Chan Wing Pui Physiotherapist I

Pamela Youde Nethersole Eastern Hospital

Introduction

Roles of physiotherapy

Special consideration in paediatric rehabilitation

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Common paediatric upper limb injuries

Treatment

Complication

Elbow fractures Supracondylar humerus fracture

Lateral condyle fracture

Radial neck fracture

Medial condyle fracture

Forearm fractures Distal forearm fracture

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Types % Mechanism Age Remarks

Supracondylar 50-70% of elbow fractures

Fall with outstretched hand

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Lateral condylar

10-20% of elbow fractures

ditto 4-10

Medial condylar

10% of elbow fractures

Fall with outstretched hand with excessive valgus stress

7-15 50-60% with concurrent elbow dislocation

Radial neck 6% of elbow fractures

Fall with outstretched hand with elbow in extension & valgus

Maybe associated with elbow dislocation

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E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p.11-17.

Distal forearm fracture 75-84% of forearm fractures

Fall with outstretched hand

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S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p. 41-67

Non-surgical Cast, splint

Surgical Pins, screws, wire

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Stiffness

Malunion

Non-union

Neurovascular injury, e.g. neurapraxia

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Physiotherapy during immobilization period

Physiotherapy post-immobilization

Special physiotherapy for non-union/delayed union

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Maintenance

Decrease swelling/pain

Advice & home care

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Physical examination

Reduce swelling/pain

Enhance mobility, including restoration of range of motion

strength & endurance

joint stability

co-ordination according to developmental milestones

Advice & home care

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Observation Swelling Muscle wasting

Palpation Increase temperature Tenderness

Movement Decrease range of motion Decrease muscle strength & endurance Decrease joint stability Impair co-ordination

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Whirlpool Heat therapy (40-42°C)

Massage

Active mobilization exercise

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Ice therapy After exercise

After daily activities at home (home care)

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Active/assisted active mobilization exercise

Passive mobilization exercise

Accessory mobilization of individual joints

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Manual Neuromuscular facilitation

& inhibition techniques

Hold relax

Contract relax

Self-stretching

Incorporate with craniosacral therapy

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Accessory movement

Mobilization with movement (Mulligan)

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Muscle Re-education Biofeedback Electrical stimulation Kinesio Taping

Mechanical resistance exercise Manual resistance exercise Proprioceptive neuromuscular facilitation (PNF)

Functionally based diagonal patterns of movement Neuromuscular facilitation techniques to evoke motor

responses & improve neuromuscular control & function

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C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5th edition. F.A. Davis Company. Philadelphia.

Improve neuromuscular control & function

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Biofeedback

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Electrical stimulation Facilitate the contraction of

weakened muscle,

e.g. neurapraxia

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Kinesio Taping Facilitate muscle contraction

Other usage:

Inhibit muscle action

Facilitate superficial lymphatic drainage

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Suitable for joint dislocation with fracture

Eye hand co-ordination

Co-ordination skill in simple sports activities Resume sports habit

e.g. badminton, table tennis

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Unwilling to remove the sling/to move Afraid of pain Misunderstanding Afraid of being hurt by others Overprotected parents

Too busy to move Focus only on academic activities Not understanding the importance of home programme

Moving too much Forget about the fracture while playing vigorously Eager to resume to sports/competition

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Magnetopulse

Low Intensity Pulsed Ultrasound (LIPUS)

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Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24,3 Supplement p. 56-61.

Safety

Fun

Alternatives

Relationship with children & parents

Understanding

Encouragement

Environmental factor

Well Done!

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1. E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p.11-17.

2. S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p. 41-67

3. C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5th edition. F.A. Davis Company. Philadelphia.

4. M. R. Folio, R. R. Fewell (2000) Peabody Developmental Motor Scales. 2nd edition. Pro-ed, Inc. Texas.

5. Electrophysical Agents. Contraindications & Precautions: An Evidence-based Approach to Clinical Decision Making in Physical Therapy. Physiotherapy Canada 2010 Special Issue Vol 62 No.5

6. S. Kitchen & S. Bazin (2002) Electrotherapy: Evidence-Based Practice. 11th edition. Churchill Livingstone.

7. Kinesio Taping® Association International. (2011) Course material of KT1: Fundamental Concepts of the Kinesio Taping® Method & KT2: Advanced Concepts and Corrective Techniques of the Kinesio Taping® Method.

8. M. Y. Boyette & J. A. Herrera-Soto (2012) Treatment of delayed or non-united fractures & Osteotomies with Pulsed Electromagnetic Field in Children & Adolescents. 35 (7) p. e1051-e1055.

9. Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24 (3) Supplement p.56-61.

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