Chapter 6: Musculoskeletal System Disorders & Burns Flashcards
Osteogenesis Imperfecta
Genetic, malformed brittle bones, small body, triangular face, loose joints, hearing loss, respiratory problems. Tx: activity/environment adaptation, preventative positioning and splinting, weight bearing.
Arthritis: rheumatoid and osteoarthritis
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.
Burns: Superficial
Superficial or first-degree burns: epidermis only. Minimal pain and edema-healing time is 3 to 7 days.
Hip precautions Posterolateral Approach & Anterolateral approach
post: no flexion greater than 90, no internal rotation, no adduction
Ant: No external rotation, no adduction, no extension
How to estimate total body surface area of burns for adults and kids
Adults: rule of nines
Kids: Lund-Browder chart (more accurate)
Compartment syndrome
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.
Intervention during burn emergent phase
0-72 hours after injury. Splint: intrinsic plus for hands, opposite client’s posture, neck elbows hips and knee extension, shoulder in abduction.
Intervention during burn acute phase
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).
Intervention during sugical and postoperative burn phase
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.
Intervention during rehabilitation phase of burn
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.
Outpatient and community burn intervention
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.
Heterotopic Ossification
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.
Pruritis
Excessive itching after burn. Use compression, lubrication,cold packs and antihistamines to alleviate.
Superficial partial thickness burn
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.
Deep partial thickness burn
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.
