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Fractures of the elbow are injuries to the lower end of the humerus (internal, external condyle, Golovatogo increasing, block) and the proximal epiphyses of the forearm bones (of the head and neck of the radius, ulna and coronoid processes of the ulna). Treatment of intra-articular fractures without displacement of fragments is carried out by fixation of the joint with a plaster splint for 1-3 weeks (depending on the location of the injury). At T and V-shaped fractures provide prompt reposition of bone fragments with fixation of their spokes, screws or screws with the subsequent imposition of a plaster cast for up to 3 weeks.
the Difficulty of restoration of function of the elbow joint after injury are explained by the complexity of its anatomical structure and special reactivity. Increased reactivity of the elbow joint in external stimulation can be partially explained by the nature of its innervation. The joint capsule contains a large number of nerve endings, coming from several nerves, one of which is the median nerve, which contains many vegetative fibers. The above features of innervation may explain the degree of expansion of the zone of irradiation pulses, resulting in irritation caused by the trauma, and increased reflex response from the surrounding muscle. You also need to consider the intimate relationship between the articular bag and muscles. There is also a certain correlation between reactive phenomena on the part of vessels, lead to long-term preservation of swelling of the tissues surrounding the joint, and stability of the restriction of mobility in it. The listed physiological characteristics make very carefully pursue restorative treatment for a given location of the injury. The beginning of movement in the elbow joint is determined by the location of the fracture, its nature, position of fragments, the severity of reactive phenomena, age-related peculiarities of reparative processes. However, you should strive to begin exercise, as long inactivety joint develop secondary changes, which steadily restricted his mobility. In this regard there are periods of absolute immobilization (physiological rest of the fixed segments of the injured limb is not broken) and relative immobilization (limb temporarily freed from the cast for teaching physical therapy). Movement in the joint fractures without displacement of bone fragments or with a slight shift you can start from the reduction of reactive phenomena (5-12 days after injury). In fractures with less favorable and less stable position of the fragments, because of the risk of further displacement, the movements must be removed before the formation of adhesions between the chips (14-21 days after injury).
The immobilization period on the practice of medical gymnastics on the background of General developmental and breathing exercises are used in free of immobilization joints (shoulder, metacarpophalangeal and interphalangeal), ideomotor exercises and isometric muscle tension in the shoulder and forearm. Because trauma area of the elbow joint often atrophy of the shoulder muscles, you must first teach patients to rhythmically stretch and relax these muscles. Rhythmic muscle tension in the forearm is due to the bending-unbending movements in fingers. Long isometric muscle tension (5-7 C) prescribe 3-4 days of immobilization.
the Classes are conducted 2-3 times a day, the duration of the class in the first 2-3 days is 10-15 min, then 20-30 min.
Selecting exercises for this period should take into account the localization of damage. Thus, in fractures of the internal epicondyle and condyle of the humerus in prometaphase the flexible joint and the phalanges can lead to secondary displacement of fragments of bone, as this reduces the flexors of the hand and fingers attached to data entities.
it is Recommended during the day to keep the injured limb in an elevated position, because this position, especially in the early stages of traumatic disease, helps reduce inflammation, pain and prevent stiffness in the shoulder joint. It is important to use the patient hand of self-service.
In postmobilization period the main objective of physical therapy is to gradually restore your range of motion and normalization of muscular apparatus of the limb with the help of special exercises for the injured joint. Plaster cast in the classroom is removed. Since the consolidation in this period is not finished yet, gymnastics is carried out with observance of certain conditions: all exercises are performed from lightweight initial positions (with a support of hands on the table surface, on a special arm rest or plunging the hand in warm water), the movement should be only active, range of motion should be to the extent necessary for an easy and painless stretching of tense muscles; passive movement, encumbrance, massage the joint and vigorous thermal procedures are excluded.
the Patient performs various movements of the fingers and in the wrist joint, and varus pronation of forearm, flexion and extension at the elbow joint, combining them with obshherazvivajushhego and breathing exercises, exercises for a healthy upper limb. The special character of exercise depends on the type and location of damage. Thus, in fractures of the olecranon are focusing on the extension of the forearm, and with fractures of the coronoid process of his bending. In fractures of the radial head bone, because of the risk of displacement of fragments, of rotational movement of the forearm should start later than bending and unbending. Due to the fact that a common complication of fractures of the elbow joint is pronational contracture, in all cases, except fractures of the head and neck of the radius, with 3-5-day administered exercises on varus of the forearm. Many of the exercises in this period performed with the healthy hand. To increase the duration of corrective exercises and consolidation of the result achieved after carrying out of therapeutic exercises, it is advisable to put the patient's hand after practice for 15-20 min between the sandbags in position of extreme flexion or extension at the elbow joint. This position provides sufficient tension of the fabrics when relaxed muscles, and ultimately contributes to the elasticity of retrievin x periarticular tissues. The duration of the procedure of medical gymnastics, which is carried out 2-3 times per day equal to 30-45 min.
With good consolidation and satisfactory range of motion activities should be carried out according to the method of the recovery period, which is full recovery of function of the injured joint and entire limb. With this purpose together with the exercises of the previous period widely used physical exercises with objects, in the pool, gymnastic wall. With a steady stiffness or contracture in the elbow joint is prescribed mechanotherapy (not earlier than through 1,5-2 months after injury). In severe atrophy of muscles of shoulder and forearm, trophic disorders, hypertonus it is recommended to massage the shoulder area and forearm, excluding the elbow (10-15 procedures per course).
During the development of the elbow joint, regardless of the time of treatment, you should not use harsh, violent methods, forced exercise, exercise in vis, lifting her arm higher value, as well as exercises that cause pain. Such actions can cause additional trauma of the tissues of the joint, a reactive effusion in sustainable and reflex muscular contracture. This often occurs when the ossification of the periarticular tissues. This significantly reduces the opportunity to obtain a favorable functional result.
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