Efficacy Of Dynamic Splinting Health And Social Care Essay

Efficacy Of Dynamic Splinting Health And Social Cargon EssayThe procedure has proven to both reliable and durable. A successful total stifle replacement all(a)ows patient to resume al more or slight all activities of daily living with minimal difficulty. In most cases patients no longer require external aids or chronic medications. Finally total human stifle joint replacement helps patients to insist their overall self esteem.Total stifle replacement is indicated when there is unremitting severe wo(e) in the genu with or without deformity. The pain/ deformity whitethorn be due to osteoarthritis, flea-bitten arthritis and diverse non specific arthritis. It relieves pain, provides mobility and correct deformity.Total knee replacement is a surgical procedure in which injured or damaged recesss of the knee interchangeable are replaced with artificial parts. The procedure is performed by sepe paygrade the muscles and ligaments around the knee to expose the knee capsule. The knee capsule is opened, clear the inside of the give voice. The residue of the femur and shinbonel are removed. The artificial parts are cemented into place. The knee testament consist of metal shell at the end of the femur, a metal and p ultimatelyic roll on the tibia and if needed a plastic button in the cap. In a way this could be more appropriately called a human knee resurfacing operation.The common pathology for total knee replacement is knee flexion contracture.DEFINITIONFlexion contracture is defined as the shortening of the connective tissue thereby rigidification the joint. It is due to tightening of the posterior capsule combined with the tightening of biceps femoris and col askance ligaments.Hence rehabilitation program should be undertaken soon subsequently TKA to maintain joint celestial orbit of motion.In p articular this instruction examined the value of alive(p) splinting in increasing range of motion and reducing the flexion contracture. Dynamic splin ting utilizes the biomechanical adaptation of keeping the joint at end-range to achieve a physiological change of molecular realignment to elongate the connective tissue. This protocol of low-load, prolonged-duration stretch with propelling tension continually reduces the contracture.ANATOMY OF KNEE JOINTThe knee joint is the largest and most complex joint in the body. It is synovial modified hinge joint. It is formed by partnership and medial tibio- femoral and kneecap- femoral joint.ARTICULAR SURFACESIt is comprised thefemoral condyles distal end of femurTibial condyles proximal end of tibia.Patellar facetes posterior come out of the closet of patella.Femoral condylesThe articular surfaces of femur are pulley shaped. The femoral condyles are planoconvex in both planes. They are extended interiorly by the pulley shaped patellar surfaces. The neck of the pulley is represented prior(a)ly by the central groove on the patellar surface and posteriorly by the intercondylar notch .111Tibial condyleThe tibial surfaces are in return curved and comprises two curved and concave parallel gutters which are separated by a blunt eminence running antero- posteriorly eminence lodges the two intercondylar tubercles.Tibio-femoral jointsThe tibial condyles correspond to the femoral condyles while the inter condylar tibial tubercles come to within the femoral intercondylar notch, these surfaces constitute functionally 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 flattened band rhomboidal in outine. It is attached above to the medial epicondyle of femur, below to the medial margin and the adjoining medial surface of tibia. leanrestrain valgus rotationLateral collateral ligamentFunctionrestrain varus rotation and resist internal rotationkneeanatAnterior cruciate ligame ntIt is attached below to the prior(a) 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 fault of the tibia on the femur when the knee is flexedTo resist varus or valgus rotation of the tibia, especially in the absence of the collateral ligamentsResists internal rotation of the tibia. blank spaceerior cruciate ligamentIt is attached below to the posterior part of intercondylar area of tibia, posterior to the attachment 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 normal kinematic rollback of the femur on the tibia. This also is important for improving the lever arm of the quadriceps utensil with flexion of the knee.MUSCLES OF KNEE JOINTQuadriceps femorisPopliteusSemitendinosusSemimembranousSartoriusBiceps femorisgastrocnemiusPlantarisBURSAE AROUND THE KNEE JOINTAnteriorlyThe suprapatellar bursaThe prepatellar bursaSuperficial intrapatellar bursaDeep infrapatellar bursaLaterallyA bursa between lateral collateral ligament and biceps sinewA bursa between lateral collateral ligament and popliteus tendonPopliteus bursa lies between the popliteus and lateral condyle of femur.MediallyThe tibial inter tendinous bursa( pes anserine bursa)A bursa between medial collateral ligament and semimembranous tendonA bursa between semimembranous tendon and tibia.PosteriorlyA bursa between lateral head of gastrocnemius and capsule.Semimembranous bursa(brodies bursa)NERVE SUPPLYFemoral kernelSciatic nerveObturator nerveBLOOD SUPPLYThe arterial supp ly to knee joint, is from the branches ofPopliteal arteryFemoral arteryTibial arteryTIBIO-FEMORAL ARTHROKINEMATICSViewed in the sagittal plane, the femurs articulating surface is convex while the tibias in concave. We idler predict arthrokinematics based on the rules of concavity and convexityDuring Knee ExtensionDuring Knee FlexionOpen orbitshut ChainOpen ChainClosed ChainTibia Glides Anteriorly On thighbonethighbone Glides Posteriorly On TibiaTibia Glides Posteriorly On FemurFemur Glides Anteriorly On Tibiafrom 20o knee flexion to full extensionfrom full knee extension to 20o flexionTibia rotates externallyFemur rotates internally on stable tibiaTibia rotates internallyFemur rotates externally on stable tibiaTHE SCREW-HOME MECHANISMRotation between the tibia and femur occurs automatically between full extension (0o) and 20o of knee flexion. These figures illustrate the top of the right tibial plateau as we look down on it during knee motion.top of tibial plateautop of tibial pla teautop of tibial plateauDuring Knee Extension, the tibia glides 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.Prolonged 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 first 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. occur 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 arthri tis and various non specific arthritis. It relieves pain, provides mobility and correct deformity.Total knee replacement is a surgical procedure in which injured or damaged 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, exposed 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-Replacement.jpgThe total knee replacement can beUnicompartmental arthroplasty The Articular surface of femur and tibia, any the medial or lateral compartment of the knee are replaced by an implant. Eg osteoathritis.Bicomprtmental arthrop lasty 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 third compartment i.e.., the patellofemoral joint is however left intact.Tricomprtmental arthroplasty the articular surface of the lower femur, upper tibia and patella are replaced by prosthesis. well-nigh 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)INDICATIONOteoarthritisRheumatoid arthritisHemophilic arthritisTraumatic arthritisSero negative arthridesCrystal deposition diseasePigmented villonoular synovitisAvascular necrosisBone dysplasiasAsymmetric arthritsCONTRA INDICATIONAbsolute contraindications Recent or curren joint infectionSepsis or constitutionatic infectionNeuropathic arthropathyPainful solid 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 LooseningTibial tray wearperoneal Nerve Palsy 0.3% to 2%Periprosthetic Femur FracturePeriprosthetic Tibial FractureWound Complications / Skin slough rarePatellar Clunk Syndrome rarePatellofemoral imbalance 0.5%-29%DVTInstabilityPopliteal artery injury 0.05%Quadriceps Tendon Rupture 0.1%Patellar Tendon Rupture StiffnessFat EmbolismMCL rupture quest AND SIGNIFICANCE OF STUDYNeed of the interpretTo reduce flexion contractureTo repair range of motionTo improve functional activitySignificance of the studyThis study is to evaluate the efficacy of dynamic splinting for knee flexion contracture following 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 splintNull hypothesisThe aught hypothesis can be stated as follows there is no significant difference in knee flexion contracture after the application of dynamic knee splint.Alternate hypothesisThe hypothesis can be stated as follows there is significant difference in knee flexion contracture after the application of dynamic knee splint.2. REVIEW OF LITERATURE1. TOTAL KNEE ARTHROPLASTYSimon H Palmer, MD, Consultant Surgeon Sep 21, 2010 Osteoarthritis destruction of the knee is the most common reason for total knee replacement.Jayant joshi, prakash kotwal says that total knee replacement rel ieves 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).Department of orthopaedics, golden jubilee national hospital, clydebank, glasgow, g81 4hx, uk. One hundred and four continuous TKA were completed by a single consultant using the OrthoPilot (BBraun, Aesculap) navigation system 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 incarnate pre-op and 2 months 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 Physical Education, Recreation, Texas State University, Cases Journal 2008, Physical therapy alone did not fully reduce the contracture and dynamic splinting was then convinced(p) for daily low-load, prolonged-duration stretch.Finger E, Willis B 29Dec2008 Dynasplint offers extension constitutions to aid in rehabilitation and recovery from flexion contracture.Clinical studies have demonstrated greatest average simplification in rehabilitation time and cost with the use of Dynasplint Systems in conjunction with physical therapy.Willis FB Biomechanics.2008 Jan 15 After surgery, a patient is often left with trim down connective tissue and may have a difficult time walk of life normally again. Wearing a dynamic knee splint will lengthen 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 results as it allows a safe, long lasting remodeling of the soft tissue.Cli ffordr.Wheeless, Iii, Md.December3, 2008. The decision of this report is to polish up 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 Average 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 joint. There is no cure for arthritis, but physical therapy can make living easier and less painful.Brigham And Womens Hospital Department of Rehabilitation Services Physical Therapy . read-only storage on with proper soft tissue balance is required to cover proper biomechanics in the knee joint. Aggressive post-opera tive PT has been shown to be effective in improving patient outcomes and shortening length of stayBalint G And Sz Ebenyl.B Showed that remediation exercises decreases pain, increases muscle fatigue and range of motion as well as improve endurance and aerobic capacity. Weight reduction is proven in grave patients with OA of knee. Therapeutic heat and cold, electrotherapy, acupuncture are widely used.Dr. Margriet van baar reported that significant beneficial effects from exercise therapy including returns 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 net follow-ups, no difference in final range of motionByrne, et al. Clin Biomech October 2002 Deficits in knee effectuality balanced by increased hip extensor naturalize rehab should optimize bilateral hip and knee function after TKAMcManus et al 2006, Jorge et al 2006 the higher frequen cies (90-130Hz) to stimulate the pain gate mechanisms thereby mask the pain symptoms.Ozcan et al, 2004 Low frequency nerve stimulant 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 Taiwan University Hospital, November 2008 PNF stretching proficiencys has been used frequently for patients with total knee arthroplasty in clinical practice to increase range of motion effectively and reduced knee pain during exercise.Huei-Ming Chai, PHD November 24, 2008 PNF stretching technique is a therapeutic technique using 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 streng thHarold B. James H. Beaty, MD Range-of-motion exercises, muscle strengthening, gait training, and instruction in performing activities of daily living are important.5. GONIOMETRIC MEASURENT FOR ROMCarlos Lavernia, MD, Range of motion assessment done 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 sexual conquests using a goniometer provided an alter degree of accuracy, but results appear to be dependent on the clinician performing the measurement.Richard l. Gajdosik Associate Professor Physical therapists may accept most knee goniometric measurements as clinically valid, and the evidence indicates that most of these measurements are reliable.6. KNEE SOCIETY makeGil 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 published in CORR in 1989 and has become the standard clinical ev aluation 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 domineering and more objective.MD, Richard D. Scott, MD, and W. Norman It is hoped the knee society rating system will become universally accepted and will be adopted by all authors, even if they wish to report results using a customary scoring method as well.3. MATERIALS AND METHODOLOGYMATERIALSEvaluation toolGoniometryKnee society scoreOutcome measureRange of motionKnee scoreFunction scoreMaterial usedDynamic knee splintMETHODOLOGY(A) view design30 subjects with flexion contracture following unilateral TKA assigned in two sort outs.GROUP A15 subjects Dynamic Splint Along With stately 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 period of 6 months.(D) SamplingRandom sampling.INCLUSION CRITERIAAge 45 to 70 years.Both sexFlexion contracture 20 12 deg (post operatively)Unilateral TKAReduced flexibility in AROM of knee extensionPain that is worsened by bending over while legs are straight stricken gait patternAbility to understand informed consent and experiment responsibilitiesEXCLUSION CRITERIAFracturesBilateral TKATKA Knee sepsisOsteomyelitis or any orthopedic infectionextensor muscle mechanism dysfunctionPsoriasisKnee joint neuropathyPrevious Stroke or Brain InjurySTATISTICS TOOLThe data collected was analyzed using separatist 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 = Difference between pretest and posttest determine of radical IX2 = Difference between p retest and posttest values of root word II= take to be difference of Group I= Mean difference of Group IIn1 = No. of samples in Group In2 = No. of samples in Group IIS = Combined standard deviationTREATMENTDynamic knee Extension splintThe Rebound Effecthttp//www.dynasplint.com/uploads/user-uploads/rebound2.gif53% Average Reduction in term and Cost Associated with ROM RehabilitationHigh-force, short-duration stretching favors recoverable, elastic tissue deformation, whereas low-force, long-duration stretching enhances permanent plastic deformation. In the clinical setting, high force application has a greater risk of causing pain and possibly ruptures of 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 succes sfully treat joint stiffness and limited 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 have been successfully treated with Dynasplint SystemsConveniently labeled and easy to usePatient 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.After achieving this time goal, when you take the splint off if you have less th an 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 half to one full turn.During the process of regaining your range of motion, if you have any doubtfulness or concerns contact your Dynasplint consultant.http//www.wheelessonline.com/images/i1/imk11.jpgCONVENTIONAL TREATMENTMODALITIES FOR PAIN CONTROL, EDEMA REDUCTIONMoist HeatFunctional electrical stimulationTranscutaneous electrical stimulationIce therapyInterferential therapyGalvanic StimulationJOINT MOBILIZATIONFlexion restrictionPosition patient seatedPosterior glide of tibia on femur-grade 3 Oscillation with 30 second hold, Repeated 5 times with patellar mobilisation of inferior glides (5 mins)Extension restrictionPosition patient prone with patella off of tableAnterior glide of tibia on femur- grade 3 oscillation and static hold (10 secs in 3 repetitions) with patellar mobilization superior glides (5 mins )EXERCISE PROGRAMClosed and open kinetic chain strengthening exercisesProprioceptive/balance exercises targeting the trunk and lower extremity musculature overtone body weighted squatsGait trainingRange of motion exercisesHeel slide (supine sitting)Stretching (prone/supine) to increase knee extension ROMGAIT educational activityForward Walking locatingsteppingBackward or Retro-WalkingFUNCTIONAL raisingStandingTransfer ActivitiesLiftingCarryingPushing or PullingSquatting or CrouchingReturn-to-Work TasksENDURANCE TRAININGUpper body exercise.Ambulation activitiesOne-leg cycling, using non-operative leg with resistance to motion.BALANCE/PROPRIOCEPTION TRAININGTandem WalkingLateral Stepping over/around objectsWeight-Shifting ActivitiesClosed Kinetic Chain Activities5. DATA ANALYSIS AND INTERPRETATIONKNEE EXTENSION ROM GROUP IPre test(Two months after TKA)Post test(conventional PT with SPLINT)DifferenceX1160161611516214162141641214014140141411314113142121201212012121111211112111Mean=12. 93PRE TEST 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 TEST 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 B30.1MEAN DIFFERENCE BETWEENKNEE SCORE AND FUNCTION SCOREDEMOGRAPHIC DATATHE AGE OF THE SAMPLES BETWEEN 45 -70 YEARS IN EACH 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. DIS CUSSIONTotal 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 conservative 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 reducing 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 control 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 i n Group B, Conventional physiot