Burn and Back Injuries: Overview and Recovery
Burn Injuries
Classification
Burns are classified by depth and size:
- 1st-degree (superficial): Affects the top layer of skin. Healing time: 2-3 weeks.
- 2nd-degree (partial-thickness): Affects the top two layers of skin. Healing time: 2-3 weeks.
- 3rd-degree (full-thickness): Affects skin, fat, and tissue above muscle. Slow healing, severe scarring, loss of range of motion.
- 4th-degree (deep full-thickness): Affects skin, fat, muscle, and bone. Slow healing, severe scarring, loss of range of motion.
A patient’s hand represents approximately 1% of body surface area.
Types of Burns
- Thermal Burns: Most common type, caused by fire, hot liquids, or hot surfaces.
- Chemical Burns: Caused by contact with acids, alkaline agents, gases, or other chemicals.
- Freeze Injuries: Include frostbite, injuries from propane, and Freon.
- Radiation Burns: Caused by high doses of radiation.
- Electrical Burns: Often show little external damage but cause extensive internal damage. Damage can continue after the initial contact.
- Inhalation Injury: Injury to the respiratory tract from smoke inhalation and carbon monoxide. Can lead to brain injury or death.
Burn Depth and Sources
- 1st & 2nd degree: Often caused by thermal sources like hot liquids or radiation (sunburn).
- 3rd & 4th degree: Often caused by fire, flame, or electricity.
Adjustment and Recovery
85% of individuals return to their former activities within six months. 15% require extensive, intermittent reconstructive or cosmetic surgery for about two years.
Skin Grafts
- Taken from the individual’s healthy skin (often back and legs).
- Donor skin (cadaver skin) is used as a temporary covering.
- TransCyte (artificial skin) is a temporary covering, not rejected by the body, primarily used for 2nd-degree burns. It is expensive and has been less available but is starting to make a comeback. Temperature regulation can be difficult, especially with 3rd-degree burns.
- RECell: Cells are scraped from a small graft, mixed with a formula, and sprayed onto the burn.
- Meshing: A small graft is put through a mesher to create a lattice-like pattern, allowing it to cover a larger area.
- Tilapia skin is being used in some countries for its proteins and collagen.
Other Treatments
- Pressure garments: Worn 23 hours/day for one year to help with scarring and mobility.
- Pain management: Burn pain can be neuropathic-like and last for years.
- Infection control: Pseudomonas (historically more deadly) and MRSA (currently less deadly) are concerns.
- Stretching: Important to prevent contractures.
Vocational Planning
- Assess ability to perform past or future jobs.
- Consider cosmetic appearance, pain management, and range of motion.
Returning to work, especially with facial burns, can be challenging. Phone jobs may be a good starting point. “Big burn” (slang) refers to a complete facial burn. Occupational engagement can help combat feelings of isolation.
Common Functional Limitations
- Mobility: Contractures caused by tissue shortening or scarring.
- Lower extremity: Walking, climbing, balancing.
- Upper extremity: Reaching, fingering, handling.
- Cosmetic disfigurement: Heat tolerance, aesthetic appearance, ability to meet the public, self-image, trauma to injured skin and/or joints.
Back Injury
Prevalence
- 80% of adults will experience back pain at some point.
- Over 25% of adults reported back pain in the last three months.
- Back pain is a leading cause of job-related disability and missed workdays.
Risk Factors and Recovery
- 90% of lower back pain cases have no specific diagnosis.
- Posture is a significant factor.
- A “high threat meter” (fear of pain) can hinder recovery and may need to be addressed before traditional physical therapy.
Diagnosis
- Subjective: Pain location, intensity, onset, history of injury.
- Objective: Strength testing, neurological testing, posture assessment.
Treatment
- First line: Symptom management and education.
- Second line: Manual therapy (joint immobilization, soft tissue mobilization, joint manipulation, modalities like ice, heat, electrical stimulation, traction).
- Last resort: Surgery (second opinions recommended; not beneficial for chronic low back strain).
A high threat meter, often associated with anxiety and depression, can complicate recovery.
Prognosis
- 90% of lower back pain cases improve within three months.
- 78% of those with a history of lower back pain experience a relapse.
Pain has both physical and mental components. Addressing the mental aspect can help manage chronic pain.