Bandage and bandage – elbow joint fixators

Immobilization of the elbow joint is one of the most important elements of complex treatment of many diseases of this segment of the upper limb. Without reliable fixation and immobilization of the joint, it is impossible to restore the anatomical relationships of the elbow elements.

You can achieve the desired effect using an elastic bandage, a fixator, or by applying a bandage to the elbow joint.

Briefly about the treatment method

Compression therapy in the treatment of lymphedema, using soft, low-stretch bandages and compression garments, is an integral part of disease management. The goal of compression therapy is to maintain and improve the reduction in edema achieved during treatment. Banding is the mainstay of treatment for stage 2 and 3 (moderate to severe) lymphedema and is an integral part of decongestant therapy. The advantages of the method are:

• Supports the results of lymphatic drainage massage, keeping 50% of daytime swelling.
• The bandage can be worn securely both day and night, due to the low resting pressure when the muscles are inactive and relaxed.
• The bandage is effective during training because it provides additional resistance.
• Dressing with special pads placed inside the dressing helps soften fibrous tissue.

When the active phase of therapy is over, you can move on to wearing elastic compression garments. However, it cannot be worn at night when the muscles are relaxed, so the band will need to be continued overnight. Compression sleeves and clothing are designed to help the lymph move in the right direction, maintaining the results of treatment. Compression hosiery frees the patient from constantly wearing bandages, which, thanks to the multi-layered and integrated components of the add-ons, become quite cumbersome. Single-layer support compression garments are a comfortable and effective addition to the daily life of a person with lymphedema. Another important benefit of compression garments is the medically integrated “compression gradient”. The gradient is of paramount importance for effective disease management because lymphatic fluid must be able to flow efficiently to the trunk, allowing for reduced drainage and limb reduction. To maintain normal blood and lymph circulation, the pressure should be moderately strong in the distal parts of the extremities (hand/foot) and less in the proximal areas (shoulder/thigh). While bandages create high operating pressures, compression garments create low operating pressures due to the elastic materials used in their construction. Clothing creates a very high resting pressure, while bandages create a low resting pressure, for these reasons it is not recommended for overnight use. Without the beneficial support provided by both forms of compression (clothing and bandages), treatment of lymphedema would be impossible, but together these forms of therapy achieve the desired effect (reduction of limb swelling).

Benefits of Elastic Compression

Bandage/clothing reduces the rate of ultrafiltration Lymph is a clear, protein-rich fluid in tissue spaces throughout the body. This fluid (1-2 liters per day) is usually carried by the lymphatic vessels, passes through the regional lymph nodes and joins the venous blood shortly before this blood enters the heart. Lymph circulation is important for maintaining normal tissue homeostasis throughout the body. The balance between fluid leaving the arterial side of the capillaries (ultrafiltration) on the one hand and the reabsorption that occurs in the venous capillaries as well as drainage through the lymphatic vessels on the other is known as Starling's equilibrium. Due to impaired lymphatic drainage in lymphedema, this balance is disrupted, protein-rich fluid accumulates in the tissues, colloid osmotic pressure increases, and all these events favor ultrafiltration. By raising tissue pressure using an external force (bandage or compression garment), the effective ultrafiltration pressure is reduced and less fluid accumulates, thereby improving the patient's condition. The bandage/garment improves the efficiency of muscle activity. Lymph moves through the various lymphatic vessels through muscle activity, contraction of the lymphatic vessels themselves, movements of the diaphragm (breathing) and negative pressure within the chest during the breathing cycle. In the limbs, skeletal muscle activity is an important factor in lymph transport. To maintain this process, normal tissue (skin and muscle) and joints are needed. The use of elastic compression increases the efficiency of muscle activity. The bandage/garment prevents the re-accumulation of lymphatic fluid. Manual lymphatic drainage is used to empty and decompress closed lymphatic vessels in the swollen part of the body. Since compression bandages compensate for the reduced tissue pressure of the skin, they prevent the re-accumulation of stagnant lymphatic fluid and thereby maintain the treatment result.

Indications and contraindications for the treatment method

If you have mild lymphedema (stage 0 or 1), you can only use compression garments. For stage 2 and 3 lymphedema, it is recommended to first develop a treatment program called total decongestant therapy to reduce swelling. Undergo bandage treatment and then use compression stockings. Banding is contraindicated if:

• The patient has stage 0 and stage 1 lymphedema: it requires other forms of compression.
• The area to be bandaged is infected.
• There is an open wound.
• The patient has severe arterial obstruction.

Graduated compression should not be used in the presence of the following pathologies:

• Arterial Pathology: Compression of small arteries will further reduce blood flow, create pain and reduce blood supply.
• Diabetes with neuropathy.
• Wet dermatosis (reddened skin, abrasive surface, secretion of serous fluid).
• Skin ulcer (not caused by venous insufficiency).
• Eczema.
• Arterial circulation disorders.
• Painful Raynaud's pathology with damage to the arterial wall.

Congestive heart failure or the presence of blood clots are conditions where you need to discuss special precautions regarding ligation (or any other form of compression) with your doctor.

Preparing for treatment

For bandaging

Low stretch bandages. Low-stretch wrap options range from the ultra-simple (short 100% cotton stretch wraps) to the more complex with a nylon/lycra blend in the outer layer and a foam inner layer that has multi-directional elasticity and adjustable compression that "doesn't migrate." Modern bandages have reusable Velcro and/or self-adhesive properties that help keep the bandages in place with little slippage. Most fabrics are cool, comfortable and breathable, hypoallergenic, hard-wearing and durable. Lotion to moisturize the skin and maintain its health. Well-moisturized skin prevents small cracks from forming and prevents bacteria from entering and causing infection. It can also prevent skin irritation from unaccustomed use of bandages. Tubular stocking. Additionally protects the skin and provides a comfortable, breathable base for wrapping. Felt cotton fabric, foam rubber, or foam sheets to add a layer of padding that evenly distributes the compression of the outer wraps.

Compression jersey

Compression clothing is selected by the attending physician. Important factors to consider are:

• compression class,
• appearance,
• material,
• finished product or to order,
• design,
• skin condition.

Elastic compression is recommended to maintain the results achieved by decongestant therapy. In the case of compression hosiery, compression is the force exerted by the product to compress the limbs and promote blood and lymph circulation. Compression is measured at specified points and expressed in millimeters of mercury. The highest value is at the ankle, called point B in medical parlance. The compression gradients indicated on the packages are measured at point B. Medical compression stockings are available in different compression grades:

• Class I: 20-30 mmHg.
• Class II: 30-40 mmHg.
• Class III: 40-50 mmHg.
• Class IV: 50-60 mmHg.

The gradient gradually decreases from point B to the edge of the garment. Sleeves are generally class I or II, gloves and mittens class I, stockings class II or III. Fibers used in elastic compression garments are typically latex or synthetic rubber, nylon, polyester, cotton, or a blend of these. Fabrics can be thick or thin, depending on the fibers used and the compression class (the higher the class, the thicker the garment). Most garments containing latex are knitted from a thread consisting of a latex core wrapped in nylon or cotton, this is important for those with latex allergies. There are three types of knitwear: round knitted, flat knitted and embroidered. Round knit fabrics are seamless but tend to bunch at the top. This creates a tourniquet effect, impeding the flow of fluid from the limb. Flat knits are often made from a rough, textured fabric that can provide a mini-massage to the skin, helping to improve fluid absorption and transport. Sewn, consist of several layers. In order for the clothes to stick better to the body, use a silicone tape inside the upper edge or several longitudinal (not circular) strips of transparent glue.

Immobilization of the elbow joint

In the complex treatment of many diseases of the ulnar segment of the arm, reliable fixation and complete immobilization of the articular joint will be required in order to restore its anatomical structure.

When applying an elastic bandage, you need to correctly align the end parts of the bones, create an anatomically correct articular joint, and fix it in a stationary bent state. It is in a bent position - this is what anatomy requires, this is what nature requires. The desired effect can be obtained with fixators and bandages, but it is required that all coaches and sports doctors be able to apply elbow bandages correctly.

The use of elastic bandages in the treatment of common injuries and diseases is indicated at the beginning of therapy, and during rehabilitation, as a preventive measure against relapses when the athlete wants to continue training.

At the same time bandaging:

• softens movements;
• reduces swelling;
• improves blood and lymph circulation in joint tissues.

Elastic bandaging treats elbows with inflammation, degenerative joint diseases, and severe bruises. An elastic bandage restores joints during dislocations or intra-articular fractures. The picture above shows what the joint looks like when the tendons are stretched.

The picture on the left clearly demonstrates how to correctly apply a fixing bandage. A diverging type of dressing is used. The hand should lie in a position that is comfortable for it, in case of severe pain or severe injury - on the table, the surface of the back of a chair. For both the convergent and divergent types, bandaging the elbow joint should maintain a minimum of movement, but not damage the nerve and vascular fibers lying on the surface of the skin with pressure from the bandage.

Requirements for bandaging:

• the bandage is applied to the arm when the elbow is bent 90°;
• each turn covers each other by ½ the width of the tape;
• The bandage is applied tightly, but cuts into the skin.

Rules for convergent bandaging:

• turns of the elastic tape are applied alternately above and below the elbow;
• the bandage crosses behind the elbow, above the process of the radius.

Rules for bandaging by divergent type:

• begins on the outside of the elbow joint;
• the turns are applied according to the pattern - one above, the other below the elbow;
• The bandage is crossed in the elbow bend.

This video shows a divergent type elbow bandage.

httpv://www.youtube.com/watch?v=embed/NhENk2YM1F8

Both types of bandaging must be done with skillful, confident movements, not forgetting to overlap the tape by half its width, cross the bandage tape carefully so that it does not slip during movements or cause discomfort. A properly applied bandage should preserve blood circulation

It is important to hold the bandage correctly: wrap it around the injured arm from left to right, this is required by the anatomy of the blood circulation. In this case, the roll must be held with your right hand, and its tail with your left, so that the rolled bandage is always on top

Elastic elbow bandage is used by athletes to prevent injuries and damage. This is a universal material that provides proper care for the damaged elbow. It combines elasticity, strength, and air permeability.

How the treatment method works

Banding technique

Compression layers help protect skin from irritation, distribute compression evenly over wide areas, and provide high operating pressure and low resting pressure to stimulate lymph flow. During active treatment, the bandages are worn 23 hours a day, 7 days a week throughout the treatment phase. The band should not be placed without proper supervision, as proper banding is a complex process. The limb should not be wrapped too tightly to “squeeze out” excess fluid. This may seem like a good idea to some, but it is absolutely forbidden to do this! A bandage that is too tight causes a tourniquet effect, which blocks the flow of lymph and further damages the affected tissues and lymphatic vessels. There are several different dressing methods. It is better to follow the method recommended by your therapist. Bandages are created from several layers of materials. The first layer is absorption. Consisting of a tubular bandage, it absorbs excess sweat and protects the skin from friction against other layers that will be placed above it. A new or washed bandage is used each time you make a new bandage. The limbs are bandaged from the base of the fingers upward to the desired height. The second layer is shock-absorbing. It consists of various materials (foam rubber, foam rubber, etc.) and is used to uniformly distribute pressure on tissues and soften fibrous tissues, as well as to shape the limb. The third layer is compression. Consists of stretch bandages. They come in different widths and lengths, depending on the area being wrapped. The technique of applying bandages is such as to provide the greatest compression at the far end of the limb and the least near the body.

Features of using compression knitwear

Sleeves and stockings are worn during the day, removed at night. Although compression stockings are made of durable elastic materials, they stretch after about twelve hours of wear. This is especially true in high-stretch areas (knee, elbow) where clothing wears more. Therefore, it is good to have several sets of elastic underwear. Compression jersey should be worn during sports or during increased physical activity. The pressure of the swelling pulls the skin so that it no longer provides a firm surface for the muscles. Exercise causes an increase in blood flow, which leads to an increase in lymphatic load. Compression clothing provides “hard new skin” for muscles and helps normal lymph flow.

Contraindications

Wearing fixators and elastic bandages on the elbow joint area has an extremely narrow range of restrictions. This makes it possible to use immobilization without the risk of complications. Obstacles to applying a bandage may be:

• Skin pustular diseases at the site of bandaging.
• Open fractures, a gaping wound in the ulnar part of the upper limb.
• Allergy to product components, such as latex.

Most contraindications can be eliminated by selecting another device or treating concomitant pathologies. If the brace in the area of ​​the elbow joint causes discomfort when worn, the patient should report his feelings to the attending physician.

Prognosis after treatment method

Although lymphedema can be reduced to normal or near-normal size with proper treatment, the lymphatic vessels never become normal again. In addition, after swelling decreases, skin elasticity is not completely restored. Therefore, external support is an important component in the treatment of the disease. Even after successful treatment, the part of the body affected by lymphedema is at constant risk of fluid accumulation again, and most people with lymphedema know that this condition requires lifelong care. Without the benefits of external compression, successful long-term disease management would be very difficult and in most cases impossible.

Types of elbow bandages

A dressing material is applied to prevent swelling and stop bleeding. The bandage allows you to keep your hand motionless. If it is applied correctly, it promotes rapid recovery.

• Bandage
• Sequencing
• Spica-shaped
• Spiral
• Errors
• Video on the topic

The types of dressings on the elbow joint are distinguished as follows:

• protective;
• pressing;
• with traction;
• immobilizing;
• corrective.

According to the bandaging technique, they are:

• circular;
• creeping;
• cruciform;
• spiral;
• returning;
• spicate;
• turtle.

Bandage

Using a dressing, the movements of the injured limb are limited. Apply a turtle bandage to the elbow joint. It is applied for sprains, bruises, and after surgery.

If it is necessary to completely close the joint, use a converging bandage. The limb should be bent at an angle of 110 degrees. The first round is applied higher in one segment. The next one is performed in figure eight. The bandage gradually converges from the periphery to the center. The cross of the tour should be in the elbow bend. My patients use a proven remedy that allows them to get rid of pain in 2 weeks without much effort.

When using a convergent dressing, the bandage is applied obliquely. The limb must be additionally fixed. To do this, use a scarf.

Observation program after treatment method

Compression jersey

It is better to wash knitwear by hand (especially clothes with silicone tape), although there are products that can be washed in a machine. When washing clothes in the machine, it is recommended to place them in a wash bag to protect the fabric. Daily washing is recommended, especially if lotions or creams are used (moisturizing lotion can damage the fibers in compression garments and should only be used at night when clothing is removed). It is better to have more than one item of clothing, they should be worn alternately so that elasticity can be restored and their effectiveness can be increased. Harsh cleaning agents, solvents, and cleaners must not be used. Use mild soaps or detergents that do not contain chlorine, fabric softeners, or other laundry additives. Clothes should not be wrung out by twisting the fabric. Place it in a towel and gently wring it out. Avoid exposure to direct sunlight when drying. It's a good idea to hang your towel on a drying rack and hang your clothes on top, as the weight of the water can stretch the fabric. Compression hosiery should be replaced approximately every six months or when the garment shows signs of wear that could adversely affect its compressive properties. Generally, if a knit no longer returns to its original shape after washing or has holes in the material, it will need to be replaced.