Acute care

Question 1

What are the differences between joint effusion and edema?

Answer 1

Joint Effusion

– Contained by joint capsule
– Feels like a water balloon
– Moves when palpated then returns

Edema

– Fluid in interstitial space
– Press on tissue with finger – dent (pit) remains

• Measurement of edema with circumference is
reasonable accurate and correlates well with CT
scans

Question 2

What is PRICE, RICE and PRICES?

Answer 2

PRICE: protect, rest, ice, compress, elevate
RICE: all of the above except protect.
PRICES: all the above, add support

Question 3

With external compression wrapping, what direction do you wrap?

Answer 3

Distal to proximal

Question 4

What accessories can you utilize to increase compression?

Answer 4

J or horseshoe shaped felt pad held in place with the wrap.

Question 5

What is internal compression and what are the methods?

Answer 5

Compression of lymph vessels and veins.

– Muscle contractions (if safe)
– ROM, pumping ankles, alphabet, isometrics

Question 6

What does external compression do for circulation?

Answer 6

Pushes fluid towards the heart (therapeutic and prophylactic for Deep Venous Thrombosis (DVT) and Venous Thrombo Embolism (VTE)

Pushes arterial blood into extremity
– Ischemia, intermittent claudication

Question 7

When is intermittent compression appropriate and what would you use?

Answer 7

Acute or chronic edema

• Mechanical device (usually pneumatic)
• Inflates to compress part

Question 8

Whats the most common form of intermittent compression?

Answer 8

Intermittent sequential graded compression

• 3- compartments
– Distal,
– Intermediate
– Proximal

• Inflated for minutes
then deflated then
repeated hours per
day

Question 9

T/F

Intermittent compression can be combined with cooling?

Answer 9

True

Question 10

What are the positive effects of elevation?

Answer 10

• Gravity augments lymph flow
• Elevation above heart level significantly
reduced edema in 20 minutes
• Dependent position increases edema (in
normals)
– Probably more profound in inflammation

Question 11

What kind of things fall under the “support” category?

Answer 11

Nutrition
Education
Taping, bracing, crutches, canes, etc.
Referral for emotional support
Etc.

Question 12

Bracing and taping are great for acute support, but what are some downsides?

Answer 12

Not much research
Tape stretches within 20-30 minutes
Bracing can inhibit muscle actions (e.g. knee brace inhibit the hamstring from contracting).

Question 13

T/F

When structure and function of a joint are not severely compromised, it’s still best to be safe and cut out any weight bearing activity on that part of the body.

Answer 13

False,

If not severely compromised, careful and partial weight bearing is better than non weight bearing.

Question 14

When fitting crutches, what should patient orientation be?

Answer 14

• Low heeled shoes
• Stand with tall posture
• Feet close together

Question 15

When fitting crutches, how should the crutch tips be oriented relative to the feet?

Answer 15

– 6”(15 cm) from outer margin of shoe

– 2”(5) cm in front of shoe

Question 16

When fitting crutches, how should the arm brace and hand brace be oriented?

Answer 16

Arm brace
– 1-2” below ant. axillary fold

• Hand brace
– elbow flexed to 30 degrees

Question 17

What are some abnormal stresses that can come from improper usage or fitting of crutches?

Answer 17

–Lumbar/pelvic subluxation
–Low back strain
–Hip strain

Question 18

What anatomy is effected by crutch palsy and what are the symptoms?

Answer 18

• Pressure on axillary nerves and vessels

* Temporary or permanent numbness

Question 19

What should be the orientation of crutches while walking for weight bearing and non weight bearing?

Answer 19

• Non-weight bearing = tripod gait
• Partial weight bearing = tripod or 4-point
gait

Question 20

How can you instruct your patients so that they don’t experience crutch palsy?

Answer 20

Instruct them to always use an upright spinal posture

Discourage them from resting on the underarm braces.

Question 21

What are the 7 aspects of tripod non-weight bearing gate with crutches?

Answer 21

• Affected foot fully elevated
• Crutch tips move 12 to 15 in. ahead of feet
• Lean forward, straighten elbows
• Pull underarm brace firmly
against torso
• Swing both legs between
crutches
• Step onto unaffected foot
• Recover crutches to forward
position

Question 22

What is swing-to gait and swing through gait?

Answer 22

Swing-to gait: bring fit to crutches (easier, less coordination)

Swing-through gait: foot lands in front of crutches (faster, more coordination).

Question 23

What’s another name for tripod partial weight bearing gait?

Answer 23

Four point gait.

Question 24

What is tripod non-weight bearing gait?

Answer 24

• Affected leg and crutches move forward together

– Partial weight placed on affected leg

Question 25

What are the two gait options when going up and down stairs?

Answer 25

Tripod gait: tripod gait if no handrail, curbs
• “The good go up, the bad go down”

Handrail gait – Preferred, safer
– Both crutches under one arm
• Away from railing
• Crutches remain on affected side if possible

Question 26

What is the proper steps to going up and down stairs with handrail gait?

Answer 26

Going up: unaffected side goes first, follow by crutches and bum leg.
Going down: crutches down, then affected leg, then unaffected leg.

Question 27

What is the proper steps to going up and down stairs with tripod gait?

Answer 27

Going up: unaffected leg goes first, followed by crutches and bum leg.

Going down: Crutches and affected leg go down first, then unaffected leg. `

Question 28

What kind of footwear should patients wear when fitting a cane?

Answer 28

Low heeled street shoes

Question 29

What is the appropriate length for a cane?

Answer 29

Superior aspect of greater trochanter

Question 30

T/F

Cane is to be used on the side of involvement

Answer 30

False,

cane’s are to be used on the OPPOSITE side of involvement.

Question 31

T/F

Cane is to move with the involved side

Answer 31

True