Therapeutic Exercise: Foundations and Techniques, 5e Chapter 24 Management of Vascular Disorders of the Extremities

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Arterial System  Types of arterial disorders  Acute arterial occlusion  Arteriosclerosis obliterans  Thromboangiitis obliterans (Buerger disease)  Raynaud disease

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Arterial System (cont.)  Clinical manifestations of peripheral arterial disorders  Diminished or absent peripheral pulses  Integumentary changes  Sensory disturbances  Exercise pain and rest pain  Exercise pain  Rest pain  Muscle weakness

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Arterial System (cont.)  Examination and evaluation of arterial sufficiency  Palpation of pulses  Skin temperature  Skin integrity and pigmentation  Rubor dependency test—reactive hyperemia  Procedure  Alternate procedure

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Arterial System (cont.)  Examination and evaluation of arterial sufficiency  Claudication time  Doppler ultrasonography  Transcutaneous oximetry  Arteriography  Magnetic resonance angiography

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Arterial System (cont.)  Management of acute arterial occlusion  Management of chronic arterial insufficiency  Medical/surgical management  Role of exercise  Special considerations in a graded exercise program for patients with chronic arterial insufficiency  Rationale for graded exercise  Exercise guidelines

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Venous System  Types of venous disorders  Thrombophlebitis and deep vein thrombosis  Chronic venous insufficiency  Clinical manifestations of venous disorders  Deep vein thrombosis and thrombophlebitis: signs and symptoms  Pulmonary embolism: signs and symptoms  Chronic venous insufficiency: signs and symptoms

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Venous System (cont.)  Examination and evaluation of venous sufficiency  Girth measurements  Competence of the greater saphenous vein (percussion test)  Tests for deep vein thrombosis  Homan’s sign  Application of a blood pressure cuff around the calf  Additional special tests

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Venous System (cont.)  Prevention of deep vein thrombosis and thrombophlebitis  Management of deep vein thrombosis and thrombophlebitis  Management of chronic venous insufficiency and varicose veins

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Lymphatic System  Conditions leading to insufficiency of the lymphatic system  Congenital malformation of the lymphatic system  Infection and inflammation  Obstruction or fibrosis  Surgical dissection of lymph nodes  Chronic venous insufficiency

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Lymphatic System (cont.)  Clinical manifestations of lymphatic disorders  Lymphedema  Location  Severity  Increased size of the limb  Sensory disturbances  Stiffness and limited range of motion  Decreased resistance to infection

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Lymphatic System (cont.)  Examination and evaluation of lymphatic function  History and systems review  Examination of skin integrity  Girth measurements  Volumetric measurements  Prevention of lymphedema

Therapeutic Exercise: Foundations and Techniques, 5e Disorders of the Lymphatic System (cont.)  Management of lymphedema  Background and rationale  Comprehensive regimens and components  Manual lymphatic drainage  Exercise  Elevation  Compressive bandages, garments, or pumps  Skin care and hygiene  Management guidelines  Precautions and self-management of lymphedema  Use of community resources

Therapeutic Exercise: Foundations and Techniques, 5e Breast Cancer-Related Lymphatic Dysfunction  Background  Surgical procedures  Mastectomy  Breast-conserving surgery  Dissection of axillary lymph nodes (lymphadenectomy)

Therapeutic Exercise: Foundations and Techniques, 5e Breast Cancer-Related Lymphatic Dysfunction (cont.)  Impairments and complications related to breast cancer treatment  Postoperative pain  Postoperative vascular and pulmonary complications  Lymphedema  Chest wall adhesions  Decreased shoulder mobility  Weakness of the involved upper extremity  Postural malalignment  Fatigue and decreased endurance  Psychological considerations

Therapeutic Exercise: Foundations and Techniques, 5e Breast Cancer-Related Lymphatic Dysfunction (cont.)  Guidelines for management after breast cancer surgery  Special considerations  Patient education  Exercise  Community resources

Therapeutic Exercise: Foundations and Techniques, 5e Exercises for Management of Lymphedema  Background and rationale  Components of exercise regimens for management of lymphedema  Deep breathing and relaxation exercises  Flexibility exercises  Cardiovascular conditioning exercises  Lymphatic drainage exercises