Dmch physiotherapy internship units

#পরিবারের মানুষ থেকে রক্ত নেয়া উচিত নয়।
শেয়ার করে মানুষকে সচেতন করুন।

Transfusion Associated graft versus host disease (TA-GVHD):
আমার পেশাগত জীবনের ৪র্থ মৃত্যু দেখতে হল রক্ত পরিসঞ্চানজনিত এই বিরল অথচ প্রায় শতভাগ মৃত্যুসম্ভাবনাযুক্ত জটিলতায়। এই ৪ জনের ৩ জনের ক্ষেত্রেই এই জটিলতার কারন নিকট রক্ত সম্পর্কীয় আত্মীয়ের থেকে রক্ত গ্রহন। এই ৩ জনের ১ম জন ও আজকের (শেষ) জনের রক্তদাতা পূ্ত্র আর ২য় জনের রক্তদাতা সহোদর ভাই। প্রথম জনের ক্ষেত্রে রক্তদাতা পূত্র ছিলেন একজন নবীন চিকিৎসক। সবচেয়ে মর্মান্তিক এই যে, এদের মধ্যে অন্তত প্রথম দুই জনের রক্ত পরিসঞ্চালন না করলেও চলত, সম্ভবত শেষ জনেরও তাই। TA-GVHD এর প্রধান ঝুঁকি ২ টি- (১) রক্ত গ্রহীতার রোগ প্রতিরোধ ক্ষমতার বিশেষ একটি ধরনের ঘাটতি, ও (২) রক্ত সম্পর্কীয় আত্মীয়ের থেকে রক্ত গ্রহন। এ বিষয়ে একাধিকবার বিস্তারিত লিখেছি যার মৌলিক দুটি নির্যাস আবারও বলি।
১) রক্ত পরিসঞ্চালন মারাত্মক অনেক জটিলতার জন্ম দিতে পারে বিধায় নিতান্ত জীবন রক্ষার প্রয়োজন ব্যতীত রক্ত পরিসঞ্চালন নয়।
২) নিকটাত্মীয়ের রক্ত নিরাপদ রক্ত- এই প্রচলিত ধারনা ভুল। রক্ত সম্পর্কীয় আত্মীয়ের রক্ত যদি নিতান্তই নিতে হয় তবে তা irradiate করে নিতে হবে।

Dr. Akhil Ranjon Biswas
Professor and Head
Department of Hematology
Dhaka Medical College Hospital

🦶 Foot drop 🦶
Foot drop is the inability to lift the forefoot due to the weakness of dorsiflexors of the foot.
➡The Dorsiflexors Muscles are the tibialis anterior, extensor digitorum longus, and extensor hallucis longus, help clear the foot during the swing phase of walking and control plantar flexion of the foot on heel strike.
➡Weakness in the ankle and foot dorsiflexors results in an equinovarus deformity. ➡Sometimes referred to as steppage gait, which is a tendency of a person walking with an exaggerated flexion of the hip and knee to prevent the toes from catching on the ground during swing phase.
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👌👌👌Etiology👌👌👌

1. Compression disorders: Entrapment syndromes of the fibular nerve at various locations along its anatomical pathway can lead to compressive neuropathy.
Sciatic nerve compression between the two heads of the piriformis muscle leading to foot drop has been reported.

Another common cause of foot drop is Lumbar radiculopathy. L5 radiculopathy is the most common lumbar radiculopathy and results from lumbar disc herniation or spondylitis in the spine.

2.Traumatic Injuries: They often occur associated with orthopedic injuries such as TKA , Fracture to tibial plateau . Patellar dislocations (33% chance of nerve damage) Ankle inversion injury. Sciatic neuropathy commonly resulting from either a traumatic injury of the hip or secondary to surgery is the second most common mononeuropathy of the lower extremity and typically presents with foot drop. Lumbosacral plexopathies, resulting from traumatic injury, a complication of abdominal or pelvic surgery, or a complication of neoplasm or radiation therapy is less common cause of foot drop.

3.Neurologic Disorders:

Charcot–Marie Tooth (CMT) is one of the most commonly inherited congenital demyelinating peripheral neuropathy. It affects both motor and sensory nerves. One of the main symptoms is foot drop and wasting of the lower leg muscles, giving a typical “stork leg” appearance.
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✍️✍️Clinical Presentation✍️✍️

1)Pain
Neurogenic pain can be experienced from damage to the common peroneal nerve.
This pain can be present over the lateral aspect of the knee as well as the dorsal part of the foot.
2) Sensory changes can also be experienced indicating nerve damage to the therapist.

🕵️‍♂️Diagnostic Procedure🕵️‍♀️

Subjective History:
Assessment of ankle dorsiflexion
Neurological exam
Gait assessment
Electromyography (EMG) / Nerve conduction studies

🦿🦿🦿Orthosis🦿🦿🦿

One way to improve function while the foot drop resolves is the use of splinting.
A solid ankle-foot orthoses (AFO) or foot-up splint can be used to keep the foot in plantar-grade.

🏋️‍♂️🏋️‍♂️Exercise🏋️‍♂️🏋️‍♂️
Physiotherapy interventions normally are focused on graded exercises to encourage active dorsiflexion and muscle recruitment. These exercises have been shown to prevent atrophy and speed up recovery but more research is needed.

1:- Towel Stretch

Sit on the floor with both legs out in front of you. You may also do this exercise while sitting in a chair.Loop a towel around the ball of your affected foot and grasp the ends of the towel in your hands.Keep your affected leg straight and pull the towel toward you.Hold for 30 seconds, then relax for 30 seconds. Repeat.

2:- Ankle Dorsiflexion & Planterflexion

Sit on the floor with your legs straight out in front of you. You may also complete this exercise while sitting in a chair.
For dorsiflexion, anchor the elastic band on a chair or table leg, then wrap it around your foot. Pull your toes toward you and slowly return to the start position. Repeat.
For plantar flexion, wrap the elastic band around your foot and hold the ends in your hand. Gently point your toes and slowly return to the start position. Repeat.

3:- Marble pickup

Sit with both feet flat and place 20 marbles on the floor in front of you.Use your toes to pick up one marble at a time and place into a bowl.Repeat until you have picked up all the marbles.

4:- Ball roll
Sit on a stable chair with both feet planted on the floor.Roll a golf ball under the arch of your affected foot for 2 minutes.

5:-Calf raise
Stand with your weight evenly distributed over both feet. Hold onto the back of a chair or a wall for balance.Lift your unaffected foot off of the floor so that all of your weight is placed on your affected foot.Raise the heel of your affected foot as high as you can, then lower.
Repeat.
6:- Balance exercises

Balance exercises are also used to treat the condition. The main goal of physical therapy for foot drop is to improve functional mobility related to walking. This can ensure that you are able to get around safely and may lower your risk of falling

7:- K.tapping
Take a piece of kinesio tape, and start on the outside of the ankle, about 4 to 6 inches above the ankle. Create a stirrup-like effect as you take the piece of tape over the heel, pulling the tape to the opposite side, over the inner aspect of the ankle, and stopping at the same level as the first piece of tape.
Put another piece of tape on the back of the foot, centering it with your Achilles (heel) tendon. Wrap the tape around the ankle to circle it around the foot. The tape should be tight enough so the foot bends, yet still feels supported.

In neurologically impaired patients such as Charcot‐Marie‐Tooth disease improved with strengthening exercises to tibialis anterior, however, other neurological diseases like muscular dystrophy strength training was not found to be effective at reducing the foot drop.

Preventing contractures and stiffness is also an important maintenance goal of physiotherapy as this is likely in neurological disease patients more so than after trauma to the knee.

➡Electro-stimulation of the affected muscle groups has also been shown to improve recovery times.stimulation of the peripheral nerves that supply the paralysed muscles using electrodes placed on the surface of the skin. In the case of foot drop the peroneal nerve is stimulated resulting in dorsiflexion and eversion of the ankle.
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🔪🔪🔪Surgery🔪🔪🔪
Direct repair of the common peroneal nerve is possible for surgical intervention however, this has been shown to have poor outcomes with residual foot drop leading to further surgery.

In extreme cases tibialis posterior can be transposed to regain active dorsiflexion by using the tendon not innervated by the common peroneal nerve, this surgery has been shown to be more successful than nerve repair.

Physio Syed Didar.
Ex-Honoray physiotherapist dhaka medical College hospital.
🔊+8801675762547.

.D Physiotherapy and rehabilitation center.

🦠🦠🦠Cervical myelopathy results from compression of the spinal cord in the neck (cervical area of the spine).

⏩⏩The neck symptoms may include:

1⃣ Neck pain

2⃣ Stiffness

3⃣ Reduced range of motion

4⃣ Weakness in the arms and hands

5⃣ Numbness or tingling in the arms and hands

6⃣ Clumsiness and poor coordination of the hands

7⃣ Difficulty handling small objects, like pens or coins

8⃣ Balance issues
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👉Diagnosis:-

A)) Physical examination
B)) MRI scan
C)) X-ray
D)) CT myelogram of your neck.
E)) EMG

🪬PHYSICAL THERAPY MANAGEMENT🪬

🔲1.CERVICAL ROTATION AROM 🔲

Stand with your hands on your hips to ensure you keep the shoulders still throughout this neck warm-up exercise.
Gently turn your head to look over your left shoulder, then the right.
Gradually increase the amount of movement.

🔲2.DIAGONAL PNF WITH BALL🔲

Stand with your weight on your left leg and right leg held off the floor.
Squat down with the ball on the outside of your left foot. Follow the ball with your gaze, ensuring that your knee travels directly over your foot.
Stretch up and twist your upper body so that the ball moves high up to the right. Follow the movement of the ball with your gaze.
Repeat the exercise. Then do the same movement with your weight on your right leg.

🔳3.SINGLE LEG STABILISATION🔳

Stand on one leg and bent forward at the hips allowing the opposite leg to straighten behind you.
Roll a ball using one hand in different directions. Keep a straight neck and back.

🔳4.CERVICAL RETRACTION🔳

Stand up straight and place the middle of a resistance band around the back of your head.
Hold the two ends in each hand in front of you.
Tuck your head back, making a gentle double chin.
You should feel the crown of your head push back into the band.
Ensuring there is always some tension in the band, keeping your head still shake the band forwards and backwards.
The aim of this exercise is to keep your head in the same position while the resistance of the band tries to pull it forwards.

🔲5.SUPERMAN ON A BOSU BALL🔲

Lie on your front on a half ball with arms overhead.
Extend your arms straight out in front of you, and activate your core stability muscles.
Simultaneously lift both arms and both legs, clenching your buttock muscles and your lower back muscles.
In a controlled manner return to starting position.
Maintain a neutral alignment with your head throughout the movement.

🔲6.Chin to chest🔲

Sit upright in a chair or stand with the shoulders and spine straight.
Slowly tilt the head so that the chin can rest on the shoulder.Gently tense the neck muscles.
Hold for 5–10 seconds, return to the center, and repeat on the other side.Repeat 2–4 times.

🔲7.Head tilt (side-to-side) stretches🔲

Sit in a chair with the neck and back straight.
Slowly tilt the neck toward the shoulder, leading with the ear.Gently tense the neck muscles.Hold for 5–10 seconds, return to the center, and repeat on the other side.Repeat 2–4 times.

🔲9.Cervical SNAGs | Neck Extension Mobilisation Exercise🔲

Use a strap, belt, or towel. Place the belt behind your neck, at the required level as guided by your therapist. Move your chin forwards and extend your neck and use the belt to assist. Perform within the pain-free range. This will help improve extension in your neck. Repeat 10 reps, for three sets.

🔹🔹 Cervical decompression / traction 🔹🔹

🔹🔹TENS to reduce pain 🔹🔹

🔹🔹Heat therapy to reduce Stiffness & pain.

craniosacral therapy

🔹🔹 Massage Therapy: 🔹🔹
soft tissue release, deep friction massage, myofascial release, trigger points release

🔹🔹Pain Relief Therapy: 🔹🔹
Ultrasound , electrical stimulation, laser, heat therapy

🔹🔹Spinal Decompression Therapy: 🔹🔹
Using computerized system creates an anti-gravity, negative pressure to the cervical spine on the spinal disc, joints, nerves and muscles.

🔹🔹 Shockwave Therapy:🔹🔹
Advanced high energy pulses effective for chronic, persistent neck muscle tightness, trigger points to stimulate healing

🔹🔹 Strengthening of arm and neck 🔹🔹

🔹🔹Balance training Exercises🔹🔹

🔹🔹Gait training Exercises🔹🔹

.D Physiotherapy and rehabilitation center

# Physio Syed Didar
Ex- Honourary physiotherapist DMCH.
Contact : 01675-762547

S.D Physiotherapy and rehabilitation center 1. UST.
2.TRACTION.
3.TENSE.
4.IRR.
5.IFT.
6.SHORT WAVE DIATHERMY.
7.MICROWAVE DIATHERMY.
8.LASSER

Special tests must be at your finger tips.
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CERVICAL RADICULOPATHY
( Tests And measures , Rehabilitation , Functional goals )

Tests And measures :

• Cervical spine AROM
• Sharp–Purser: Atlantoaxial instability
• Cervical passive intervertebral motion testing
• Sub-cranial translation instability testing
• Passive physiological intervertebral mobility testing (PPIVM)
• Upper-extremity screening examination
• Postural examination
• Muscle length testing, including upper trapezius, levator scapulae,
pectoral muscles
• Upper limb nerve tension test
• Neck Disability Index (NDI)
• Deep neck- exor endurance test
• Upper-extremity neurological screen
(dermatome, myotome, reflexes)

Rehabilitation :

• Rest
• Joint manipulation to the thoracic and upper-cervical spine
• Cervical distraction and traction to relieve nerve compression
• Cranio-cervical exion exercises
• Periscapular strengthening
Periscapular meaning ( serratus anterior , levator scapula , pectoralis minor , rhomboids, and trapezius )

• Address pain

○ Electrical stimulation
○ Heat/Ice to increase mobility
• Address hypertonicity
○ Soft tissue massage
○ Heat
• Address muscle weakness
○ Deep neck-flexor training
○ Strengthening of lower/middle trapezius, rhomboids, rotator cuff
Serratus anterior, latissimus dorsi

Functional Goals :

• Patient will be able to
○ Sit with a neutral cervical and thoracic spine posture for > 30
minutes with 0/10 pain rating.
○ Patient will be able to sit at work station and perform computer
work for 45 minutes with 0/10 pain rating.
○ Patient will be able to rotate cervical spine 70 degrees to talk on
phone with 0/10 pain rating in the neck or arm.

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Structures on the lateral aspect of the knee joint

Osteoarthritis ( X-ray )
Quick Review

EXERCISE FOR ERBS PALSY BABY.

✅ PHYSIO IN KNEE OSTEOARTHRITIS.

Physiotherapy has become an important part of health care. Since its inception, the numerous approaches applied in the management of ailments have yielded little to no adverse effects.

One of the conditions physiotherapy can help manage is knee Osteoarthritis.Knee Osteoarthritis is a degenerative condition.
It occurs when the cushion at the knee joint known as articular cartilage wears out or degenerates.

The knee joint is one of the most weight bearing Joints. It is formed by two big bones; femoral and tibial bones. There is a cartilage and meniscus on the femoral and tibial bone respectively providing cushion at the bony surface, preventing direct bony contacts. In knee osteoarthritis, this cartilage gradually wears out leading to direct bony contact and consequently lead to excessive pains, stiffness and weakness in the knee joint.

Most Physiotherapy approaches which are utilized in the management of knee osteoarthritis will not cause regeneration of the worn out articular cartilage.The rate at which the cartilage degenerates, will be minimized. Furthermore, most of the approaches help minimize pt pains, and restore ample strength that largely provides stability in the joint. This by large contributes to the possibility of reduced cartilage degeneration.

➡️PAIN MANAGEMENT

Managing pain associated with knee Osteoarthritis is an important part of making the individual active as much as possible.

There are established ways Physiotherapy can help you manage your knee pains not limited to exercise prescription. The use of modalities such as cold and heat packs, Infrared radiation, shortwave diathermy may be helpful in managing your pains.

Clinically, it is always safer to use cold therapy for acute pains and heat therapy for chronic pains. Usually, acute pains have lasted for about few days to few weeks whilst Chronic Pains have lasted more than 3 months to years. Figure 8.

Exercises are also helpful in pain management. When you perform an exercise,the body releases natural pain Killers called enkephalin which help minimize pain. Most of these Exercises pt with knee osteoarthritis can perform can be revised from the attached images. Largely, some of these Exercises help promote strength in the surrounding muscles like Quadriceps and hamstrings so that they provide stability in the joint during activities.

This will help reduces the rate at which the cartilage degenerates.

KNEE, ANKLE PAIN REHABILITATION EXERCISES.

KNEE OSTEOARTHRITIS AND PHYSICAL THERAPY

A 2000 study revealed that a combination of manual physical therapy and a supervised exercise have functional benefits for patients with knee osteoarthritis and can delay or prevent the need for surgery.

Physiotherapy can help reduce your pain, make your knee joint more functional, reduces stiffness and helps you with weight control too.

Physiotherapy cannot help in your worn out cartilage regeneration, but can help reduces further damage.

One might think that engaging in exercises will make their knee hurts the more but this should be a myth and be disregarded once and for all. Many people with knee osteoarthritis live a pain free life after going through physiotherapy.

Just as medication does to relieve you from pain, protocols from physical therapy for your knee OA do same and adds even more health benefits.

Most of the physiotherapy protocols are based on the severity of the knee OA. There’s however not a generalized treatment for knee osteoarthritis. In all, your physical therapist will do thorough assessment to determine the state of your condition, whether mild, moderate or severe. He will then set your treatment plan based on your state.

The main goal of physiotherapy is to help reduce the pain, improve and maintain knee Rom, strengthen surrounding muscles and facilitate mobility. As a result, most of the treatment protocols from your physical therapist may be geared towards helping you achieve these benefits.

These may involve;

HEAT AND COLD THERAPY
Heat is known to be a pain relieving modality. When heat is applied to a specific area of the body, there is improved circulation in the area. Heat also help stimulate your body to release natural pain killers such as endorphins, enkephalins and more which help minimize your pains.
In the case of knee osteoarthritis, heat application will also warm the joint and make it more labile and flexible. Since heat improves circulation, it may worsen an inflammation and will not be the best choice for pain management in the acute phase of knee osteoarthritis. Hence Cold therapy comes in there.

As cold reduces circulation, it reduces inflammation and swelling in the knee joint, especially in the acute phase of the condition. It also has a pain relieving effects.

STRENGTHENING EXERCISES
Strengthening the knee joint will also helps in reduces pain in the knee. Engaging in exercises can help promote the strength of muscles that surround the knee joint. This help ease lot of pressure from
your knee joint and prevents further cartilage destruction.
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FLEXIBILITY EXERCISES
Special ROM exercises can help reduce knee stiffness which is one of the commonest feature of knee osteoarthritis. Stiffness in the knee joint will affect mobility and worsen one’s pain.

HYDROTHERAPY
Hydrotherapy is an exercise done in a pool of water.
The idea of exercising in water is based on certain properties of water like buoyancy, viscosity and hydrostatic pressure. Based on one’s symptoms and needs, a physical therapist can recommend hydrotherapy as part of your treatment.

AEROBICS

This is also very significant to most patients living with knee osteoarthritis. Due to the pain, many knee osteoarthritis patients becomes glued to sedentary living and this affects their endurance level. Enraging them into endurance activity will help them to be able to cooperate with many physical activities without getting tired early.

PULSE SITES:

Pulse is defined as the number of heart beats in a minute. It is measured in beat per minute-bpm

There are certain areas on our body where we can feel the beat of the heart when we place our fingers on those sites.
These areas are pulse sites.
This post highlight the areas to you.
If you are able to locate the pulse site, it is then up to you to know the right way to check the pulse manually.
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By getting your stop watch ready with you, set a minute duration. Get one of these pulse sites,and place either your thumb or two fingers; index and middle finger over the site.

You may press down on the part slight to put slight pressure over the artery in question to help you feel the beat well in the course.

Now, start your stop watch and begin to count the beat till the minute duration from your stop watch gets exhausted.
The number of beats you had in the one minute duration count down represents the number of beat your heart pumps blood in a single minute.

Usually an average normal pulse rate is 72 b.p.m.
Phusio syed didar. Hotline :01675762547.

Frozen Shoulder: Post 3

⚛️Stages of Frozen Shoulder

🛐There are 3 stages of frozen shoulder.

1️⃣Acute/freezing/painful phase:

♿Gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhere from 2-9 months.

2️⃣Adhesive/frozen/stiffening phase:

♿Pain starts to subside, progressive loss of GH motion in capsular pattern. Pain is apparent only at extremes of movement. This phase may occur at around 4 months and last til about 12 months.

3️⃣Resolution/thawing phase:

♿Spontaneous, progressive improvement in functional range of motion which can last anywhere from 5 to 24 months. Despite this, some studies suggest that it's a self limiting condition, and may last up to three year. Though other studies have shown that up to 40% of patients may have persistent symptoms and restriction of movement beyond three years. It is estimated that 15% may have persistent pain and long term disability. Effective treatments which shorten the duration of the symptoms and disability will have a significant value on reducing the morbidity.

🔦 OCCIPITAL NEURALGIA

Occipital Neuralgia or C2 Neuralgia is a form of headache in which there is throbbing electric-shock like pain in upper neck, back of head, and behind ears generally occurring on one side of head. The pain generally begins in neck and then slowly radiates upward. Some people may also have pain in forehead, scalp, and behind eyes and there maybe tenderness in the scalp and eyes become sensitive to light. The pain is located in areas supplied by greater and lesser occipital nerve, which runs from area where spinal column meets neck to scalp at back of head.

Occipital Neuralgia or C2 Neuralgia can often be confused with migraine or other types of headache because the symptoms can be similar, but occipital neuralgia is a distinct disorder that requires an accurate diagnosis to be treated properly.

There Are Two Major Types of Occipital Neuralgia or C2 Neuralgia:

🔎 Greater Occipital Neuralgia: Greater occipital neuralgia is a common type of posttraumatic headache, but is also seen in patients without injury. The pressure, aching, stabbing, or throbbing pain may be in a nuchal-occipital, temporal, parietal, frontal, periorbital, or retro-orbital distribution. The headache may last for minutes or hours to days and can be unilateral or bilateral.

🔎 Lesser Occipital Neuralgia: Lesser occipital neuralgia is similar to that of greater occipital neuralgia, but the pain generally refers more laterally over the head.

The pathophysiology of Occipital Neuralgia or C2 Neuralgia is unknown although it may by secondary to whiplash injuries as well as systemic or local diseases. It is believed to be related to increased muscle activity in the cervical region or entrapment of the second cranial nerve root by paravertebral structures.

Occipital Neuralgia or C2 Neuralgia can be caused by multiple different factors the most common cause being a head trauma. Neck injury such as a whiplash may result in damage and inflammation to the occipital region causing pain and nerve irritation. Occipital Neuralgia or C2 Neuralgia may be caused due to pinching or entrapment of the nerve root in the neck with the most common causes being tumors, tight muscles, and some spine conditions. Diabetes or gout may also cause occipital neuralgia, but are less common. However, the cause is unknown is some of the cases.

🔎 Symptoms for Occipital Neuralgia or C2 Neuralgia May Include:

- Burning, aching and throbbing pain that starts typically at the base of the head and radiates to the scalp
- Pain can be on one side or both sides of the head
- Sensitivity to light
- Pain behind the eye
- Scalp tenderness
- Pain when moving the neck.

🔑 Treatment of Occipital Neuralgia

- Pain killers
- Applying heat to the neck
- Resting in a quiet room
- Massage of the tight and painful neck muscles
- Muscle relaxants
- Surgery.

Dmch physiotherapy internship units updated their website address.

Most Equipments using in Pediatric Rehabilitation center.

PHYSIOTHERAPY IN VOLKMANN’S CONTRACTURE.

The main goal of physiotherapy in volkmann’s contracture will geared towards improving Rom of the joints of fingers, and wrist of the affected hand.

Physiotherapy will also help minimizing the rate at which the intrinsic muscles of the hand may atrophy and get weakened. It will also helps facilitate functioning of the affected hand using certain fine motor and gross motor skills.

Therefore, therapists can adopt certain strategies to achieve most of these goals which could either involve the under-listed.

The wrist is splinted for 3–4 weeks in slight extension to prevent adhesion between nerve and scar post surgery. It is important to ensure that the mobility is recovered through: Gentle mobilization of the peripheral joints, Range of motion exercises to enhance soft tissue elasticity, and Passive stretching techniques. In instances where cast is feasible, it should be used either as long serial cast will be effective to render prolong stretch to soft tissues that are contractured to improve ROM.

Activating and strengthening the weak agonist to ensure equilibrium in agonist and antagonist pull during joint movement will be crucial part of physiotherapy management. This can be achieved by using hand and grip exercises using squeeze ball.
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Also, Progressive Splinting, passive stretching and tendon gliding can also be done to purposefully elongated contracted muscles and improve joint ROM. Massage used in mild to moderate cases of Volkmann's contracture can also be helpful to cause soft tissue relaxation.

Training affected muscles with cooperativity using an electromyographic device will help the patient to get feedback

CUBITUS VALGUS

In this elbow deformity, the elbow is angulated extremely to the lateral side of the body.

The angle formed by this deformity exceeds the carrying angle of 15 degrees.The carrying angle which the ulnar bone forms with its articulation with the humeral bone ranges from 10-15 degrees in females and 5 degrees in males. This is the normal angle for both genders.

However, in cubitus valgus, when the arm is straightened or put forward, so that the elbows are extended, there is more obvious valgus deformity which goes beyond the normal carrying angles.

Cubitus valgus does not necessarily needs treatment but most of the cases, treatment must be done especially if the it causes pain to the patient.

The actual causes of this deformity is not well established, yet the most commonest predisposing factors can be related to genetic abnormalities.

For example, the condition is known to be common amongst people who go through Nanoon and Turner syndromes.

Turner syndrome is a chromosomal disorder in which a female is born with only one X chromosome. People with Turner syndrome experience a number of other symptoms, including short stature and delayed puberty. Treatment usually involves hormone replacement therapy.

Noonan syndrome is another genetic disorder that results in delayed development. It’s usually caused by a genetic mutation, but sometimes doctors aren’t sure why it develops. While there’s no cure for Noonan syndrome, there are a number of treatments that can help minimize its effects.

In some cases where cubitus valgus will require massive treatment, the problem has resulted to ulnar neuropathy where the ulnar nerve gets irritated due to the impingement from the ulnar bone or extreme stretch to the nerve.
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Furthermore, ulnar nerve palsy can also be another complication that will warrant massive treatment. This ulnar nerve palsy can causes lots of uncomfortable symptoms, like burning sensations, tingling sensation, pain and weakness, which can be more common in the dermatome of the ulnar nerve.

In very extreme cases such as that, surgery can be done to correct the deformity to relieve the nerve of pressure and to aid comfort.

This surgical procedure can be osteotomy or
fixation. This will be adapted only when conservative management fails to provide great change to the condition.