MEDICAL AND SURGICAL CONDITION

PHY 204

BY

POMA JOSEPH IM

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 INTRODUCTION TO MEDICAL AND SURGICAL CONDITION

MEDICAL CONDITION: This are conditions as a result of body reaction to a disease processes,
infections,virus,bacterials,neurological disorder etc. Examples are poliomyelitis, facial nerve palsy,
CVA(stroke), cerebral palsy, burns, amputation, Obstetrics/Gynecology, Edema etc

SURGICAL CONDITION: These are condition related to sudden attack on body tissues or organs,
accident (local or RTA), violence. Examples are: LBP, Peripheral nerve injuries, fracture, soft tissue
injuries, degenerative athropathies (OA), spinal cord injuries, sport injuries, prolapsed intervertebral disc
lesion (PIVD)

ROLES OF PHYSIOTHERAPY IN OBSTETRICS

a. To assist in physical health and identify any musculoskeletal or neuromuscular problem that
could be aggravated by pregnancy e.g. A woman with history of back pain needs the following:
1. Strengthening of weak muscles and mobilization of stiff joint
2. Teach leg exercises to keep circulation moving
3. To prevent varicose vein formation if patient life style involve standing for a long period
4. Teaching of abdominal contraction exercises
5. Pelvic tilting and posture awareness are also thought in various position
6. Pelvic floor contraction are thought in stride sitting.
b. Advice on continual sports and walk and how to recognize fatigue, muscle arch etc
c. Advice on back arch and lifting eg. Postural correction and treatment of post-natal back pain
resulting from stress or posterior back muscles and ligaments.
d. Treatment of neuromuscular and musculoskeletal problems eg. (i) sacro-illiac pain and (ii) pubic
pain.
e. Lumbar pain: May be ease by soft tissue kneading and mobilization.
f. Cramps : Occurs on calf muscle. Relieve by slow-sustained stretch on the muscle and pushing the
foot and the ankle into dorsiflexion.
g. Bladder control: Strong pelvic floor muscles are needed to support the ever-increasing weight of
the abdomen. If muscles are weak, a slight dribble of urine can occur, when the abdominal
pressure is treated in coughing, sneezing, laughing and lifting. Also previous pregnancies make
the women more likely to have the problem.
h. Teaching post-natal exercise: The importance of this is to regaining fitness and prevent long term
problems like: abdominal weakness, back ache and stress incontinences interferential therapy.
i. Giving post-operation care following a Caesarean section egg. Teaching coughing and huffing

AIMS OF PHYSIOTHERAPY IN GENERAL POST AND PRE-OPERATIONS

1. To teach breathing exercise

2. To prepare patient pre- to operation
3. To teach posture correction.

THROMBOSIS (from ancient Greek means ‘’Clotting’’) : This is the formation of a blood clot inside the
blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (vein and
artery) is injured, the body uses platelet and fibrins to form a blood clot to prevent blood loss

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TYPES OF THROMBOSIS

There are two main types of thrombosis:

1. VENOUS THROMBOSIS: This is when the blood clot blocks a vein. Veins carry blood from the
body back into the heart
2. ARTERIAL THROMBOSIS: Is when the blood clot blocks an artery. Arteries carry oxygen-rich
blood away from the heart to the body

CAUSES OF THROMBOSIS

VEINOUS THROMBOSIS

a. Sedentary (immobility) due to bed rest , sitting too long

b. Obesity
c. Disease or injury to the leg vein
d. Fracture
e. Genetic or inherited disorders
f. Autoimmune disorder that make it more likely to clot blood
g. Certain birth control medicines increase risk of clotting.

ARTERIAL THROMBOSIS: May be caused by :

a. Arteriosclerosis (hardening of the arteries as a result of calcium or fatty deposit)

b. A lack of exercise
c. Regular drinking of excessive amounts of alcohol
d. Smoking
e. High blood pressure, high cholesterol and diabetes

SYMPTOMS

1. Pain in one leg(usually the calf or inner thigh)

2. Swelling in the leg or arm
3. Chest pain
4. Numbness or weakness on one side of the body

COMMON SITES OF THROMBOSIS

This are in the vein, around the heart when it loses it function.(subclavian, brachialveins, auxillary etc

EFFECTS OF THROMBOSIS

The primary effect of thrombosis is ANAEMIA, but it general effect depend upon the vessels affected. It
is worst in the heart and brain because any slight disturbances in blood supply will lead to loss of life.

TREATMENT

a. Blood thinner or anticoagulants makes it hard for blood to clot. This means the possibility of
having clots will reduce in the body.

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 b. Compression stockings
c. Venacava filter

PHYSIOTHERAPY TREATMENT

1. COMPRESSION THERAPY: (using socks below the knee): Which help to reduce swelling and
improve circulation.
2. MASSAGE THERAPY: Helps improve the body stimuli in the tissue and veins to increase
circulation prevent clotting.
3. AEROBIC EXERCISE: Such as walking, running and hiking can help strengthen the muscles
circulation by reducing discomfort and swelling.
4. STRETCHING of the leg, ankle and feet can help reduce pain and swelling and increase blood
flow
5. ANKLE CIRCLES: Can help increase movement and circulation in the feet.

EMBOLISM

An Embolism is a foreign body circulating in the blood stream. When it enters a vessel too small to allow
it to pass, it becomes impacted and block completely to the vessel there by producing ANAEMIA. An
Emboli is a dislodge thrombus which floats in the vessel. Another example of embolism is when a portion
thrombus breaks away from the left atrium.

CAUSES

a. SMOKING: This narrows and damages the lining of the blood vessels making it more likely for
blood to form
b. ARTEROSCLEROSIS: A build up of cholesterol plaque in the wall of arteries, causing
obstruction of blood flow
c. Obesity
d. OLDER AGE: The elderly are at increase risk for pulmonary embolism because of the
immobility that accompanies them
e. High blood pressure.

CLINICAL FEATURES

1. Chest pain and cough

2. Breathing difficulties
3. Cold, numbness of the limbs and muscle pain
4. Palpitation
5. Haemoptysis

SITES

a. Venous or Arterial system

b. Arterial emboli occur in the leg and feet
c. Brain embolism causes stroke
d. Heart embolism causes heart attack

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TREATMENT

PHYSIOTHERAPY MANAGEMENT

(A)Mobility is vital to patient recovery

The main aim of physiotherapy is to restore a clear lung field through CHEST PHYSIOTHERAPY:

a. Effective/productive coughing techniques

b. Postural drainage in sitting and lying
c. Manual assistance including percussion, vibration and shaking
d. Encourage walking exercise daily

OEDEMA

This is the tendency of fluid to accumulate into the intercellular tissue space, or A build up of fluid in the
body which causes the affected tissue to become swelling. The movement of fluid into the blood vessel
are pass into a tissue space through the permeable wall of the capillaries, it is here that the waste product
from the tissue wall are removed into the systemic circulation (blood stream). At the beginning, excess
fluid are absorbed into the cell rendering the firm, but when fluid can no longer be absorbed it is collected
into the tissue space or cavity, at this time, Edema is said to set in.

STAGES OF OEDEMA

1. LOCAL OEDEMA
2. GENERAL OEDEMA

TYPES OF OEDEMA

a. Oedema of the chest –HYDROTHORACIC

b. Oedema of Abdomen- HYDROPERITONEUM
c. Oedema found in tissue space- INTERCELLULAR OEDEMA (local/general)
d. Oedema of the heart- HYDROPERICARDIUM
e. Oedema of the head- HYDROCEPHALUS

CAUSES OF OEDEMA

(A)GENERAL: This is Oedema of the whole body tissues contains. Several FACTORS that could lead to
general occurrence of Oedema are as follows:

1. CARDIAC FAILURE:

2. KIDNEY FAILURE;

. STARVATION

(B) LOCAL: This is Oedema of a localized body part arise as a result of traumatic injuries. Eg bleeding is
involved and swelling is set in because of the influx or increase of blood moving into an area to arrest the
invading organism or to engulf the injured area and to form clot.

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LOCAL CAUSES

1. GRAVITY: An important factor in determining the site of Oedema. Even in healthy people
oedema of the leg and feet can occur if the limbs remain dependent for too long, as in a long
flight. Change of posture can be of great importance in controlling oedema
2. INACTIVITY; The venous return especially from the legs depends on compression of the vein by
muscular activity. If the muscles are inactive, the venous return, the venous capillary pressure is
raised and so oedema occur.
3. VARISCOSE VEIN: A medical condition in which superficial veins become enlarged and
twisted. This greatly impair venous return from the legs.

OTHER CAUSES ARE:

a. Increased venous blood pressure

b. Reduced plasma protein, osmotic pressure
c. Increase permeability of the capillaries wall, allow more protein
d. Increase osmotic pressure of the tissue fluid
e. Obstruction of lymphatic drainage

CLINICAL FEATURES OF OEDEMA

1. Mild pain or a sore feeling in the affected area

2. Difficult in walking if your leg,ankle or feet swelled
3. Swelling or puffiness of the tissue right under the skin
4. Stretched or shinny skin
5. Coughing or have trouble breathing
6. Tightness in your swelling body part
7. Skin that holds a dimple, also known as pitting after its been pressed for a few second.

SITES

Oedema can affect any part of the body, but likely more in the legs and feets, ankles, hands and arms

TREATMENT: There are certain objectives that should be borne in mind, they are the AIMS of the
treatment. This is dependent on the types of Oedema. Things to put in consideration in the treatment of
Oedema are:

- As much as possible, reduce pain

- Discourage fibrous formation
- Encourage venous return through the lymphatic gland
- Improve mobility

PHYSIOTHERAPY TREATMENT OF OEDEMA

a. Application of ice therapy in acute phase

b. Application of gravitational force: Elevation of the oedema above the heart. Don’t place the
oedema area below, so that gravitational force of the body weight falls more on the area.

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 c. Application of heat therapy above the edematous area proximal to the lymphatic glands. In
treating oedema with heat, apply infrared heat proximal to the site of oedema(Above the oedema
area nearer to the heart). Application of heat is necessary because it increases the lumen of blood
vessel eg (vasodilatation of blood vessel).
d. Application of massage manipulation: Application of massage therapy is necessary because, after
increasing the lumen of the above blood vessels by heating. Effleurage massage is applied to
drain the fluids to the heart.
e. Application of crepe bandage (compression and Immobilization) to reduce more fluid from
flowing into the area, after massage, apply crepe bandage above the oedema to decrease the
swelling by tying the area. It must not be too strong but firmly done for circulation
f. Muscular Contraction: Muscles contraction is gained through exercises. When the muscles
contract, it squeeze out fluids from the tissue space. But when it cannot be contracted through
exercises, stimulating machines is used to contract the muscles artificially.

INFLAMMATION

This is the body reaction to external injury, infection or disease condition or an irritation extended by pain
or swelling. Or when any part of the body tissue reacts to foreign body or to a sudden attack.

If this happens natural tendency to repair or try to regenerate to the normal functioning is done in 2 ways:

a. Removal of the foreign body

b. Repair of tissue damaged

CLINICAL FEATURES

- PAIN: When an area is inflamed, the area tend to be painful due to some waste product deposited
by invading bacteria(poison) or by continuous irritation of the bacteria itself or when more
tissue damaged is involved.
- SWELLING: The body soldiers r migrate to an inflamed area through the blood stream (blood
cells) to repair and invade or engulf the foreign body. Secondly, there is tendency that the tissue
around heed more food particles and so more blood flows into the area. When more blood flows
than normal, it gives rise to swelling. Waste product of the foreign body tends to generate the
swelling rate
- REDNESS: Redness in inflammation is mostly witness in fair patients because as more and more
blood flows into the area than normal, changes in color arises, the amount of red blood cells that
migrate are more in number. Blood color is red.
- LOSS OF USED: Because the point affected is in pain, there would be the tendency that the area
is not put to used and when this happen, muscles around the area may waste away or atrophy.
- INCREASE IN TEMPERATURE: Increase in temperature may occur because of high rate of
metabolism. More food moves to the affected area, increase waste products. An increase in rate of
metabolism will increase the temperature of the inflamed area as more blood moves in (arterial
blood).
- TENDERNESS: The inflamed area will be tender (heavier}.

CAUSES OF INFLAMMATION

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 1. PATHOGEN (germs): like bacteria, virus or fungi
2. EXTERNAL INJURIES: like scrapes or damage through foreign object eg. A thorn in your
finger.
3. EFFECT OF CHEMICAL OR RADIATION.

PATHOLOGY/CHANGES IN INFLAMMATION

These are some of the changes that tend to arise within the tissues that are inflamed:

a. The blood vessels widen or dilate: It is the capillaries and the renal vessels that dilate due to
more food particles that are needed to repair tissues enters into the veinules and food is collected
into the tissue through the capillary.
b. There would be slow down of flow of blood into the area due to the struggling of blood flow into
the area.
c. The blood vessels wall stretches and its wall open up. This will enhance bigger cells to pass into
the tissues spaces. These bigger cells include macrophages. When monocytes move out of the
vessel into the tissue space, they are called MACROPHAGES. The moving out of this
macrophages are called EMIGRATION. The escape of fluid (plasma) from the opened walls of
the capillary vessels is EXUDATION. Macrophages are cells that can engulf bigger
objects(bacteria)

STAGES OF INFLAMMATION

There are three main stages of inflammation which can each vary in intensity and duration.

1. ACUTE: (swelling stage)or immediate inflammation-During this stage, there is evident erythema
(redness & swelling) due to vascular changes. Exudation of cells and chemicals cause swelling
and pain. This phase last for 3-5 days after injury.
2. SUB-ACUTE or Repair and Regeneration stage: Is the commencement of healing and repair.
Noxious chemical are further neutralized and new capillary bed growing into the damaged areas
are supported by connective tissue growth. Visible sign of inflammation start to subside and
range of movement increases with pain felt at the point of tissue resistance. This phase last for
2days-8weeks.
3. CHRONIC or Remodelling and maturation inflammation stage: Is the period when tissue
remodeling takes place. Signs of inflammation are absent and scar tissue is maturing. Pain is felt
further into the range of movement after the tissue resistance has been reached. MATURATION
refers to the growth of fibroblast to fibrocytes and REMODELLING refers to the organization of
or the final phase of healing process in which the granulation tissue matures into scar and tissue
tensile strength is increased. As healing progresses, the tissue continue to remodel, strengthen and
improve it cellular organization. It may take months or years to end tissue remodeling.

HEALING

When inflammation subsides healing set in. In healing of wounds, tiny raised red clot can be clearly seen,
these red clots are referred to as GRANULATION TISSUE. It is made up of fibroblast and macrophages
plus other tissues cells. No matter the extent of tissue damages to the body , healing starts by formation of
granulation tissue. Some tissues cells such as EPITHELIUM BONE MARROW, LYMPH GLAND etc

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continue to divide through out life such tissue have the ability to regenerate but some cells like the muscle
cells have no power to reproduce themselves and in this case, granulation tissues found will eventually be
converted into scar tissue.

REGENERATION

This is the process where lost cells regenerates or replace itself when they are damaged.

REPAIR

This is the replacement by scar tissue when the injured tissue cannot regenerate itself unless the
granulation tissue tend to change into scar. Healing of wound is of two (02) types:

1. FIRST INTENSION HEALING: This is the repair of open wound or clear cut tissue without any
involvement of infection i.e primary union.
2. SECOND INTENSION HEALING: In second intension healing, the wound is infected and
before healing set in, body antigens will have to remove or engulf the bacteria first before lost
tissue are (can be) healed. These infection could be debris, or toxins deposited by invaded
organism.

RATE OF HEALING FACTORS

In healing procedure, the extent or rate of repair is characterized by the following:

- The amount of tissue lost: When there are large amount of tissue lost involved in an injury, it
rate tends to delayed before the area is properly returned to normal or scar.
- NUTRITION: Supply of food nutrients are also responsible for quick healing- When an injury do
not get enough nutrient supply. Every tissue of the body require balanced diet for effective
functioning.
- BLOOD SUPPLY: Poor blood supply to an injured area will retard it rate of healing. Supply of
blood must be adequate.
- CLOTTING FORMATION; When an area is injured and anything tends to retard the clot
formation, it rate of healing will be delayed. Clotting in bleeding occur within 2-3hrs of bleeding.
Granulation tissue is formed in healing 24hrs. But fibrous tissue get strengthen within 2days. In
healing process, the vascularization process vary from one tissue to the other and this affects
healing of different part of the body.

LOCAL FACTORS OF HEALING

1. REST: For proper healing to take place, the part needs not to be interrupted. It needs rest. When a
healing wound is interrupted, healing procedure is delayed. It must not be rough handled.
2. IMPAIRED CIRCULATION: This is disturbance in circulation either to the artery or there are
congestion in the artery or veinary oedema.
3. INFECTIONS: When a wound is infected, healing process is delayed because the invading
bacteria or its waste product must be clear first before healing set in.
4. RESISTANT IRRITATION: when there is continuous irritant like sand and debris of bacteria,
healing is delayed. The earlier the irritant is cleared, the earlier healing sets in

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PHYSIOTHERAPY TREATMENT

1. CRYOTHERAPY: The application of cold therapy, such as ice packs or cold compression in
acute stage can help reduce pain and swelling associated with inflammation.
2. THERMOTHERAPY: Heat therapy such as hot packs or warm compresses, can help increase
blood flow, relax muscles and relieve pain. Commonly used in sub-acute or chronic inflammation
3. COMPRESSION THERAPY: Such as bandages can help control swelling and promote fluid
drainage in inflamed area.
4. TRANSCUTANEUOS ELECTRICAL NERVE STIMULATION (TENS): TENS involves the
use of low voltage electrical currents to alleviate pain associated with inflammation by blocking
pain signals and stimulating the release of endorphins, the body natural pain-relieving chemicals
5. ELECTRICAL MUSCLES STIMULATION (EMS): EMS utilizes electrical currents to stimulate
muscles contractions. It can be used to prevent muscle atrophy and improve blood circulation
which can be beneficial in managing inflammation and promoting tissue healing
6. ULTRASOUND THERAPY: Uses high frequency sound waves to generate heat and mechanical
vibrations within the tissue. It can improve blood flow, promote tissue healing , and reduce
inflammations
7. MANUAL THERAPY: Such as joint mobilization, soft tissue mobilization and massage, help
reduce pain,improve joint mobility, and promote circulation. These techniques can be beneficial
in addressing inflammation related condition such arthritis or tendonitis.
8. THERAPEUTIC EXERCISES:Like range of motion,stretching, strengthening exercise and
functional training can help in management of inflammation.

MEDICAL AND SURGICAL TERMINOLOGIES

- ASPHYXIA: Choking or loss of consciousness

- DERMA: To do with the skin.
- ENCEPHALO:To do with the brain
- STASIS; Causing the flow of fluid such as blood to slow or stop
- VISCOSITY: Sticky or thick
- ACUTE: Recent or short term pain
- ADHESION: Stiffness around tissue
- BIOMECHANIC: Study of how the body function
- CHRONIC: Long term or persistent pain
- DEGENERATIVE: Wear and tear
- JOINT: A point were two bones meet
- LIGAMENT: Two bond that hold bones together
- MANUAL THERAPY: Treatment done by hand
- ORTHOSIS: Supporting device
- PATHOLOGY; Causes or symptom of condition
- RECURRENT: Condition that come and go
- PROPRIOCEPTION; Lost of balance by injured part
- REFFERAL: Transfer of case for better treatment
- REHABILITATION; Bring back to full function

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TERMINOLOGIES USED IN SURGICAL CONDITIONS

1. AMNIOCENTESIS: Surgical puncture of the amniotic fluid sac to remove fluid

2. OSTEOCLASIS; Intentional surgical fracture of a bone to correct a deformity
3. ARTHRODESIS: Fixation of a joint by a procedure designed to accomplished fusion of the joint
surface
4. APPECDECTOMY: Surgical removal of the appendix
5. ELECTROCARDIOGRAM; Record the electrical signal from the heart to check for different
heart conditions
6. ANASTHETIZE: To induce a state of anesthesia; to make one “feeling less”
7. DIALYSIS; The removal or detachment of certain element from the blood or lymph by passing
them through a semi permeable membrane
8. PELVIMETER: Instruments used to measure the diameter and the capacity of the pelvis
9. BIOPSY: Removal of a small piece of living tissue from an organ or part of the body for
“viewing” under a microscope
10. LITHOTRIPSY: Crushing of a stone in the bladder; may be accomplish by ultrasound or laser

COMPLICATIONS COMMON TO ALL OPERATION

A. SHOCK: Shock is a severe drop in blood pressure that causes a dangerous reduction of blood
flow throughout the body. Shock may be caused by blood loss, infection, brain injury or
metabolic problem.
B. HEMORRHAGE: Means bleeding. Rapid blood loss from the site of surgery, can lead to shock.
C. WOUND INFECTION: When bacteria enter the site of surgery, an infection can result. Infection
can delay healing. Wound infection can spread to near by organs or tissue through the blood
stream.
D. DEEP VEIN THROMBOSIS(DVT) and pulmonary embolism(PE): Together, these conditions
are referred to as venous thromboembolism (VTE). This term is used because the conditions are
very closely related. And because their prevention and treatment is also closely related. A deep
vein thrombosis is a blood clot in a large vein deep inside a leg, arm, or other part of the body.
E. PULMONARY EMBOLISM: The clot can separate from the vein and travel to the lungs. This
form a pulmonary embolism. In the lungs, the clot can cut the flow of blood and may cause death.
F. URINARY RETENTION: The inability to empty the bladder, may occur after the surgery.
Caused by the anesthetic
G. REACTION TO ANESTHESIA: Although rare, allergies to anesthetic do occur.
H. LUNG(pulmonary) COMPLICATIONS: Pulmonary complication arise due to lack of deep
breathing and coughing exercises within 48 hours of surgery. They may also result from
pneumonia or from inhaling food, water or blood, into the airways.

AIMS OF POSTOPERATIVE CARE

- To ensure proper healing

- To rule out presence of complication
- To promotes recovery after surgery by managing pain
- To reduce the patient’s surgical and anesthetic preoperative morbidity or mortality

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 CHARACTERISTICS OF A SYNOVIAL JOINT

a. The presence of articular cavity filled with synovial fluid

b. Joint capsule
c. Articular capsule with synovial membrane
d. Articular cartilage

DISLOCATION

When a joint is force out of its normal position or is a medical term for bones in a joint being pushed out
of their usual place. They can affect any joint in your body. A joint is a place where two bones meet.

TYPES OF DISLOCATION

1. COMPLETE DISLOCATION (luxation): A complete dislocation happens when the bones in

your joint are totally separated and pushed out of place.
2. SUBLUXATION: This is a partial displacement or dislocation of a joint .Subluxation happen
when your joint is pulls apart and the bones still touch, not a complete as usual.

SYMPTOMS OF DISLOCATION

a. Pain
b. Swelling
c. Bruising
d. Loss of function
e. Joint weaker than usual
f. The joint look noticeably different or out of place

CAUSES OF DISLOCATION

- Accidents/Trauma
- Sports injuries
- Falls

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