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Scurvy

★ CMTO Exam Focus

Scurvy is a nutritional deficiency disorder caused by severe lack of vitamin C (ascorbic acid), which is essential for collagen production. Without collagen, endothelial cells are not properly cemented together, making blood vessel walls extremely fragile and prone to rupture. Rare in modern developed societies but still encountered in individuals with extremely poor diets, alcohol use disorders, eating disorders, or GI malabsorption conditions.

Recognition

  • Tender, swollen gums and loosening of teeth (periodontal ligament deterioration)
  • Easy bruising and very poor wound healing (fragile vessel walls)
  • Unexplained petechiae (small red spots) or ecchymosis (bruising)
  • Profound fatigue and weakness (systemic metabolic toll and associated anemia)
  • Dry skin and hair. Subcutaneous bleeding
  • Muscle aches and joint pains without specific injury history
  • At-risk populations: Elderly, homeless, or socially isolated individuals. Those with GI malabsorption. Alcohol use disorder. Eating disorders
  • In children: misshapen bones similar to rickets

MT Relevance

  • Primary risk is causing bruising and internal bleeding from fragile vascular walls — pressure must be significantly modified. Use light effleurage or holding techniques only
  • Skin integrity: Avoid areas with broken skin or open sores. Poor wound healing is a hallmark — any break in skin integrity poses infection risk
  • Session duration: Shorter sessions with light pressure until nutritional status is medically stabilized
  • Pain management: Gentle, non-intrusive approach for musculoskeletal aches and joint pains

Required Actions

  • Refer for medical evaluation if an undiagnosed client presents with unexplained bruising, bleeding gums, petechiae, and poor wound healing
  • Do not apply moderate or deep pressure until vitamin C status is corrected and vascular integrity is restored
  • Strict hand hygiene — open sores are potential infection portals

Key Takeaways

  • Scurvy results from severe vitamin C deficiency, impairing collagen production and making blood vessel walls extremely fragile.
  • The primary RMT risk is causing bruising and internal bleeding. Pressure must be significantly modified.
  • Open sores are infection portals requiring strict avoidance and hand hygiene.
  • Classic signs: tender swollen gums, easy bruising, poor wound healing, petechiae, and ecchymosis.
  • Prioritize shorter sessions and light pressure until nutritional status is medically stabilized.

Sources

  • Rattray, F., & Ludwig, L. (2000). Clinical massage therapy: Understanding, assessing and treating over 70 conditions. Talus Incorporated.
  • Werner, R. (2012). A massage therapist's guide to pathology (5th ed.). Lippincott Williams & Wilkins.
  • Norris, T. L. (2019). Porth's essentials of pathophysiology (5th ed.). Wolters Kluwer.