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PHTH 536 - Body Systems > Amputation > Flashcards

Amputation Flashcards

1
Q

What are the considerations with amputations?

A

the boundaries of dead or diseased tissues
considering prosthesis
possible mobility and function
cosmesis

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2
Q

What is myodesis?

A

muscle secured to the bone by suturing the distal tendon through holes thats been drilled in the bones
- most often in BL/AKA to help with deformities of the residual limb

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3
Q

What is a myoplasty?

A

attaching sectioned muscle to opposing muscles

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4
Q

What is the difference between a minor and major amputation?

A

minor - toe or partial amputations

major - proximal to tarsometatarsal joints

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5
Q

What are the primary indications for amputations?

A
  • peripheral vascular disease
  • diabetic wounds
  • trauma (MVA or gunshots)
  • infections
  • tumor/cancer
  • congenital
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6
Q

How is balance affected by an amputation?

A

decreased balance if ankle joint is gone = loss of somatosensory, decreased WB, reduced confidence, limits of daily activities

loss of ankle joints changes postural control = increase reliance on other balance strategies

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7
Q

What is a partial foot amputation?

A

transmetatarsal

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8
Q

How does transmetatarsal amputation assist with balance?

A

Keeps ankle integrity

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9
Q

What is the most common amputation?

A

partial foot amputation - transmetatarsal

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10
Q

What is the return for tranasmetatarsal amputation?

A

use of prosthetic or standard foot wear

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11
Q

What are the effects of gait for partial foot amputation?

A

loss of power generation

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12
Q

What is symes?

A

removal of foot
- medal and lateral malleoli is removed
- heel pad relocated to distal tibia

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13
Q

What is chopart?

A

disarticulation between the navicular/cuboid bones and the talus/calcaneus bones

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14
Q

What is lisfranc?

A

tarsometatarsal joint amputation

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15
Q

What is transmetatarsal amputation?

A

midshafts of MTs

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16
Q

What is a transtibial amputation?

A

“BKA” - below-knee amputation
- this preserves the knee
- loss of muscular control of LE groups and foot/ankle (well man aint no more there tf)

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17
Q

What are the gait characteristics?

A
  • decreased gait velocity
  • shorter step length
  • increased stance phase
  • increased time on sound limb
  • asymmetrical stance phase duration
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18
Q

What is transfemoral?

A

“AKA” - above-knee amputation
- preserves hip joints
- loss of joints below and impaired muscular below pelvis

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19
Q

UE amputation

Interscapular thoracic

A

whole ahhh upper limb with clavicle and scapula

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20
Q

UE amputation

Shoulder disarticulation

A

whole ahhh upper limb through shoulder joint

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21
Q

UE amputation

Transhumeral

A

through humerus

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22
Q

UE amputation

Elbow disarticulation

A

thru elbow joint

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23
Q

UE amputation

Transradial

A

thru radius and ulna

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24
Q

UE amputation

Wrist disarticulation

A

thru wrist joint and removing carpal bones

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25
Q

UE amputation

What is amputated with a partial or full removal?

A

hand, metacarpal, thumn and phalangeal

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26
Q

UE amputation

What is trans-radial?

A

“below elbow” amputation

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27
Q

UE amputation

What is trans-humeral?

A

“above elbow” amputation

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28
Q

What is the prevalence of UE amputations?

A

> 80% of UE amputations are because of trauma
- common in men ages 15-45
- followed by cancer/tumor

Risk increases with age

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29
Q

What age is at the greatest risk of UE amputation?

A

age 65 and over

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30
Q

What is the general goals for post-op amputations?

A
  • promote wound healing in residual limb
  • pain management
  • optimize ROM and strength
  • protect residual limb
  • functional sitting/standing balance
  • train for safety with bed mobility and transfers
  • ambulation training with AD
  • proper sitting and bed positioning education
  • discuss next phases of rehab
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31
Q

When looking at shape, what are we looking at?

A

cylindrical shape
bulbous
“dog ears”
bone length

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32
Q

What should we be careful when measuring strength?

A

pressure on the surgical site
grade of test

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33
Q

Where are some common contracture sites?

A

hip flexion
hip abduction
hip ER
knee flexion
ankle PF

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34
Q

What are some considerations for stump pain and skin checks?

A

Look at the wound site
skin integrity
depending on healing - it can either slow or increase healing rate

delayed healing because of infection or non-compliance

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35
Q

What is phantom limb pain?

A

Its the perception of pain in the missing limb
- described as tingling, prickling, pins and needles
- the severity gets less with more stimulation

more common in women than men

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36
Q

What is the pain management for the residular limb?

A
  • medication
  • compression
  • breathing and relaxation techniques
  • massage, biofeedback and TENS
37
Q

How is the total length including soft tissue measured?

A

taken from an easily identified bony landmark to the palpated end of the long bone, incision line or end of soft tissue

38
Q

How is the circumference measured?

A

medial tibial plateu or tibial tubercle and at equally spaced points to end of limb

39
Q

What is the post-op amputee rehab goals?

A
  • contraction prevention
  • pain mangement
  • emotional care
  • post-op edema
  • early ambulation
  • residular limb protection
  • bed mobility and transfers
  • fall prevention
  • trunk stabilization
  • desensitization while loading of distal stump progressively
  • scar management and mobilization
40
Q

What are the precautions/contraindications for PT?

A

Signs and symptoms:
- excess drainage through bandages or rigid dressings
- sharp local pain on stump
- fever
- foul odor = infection

Hold PT and resume when pt is stable

41
Q
A
41
Q

What are the clinical considerations?

A
  • cognitive dysfunction
  • comorbidities
  • cardio-pulm conditions
  • ulcers or infection
  • flexion contractions
  • age
  • psychoscial factors
42
Q

Post-op dressing options

What are the advantages of ace wrap?

A
  • edema control
  • wound access
  • inexpensive
43
Q

Post-op dressing options

What are the disadvantages of ace wrap?

A
  • does not protect wound/residual limb from external environment
  • hard for patient to apply
  • difficult for proper application and maintain even compression
  • will not prevent contracture
44
Q

Post-op dressing options

What are the advantages of a shrinker?

A
  • edema control
  • wound access
  • inexpensive
  • even compression layers
45
Q

Post-op dressing options

What are the disadvantages of shrinker?

A
  • may catch on staples/suture lines
  • may increase pain during application
  • does not protect wound/residual limb from external environment
  • will not prevent contraction
46
Q

Post-op dressing options

What are the advantages of rigid dressing?

A
  • residual limb protection
  • best edema control option
  • residual limb protection in a fall
  • BKA contracture prevention
47
Q

Post-op dressing options

What are the disadvantages of rigid dressing?

A
  • high risk of infection = pose barrier to non-removal type
  • bulky, heavy
  • needs to monitor closely
  • limited wound access
48
Q

Post-op dressing options

What are the advantages of an elastic roller bandage?

A
  • readily available and accessible
  • inexpensive
  • easy to access to incision
49
Q

Post-op dressing options

What are the disadvantages of elastic roller bandage?

A
  • cabe hard for patients and family to get proper pressure
  • can produce areas of high pressure that can impair healing
  • needs frequent rewrapping
  • increased likelihood of knee flexion contracture with transtibial amputation
50
Q

Post-op dressing options

What are the advantages of semirigid dressing?

A
  • better edema control than soft dressing
  • RL protection
51
Q

Post-op dressing options

What are the disadvantages of semirigid dressing?

A
  • needs frequent changing
  • can’t be applied by patient
  • no access to incision
52
Q

Post-op dressing options

What are the advantages of IPOP?

A
  • excellent edema control
  • excellent stump protection
  • control of stump pain
  • decreased time to fit with prosthesis
53
Q

Post-op dressing options

What are the disadvantages of IPOP?

A
  • no access to incision
  • more expensive than other dressings
  • needs proper traning for use
  • needs skilled practioner for frequent reapplications and fittings
  • patient needs to carefully adhere to all procedures
54
Q

What are the causes of residual limb edema?

A
  • possible delayed healing
  • stump break down because of fitting hardships
  • poor venous return
  • other associated disorders
  • arterial disease
55
Q

What are some pre-prosthetic considerations?

A
  • edema management
  • skin care
  • contracture positioning prevention
  • mobility, strength, function and balance
  • equipment needs
  • vascular assessment
56
Q

What is the goal for joint mobility strengthening and function?

A
  • maintain or restore ROM above amputation
  • prevent joint contractions (proper positioning)
  • gait training
57
Q

What is the gold standard for outcome measures?

A

Ampute mobility predictor

58
Q

What is the MDC for amputee mobility predictor?

A

3.4-point change

59
Q

What are the considerations for stump wrapping?

A
  • from distal to proximal
  • figure 8 pattern
  • partial overlap of the layer before
  • no gaps
  • cylindrical shape
  • even pressure = no wrinkles or creases
  • with tape securing it
60
Q

What are the bandages used for a BKA?

A

2 4-inch bandages

61
Q

What are banadages used for AKA?

A

1 4-inch
1 6-inch

62
Q

How often should bandages be removed?

A

Every 4 hours hours or sooner if it loosens up

63
Q

Why is compression so important for all amputees?

A
  • reduce edema
  • pain control
  • increase wound healing
  • protects incision during functional activity
  • faciliate prosthetic placement preparation by shaping it and desensitizing
64
Q

Compression bandaging

When is a rigid banadage applied?

A

Applied surgeon in the OR
- removed in 3-4 days
- can put new IPOP = lets limited TTWB in 2-3 days by the prosthetist

65
Q

Compression bandaging

What is rigid bandage not good for?

A

for patients with higher risk for infection because of wound status
- can’t really it unless its removed

66
Q

Compression bandaging

When is a semi-rigid applied?

A

By the prosthetist with a negative mold or when rigid is removed in 3 days post op

67
Q

Compression bandaging

What kind of materaial is semi-rigid made of?

A

Polyethylene making it lightweight, easy to clean and more durable than plaster

68
Q

Compression bandaging

When is soft bandaging applied?

A

once a suture line is healing (10-21 days)
- using shrinker TT/TF
- Jobst for TF (???????)

69
Q

What are the principles of Ace-wrapping?

A
  • distal pressure should exceed proximal
  • pressure applied on oblique turns only - no wrinkles
  • reapplied every 4 hours
  • no metal clips dummy
  • remove if aching, burning or numbness
  • wear 23 hrs of the day (remove it to clean it bro)
  • continue until pt. has definitive prosthesis and pt can leave stump unwrapped overnight and don it easily
70
Q

What are the strategies of phantom limb pain?

A
  • patient education (them boys be standing thinking they got both)
  • look for neuroma or infection
  • compression
  • prosthesis use
  • desensitization techniques (rub that thang)
  • heat
  • some medications (wack stuff frfr)
71
Q

What are the pain management when it comes to PT treatments?

A
  • give time for pain meds (dey be complainin)
  • education on imagery and relaxation
  • TENS = wound and relaxation methods
  • US (america??)
  • cold therapy
  • massage (rub that thang)
  • wearing prosthesis/compression bandages
72
Q

What is the most common contractures to prevent for transtibial (BKA)?

A

hip flexion
knee flexion

73
Q

Why are BKA contractions happening?

A
  • long periods of sitting in w/c and bed = flexion is position of comfort
  • protective flexion withdrawl is associated with LE pain
  • muscle imbalances
  • loss of sensory input from foot in WB
74
Q

What are the contractures common in transfemoral amputations?

A

hip flexion
hip abduction
hip lateral rotation

75
Q

Contraction management

How do you keep the knee in extension in bed?

A

avoid using pillows under the residual limb

76
Q

Contraction management

How do you keep the knee in extension in the W/C?

A

using an amputee board, elevated amputee hanger
- avoid long periods of sitting

77
Q

Contracture management

What are other forms of management?

A
  • prone
  • PNF
  • manual stretching
  • mobility
  • AROM
  • PROM
78
Q

Strengthening Principles

What is the reason for UE/LE/trunk strengthening and endurance?

A
  • safety
  • energy efficient prosthetic gait
  • contraction prevention
  • mobility
79
Q

Strengthening Principles

What kind of exercises for post-op muscle strengthening?

A

isometric contraction with limited ROM @ proximal joint to prevent stress across incision
- no valsalva

progression of wound healing = longer arc of motion, active resistive exercise, the reg ya know?????

80
Q

What are other POC considerations?

A
  • hip ext, abd, add and knee ext
  • overall strengthening
  • aerobic to increase endurance
  • mobility
  • posture COG shifted up, back and toward remaining leg (feeling bad frfr)
  • skin integrity
  • balance
81
Q

Medicare functional classification scale

K0

A

not able to ambulate or transfer without assistance

82
Q

Medicare functional classification scale

K1

A

Use of prosthesis and walks mainly on level surfaces or fixed cadence
- household ambulator

83
Q

Medicare functional classification scale

K2

A

uses prosthesis and walks in limited community distances, uneven surfaces, curbs and stairs

84
Q

Medicare functional classification scale

K3

A

Use prosthesis and waks community ambulation distances
- can traverse most barriers in environment
- variable cadence

85
Q

Medicare functional classification scale

K4

A

potential for prosthesis and walks without any limitations
- exceeds basic abilities/demands for gait
- can handle high-impact activity

86
Q

who/when to prescribe a prosthesis to a TTA?

A
  • patient has their own knee power
  • prosthesis helps w/ transfer
  • prosthesis helps with STS
87
Q

Who/when to prescribe a prosthesis to a TFA?

A
  • patient has no knee power
  • prosthesis has no knee power
  • transfers - often easier without prosthesis
  • STS - prosthesis makes it more challenging
88
Q

What should the patient master before a TF prosthesis?

A
  • transfer independently
  • STS independently
  • walks in parallel bars or walker for at least 6-8 meters

PHTH 536 - Body Systems (28 decks)

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