Massage Therapy (1) (1).pdf

TOPIC 3: SKIN EXAMINATION The skin Entirely surrounds us as a natural barrier. Most ancient and sensitive organ Defines our individuality. Provides valuable information of our general health condition. Wrap membrane, alive, relatively waterproof, elastic and mobile. Continuity with the mucous membra...

TOPIC 3: SKIN EXAMINATION The skin Entirely surrounds us as a natural barrier. Most ancient and sensitive organ Defines our individuality. Provides valuable information of our general health condition. Wrap membrane, alive, relatively waterproof, elastic and mobile. Continuity with the mucous membranes. Highly vascularised. Segmental Innervation Dermatome (EXAM QUESTION) Skin area innervated by a spinal nerve corresponding to a spinal segment. I.e. skin area that contains sensitive information related to a single spinal root Essential when assessing aesthetic impairment (neuro). Keep in mind… The dermatomes OVERLAP (overlapping is even greater for vibration and soft touch, pain and temperature) Skin assessment Visual inspection Palpation Mobilization (Active and passive mobilization) Instrumentation Visual Inspection Conditions for observation Respect the patient’s PRIVACY Quiet, well ventilated, nice-looking Light conditions ( DAYLIGHT ) Bilateral Bony prominences + orthopedic/prosthesis supporting areas. Cover the stretcher with a pad/sheet and the patient with towels. * > ↑P = - blood supply ↓ Mass 1. Skin coloration Redness: increase in temperature and if bright red send to emergency room. Purplish or bluish: there is a lack oxygen and reduced temperature Black: Death of cells and necrosis. Yellowing: Problem with the liver. Marble or pale skin: no blood supply and vasoconstriction. Orange - Brown areas: high pressure. Hyper-pigmentation: the skin remains the same Color but melanilocytes will produce more melanin. Hypo pigmentation 2. Hairiness 3.Volume 4. Skin appearance Scaly plated Cellulitis Stretch marks Wrinkled Atrophic 5. Secretion Normal skin —> No Signs of dryness or sweating Sudorative disorders (Dry and plated) —> Injured nervous plexus and/or peripheral nerve 6. Flexion Creases In Down Syndrome people Eczema 7. Hairs and nails RIngworm Fungical infection PALPATION AND MOBILIZATION 1. Skin mechanical properties # Tested through the skin fold Consistency —> force used to form and maintain the skin fold Thickness —> width Extensibility —> how much it can be pulled Flexibility —> how much the skin fold can be twisted. Mobility —> Skin rolling, how much of the skin rolled can be moved. Elasticity —> ability of returning to its original state 2. Trophism and blood supply ⑳ Temperature Hyper Vs Hypothermia Skin Skin Texture Trophism and blood supply Pulse ( Radial artery, Brachial artery, Subclavian, Tibial artery, Pedius artery, Temporalis artery, Facial artery) Oedema -Venous -Lymphatic # * -Combined lymphodoema -Fovea Sign test -Stemmer’s Sign test Humidity Sudoral secretion —>. Hyperhidrosis Vs Anhydrosis Sebaceous secretion —> Normal, dry or oily skin Scars Resting Skin Tension Lines Normal Keloid Hyper/Hypotrophic Instrumental Quantificaiton Oedema Centimetric measurement for perimeters Volumetric quantification Skin thickness —> Adipometer Skin Temperature —> Temperature probe Trophism and blood supply —> Moberg test Static posture —> Digital Photographic control Supporting areas —> Barometry (for pressure) Sensory Assessment Superficial (exteroceptive) Algesia (pain) Thermal (T) Tactile (touch) Deep (interoceptive) Baresthesia (pressure) Algesia (pain) Palesthesia (vibration) Proprioception (articular position) Cortical or combined Stereognosis 2 point Discrimination Graphestesia General basis Ensure proper understanding of orders and cooperation Restrict distractions Shealthy Bilateral * Eyes closed Don’t exceed 20 min side Surface sensitivity Exteroceptive, Protopathic or Thalamic sensitivity Normoesthesia: Physiologic functioning Hypoesthesia: Decreased sensitivity Hyperesthesia: Amplified sensitivity Anesthesia: Absence of perception Dysesthesia: Altered perception Paresthesia: Tingling, prickling, numbness, burning. Synesthesia (same path for senses): Visual-tactile, pain-colour, Auditory tactile (Scon tissue - & Above makes poin O Healthy C time Proprioceptive, Epicritic or Cortical Sensitivity —> Deep sensitivity Baresthesia Digital pressuring: trapezius, Gastrocnemius & Brachial biceps Semester-Weinstein monofilaments Palesthesia Turning fork Distal to proximal Hypoalesthesia, hyperalesthesia, a Palesthesia * Bathesthesia Combined or Cortical Sensitivity Sterognosis: Ability to identify the objects by touch. Graphesthesia: Ability to identify signs on the skin. Two point discrimination: Ability to differentiate 2 points applied in the skin at the same time. The skin Wrap membrane, alive, relatively waterproof, elastic, mobile. Continuity with the mucous membranes orifices. Highly Vascularized. Originated in 2 blastodermic layers: Ectoderm (Epidermis and appendages (hair and nails) Mesoderm (Dermis and Hypodermis) Layers of Skin Epidermis Stratum Corneum Stratum Granulosum Stratum Spinosum Stratum Básale Dermis Papillary Reticular Hypodermis Skin Annexes —> hair, nails, sweat and sebaceous glands Functions of the skin Protective Mechanical protection —> Hypodermis Antimicrobial protection —> Sweat glands Thermal protection —> Insulation (fatty tissue (Hypodermis) for passive, Active —> dermis/ blood vessels) Electrical protection —> fatty tissue (Hypodermis) + Sebaceous Glands (Active) Light protection —> Dermis (Melaninocytes) # Chemical protection * = Sensory Sensitivity = First skill to interact and protect our being. Sensory receptors Located in afferent neurons peripheral endings Respond to internal and external stimuli Triggered by specific stimulus (pressure, temperature, chemicals, injury) in a specific intensity range. Nerve signal transduction Somatic receptors Proprioception Located in peripheral tissues: -Skin + Superficial fascia -Tendons -Joint capsules and ligaments Functional types of skin sensory receptors A. Thermoreceptors (Low threshold) Krause (Heat loss) Ruffini (Heat > 45 degrees Celsius) B. Mechanoreceptors (Low threshold) According to the response time to the stimuli: Slowly adapting receptors —> Pressure (Soft tissue will have a decreased blood supply, Hard tissue will break) Rapidly adapting receptors —> Superficial touch/ tickling, movement and vibration. According to the covered surface area: -Type 1 —> Small and surface covering -Type 2 —> Wide and well defined surface covering. Materiel discs (type 1, slowly adapting) Sensitive to skin displacement and maintained pressure Reticular dermis Pacinian Corpsucles (type 2, rapidly adapting) Sensitive to skin displacement and vibration Papillary dermis, Hypodermis, periosteum, tendons, synovial membranes. Ruffini corpuscles (type 2, slowly adapting) Skin displacement and maintained pressure Reticular dermis and hypodermis Both hairless and hairy skin Krause end bulbs (type 2, rapidly adapting) Light touch Reticular dermis Mucocutaenous and synovial membranes Meissner’s corpuscles (type 1, rapidly adapting) Light and discriminatory touch, vibratory. Papillary dermis Located in thick hairless skin —> finger pads C) Nociceptors (low threshold) Triggered when the tissue is damaged Some emotions are brought along with the physical sensation. (Ex: anger (feel less pain as higher threshold, anxiety feel more pain as lower threshold or fear) Small non or lightly myelinated afferent neurons