynamic splint along with conventional physiotherapy was given and in Group B, Conventional physiot