Pathology A to Z A Handbook for Massage

Dandruff Description: chronic inflammation of skin in areas of concentrated sebaceous glands Cause: unknown; could be related to fungal or bacterial involvement or rapid proliferation of cells located superficially Signs and Symptoms – Whitish, powdery scaling of scalp with some itching, redness – Oily form: greasy scales and crusts over red, inflamed skin – Lesions occur in scalp, in and between eyebrows, in eyelid margins, on cheeks, around ears, in body creases Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dandruff (cont. ) Risk Factors: more common in men, during winter, and in people with Parkinson’s disease Medical/Surgical Treatment – Frequent shampooing (medicated or not) – Corticosteroid lotions Massage Therapy Cautions and Recommendations – Not contagious – Avoid massage in areas with inflamed skin and pustules. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diabetes mellitus Description: chronic disease of endocrine function of pancreas, marked by inadequate secretion of insulin Cause: impaired release of insulin by pancreatic beta cells, presence of inadequate or abnormal insulin receptors on cells, or rapid destruction of insulin even before it can carry out its action Signs and Symptoms – Excessive urination, thirst, and hunger; weight loss – Fatigue, lack of energy, dehydration, muscular weakness – Neuropathies, circulatory problems, foot ulcers – Loss of sensation in hands and feet; eyesight problems Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diabetes mellitus (cont. ) Risk Factors: see Cause Medical/Surgical Treatment – Dietary changes, exercise, antidiabetic drugs, insulin – Pancreas transplantation Massage Therapy Cautions and Recommendations – Perform relaxing, gentle massage. – Be aware that massage may affect daily insulin requirements. – Avoid working in and around diabetic ulcers or injection sites. – Watch for acute complications, such as hypoglycemia. – Keep sugar sources (juice) handy in case of drop in blood sugar. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diarrhea Description: frequent passage of loose, watery stools Causes: infection, lactase deficiency, high intake of magnesiumcontaining antacids, rapid motility of intestines, inflammatory conditions Signs and Symptoms – Frequent passage of watery stools – Colicky pain in abdomen – Dehydration; dry, loose skin; parched mouth; sunken eyes – Fatigue, weakness, fainting, nausea, vomiting Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diarrhea (cont. ) Risk Factors: inadequate sewage disposal and water supplies; lack of refrigeration; overcrowding; lack of personal hygiene; intravenous drug use; engaging in nonhygienic sexual activity Medical/Surgical Treatment: electrolyte and fluid replacement, antibiotics, drugs to slow movement of intestines Massage Therapy Cautions and Recommendations – Avoid massaging clients with acute diarrhea. – Avoid abdominal massage in clients with chronic diarrhea. – Avoid working at all if you have diarrhea. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dislocation Description: disturbance to normal relationship of bones in a joint, resulting in complete displacement of articulating surfaces Cause: trauma to joint, weakness of supporting structures (paralysis, lax ligaments), congenital condition, subluxation Signs and Symptoms – Severe pain and deformity, inhibition of movement by pain, protective spasm – Snapping sound, injury to surrounding tissues, inflammation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dislocation (cont. ) Risk Factors: joints more susceptible to dislocation include glenohumeral, acromioclavicular, metacarpal, interphalangeal Medical/Surgical Treatment – Joint reduction surgery, immobilization, rest, ice, compression, elevation, range-of-motion exercises Massage Therapy Cautions and Recommendations – Massage is contraindicated locally in acute/subacute stages. – Massage compensating muscles with broad strokes. – Employ passive ROM movements, deep moist heat (chronic stage). Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diverticular Disease Description: intestinal disorder characterized by presence of diverticula, bulges that protrude through muscular walls of GI tract Cause: increased pressure in lumen of bowel, which pushes inner lining through muscular layer, especially in weak areas Signs and Symptoms – Diverticulosis: asymptomatic or mild pain, alternating diarrhea and constipation, blood in stools – Diverticulitis: inflammation of diverticula, lower left abdominal pain, excess gas formation, nausea, low-grade fever, irregular bowel movements Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diverticular Disease (cont. ) Risk Factors: more common in U. S. , with about 50% of people over 50 being affected; inadequate dietary fiber, sedentary lifestyle, irregular bowel habits Medical/Surgical Treatment – Altering diet; stool softeners; increased intake of water, vegetables, fruits, whole-grain bread, wheat, and bran – Antibiotics and anti-spasm drugs, surgery Massage Therapy Cautions and Recommendations – Massage is contraindicated in acute stage. – Gentle massage in older clients helps regulate bowel movements. – Avoid pressure or rigorous massage of abdomen of older clients with constipation. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Down Syndrome Description: genetic, congenital disorder marked by mental and physical impairments Cause: presence of three instead of two copies of chromosome 21, resulting from defects in way ovum or sperm divide Signs and Symptoms – Mental disability (extent variable) – Slanting, almond-shaped eyes; protruding tongue – Small skull, mouth, and chin; slow development of teeth; flat bridge of nose; small, rounded ears – Short stature, short limbs, small hands, flat feet, poor balance and coordination Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Down Syndrome (cont. ) Risk Factors: birth of subject when mother is older than 34 or father is older than 42; genetic predisposition from mother or father; exposure to radiation and certain viruses Medical/Surgical Treatment: prevention through genetic screening and counseling Massage Therapy Cautions and Recommendations – Use caution when working around joints, which are lax and hyperflexible. – Seek special training if working with such clients regularly. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dupuytren’s Contracture Description: progressive, painless thickening and tightening of palmar aponeurosis, resulting in flexion contracture of fourth and fifth fingers Cause: usually unknown; sometimes inherited Signs and Symptoms – Small, thickened nodules in middle of palm, close to ring finger – Dimpled skin; spread of thickening, forming cordlike bands – Fourth and fifth fingers remain flexed at metacarpophalangeal and interphalangeal joints – Inflammation; pain on extension of fingers; bilateral Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dupuytren’s Contracture (cont. ) Risk Factors: more common in older men, alcoholics, people with diabetes or epilepsy; may be associated with occupations requiring prolonged, forceful gripping of tools Medical/Surgical Treatment: splinting of hand, surgery Massage Therapy Cautions and Recommendations – Avoid massage if client is taking anti-inflammatory drugs. – Apply ice if inflammation is present. – Use deep moist heat application prior to massage (subacute and chronic stages). – Use friction strokes, followed by ice application. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dysmenorrhea Description: abdominal pain during menstruation excessive enough to prevent normal activity and require medication Cause: usually unknown; can be associated with other diseases and increased levels of prostaglandins Signs and Symptoms – Lower abdominal pain 1– 2 days before menstruation – Pain may be intermittent – Headache, nausea, vomiting, irritability, dizziness Risk Factors: see Cause Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dysmenorrhea (cont. ) Medical/Surgical Treatment – Antiprostaglandins (ibuprofen) and other painkillers (aspirin) – Counter-pressure, heat applications, and exercise – Hormone therapy (oral contraceptives) Massage Therapy Cautions and Recommendations – Perform relaxing whole-body massage, with focus on lower back and abdomen. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins