RU2286085C2 - Method for rehabilitation in patients with contractures of ulnar joint - Google Patents

Abstract

FIELD: medicine, surgery, traumatology, anesthesiology, physiotherapy, curative physical training.

SUBSTANCE: before carrying out curative physical training it is necessary to fulfill anesthesia of brachial plexus at the side of affected limb due to injecting pharmacological solution consisted of 45 ml 0.5%-lidocaine solution and 0.3 ml 1%-adrenaline solution; anesthesia should be fulfilled twice or thrice per the course of curative physical training in 5-6 d; curative physical training should be started in 1.5-2 h after anesthesia. The present innovation increases the volume of movements due to removing muscular hypertension, improving muscular circulation in area of the lesion that, in its turn, prevents complications in tissues of areas of operated limb, it, also, increases efficiency of curative physical training and shortens restorative period 2-fold.

EFFECT: higher efficiency of rehabilitation.

2 ex, 4 tbl

Description

The invention relates to the field of medicine and can be used in the rehabilitation of patients during physical therapy to restore the function of the elbow joint.

A known method of rehabilitation according to the method of doctor of medical sciences Professor Ataev Z.M., Ph.D. Menchukova O.N. "Restorative treatment of patients with injuries of the elbow joint" Methodical recommendations - M., 1976, 34 pp.

The technique includes physical therapy exercises with patients in groups. In this case, exercises aimed at restoring the amplitude of motion in the elbow joint are performed. At a later date, mechanotherapy is prescribed.

However, we believe that with contractures of the elbow joint an individual approach is advisable, which takes into account the development and course of the disease. Performing therapeutic exercises with increasing range of motion causes pain, which is a deterrent.

Ongoing mechanotherapy is a violent method for the elbow joint and can cause microtrauma of the muscles.

There is also known a method of MD, professor Kaltelin A.F. "Restorative treatment for injuries and deformations of the musculoskeletal system." Publishing house "Medicine" - 1969, p. 261.

Kaptelin A.F. in its methodology, it takes into account the pronounced desmogenic nature of the contracture of the elbow joint and includes exercises aimed at straightening the joint bag, stretching paraarticular tissues - self-help exercises, burdening the hand with a small load (250-300 g).

This technique leads to a protective increase in muscle tone and fixation of contracture.

The closest is the method of MD Ivan B. Matev, D. Bankov "Rehabilitation for injuries to the hand." Medicine and Physical Education - Sofia. 1981, pp. 207-210.

The technique focuses on exercises for muscle relaxation. Also included are elements of post-isometric relaxation.

Nevertheless, sometimes stagnation occurs during treatment, achieved during treatment, the range of movements is again limited, as if due to the withdrawal caused by elastic forces due to resistance exercises.

The objective of the invention is to increase the efficiency of restoration of the function of the elbow joint in a simpler and more reliable way in a shorter time, in which a painless restoration of the amplitude of motion of the elbow joint is achieved.

The solution to this problem is achieved through the rehabilitation of patients with contractures of the elbow joint during physiotherapy exercises with muscle relaxation. Before physical therapy, plexus anesthesia of the brachial plexus is performed by administering an anesthetic solution of lidocaine 0.5% 45.0 ml and adrenaline 1% 0.3 ml on the side of the injured limb. Anesthesia is performed 2-3 times after 5-6 days for a course of physiotherapy exercises, and physiotherapy exercises begin 1.5-2 hours after anesthesia.

The novelty of the method lies in the fact that:

- before conducting physical therapy, plexus anesthesia of the brachial plexus is performed on the side of the damaged limb. Anesthesia can relieve pain, muscle relaxation occurs, muscle blood circulation improves;

- anesthesia is performed 2-3 times in 5-6 days for a course of physiotherapy exercises;

- anesthesia is carried out by the introduction of an anesthetic solution of lidocaine 0.5% - 45.0 ml and adrenaline 1% - 0.3 ml;

- physiotherapy exercises begin after 1.5-2 hours after anesthesia. This is the onset of anesthesia. During this period, the hypotensive and orthostatic effects of the resorptive action of the local anesthetic are minimally manifested, which makes the exercise therapy procedure as painless and safe as possible.

The set of essential features of the invention allows to achieve a painless increase in range of motion by relieving muscle hypertension, to improve blood supply to muscles in the affected area, which leads to the prevention of complications in the tissues of the areas of the operated limbs (osteomyelitis, pseudarthrosis, suppuration) and an increase in the effectiveness of exercise therapy, which reduces the recovery period 2 times.

Observations showed that one of the reasons for limiting movements in the joint is severe pain. The second no less important reason is myogenic limitations associated with severe changes in paraarticular tissues. Especially revealing in this regard are the processes of scarring, leading to the adhesion of joint tissues with surrounding muscles, ligaments, and skin. It becomes obvious that one of the conditions for increasing the range of motion in the elbow joint is the elimination of pain and muscle hypertension with it. This is only possible with anesthesia before exercise therapy.

We believe that the use of local pharmacological effects on the trunks of the brachial plexus of the injured limb before the sessions of physiotherapy exercises will not only relieve pain. Vegetative denervation of limb tissues under the influence of plexus anesthesia is accompanied by a number of positive effects. The maximum possible value of the sympathetic denervation of their vessels is achieved due to the fact that both paravasal vegetative plexuses and vegetative fibers following in the somatic nerves are simultaneously blocked. At the same time, in the anesthetized limb, the volume of blood flow increases with blockade of the brachial plexus in the interstitial space by 3.7 times. In addition, denervation of limb tissues has a significant effect on the drainage system of their lymphatic vessels and precisely in the area of conduction anesthesia.

The feasibility of repeated brachial plexus blockade during the course of physical therapy treatment of patients with elbow joint contractures is due to the pharmacodynamic and pharmacokinetic properties of lidocaine and its ability to provide the duration of the period of autonomic denervation.

The method is as follows: the patient’s position is horizontal, his head is in the midline, the upper limbs are brought to the body. An angle with an apex is drawn on the patient's skin with dye - the upper edge of the sternoclavicular joint. The rays of the angle are: the axis of the clavicle and the straight line connecting the mastoid process with the apex of the angle. The perpendicular from the middle of the clavicle is restored to the bisector of the obtained angle, and the point of their intersection is the place for the injection needle. The injection needle moves at an angle of 40 ° -45 ° relative to the frontal plane of the patient, but perpendicular to the axis of his cervical spine to a depth of 2.5-3.0 cm. When symptoms of mechanical irritation of the long branches of the brachial plexus appear, the position of the needle is controlled - an aspiration test with a syringe. If the test is negative, then an anesthetic solution is introduced (lidocaine 0.5% 45.0 ml and adrenaline 1% 0.3 ml). The latent time of the onset of vegetative denervation of the limb is 1.5-2 hours. After the onset of anesthesia of the upper limb, physiotherapy exercises are performed with the involvement of the elbow joint. Plexus anesthesia of the brachial plexus is carried out on the side of the injured limb 2-3 times after 5-6 days for a course of physiotherapy exercises. The main task of physiotherapy exercises is relaxation and stretching of muscles, the attachment points of which are brought together as a result of contracture. After anesthesia, relaxation exercises are excluded - this problem was solved by the blockade. Therefore, exercises aimed at increasing the amplitude of flexion and extension in the elbow joint were used. Exercises in the elbow joint alternated with exercises performed by the hand and in the shoulder joint. Many exercises were performed with the help of a healthy hand, with objects. Then, special exercises of local orientation were performed in accordance with the individual characteristics of the restoration of limb function of each patient. In other words, exercises should be aimed at lagging elements of limb function individually. Due to the fact that pronation contracture is still a frequent complication, exercises in supination of the forearm were prescribed. In order to increase the duration of the corrective effect of the exercises and consolidate the achieved result, the exercise therapy procedure was completed by treatment with a position with more intense stretching of the paraarticular tissues - the patient’s arm was placed in the position of extreme extension or flexion in the elbow joint for 5-10 minutes.

EXAMPLE 1

Patient G., medical history No. 290813, was in the rehabilitation department with a diagnosis of Fracture of the external condyle of the right shoulder. After the treatment - plaster immobilization for 1.5 months. came extensor contracture of the right elbow joint. Objectively: complaints of pain and restriction of movements in the right elbow joint. Range of motion: flexion - 90 °, extension - 165 °. 10/06/2003, performed rheovasography (RVG) of the right shoulder:

Table 1 At MU OOP CAS% S 2.0 6.6 1.4 53.8 D 1.3 6.6 0.9 S 2,5 4.9 1,6 47.0 D 1.7 4.9 1.01

10/10/2003, plexus anesthesia of the right brachial plexus was performed by the introduction of an anesthetic solution of lidocaine 0.5% - 45.0 ml and adrenaline 1% - 0.3 ml.

After 1.5 hours, the muscles of the arm relaxed, and the development of movements in the right elbow joint began by performing a set of the following exercises:

Flexion extension of the arms in the elbow joint, 8 times.

Slipping hands to the axillary hollows, bending them in the elbow joints, 6 times.

Stroking the head alternately with a healthy and sore hand 6 times each.

Hands behind the castle. Flexion extension of the arms in the elbow joints, 6 times.

Hands to the side. Put the right brush behind the head. Then the same with the left brush. 6 times with each hand.

Arms extended forward. Flexion, extension of the hands.

Stick exercises:

Circular movements of the hands back and forth 6 times in each direction.

Put the wand on the floor, a sore hand on top. Circular movements one way 6 times and the other 6 times.

Wand in the back, flexion and extension of the arms in the elbow joints.

The wand is in the back, circular movements in one direction 6 times and in the other 6 times.

Wand in front. Raise your hands up, put the stick on your shoulders and return to the starting position, 6 times.

Take the wand from two sides. Lead of arms to the left 4 times and to the right 4 times.

Performing flexion and extension in the elbow joint of a sick hand with a healthy one, 1 min.

Performing flexion and extension in the elbow joint by the methodologist 1 min. The emphasis is on flexion, since extensor contracture.

Performing a flexion and extension movement in the elbow joint using a roller trolley on a smooth polished surface, 2 min.

Correction of position - special styling with fixation of the elbow joint in the flexion position, 10-15 min.

The advantage was given to exercises for flexion of the elbow joint.

The range of motion in the elbow joint increased: flexion - 85 °, extension - 170 °. The range of motion increased by 10 °.

From 11 to 15.10.03 physiotherapy exercises without analgesia, during which the acquired skill of the stereotype of movement is fixed. We repeat the proposed complex.

On October 16, 2003, repeated plexus anesthesia of the brachial plexus was performed with the introduction of an anesthetic solution of lidocaine 0.5% - 45.0 ml and adrenaline 1% - 0.3 ml.

After 1.5 hours, after muscle relaxation, the development of movements in the elbow joint was started.

Exercise in water has been added to the proposed complex. Flexion and extension in the elbow joint. Water temperature 37 ° -38 ° C.

At the end of classes, the range of motion in the joint: flexion - 80 °, extension - 175 °, the range of motion increased by another 10 °.

The course of exercise therapy - 15.

At the end of the course of treatment, repeated RVH of the right upper limb was performed.

table 2 At MU OOP CAS% S 2,4 11.3 1.06 50,0 D 1,6 7.5 0.94 S 1.9 10.6 0.96 18.0 D 1,6 8.5 1.06

Example 2

Patient S., medical history No. 296663, was in the rehabilitation department with a diagnosis of flexion-extensor contracture of the elbow joint after fracture of the external condyle of the left shoulder. Gypsum immobilization of 1.5 months and rehabilitation treatment for 1 month did not give a positive effect, since during the exercise the patient experienced pain. Objectively: lack of active movements in the left elbow joint. Range of motion - flexion - 120 °.

02/03/2004 year performed RVG.

Table 3 At MU OOP CAS% S 2.2 9.34 1,2 0 D 2.2 9.09 1.18 S 2,4 11.7 1,04 26.3 D 1.9 12.1 1.13

Pulse blood flow on the shoulders is impaired. Pronounced decrease in vein tone with difficulty in outflow. Pronounced muscle hypertonicity.

02/04/2004, plexus anesthesia of the left brachial plexus was performed by the introduction of an anesthetic solution of lidocaine 0.5% - 45.0 ml and adrenaline 1% - 0.3 ml.

After 2.0 hours, muscle relaxation began, passive development of movements in the left elbow joint began, as there were no active movements. Performed the following exercises:

Performing flexion and extension in the elbow joint of a sick hand with a healthy one, 3 min.

Performing flexion and extension in the elbow joint by the trainer, 3 min.

Performing flexion and extension movements in the elbow joint using a roller trolley on a smooth polished surface, 2 minutes, helping with a healthy hand.

Correction of position - special laying with fixation of the elbow joint in the position of flexion and extension for 7 minutes.

The range of motion when measuring at the end of classes: flexion - 125 °, extension - 130 °. I did not feel pain during the exercises, the arm is relaxed.

From 05.02.04 to 9.02.04, physical therapy sessions were continued without anesthesia. The pain syndrome decreased and muscle hypertonicity decreased.

02.10.2004 the second plexus anesthesia of the brachial plexus was performed. After 2 hours, the development of movements in the elbow joint was started. The complex of exercises included already active exercises, the same as in example 1, since there were active movements in the left upper limb - in the elbow joint. Range of motion after exercise: flexion - 120 °, extension - 135 °.

02.16.2004 performed the third plexus anesthesia. After 2 hours, the development of movements in the left elbow joint was started. We repeat physical therapy classes, as in example 1. At the end of classes range of motion: flexion - 115 °, extension - 145 °. The course of treatment is 17 days.

03/21/2004, conducted RVG.

Table 4 At MU OOP CAS% S 2,4 10.1 1.4 7.0 D 2,4 10.6 1.3 S 2.1 11.8 1.32 27.0 D 2.0 12.1 1.21

Improving pulse blood flow on the left shoulder.

The proposed method was performed in 18 patients. At the same time, an effect was achieved in all in the form of an increase in the range of movements, the results of rheovasography showed an increase in pulse blood flow in the diseased limb, the analgesic effect of the blockade progressively removed the muscle reaction from session to session, the duration of the recovery period was reduced by more than half. When conducting a course of exercise therapy by traditional methods, the course of treatment for this pathology is usually 30-40 days, according to the proposed method, 15-20 days.

The method was used on the basis of the Regional Clinical Orthopedic Surgery Hospital for Reconstructive Treatment of the city of Prokopyevsk.

Claims (1)

A method of rehabilitation of patients with elbow joint contractures by means of physiotherapy exercises with muscle relaxation, characterized in that plexus anesthesia of the brachial plexus is performed before physiotherapy exercises by administering an anesthetic solution of lidocaine 0.5% 45.0 ml and adrenaline 1% 0.3 ml per side of the injured limb 2-3 times after 5-6 days for a course of physiotherapy exercises, and physiotherapy exercises begin 1.5-2 hours after anesthesia.