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Infrared Light Therapy – Treating Equine Leg Injuries

  • Posted on February 2, 2012 at 2:45 am



Infrared therapy is a safe, effective tool in your equine veterinary procedures. Not only can it accelerate healing and reduce inflammation in most equine leg injuries, it can help to prevent injuries, and improve circulation through routine use.

When can infrared therapy help your horse’s leg injuries?

Infrared therapy works most effectively on soft tissue injuries, where it can penetrate the deepest. Here, it can increase healing by stimulating blood flow, protect against infection, and some studies suggest it has a natural analgesic effect. If your horse has just suffered an injury to a tendon or ligament, cold is your first step. However, after initial veterinary attention, infrared therapy can be very helpful in your horse’s rehabilitation. Injuries such as bowed tendons or ligament strains, which can take a very long time to heal, can be encouraged to repair faster with infrared therapy. Not only that, but as horses with these types of injuries are often restricted to their stables, infrared therapy can help reduce ‘stocking up’, which is when the horse’s legs become puffy due to lack of movement. Infrared also has a natural analgesic effect, helping to make horses with these painful injuries more comfortable with fewer medications.

Many equine lower leg injuries are injuries to the bone. In these cases, such as fractures, infrared therapy is less effective than for soft tissue damage, but it can play a role in speeding up healing. By increasing blood flow to the injured area, infrared therapy will increase the supply of healing oxygen and nutrients to the affected area. Stimulating circulation will also help to reduce inflammation and lymphedaema, especially helpful if the horse’s mobility is limited. For some injuries, like bruised or ‘broken’ knees or hock injuries, early use of infrared can help protect against permanently capped knees and hocks.

Some bone injuries aren’t injuries to the bone itself, but are consequences of overwork or poor conformation. Shin splints for example, are calcium deposits where microscopic fractures have occurred on the cannon bone. Infrared therapy can reduce the pain and inflammation the horse experiences until the splints ‘settle’ or harden. You can prevent discomfort for a horse that has had its workload increased, or who needs to work on hard ground, through routine use of infrared after hard workouts. Since infrared therapy has no dangerous side effects, you can use it daily to help prevent overuse injuries in the horse’s lower leg.

Old injuries and other conditions may also benefit from infrared therapy. However, ridding your horse of an established bog spavin, thoroughpin, capped hock or curb is almost impossible. Early treatment with infrared therapy – at the first sign of swelling, is essential.

What equipment do I need?

The good news is, you don’t need to be a vet to take advantage of infrared technology to treat your horse. With a one-time investment in some basic supplies, you will be equipped to treat your horse, whether in an emergency or for more long-term therapeutic purposes. Here are some of the best supplies for treating equine leg injuries with infrared therapy.

Prolotex leg wraps: Prolotex uses bioceramic technology. Bioceramics uses a mixture of chemicals that naturally emit infrared rays. There are many different combinations on the market, some more effective than others, so always choose a well-known supplier like Prolotex. The chemicals used in Prolotex leg wraps are deeply penetrated into the fabrics, so they don’t rub off or wash out. Revitavet IR2 boots: The Revitavet IR2 system uses actual LED lights to emit the infrared. This means you can pinpoint the specific are you want to treat, and adjust the wavelengths for lesser or greater tissue penetration. It is a bigger investment than bioceramics, but once you’ve got the base unit, you can get different treatment wraps such as hock and knee boots. The unit is rechargeable, so you don’t need to plug it in while it’s on the horse, but you do need to remember to recharge it! Thermotex leg wraps: Thermotex uses electrically generated infrared to create therapeutic heat and penetration. The benefit of Theormotex is greater intensity than you can get from bioceramics, but the downside is the wraps have to stay plugged in, meaning you need to keep the horse near an electrical outlet. You can use up to eight heating pads, but the effect is a more general one on the leg overall, rather than the spot treatment of Revitavet.

Whichever equipment you choose, you can be sure that you have made a great investment in your horse’s health and comfort for years to come!

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Human Growth Hormone Therapy – How it Affects Your Facial Muscles

  • Posted on January 23, 2012 at 7:04 am



Craniofacial muscles are basically the muscles that you are able to see on your face. For example the muscles that support your cheeks, forehead and the jaws as well as the muscles that make up the back of the head all fall into this category. Human growth hormone therapy has a very beneficial effect on shaping craniofacial muscles.

In HGH deficiency states like Prader-Willi syndrome, it is very common to see children with puffy or bloated faces. If your child has low levels of the hormone, it is not uncommon to see craniofacial muscles that are ill-defined and out of shape. This is because lack of growth hormone activity in this area facilitates fat deposition on the muscles of the face leading to a bloated look.

In such a condition, your doctor may advise you to go for injections of growth hormone. These injections are typically administered in doses of 0.1 to 0.15 units/kg/day depending on the severity of the condition.

So how does human growth hormone therapy affect craniofacial muscles?

HGH therapy causes the release of fatty acids from adipose or fatty tissue. This means the levels of fatty acids in the body increase. Consequently, your body will start using fat to get energy as opposed to carbohydrates and proteins. Therefore one of the earliest signs when HGH therapy is started may be lean muscle mass that is evident on your face. You will lose the bloated and puffy look and gain an acceptable facial profile.

However many studies have suggested that the timing of HGH supplementation may play a big role in its eventual effects on craniofacial muscles.

Growth hormone also stimulates growth of bone and cartilage. Therefore the eventual shape of the main bones of the face including the jaws may change for the better if hormone therapy is instituted at an early stage.

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Can Massage Therapy Treat Fracture Injuries?

  • Posted on January 18, 2012 at 3:19 am



Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.

Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.

Considerations for treatment

It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.

In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.

Before your massage therapist begins to treat you, he or she will want to verify the following information: your physician has approved massage therapy are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics). what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?) are there any open wounds which must be addressed? (i.e. with a compound fracture) Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue? is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities? do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated. the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated. have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries) muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone. tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.

Types of fractures

There are several basic types of fractures:

1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.

2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.

3. Comminuted - a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)

4. Compression – a fracture where the bone is crushed

5. Depression – a fracture where the bone is crushed and pressed inward

6. Impacted – bony surfaces are forced into each other (impacted)

7. Spiral – an break with ragged edges that result from twisting

8. Greenstick - an incomplete break that is common in children, as bones are more flexible

9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray

10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.

Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.

Finding the best massage therapist for you

It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.

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Internal Fixation of Bone Fracture – Part 2

  • Posted on December 24, 2011 at 6:19 am



If used for permanent fixation pins and wires are usually chosen if very little load is going through the fracture site or they are adding to the stability of a plate or an external fixator. Typical uses for wires or pins are to fix finger fractures, hand fractures, shoulder fractures and wrists. K-wires are often used to assist with the fixation in fractures of the patella, elbow and ankle. A device known as an image intensifier is often used to insert the device under x-ray guidance, allowing insertion of the pin or wire through the skin without operation.

Larger than wires and able to be threaded, Steinmann pins are typically employed to apply traction skeletally for one of the long bones, mostly in the leg. They are driven through the bone and attached to a weight via a stirrup-like device which applies the traction to maintain bony alignment until sufficient callus has formed for the traction to be removed. Traction is used much less often now as this technique has been overtaken by more advanced methods of internal fixation which allows us to avoid the negative consequences of long term bed rest needed for traction.

Screws

Using bone screws is a basic technique of modern orthopaedic and trauma management, used either on their own or as part of another implant technique. Screws can be self tapping or need tapping beforehand. The force needed to pull a screw out of the bone is affected by various factors and the main determining factor is the density of the bone into which it is inserted. The total area of contact between the bone and the threads is also important and self tapping screws are typically used. Screws are inserted clockwise either straight in or along a path already drilled and once the screw head hits the cortical bone it generates tension with screws typically inserted at a force equivalent to 80 percent of the force which would strip them.

Bone is an active and dynamic body organ and can adapt to the stresses formed by the application of the screws, allowing a gradual reduction in fixation force with time. However, the fracture is usually healed before the fixation is likely to loosen. The two main kinds of screws available are cancellous and cortical bone screws, the denser bone of the cortex being fixed with cortical screws and the more honeycomb bone of the bone ends fixed with cancellous screws. The surface areas of contact between thread and bone are greater in cancellous screws, allowing cancellous screws to achieve purchase in less dense bone.

Cancellous bone does not usually need tapping or pre-drilling, as it is less dense, more porous and can easily be screwed into. It may be advantageous to directly screw into this type of bone as this may make the bone more compressed over the insertion track and allow the screw to hold more strongly. An implant mechanism such as a plate can be held in place by positional screws and compress the metal plate against the bone. A pilot hole is typically drilled to start with and then the hole tapped with a screw thread unless self tapping screws are to be used.

A degree of compression can be produced by inserting lag screws across the line of a fracture to increase alignment and stability of a long bone fracture and to produce and maintain reduction of a fracture across a joint. To provide the greatest degree of stability requires the screw to be placed at right angles to the line of the break. It is unlikely that lag screws will give sufficient stability alone so they are often supplemented with added stability from an external fixator or a plate.

Cannulated screws are another type of fixation, inserted over a guide wire which has already been inserted under x-ray control, allowing the initial wire fixation to be precisely completed by the final fixation. They can be used in a percutaneous way, without open operation, such as with hip fracture pinning. Cannulated screws can also be used in operations with limited open technique to minimise the size of the operation and the consequent soft tissue damage. Modern designs both drill and tap themselves on insertion and these hollow design screws are much more expensive than non-cannulated versions.

Continue reading Internal Fixation of Bone Fracture – Part 2

Internal Fixation of Bone Fracture

  • Posted on December 14, 2011 at 7:50 pm



The challenge of fractures through the ages has been how to manage the severe pain, immediate disability and long term sequelae of these acutely presenting emergencies, making broken bones clear priorities due to the large number of incidences. The variety of fracture treatments includes traction, joint replacement, immobilisation, amputation and internal fixation. Open fractures with significant soft tissue injury and damage were and remain at risk of infection which was commonly treated with amputation in the past. Lister, who pioneered immunisation, developed the ideas of the open reduction of patella fractures and their internal fixation.

In the 1880s and 1890s the use of plates, screws and wires was introduced but was compromised by infection, implant design, allergy to the metals and a poor understanding of the biology underlying fracture healing. The techniques and principles of fracture fixation developed in the 1950s and more recent scientific advancement in mechanical and biological understanding of fractures and their healing have led to modern methods of assessing, managing and fixing fractures.

The maintenance of an adequate blood supply is vital for healing and a fracture disrupts both blood supply through the bone and that of the membrane surrounding the bone, the periosteum. The four stages of bone repair are inflammation, soft callus formation, hard callus formation and remodelling. Clinical signs of inflammation are pain, swelling, redness and heat, with a haematoma forming from the considerable bleeding which occurs at the fracture site. Inflammatory cells migrate in, which stimulate formation of new blood vessels and general cell multiplication.

The Biology of Bone Fracture Repair

The inflammatory phase is followed by the haematoma around the fracture site being infiltrated by fibrous tissue and cells which secrete cartilage, called chondroblasts. This material is more stable than the blood clot and begins the process of gradual stabilisation. Steadily the soft callus is converted into rigid bone, the hard callus phase, by conversion of the cartilage to bone and bone formation below the periosteum. Once the connection between the fracture fragments is more solid the fracture is said to have united and then it proceeds to remodelling where it becomes mature or lacunar bone.

Indirect fracture repair or secondary bone union is the process whereby fibrous bone is changed into mature lamellar bone, the typical way that fractures heal. In secondary healing the formation of callus occurs in a fracture which is not rigidly fixed and which has some displacement. The healing bone biology can be altered by reducing the fracture closely, i.e. getting the fragments in close contact and then fixing it internally. Removing the stresses applied to the fracture is achieved by the close approximation and stabilisation of the break and this can lead to the missing out of the callus stages in a direct healing across the break. As long as inappropriate levels of force are not applied to the site whilst healing the process completes, a process named primary bone union or direct bone healing.

The surgeon’s decisions about which form of internal fixation to use for a particular fracture determines the method of fracture healing which occurs at the operated site. If a high level of stability is provided, with little or no movement at the fracture, then primary or direct bone healing will occur with remodelling. If a lower degree of stability and more potential movement is present at the fracture the healing will be secondary or indirect bone repair.

Types of Fixation – Pins and Wires

Fractures are fixed by a variety of devices which include pins, wires, nails, plates and screws, depending on the location and severity of the fracture and the type of fixation provided. Pins and wires are the simplest methods of fracture fixation and the commonest ones are named after the people who developed them. Kirschner or K-wires are narrow wires varying in diameter from 0.6 to 3.0 millimetres and Steinmann pins vary from 3 to 6 millimetres in diameter. K-wires are not stiff and can be easily bent as a typical wire can, so they are mostly an addition to other methods of fracture stabilisation. These techniques can initially fix a fracture in preparation for more definitive techniques later, with minimal soft tissue and bone damage occurring.

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The DXA Bone Density Test

  • Posted on November 17, 2011 at 1:45 am



The Bone Density test comes in many forms. You may have seen the small machines at Health Fairs or at your local pharmacy.

These devices measure bone density by ultrasound technology. It is inexpensive, portable and there is no radiation exposure. Several studies have shown it to be a good predictor of fracture risk. It is sometimes called Quantitative Ultrasound(QUS).

However, ultrasound is not recommended to monitor osteoporosis long term because of limited precision of the machine and the fact that bone mass at peripheral sites (e.g. heel) changes very slowly. If an ultrasound test reveals an abnormal result we suggest obtaining a confirmatory DXA scan of the hip and spine.

It is also possible to use Quantitative Computed Tomography (QCT) to measure bone density. It is used less often than DXA. It is more expensive, less reproducible and emits a higher radiation dose than DXA.

So let’s talk a little about DXA. DXA is short for Dual X-Ray Absorptiometry. It is also known as DEXA, Bone Densitometry or the Bone Mineral Density (BMD) test/scan. It is really the ‘gold standard’ of bone density measurement techniques. DXA uses a very low radiation dose. The radiation is equivalent to the dose received when flying on an airplane from San Francisco to New York! So as you can see the exposure is minimal, but you should NOT undergo a scan if there is any chance of you being pregnant. DXA measures the BMD in one hip and in the lumbar spine. A few centers will measure both hips. Smaller, more mobile peripheral DXA devices are also used(pDXA). Talk to your physician about which Bone Density Test is available in your area.

So when you have had your scan you will be given a t-score. This is a statistical number that compares your bone density to that of a young adult. The more negative the t-score the worse your bone density. The lower the t-score the higher your risk of fracture. Take a look at this scale to see where your t-score lies.

The World Health Organisation classifies your t-score as follows:

T-SCORE better than -1.0 is NORMAL

T-SCORE from -1.0 to -2.5 is OSTEOPENIA

T-SCORE -2.5 or worse is OSTEOPOROSIS

On the day of the exam, eat normally, but don’t take calcium supplements for at least 24 hours beforehand. Wear loose, comfortable clothing, avoiding garments that have zippers, belts, or buttons made of metal. Inform your physician if you recently had a barium examination or have been injected with a contrast material for a computed tomography (CT) scan or radioisotope scan; you may have to wait 10-14 days before undergoing a DEXA test. Women should always inform their physician or x-ray technologist if there is a possibility they are pregnant.

The results of a DEXA bone density exam are interpreted by a physician specially trained in Bone Densitometry.I am a Certified Clinical Densitometrist with the International Society for Clinical Densitometry (www.iscd.org). I send an interpretation of your results and a signed report to your primary care physician, who will work with you to develop a treatment plan. Usually available within a few days, your test results will be in the form of two scores:

T score — This number shows the amount of bone you have compared to a young adult of the same gender with peak bone mass. A score above -1 is considered normal. A score between -1 and -2.5 is classified as osteopenia, the first stage of bone loss. A score below -2.5 is defined as osteoporosis. It is used to estimate your risk of developing a fracture.

Z score — This number reflects the amount of bone you have compared to other people in your age group and of the same size and gender. If it is unusually high or low, it may indicate a need for further medical tests.

Despite its effectiveness as a method of measuring bone density, DEXA is of limited use in people with a spinal deformity or those who have had previous spinal surgery. The presence of vertebral compression fractures or osteoarthritis may interfere with the accuracy of the test. CT scans may be more useful in such instances. DEXA cannot predict who will experience a fracture, but can provide indications of relative risk.

Central DEXA devices are more sensitive than pDEXA devices, but they are also somewhat more expensive. The peripheral devices don’t accurately follow changes in your bones during therapy. A test done on a peripheral location, such as your heel or wrist, may help predict the risk of fracture in your spine or hip. But because bone mass tends to vary from one location to the other, measuring the heel is not as accurate as measuring the spine or hip.

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