Exam 1 Hard Shit Flashcards
What are clinical signs of peripheral neuropathy?
Decreased Sensation
Autonomic Dysfunction
Motor Impairments
Diabetic complications leading to amputations.
Severe ischemic pain
Acute embolism
DVT
Systemic Toxicity
Loss of distal pulses
Local Necrosis
Osteomyelitis
What are the classic symptoms of PAD?
Intermittent Claudication
Numbness
loss of distal pulses
Trophic Changes
How do we help diabetic patients and PAD patients prevent limb loss?
Give diabetic foot screens and check:
temperature
distal pulses
protective sensations
observe: deformities, swelling, callus formation and nail shape/color
What are challenges associated with traumatic amputations?
Pain
Other Injuries
Multiple surgeries
partial vs full amputation
viability of the tissue
limb length/shape
How will pts with osteosarcomas present?
pain with weight-bearing, complaints of deep pain and fractures.
What are the challenges of congenital deficiencies?
cosmesis
growth
provide for function
What factors affect the level of amputation?
vascular disease
disarticulations
postoperative fxn
trauma and malignancy
advantages of myoplasty:
more vascularization
advantages of myodesis:
more stability and mobility sooner
anterior/posterior flaps are best for __________ healing while a long posterior flap is best when __________ is a concern.
bone; vascularity
What is the shortest level compatible w knee function?
tibial tubercles
Why would someone choose a transfemoral amputation over a transtibial?
gangrene developed
poor circulation at transtibial level
trauma
what are common post-op issues for all amputations?
pain
wound healing
edema
heterotrophic ossification
what are common post - op issues for transfemoral amputations?
hip adductor roll
hip abductor contracture
hip flexor contracture
glute weakness.
What can contractures lead to?
pain, immobility, functional issues, and pressure ulcers
what are the benefits of osteointegration?
eliminates socket need
short residual limb
more natural feeling
more natural gait
normal swelling
disadvantages of osteointegration:
multiple surgeries
long period of immobility
illegal in US
reduction in high torque exercises
infection/ fracture risk
indications for a knee disarticulation:
cannot have a good transtibial limb due to trauma
knee flexion contracture above 45 degrees
infection of soft tissue close to knee joint
congenital deformity
when is an ankle disarticulation used?
sever foot trauma
gangrene
congenital deformity
What is the role of the heel pad in ankle disarticulation?
heel pad has to have good circulation to be successful
help pad and bone are close which may result in pain and an ineffective fit for a prosthetic.
Transmetatarsal amputations are performed secondary to:
infection or diabetes
Components of a post surgical evaluation and trx:
chart review/ pt interview/ general systems review
cognition/emotion
pain and sensory testing
ROM, strength, balance
functional status
post - surgical status
post op complications
What are the attention and cognition assessments?
MOCA
Mini - Cog
MMSE
What can you also screen for with amputated pts when screening for cognition?
Delirium
Depression
Fear
what is used for neuropathic pain?
gabapentin
how do we treat pain?
medications
ace wraps
pt education
modallities
movement
when examining the residual limb we look at:
wound healing
vascularity
length
volume
where are measurements taken from if the person has a TTA?
fibular head
medial joint line
tibial tuberosity
What do we check on the contralateral limb?
DVT
Sensory Testing
Strength/ROM testing
diabetic foot screen if needed
What are common DVT symptoms?
Swelling
Tenderness
increased redness
What are transtibial key muscles to stretch?
Hamstrings
gastroc/soleus
quads
What are transfemoral key muscles to stretch?
hip flexors
hip abductors
hip external rotators
lumbar extensors
contralateral LE
What strengthening can you do immediately post op?
isometric and AROM
core strength
contralateral limb
What are transtibial key strength muscles?
hamstrings
quads
glute max
glute med
abdominals
UE
What are key muscles to strengthen with transfemoral?
UE
lumbar spine
pelvic floor
abdominals
glute med
glute max
hip adductors
What is something we should know about balance assments?
they are all done without a prosthetic
what is the strongest predictor of functional post-operative prosthetic use?
pre amputation ambulatory status
What will indicate a pt’s ability to ambulate?
assessment of standing balance
What are pre prosthetic goals?
Independence of residual limb care and of intact limb
independence in joint mobility and demonstration of HEP
fall prevention
