Chapter 6: Musculoskeletal System Disorders & Burns

Question 1

Osteogenesis Imperfecta

Answer 1

Genetic, malformed brittle bones, small body, triangular face, loose joints, hearing loss, respiratory problems. Tx: activity/environment adaptation, preventative positioning and splinting, weight bearing.

Question 2

Arthritis: rheumatoid and osteoarthritis

Answer 2

Deformities common with rheumatoid, ulnar deviation and subluxation of the wrist and MCP joints, boutonniere deformity, swan neck deformity. Evaluation: focus on active range of motion not passive, do not test muscle strength unless physician orders, measure pain and edema. Tx: resting hand splint in acute stage, ulnar drift splint, silver ring splints for finger deformities, joint protection techniques, Energy conservation techniques, active range of motion, mild strengthening, paraffin wax, purposeful and occupation based activities.

Question 3

Burns: Superficial

Answer 3

Superficial or first-degree burns: epidermis only. Minimal pain and edema-healing time is 3 to 7 days.

Question 4

Hip precautions Posterolateral Approach & Anterolateral approach

Answer 4

post: no flexion greater than 90, no internal rotation, no adduction

Ant: No external rotation, no adduction, no extension

Question 5

How to estimate total body surface area of burns for adults and kids

Answer 5

Adults: rule of nines

Kids: Lund-Browder chart (more accurate)

Question 6

Compartment syndrome

Answer 6

Inelasticity of eschar (burned tissue) can increase pressure within fascia comparments. Symtoms: paresthesia, coldness, decreased pulse in extremities. Surgical excision of eschars can release pressure.

Question 7

Intervention during burn emergent phase

Answer 7

0-72 hours after injury. Splint: intrinsic plus for hands, opposite client’s posture, neck elbows hips and knee extension, shoulder in abduction.

Question 8

Intervention during burn acute phase

Answer 8

72 hours after injury or until wound is closed (could be months). Splinting in antideformity positions, edema mgmt, early participation in ADLs, client and caregiver education. ROM as tolerated, no PROM or AROM with exposed tendons or recent grafts (must wait 5-7 days).

Question 9

Intervention during sugical and postoperative burn phase

Answer 9

Immobilazation after skin graft usually for 3-10 days. Positioning in anticontracture position, goal is to promote greatest surface area for graft placement. After immobilzation period, start with gentle AROM.

Question 10

Intervention during rehabilitation phase of burn

Answer 10

Wound is healing and closed. Skin conditioning: Skin lube should be applied several times per day. Skin massage to desensitive grafted sites or burn scars, Scar mgmt: Compression therapy for edema and scars with bandages or garments, Therapeutic exercise & activity, anticontracture splinting, dynamic splinting, ADLs.

Question 11

Outpatient and community burn intervention

Answer 11

Continue scar mgmt through compression, skin conditioning, splinting, and exercise until scar is mature (1-2 years), improve skin tolerance, promote ROM & stength, adapt activites if movement limitations from scars, address PTSD and other psychosocial issues.

Question 12

Heterotopic Ossification

Answer 12

Formation of bones in abnormal areas, ususally in soft tissue around elbow, knee, hip, shoulder joints. Loss of ROM, pain, hard end feel during PROM. Discontinue PROM and dynamic splinting, begin AROM within pain-free range.

Question 13

Pruritis

Answer 13

Excessive itching after burn. Use compression, lubrication,cold packs and antihistamines to alleviate.

Question 14

Superficial partial thickness burn

Answer 14

Superficial partial thickness burn: 2nd° burn involving epidermis and upper portion of dermis. Red blistering wet. Painful but no grafting necessary. Healing time is 7 to 21 days. . Treatment: range of motion 72 hours post operative. Sensation and strength when wounds are healed. Wound care and range of motion. Edema control and splitting if necessary. ADLs.

Question 15

Deep partial thickness burn

Answer 15

Deep partial thickness burn: 2nd° burn involving epidermis and the portion of dermis, hair follicles and sweat glands. Appears red, white, and elastic. Sensation may be impaired. Potential to convert to full thickness if infected. Healing time is 21 to 35 days.

Question 16

Full thickness burn

Answer 16

Full thickness burn: 3rd° burn involving the epidermis and dermis hair follicle sweat glands and nerve endings. Appears white waxy leathery and nonelastic. No sensation and requires skin graft. Hypertrophic scar. Healing time is months. Treatment: ROM 5 to 7 days post operative. Other evaluations see above. 72 hours: dressing changes splint at all times. 5 to 7 days: begin active range of motion, ADL and meaningful activities, sterile whirlpool. Over seven days: PROM as tol, ADLs, when wounds heal: massage, compression garments, strengthening.

Question 17

Subdermal Burn

Answer 17

4th° burn: involves fat muscle and bone. Can be from an electrical burn.

Question 18

three steps to treat contractures

Answer 18

superficial and deep heat, slow stretch, and static splinting.

Question 19

Facet Joint Pain

Answer 19

Inflammation or changes of the spinal joints.

Question 20

Mutilans Deformity

Answer 20

Present with RA. Very floppy joints with shortened bones and redundant skin. Most common in MCP, PIP, radiocarpal and radioulnar joints.

Question 21

Prosthesis control training

Answer 21

operation of each component of the prosthesis

Question 22

Prosthesis use training

Answer 22

integration of prosthesis components for efficient assist during functional use

Question 23

prepositioning training

Answer 23

identification of the optimal position of each positioning unit (wrist, elbow) to perform and actibity or grasp and object.

Question 24

prehension training

Answer 24

TD control during grasp activities

Question 25

functional training

Answer 25

control of prosthesis during functional activities, includes incorporating TD as a functional assist, problem solving approach