Contrast bath:

Contrast bath:

Contrast baths are the immersion of a body part alternately in cold and hot water. This causes alternate contraction and dilation of blood vessels, which increase blood flow, white blood cell activity, and the oxidation process to speed up healing.

This treatment is based on the principle that by alternate contraction and dilation of the blood vessels, brought about by the contrasting application of heat and cold, the circulation is improved and the removal of waste products is hastened.

Indications and Counter Indications:

Contrast bath treatment can help with the following health problems:

1.    Congestive headaches

2.    Infections (give treatment 2-6 times per day to stimulate local defense against infection)

3.    Sprains, strains, and other traumas

4.    Poor circulation, congestions, indolent ulcers

5.    Osteoarthritis

However, contrast bath treatment is dangerous if you have the following health conditions:

1.    Loss of feeling in the feet or legs

2.    Extreme peripheral vascular disease of the feet or legs

3.    Hemorrhages

Here are some indications from Dr. Neil Nedley’s book Depression: The Way Out:

For more than 100 years, Mental illness has occasionally been treated with warm baths utilizing natural hot springs or other sources. Before the 1950s, special showers, baths, wet sheet wraps, and other forms of hydrotherapy were routinely used in psychiatric hospitals throughout the United States and Europe. These approaches were not only used to treat depression, but were also used to treat delirium, agitation, insomnia, gastrointestinal disturbances, and pain syndromes’

Procedure:

Equipment:

1.    Two containers large enough to allow body part to be immersed completely

2.    Thermometer

3.    Drape sheet or gown

4.    Thick towels

5.    Cold compress for head or neck, ice bag for heart if necessary

6.    Pitcher to add hot water

7.    Container to heat water in

8.    Ice for cold compress and cold bath if desired

Important Considerations:

1.    If a large part of the body is treated, used cold compress to head and neck (ice bag to heart if pulse goes over 80 BPM)

2.    Do not use temperatures over 115° F (46°C)

3.    Temperatures above 103° F (39°C) should not be used in cases of blood vessel disease of the legs and feet

4.    Extremes of hot and cold should not be used on patients with ‘peripheral vascular disease’ (this is different from varicose veins) or diabetes

5.    Begin hot water immersion at lower limit than tolerance, increasing the temperature during the application

Treatment:

1. Assemble the necessary materials
2. Have treatment room warm and free of drafts
3. Explain the procedure to the patient
4. Check the patient’s pulse
5. Assist the patient as necessary
6. Place area to be treated in hot water (about 103° to 105° F or 39°C to 41°C) and quickly increase temperature to the highest you intend to use for that treatment, keeping submerged for three minutes
7. Place part in cold water for 30 seconds to one minute
8. Check the patient’s pulse every five minutes; apply cold compress to neck and ice bag to heart if needed
9. Make six to eight changes, ending with the cold water, except when treating rheumatoid arthritis, in which case, and finish with a hot application. Total treatment time should be 20 to 30 minutes.
10. Dry the patient thoroughly and give cooling measures if needed, encouraging patient to rest for at least half an hour.

Anesthetic Injection-for Wrist Pain:

Use of Local Anesthetic Injection-for Wrist Pain:10

Therapeutic value of just local anesthetic injection is very limited. The procedure is performed only as a diagnostic procedure. Wrist joint is often treated with local anesthesia to relieve pain prior to aggressive physical therapy.

Indications for Wrist Joint Local Anesthesia Injection-

·         Diagnostic Injection- Procedure is performed to evaluate cause of pain.

·         Painful Physical Therapy- Injection is performed prior to aggressive physical therapy.

·         Painful Wrist Joint- Injection is performed prior to nerve conduction or radiological study.

·         Post-Surgical Pain- Intolerable pain following wrist joint surgery is treated with wrist joint injection using local anesthesia.

Contraindication for Wrist Joint Corticosteroid Injection

·         Septic Arthritis

·         Skin Infection

·         Septicemia

·         Allergies to Local Anesthetics

Corticosteroid Injection- for Wrist joint Pain:

Corticosteroid Injection- for Wrist joint Pain: 09

Cortisone injection is performed to reduced inflammation. Severe pain caused by inflammation and nerve irritation is initially treated with NSAIDs and opioids. Inadequate pain relief is later treated with cortisone injections. Initial 2 or 3 injections are performed within 6 to 8 weeks. Later cortisone injections are repeated every 3 to 6 months. Cortisone injection is not recommended for chronic pain caused by Gout and Septic Wrist Joint Arthritis.

Indications for Wrist Joint Corticosteroid Injection-

·         Wrist Joint Sprain Caused By Inflammation of Ligaments.

·         Wrist Joint Tendonitis Caused By Inflammation of Wrist Joint Tendon.

·         Wrist Joint Bursitis Caused By Inflammation of Wrist Joint Bursa.

·         Wrist Joint Arthritis Caused By Inflammation of Wrist Joint Cartilages and Bones.

·         Wrist Joint Fracture Causing Severe Pain.

·         Wrist Joint Dislocation Causing Inflammatory or Pinched Nerve Pain.

·         Post-Surgical Pain.

Contraindication for Wrist Joint Corticosteroid Injection

·         Gout

·         Septic Arthritis

·         Skin Infection

·         Septicemia

·         Allergies to Corticosteroids

Pain Therapy for Wrist Joint Pain 05

Interventional Pain Therapy for Wrist Joint Pain:08

Interventional pain therapy is an invasive treatment. Choice of Interventional Pain Therapy is as follows-

A. Needle Therapy

B.  Nerve Ablation Treatment

C.  Placement of Spinal Cord Stimulator

D. Placement of Intrathecal Catheter and Programmable Pump

A. Needle Therapy

Needle therapy treatment includes injection of medications using needles. Needle placement depends on the cause of pain.

Anatomical Area of Needle Placement to Relieve Wrist Joint Pain-

·         Subcutaneous Injection- Indicated for subcutaneous abscess or cellulitis.

·         Wrist Joint Injection or Wrist Joint Block (Injection within the joint) - Indicated for bursitis, sprain ligament, tendonitis, dislocation or fracture.

·         Wrist Joint Nerve block (injection close to nerve)- indicated for pinch nerve and wrist joint neuritis.

·         Cervical (neck) Epidural Injection- Indicated for chronic wrist joint pain.

·         Brachial Plexus Block performed by placing needle in axilla or neck.

Medication Injected In Wrist Joint -

·         Corticosteroid

·         Local Anesthetics

·         Chemical Nerve Ablation Using Phenol or Alcohol.

Wrist Joint Injection Procedure-

·         Wrist joint injection in majority of the patient is performed under local anesthesia.

·         Physician will spray the wrist joint skin with numbing medicine so first prick or insertion of needle is painless and then he will inject local anesthetics to numb all the tissue to be treated including skin.

·         Needle placement is not very painful.

·         Image intensifier (portable X-Ray) is used to identify wrist joint structure and depth of the needle during placement of needle for injection.

·         Nerve to be treated is identified by nerve stimulator.

·         Occasional ultrasound is used to evaluate needle placement during procedure.

·         Few patients suffer with "needle phobia" (fear of needle) for such patients doctor will provide oral or intravenous antianxiety medications or sedation.

Continue……………………………………

Wrist Joint Pain for Physical Therapy (PT) 04

Physical Therapy (PT) for Wrist Joint Pain:07

Physical therapy is a conventional treatment provided as an adjuvant therapy to medication, interventional pain therapy and surgery. Physical therapy is prescribed before surgery as a conservative treatment and after surgery as a supporting therapy. Patient with severe pain often resist physical therapy and in such situation injection of local anesthetics in wrist joint often precedes physical therapy.

Goal of Physical Therapy (PT)-

·         Improve Joint Movements

·         Enhance Muscle Strengthening

·         Maintain Normal Muscle Tone

·         Augment Coordination.

Indications for Physical Therapy to Treat Wrist Pain

·         Chronic Wrist Joint Pain

·         Muscle Spasm of Hand And Forearm Muscles

·         Post Surgery Wrist Joint Stiffness

·         Post Surgery Wrist Joint Instability

·         Muscle Atrophy- Hand And Forearm Muscles

·         Hand and Forearm Muscle Weaknesses

Physical Therapy Techniques-

·         Exercise

·         Stretching

·         Ultrasound Therapy

·         Infrared or Heat Therapy

·         Cold Therapy

·         Massage Therapy

Wrist Joint Pain Treatment 03

Muscle Relaxants for Wrist Joint Pain-06

Muscle pain or spasm of muscles of hand and forearm are treated with following muscle relaxants. Muscle relaxant causes sedation and sleepiness in few patients. Combination of opioids and muscle relaxants can be fatal. Physician will frequently monitor their patients for side effects and medication consumption behavior. Wrist pain due to muscle spasm or muscle pain is treated with one of the following muscle relaxants.

Baclofen

·         Pills available as 5 mg, 10 mg, 15 mg and 20 mg.

·         Suggested safe dosage per day- 30 to 60 mg.

Flexeril

·         Pills available as 5 mg and 10 mg.

·         Suggested safe dosage per day- 20 to 30 mg.

Skelaxin

·         Pills available as 800 mg.

·         Suggested safe dosage per day- 2400 to 3200 mg.

Robaxin

·         Pills available as 500 mg and 750 mg.

·         Suggested safe dosage per day- 1500 to 2150 mg.

First aid for burn injuries:

First aid for burn injuries:

What can you do to help reduce the effects of a burn injury?

·         Ensure that all adults in the household know and understand proper first aid.

·         Teach children the general first aid principles.

First aid:

If on fire:

·         Stop, Drop, Cover and Roll

·         Smother the flames with a blanket

·         Move away from heat source

Protect your own safety at all times

For all burns apply cold running water:

·         For at least 20 minutes

·         If running water not available, wet 2 cloths and alternate them onto the burn every 2 minutes

·         Keep the rest of the body warm

Do NOT use ice, butter, creams, etc.

Remove clothing and jewellery

·         Clothing can hold heat on the burn

·         If swelling occurs jewellery can stop blood flow to the burn

Seek medical attention

·         For any burn bigger than 20c piece size, or that blisters

·         If there are any concerns

Prescription for wrist pain:02

Prescription for wrist pain: 05

b. Long Acting Opioids for Wrist Joint Pain-

Indications for long acting opioids are as follows-

·         Post Surgical Pain Not Responding To Short Acting Opioids.

·         Chronic Pain Caused By:

1.   Wrist Joint Sprain

2.   Wrist Joint Tendonitis

3.   Wrist Joint Dislocation

4.   Wrist Joint Fracture

5.   Wrist Joint Bursitis

·         Chronic Pain Not Responding To-

1.   NSAIDs

2.   Antiepileptic Analgesics

3.   Anti-depressant analgesics

Long Acting Medications-

Oxycodone- Oxycontin

·         Pills available as 10 mg, 20 mg, 40 mg and 80 mg.

·         Suggested safe dosage per day- 40 mg to 160 mg.

Morphine- MS Contin

·         Pills available as 15 mg, 30 mg, 60 mg, 100 mg and 200 mg.

·         Suggested safe dosage per day- 90 mg to 200 mg.

Methadone

·         Pills available as 10 mg.

·         Suggested safe dosage per day- 40 to 80 mg.

Continue…………………….