Endocrine - Exam Flashcards
What are the physical therapy considerations for wounds?
- daily routine activities
- proper footwear
- foot deformities
- prior foot hx
- neuropathy
- any wound
- observe contralateral foot
- pain response bilaterally
PT considerations
What should we look out for with the wound?
- Location
- onset
- trauma vs insidious onset
- prior wound in the same location
- any treatments received
What are the PT exam tests and measures?
- general demographics
- integumentary system
- musculoskeletal system
- neurological system
- cardiovascular system
- medical system screening
- shoe examination
What PTs look for when observing and palpating?
- look at the lower extremities and feet
- skin appearance: color, texture, quality and hair growth
- foot deformity, blisters, calluses and nail appearance
- wound appearance
- fungual infection
- odor
Characterisitics of Ulcers
Size of ulcer
a variety which is dependent on duration from:
- onset
- degree of deformity
- location of the foot
Characterisitics of Ulcers
Shape of ulcer
typically round with a “punched out appearance”
Characterisitics of Ulcers
Depth of ulcer
Most often deep
- can even have exposed bone
Characterisitics of Ulcers
Peri-wound region of ulcer
maceration often present of edges from any drain
- callus can be present and needs to be removed to assess wound bed fully
Characterisitics of Ulcers
Wound bed of ulcer
Typically red
- unless the vascular system is compromised
-
Characterisitics of Ulcers
Drainage of ulcer
tends to be heavy drain amount
- unless would can be off-loadded properly
- drainage decreases when pressure becomes relieved
Wagner Ulcer Classification Scale
Grade 0
intact skin
pre-ulcerative lesions could exist
bony deformity present or healed ulcer
Wagner Ulcer Classification Scale
Grade 1
Superficial ulcer (no subcutaneous tissue involved)
Wagner Ulcer Classification Scale
Grade 2
deep ulcer (subcutaneous tissue involved; could have tendon or bone exposed)
Wagner Ulcer Classification Scale
Grade 3
Deep, infected ulcer (abscess, osteomyelitis, osteitis)
Wagner Ulcer Classification Scale
Grade 4
Partial-foot gangrene (digits affected)
Wagner Ulcer Classification Scale
Grade 5
Full foot gangrene (beyond digits - needs surgical involvement)
What should PTs look for with musculoskeletal exam?
- Lower extremity
- foot and anle ROM-strength-PROM
- contractures
- structural foot deformities
Foot deformity
What is claw toe?
hyperextension of MTP joint with flexion of the PIP and DIP joints
Foot deformity
What is hammer toe?
hyperextension of MTP joint and flexion of PIP joint
- extension of DIP joint
Foot deformity
What is pes cavus?
High longitudinal arch
Foot deformity
What is pes planus?
flat foot
loss of arch support
Foot deformity
What do we consider for prior amputations?
adjacent weight bearing areas on the surrounding distal limb
What are the components of a neurological examination?
- coordination, equilibrium and gait
- DTR
- Sensation
- Proprioception
- Balance
Neuro exam
What are some test performed for coordination, equilibrium and gait?
- look at normal walking pattern
- Romberg
- all coordinations especially for the fingers and toes
Neuro exam
What are some sensation testing performed?
- 10 gram monofilament testing
- vibration
- pinprick
- light touch
What is the levels of sensation for the monofilament testing?
4.17 / 1g = normal sensation
5.07 / 10g = protective sensation
6.10 / 75g = loss of protective sensation (insensate)
