Joint physiotherapy

Spasticity, muscle contractures, painful shoulder and other joints of a paralyzed limb, malalignment or subluxation of the shoulder, falls and fractures can all potentially be avoided by good nursing and physiotherapy. Osteoporosis in a paralyzed Umb presumably increases the risk of fractures but may be unavoidable (Sato et al. 1998). 

The patient s priority is relief of joint pain, swelling and stiffness. In addition to providing symptomatic relief, the doctor must avoid the long-term effects of inadequately treated joint inflanunation, which leads to joint failure requiring multiple orthopaedic operations. There is no cure for arthritis (except septic arthritis), and the available drugs are sometimes poorly tolerated. Many patients with arthritis turn to complementary therapies which may interact with conventional drugs. Successful treatment of arthritis usually requires a multidisciplinary approach with physiotherapy, occupational therapy and adjustment on the part of the patient all being important. 

The information that must be included in a PGD for a physiotherapist follows the same general rules that are listed in the podiatric example given earlier in this chapter. Specific examples of drugs that might be included in a physiotherapy PGD are triamcinolone acetonide lOmg/ml and methylprednisolone acetate 40 mg/lidocaine hydrochloride 10 mg/ml, which are administered by intra- or extra-articular injection. Both of these drugs are used for the treatment of inflammatory conditions such as soft tissue injuries and isolated joint inflammation (see Chapter 7). 

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