Pathology A to Z: A Handbook for
Massage Therapists
D
By Kalyani Premkumar
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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
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
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
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
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