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VISHNU VARDHAN S MPT19415 1st case..pptx
- 1. MPT19415 - CLINICAL TRAINING CASE PRESENTATION PRESENTED BY VISHNU VARDHAN S RA2122204010004 MPT ORTHOPAEDICS II YEAR IV SEM SRM COLLEGE OF PHYSIOTHERAPY SRMIST
- 2. DEMOGRAPHICS • Name: Mr. Vishumoorthy • Age: 28 • Gender: male Marital status: Married • Occupation: Farmer • Date of assessment: 06.01.2023 • Date of surgery: 07.01.2023 • Address: Chengalpattu
- 3. SUBJECTIVE ASSESSMENT CHIEF COMPLAINTS patient complains of mild pain over Left forearm and sometimes a pin prick pain, unable to use his left hand, mainly thumb and has difficulty in ADL using left limb. PRESENT HISTORY Patient came to SRM with RTA and sustained injury to his left forearm and diagnosed as left galaezzi fracture. He has undergone for native pop cast for 1 week and came to SRM for opinion. Since the fracture is displaced, he was advised for open reduction and internal fixation.
- 4. PAST HISTORY No relevant history. MEDICAL HISTORY No comorbities reported SURGICAL HISTORY: ORIF with plating and k- wire fixation done on 12/01/23 PERSONAL HISTORY: Mixed Diet Appetite: Normal No sleep disturbances No addiction reported PATHOMECHANICAL MODEL: Patient had RTA (2 wheeler vs sheep) he fell on ground with outstretched hands that planted on ground and sustained injury to Left Radius.
- 5. PAIN ASSESSMENT • Site And Side: Left forearm • Onset : Sudden • Duration : 10 Days • Nature : Traumatic • Type : Deep ache • Behaviour : intermittent • Severity Vas : I X I • Irritability : mild • 24 Hours Pattern : Night pain not present • Aggravating Factors : Pain While Doing Any Movements In left forearm and wrist • Relieving Factors : Rest and hands in neutral
- 6. ON OBSERVATION GENERAL OBSERVATION • Built : Mesomorphic • Posture : slouched sitting with forearm in mid prone position • Gait : bipedal biphasic • External fixation : shoulder sling with pop from mid forearm till metacarpal • Mobility Aids : none LOCAL OBSERVATION • Local swelling : present • Bony contour : Absent • Soft tissue contour : Absent • Muscle wasting : no wasting • Skin changes : No abnormal changes • Hair loss : Absent • Clubbing : Absent • Cyanosis : Absent • Open wound/scar : Suture covered with dressing
- 7. ON PALPATION • Tenderness : Grade 2 on left forearm • Warmth : left forearm and hand • Spasm : over left forearm muscles • Scar : Suture covered by dressing • Crepitus : Absent • Bony Spur : Absent • Oedema : Absent ON EXAMINATION RANGE OF MOTION Right Left Supination, pronation Optimal Immobilized Wrist Optimal Limited at end range
- 8. • MUSCLE STRENGTH • Limb Length : No Discrepancy Found • Muscle Girth : No muscle wasting found • REFLEX ASSESSMENT: Unable to elicit on left bicep and brachioradialis. Right side both are intact. • SUPERFICIAL REFLEXES: Normal plantar reflexes RESPIRATORY ASSESSMENT • VENTILATION: Spontaneous • DEPTH OF BREATHING: Shallow and rapid • CHEST EXPANSION: Axillary level - 2 cms Nipple level - 2 cms Xiphoid process - 3 cms • PATTERN OF BRETHING: Thoracoabdominal • SYMMETRY OF CHEST: Symmetrical chest expansion JOINT RIGHT LEFT Forearm and wrist 5/5 Unable to assess Grip strength Good Fair
- 9. • SENSORY EVALUATION : Intact • BALANCE Static and dynamic balance are Good • GAIT: Bipedal Biphasic • FUNCTIONAL ASSESSMENT: DASH - moderate disability Jebson Taylor hand function test • INVESTIGATION x ray: pre op- shows distal one third shaft of radius with displaced fracture ends. Post op- implant insitu
- 10. DIAGNOSIS DIAGNOSIS Left Galezzi fracture PHYSIOTHERAPY DIAGNOSIS Impaired joint range and muscle strength secondary to Left Galezzi fracture PROBLEM LIST Pain over suture site unable to do wrist movement Impaired supination, pronation, wrist movements. Impaired strength of forearm muscles Impaired grip strength Difficulty in ADL
- 11. AIMS OF TREATMENT SHORT TERM GOALS To educate the patient To reduce pain Promote range of motion Promote active range of uninvolved joints LONG TERM GOALS Strengthen supinator, pronator, grip muscle To initiate and progress weight bearing and weight lifting. Promote the ADL independence
- 12. • Active range of motion to R upper limb and L shoulder and elbow joints. • Active range of motion to L fingers. • Grip muscles strengthen exercise using smiley ball and resistance band Progression: • Elbow, wrist range of motion exercises. Supination and pronation initiation and progressed to full range. • Strengthening of forearm muscles using resisted ranges. • Progressive resisted exercise to left upper limb. • Ergonomic advices Home advices: • Use shoulder sling for left upper limb support • Do not weight bearing in left upper limb. • Continue exercise regularly. MANAGEMENT
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