Degenerative disorders II Flashcards
Knee
patellar involvement-muscle involvement
lateral compartment secondary to genu valgum
medial compartment secondary to genu varum
unicompartment
bilateral compartment
TKA or TKR
numerous implant and fixation choices available:
- cemented, uncemented, hybrid
- metal backed or all polyethylene
- patella resurfacing or patella retaining
Effective in treating OA that is not responsive to conservative therapy
recovery of strength to normal levels is rare
early intensive rehab has been proven effective
evaluation/ examination
current and past med hx
PLOF
precautions
physical exam
strength testing
ROM
functional assessment
Specific mobility assessments
TUG
30 sec chair stand test
functional reach test
stair climbing test
6 minute walk test
Post surgery: phase I (inpatient)
1-5 days post
goals- prevent complications, reduce pain, reduce swelling, promote ROM, restore safety and independence
post surgery: phase IIa (SNF)
6-14 days post
goals: same as phase I. 120 deg knee flx in two weeks.
Post surgery: Phase 2b (outpatient/home health)
1-3 weeks post
goals: become safe in home, improve transfers, gait, ADLs
Post surgery: phase III (outpatient)
3 to 8 weeks
goals- normalized gait, reduce assisted device use, increase ROM, improve WB, strength, balance, endurance, and proprioception
Neuromuscular electrical stimulation (NMES)
6 weeks 2x per day post TKA better than typical rehab post TKA
improvements in quads and hs strength, functional performance, and knee ext ROM
Knee exercise ideas: Knee extension in open-chain
place cuff wt on involved limb
use uninvolved to assist into ext
allow slow eccentric control on knee ext
Knee exercises ideas: eccentric extension in closed chain
using leg press machine, use uninvolved to press wt into ext position
utilize slow eccentric control of knee ext of involved LE
Other ideas for exercises
forward cone walking
lateral cone walking
step onto BOSU
lunge or mini lunge onto BOSU
aquatic therapy
Manual therapy
manual stretching and PROM
jt mobs with manual ROM
distraction with flexion
flx mobs
ext mobs
kinesio taping
ice and elevation
Hip
primary
secondary- avascuar necrosis, SCFI, congenital dislocation of hip
secondary type can be relentlessly progressive
osteotomy may be approp in young adult
THR
Hip mobility assessment
TUG
30 sec chair stand test
berg balance
tinetti baance
functional reach
harris hip score
