CCR 9

Question 1

what are posterior THA precautions?

Answer 1

BLT bending, lifting, twisting, avoid flexion past 90, adduction, internal rotation

Question 2

what are the anterior THA precautions?

Answer 2

avoid excessive hip extension, abduction, and external rotation.

FYI - labrum is more thick anteriorly as compared to posteriorly and therfore you will have more posterior dislocations as oppose to anterior)

Question 3

the angle of inclination is what?

what is the normal angle of inclination?

Why should your hip be at this angle?

Answer 3

• angle within the frontal plane between the femoral neck and the medial side of the femoral shaft.
• at birth 140-150, iseal is about 125 degrees
• angle is bascically the best position the femur can be within the acetabulum, you get the most coverage. proper alignement will increase stability.

Question 4

what is coxa vara and coxa valga?

Answer 4

coxa vara = angle of 105, less than 125. could see a possible decrease in leg length,

coxa valga is angle of about 140 degrees. greater than 125, could see an increase in leg length, could also cause a circumduction gait.

Question 5

femoral tosion/anterversion is what

Answer 5

relative motion or twist between the bones shaft and neck

Question 6

normal degree of torsion is what?

Answer 6

8-15 degrees

Question 7

if torsion is great the what will equal excessive anteversion?

Answer 7

great than 15 degrees

Question 8

if torsion is less than what would equal retroversion?

Answer 8

less than 15 degrees.

Question 9

where is the femoral head seated in excessive anteversion?

Answer 9

femoral head is seated more anteriorly

Question 10

what are some gait compensation for excesive anteversion?

Answer 10

toe in gait pattern to seat femoral head more posterior and keep forces centered

Question 11

where is the femoaral head seated when you observe femoral retroversion?

Answer 11

seated more posteriorly in the acetabulum

Question 12

what are some gait compensation you might see with retroversion?

Answer 12

toe out gait pattern to seat femoral head more anteriorly

Question 13

what is the normal foot progression angle?

Answer 13

normal angle is 10 degrees.
toe in = less than 10 degrees
toe out = more than 10 degrees

Question 14

a patient presents with a -10 degree foot progression angle. what type of gait pattern would you see? and what may their diagnosis be?

Answer 14

toe in gait pattern due to increase hip IR

seen commonly with excssive femoral hip anteversion

Question 15

what condition is an orthopedic defect, present at birth, in which the head of the femur does not articulate with the acetabulum as a result of an abnormal shallowness of the acetabulum?

Answer 15

congenital hip dysplasia, or developmental dysplasia of the hip.

Question 16

an 18 year old female presents to PT with reports of pain and some inflmmation of her hands and wrist, small rash on her face covering only her nose and under her eyes, as well as sharp pain in her chest when she breathes “sometimes”. she has as a past medical history seasional allergies, IBS, and tonsillectomy, what is the possible diagnosis?

Answer 16

possible Lupus.
PMH: IBS, crohn disease, fibromyalgia.
female more than males
symptoms of lupus: butterfly rash, arthritis in joints, (+) pleurisy

Question 17

what is pleurisy?

Answer 17

inflammation of the pleura of the lungs. when the pleura gets inflammed it rubs together causing a rough, grating, squeaky/leathery sounds.

most common pulmonary manifestation of lupus.

Question 18

difference between primary lymphedema and secondary lymphedema?

Answer 18

primary - caused by condition that is congenital or hereditary
secondary - caused by injury to one or more parts of the lymphatic system.

Question 19

which is more common primary or seconday lyymphedema?

Answer 19

secondary

Question 20

true or false: primary lymphedema is associated with lymph node/vessel formation being abnormal, causing “hypoplasia”

Answer 20

true

Question 21

what is hypoplasia?

Answer 21

a condition where there are fewer lymphatic vessels nd they are smaller than normal.

Question 22

what is stemmers signs?

Answer 22

diagnostic sign for lymphedema.

a postive stemmers sign is the inability to pinch a fold of skin at the base of the toes.

Question 23

phase 1 of complete decongestive therapy? (CDT)

Answer 23

Phase 1; intensive, includes skin care, manual lymph drainage, bandageing, exercise, and compression garments at END of phase

Question 24

What is phase 2 of CDT?

Answer 24

self mangement, skin care, compression garment during the day, exercise, bandaging at night, and manual lymph drainage as needed.

Question 25

manual lymph drainage should be directed in which direction

Answer 25

toward the the midbody.

Question 26

what is manual lymph drainage used for?

Answer 26

used to treat sports injuries and post op swelling

*** NOT used for cardiac/pulmonary related edema

Question 27

with manual lymph drainage you should decongest limb from where?

Answer 27

proximal to distal. clear the fluid that is closest to the torse first.

Question 28

what is centrifugal versus centripetal direction?

Answer 28

centrifugal - toward the feet, away from the heart
centripetal - toward the heart
** you want to massage toward the heart when doing MLD

Question 29

when it comes to compression therapy, what pressure should you achieve with short stretch bandages?

Answer 29

20-40 mm HG

Question 30

what type of bandages provide low resting pressure and high working pressure?

Answer 30

short stretch bandages

Question 31

what type of bandages provide high resting pressure and low working pressure

Answer 31

long stretch bandages. typically not used with lymphedema.

Question 32

when do you NOT want to use pneumatic pump compression?

Answer 32

1 - HTN or bp > 140/90
2 - acute inflammation
3 - local infetion
4- positive for DVT
5- cardiac or kidney dysfunction
6 - obstructed lymph channel
7- impaired cognitive function