VISUAL VIGNETTE
Don’t Put Your Scar on the Vibrating Platform Franco Franchignoni, MD, Stefano Vercelli, PT, and Levent O¨zc¸akar, MD From the Unit of Occupational Rehabilitation and Ergonomics, FSalvatore Maugeri_ Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Rehabilitation Institute of Veruno (NO), Veruno, Italy (FF, SV); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LO¨). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. 0894-9115/14/9308-0734 American Journal of Physical Medicine & Rehabilitation Copyright * 2014 by Lippincott Williams & Wilkins DOI: 10.1097/PHM.0000000000000103
FIGURE 1 Right thenar eminence of the patient showing the
A
palmar scar, erythema, and small blisters.
55-yr-old man was seen for pain, erythema, and small blisters in the thenar region of his right hand. He reported that he had placed his palmVas a self-prescribed treatmentV on a synchronous whole-body vibration (WBV) platform for home use (two bouts of 2 mins each, at 30 Hz, amplitude of 2 mm) the day before. On detailed questioning, he described a traumatic (occupational) hand injury 5 mos before whereby his hand had been crushed by a press machine. He had also undergone surgical treatment that consisted of K-wire fixation for phalangeal fractures at the third, fourth, and fifth fingers; myorrhaphy; and median nerve release. The medical history was otherwise noncontributory. On physical examination, a palmar scarVnot thick but with low pliability, surface irregularities, and adhesion between skin and underlying soft tissuesVwas observed (Fig. 1). Thenar atrophy and mild hypoesthesia distal to the scar tissue were also present. The patient was followed conservatively, and erythema, blisters, and pain resolved within the following 4 days. Usual contraindications for WBV include recent wounds, but little (if any) attention has been paid to scars (particularly adhesive ones), andVto the best of the authors’ knowledgeVstudies addressing the physiologic effects of WBV on weight-bearing arms are lacking. This field deserves more attention, considering that Internet; WBV information booklets; and, recently, also a scientific article1 are proposing closed kinetic chain exercises (such as pushups) with the hands bearing on the vibrating platform, although the literature about occupational disorders and safety aspects connected to WBV2,3 recommend caution while performing them. All correspondence and requests for reprints should be addressed to Levent O¨zc¸akar, MD, Hacettepe U¨niversitesi Tip Faku¨ltesi Hastaneleri Zemin Kat FTR AD, Sihhiye, Ankara, Turkey.
734
In this case, the patient’s clinical condition (palmar adhesive scar and impaired skin quality) was not listed in the booklet of the WBV platform manufacturer. On the other hand, it is well known that when adhesion of the scarred tissue causes reduced shifting movements between the more superficial epidermal strata and the underlying layers (stratum spinosum), high-level friction and shear forces (such as those produced by the vibrating platform and its textured rubber cover) can induce a compromised tissue tensioning with the development of a cleft.4 Then, the area of separation is filled with fluid as a result of hydrostatic pressure, resulting in a blister. In short, there is need for further research about the effects of closed kinetic chain exercises of the upper extremity on WBV platforms, and meanwhile, the authors caution against applying direct vibration on skin with poor tribological quality.4
REFERENCES 1. Hand J, Verscheure S, Osternig L: A comparison of whole-body vibration and resistance training on total work in the rotator cuff. J Athl Training 2009;44:469Y74 2. Rittweger J: Vibration as an exercise modality: How it may work, and what its potential might be. Eur J Appl Physiol 2010;108:877Y904 3. Robbins D, Zeinstra E, Jimenez A, et al: Does whole body vibration have clinically significant neurophysiological and neurovascular implications? Int J Prev Treat 2012;1:18Y26 4. Li W, Kong M, Liu XD, et al: Tribological behavior of scar skin and prosthetic skin in vivo. Tribol Int 2008;41:640Y7
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 8, August 2014 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Don’t Put Your Scar on the Vibrating Platform Franco Franchignoni, MD, Stefano Vercelli, PT, and Levent O¨zc¸akar, MD From the Unit of Occupational Rehabilitation and Ergonomics, FSalvatore Maugeri_ Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Rehabilitation Institute of Veruno (NO), Veruno, Italy (FF, SV); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LO¨). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. 0894-9115/14/9308-0734 American Journal of Physical Medicine & Rehabilitation Copyright * 2014 by Lippincott Williams & Wilkins DOI: 10.1097/PHM.0000000000000103
FIGURE 1 Right thenar eminence of the patient showing the
A
palmar scar, erythema, and small blisters.
55-yr-old man was seen for pain, erythema, and small blisters in the thenar region of his right hand. He reported that he had placed his palmVas a self-prescribed treatmentV on a synchronous whole-body vibration (WBV) platform for home use (two bouts of 2 mins each, at 30 Hz, amplitude of 2 mm) the day before. On detailed questioning, he described a traumatic (occupational) hand injury 5 mos before whereby his hand had been crushed by a press machine. He had also undergone surgical treatment that consisted of K-wire fixation for phalangeal fractures at the third, fourth, and fifth fingers; myorrhaphy; and median nerve release. The medical history was otherwise noncontributory. On physical examination, a palmar scarVnot thick but with low pliability, surface irregularities, and adhesion between skin and underlying soft tissuesVwas observed (Fig. 1). Thenar atrophy and mild hypoesthesia distal to the scar tissue were also present. The patient was followed conservatively, and erythema, blisters, and pain resolved within the following 4 days. Usual contraindications for WBV include recent wounds, but little (if any) attention has been paid to scars (particularly adhesive ones), andVto the best of the authors’ knowledgeVstudies addressing the physiologic effects of WBV on weight-bearing arms are lacking. This field deserves more attention, considering that Internet; WBV information booklets; and, recently, also a scientific article1 are proposing closed kinetic chain exercises (such as pushups) with the hands bearing on the vibrating platform, although the literature about occupational disorders and safety aspects connected to WBV2,3 recommend caution while performing them. All correspondence and requests for reprints should be addressed to Levent O¨zc¸akar, MD, Hacettepe U¨niversitesi Tip Faku¨ltesi Hastaneleri Zemin Kat FTR AD, Sihhiye, Ankara, Turkey.
734
In this case, the patient’s clinical condition (palmar adhesive scar and impaired skin quality) was not listed in the booklet of the WBV platform manufacturer. On the other hand, it is well known that when adhesion of the scarred tissue causes reduced shifting movements between the more superficial epidermal strata and the underlying layers (stratum spinosum), high-level friction and shear forces (such as those produced by the vibrating platform and its textured rubber cover) can induce a compromised tissue tensioning with the development of a cleft.4 Then, the area of separation is filled with fluid as a result of hydrostatic pressure, resulting in a blister. In short, there is need for further research about the effects of closed kinetic chain exercises of the upper extremity on WBV platforms, and meanwhile, the authors caution against applying direct vibration on skin with poor tribological quality.4
REFERENCES 1. Hand J, Verscheure S, Osternig L: A comparison of whole-body vibration and resistance training on total work in the rotator cuff. J Athl Training 2009;44:469Y74 2. Rittweger J: Vibration as an exercise modality: How it may work, and what its potential might be. Eur J Appl Physiol 2010;108:877Y904 3. Robbins D, Zeinstra E, Jimenez A, et al: Does whole body vibration have clinically significant neurophysiological and neurovascular implications? Int J Prev Treat 2012;1:18Y26 4. Li W, Kong M, Liu XD, et al: Tribological behavior of scar skin and prosthetic skin in vivo. Tribol Int 2008;41:640Y7
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 8, August 2014 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
