Exam 2 Flashcards
List the 8 indications for surgery for musculoskeletal disorders
a. Incapacitating pain at rest or with functional activities.
b. Marked limitation of active or passive motion.
c. Gross instability of a joint or bony segments.
d. Joint deformity or abnormal joint alignment.
e. Trauma resulting in significant tissue damage.
f. Significant structural degeneration
g. Chronic Joint swelling.
h. Failed conservative (non-surgical) or prior surgical management.
i. Significant loss of function leading to disability as the result of any of the preceding factors.
Identify and describe the 7 components of preoperative patient education.
a. Overview of the plan of care: Gives the patient an explanation of what their plan of care might look like and an idea of what to expect post-operatively.
b. Postoperative precautions: Advise patient of postoperative precautions/contraindications,
c. Bed mobility and transfers: Demonstrate and teach patient how to move/ preform safe transfers, while maintaining postoperative precautions.
d. Initial postoperative exercise: teach patient any exercises that will be started during the very early postoperative period which include Deep-breathing, active ankle exercises, gentle muscle-setting exercises.
e. Gait training: Teach patient to use assistive device postoperatively.
f. Wound Care: Explain and reinforce postoperative care of the surgical incision for optimal wound healing.
g. Pain Management: educate patient on correct use of cryotherapy for postoperative pain management.
Describe the steps/process to inspect a surgical incision site.
a. Check for signs of redness or tissue necrosis along the incisions and near sutures.
b. Palpate along incision and note signs of tenderness and edema.
c. Palpate for evidence of increased heat.
d. Check for signs of drainage.
e. Assess integrity of an incision crossing a joint during and after exercise.
f. As the incision heals, check the mobility of the scar.
What are the signs of infection of a surgical incision?
Redness, pain, inflammation, oozing
What factors influence the progression and outcomes of a post-operative rehab program?
Transitional sequences of tissue healing, by the permitted level of activity, by the degree of protection or by sequential numbering.
List 5 potential postoperative complications.
DVT and Pulmonary Embolism, joint subluxation, restricted motion from adhesions and scar tissue formation, Failure, displacement , or loosening of the internal fixation device.
What would you do as a PTA if you suspected your patient had a DVT?
Alert Supervising PT, If a patient presents with signs or symptoms of possible pulmonary embolism, immediate medica referral is warranted for a definitive diagnosis and management.
What is the difference between an open approach versus an arthroscopic approach?
An open surgical procedure involves an incision of adequate length and depth through the necessary superficial and deep layers of skin, facia, muscles, and joint capsule that allows the operative field to be fully visualized by the surgeon during the procedure. However, and arthroscopic procedure is used as a diagnostic tool and as a means of treating a variety of intra-articular disorders. Involves very small incisions.
How long after a tendon repair should end-range stretching, and high-intensity resistance exercise be withheld? Why?
Vigorous stretching and high-intensity resistance exercise should not be initiated for at least 8 weeks after repair, when healing of tendon is mature.
Name two examples of a procedure that can be identified as a tendon transfer or realignment.
For a patient with significant neurological deficit, a tendon transfer from one bony surface to another is sometimes indicated to prevent deformity and improve functional control. Another example would be for a child with cerebral palsy, the transfer of the distal attachment of the flexor carpi ulnaris to the dorsal surface of the wrist changed the action of the muscle tendon unit from a wrist flexor to a wrist extensor. This overall can prevent wrist flexion contracture and improve active wrist extension for functional grasp.
How are the positions of a joint determined for arthrodesis? Why is proper positioning important?
The optimal joint position for arthrodesis is somewhat dependent on the functional needs for goals of each patient and may vary between or even within patients for some joints. Eliminates pain and creates stability
What are the contraindications of a total joint arthroplasty?
Active infection in the joint
Chronic osteomyelitis
Systemic infection
Substantial bone loss or malignant tumors that prohibit adequate implant fixation.
Significant paralysis of muscles surrounding joint
Neuropathic joint
Inadequate patient motivation
What does ORIF stand for? When might it be used?
ORIF stands for Open Reduction and Internal Fixation. Used to stabilize and maintain alignment of the fracture site as it heals.
Describe the differences between autograft, allograft, and synthetic graft. (Do not just give the definitions - also include what is similar, different, and when they might be used and any long-term risks), benefits, and rehab considerations for each.
Autograft: uses a patients own tissue harvested from donor site in the body.
Risks include need for two surgical procedures and potential for negative consequences at the donor site.
Allograft: Uses fresh or cryopreserved tissue that comes from a source other than the patient, typically from a cadaveric donor. Associated with several risks, such as disease transmission from donor, compromised graft strength, and failure secondary to immunological rejection.
Synthetic graft: Materials such as Gore-Tex and Dacron offer an alternative to human tissue and have been used on a limited basis for ligament reconstruction in the knee. Have a high rate of failure and have not maintained their integrity over time.
How can the risk of a patient developing a DVT be reduced? What is your role as a PTA in reducing the risk?
Educating the patient on things they can do or avoid on the daily basis to reduce the risk of developing a DVT. For example, elevating legs when lying in supine or when sitting. No prolonged periods of sitting, especially for the patient with a long-leg cast. Initiating ambulating as soon as possible after surgery. Actice “pumping” exercises. Use of compression stockings.
Why is important for the PT and PTA to know the risk factors in the prevention of DVTs
Early recognition and Intervention, It can help minimization of complications and allows PTA’s to give adequate patient education
What is “Functional Articulation”? Please give one example in the upper extremity.
Typically refers to the range of motion and movement capabilities of a joint that are necessary for performing daily activities or functional tasks. In the context of physical therapy or rehabilitation, it often involves assessing and improving the joint’s ability to move through its full range of motion in a way that supports the patient’s functional goals. One example is the Scapulothoracic Articulation. There is considerable soft tissue flexibility, allowing for scapula to slide along thorax and contribute to all upper extremity motions.
What effects does faulty posture have on the shoulder girdle? What muscles are shortened in a forward head posture vs what muscles are weak/lengthened?
With faulty scapular alignment, muscle length and strength imbalances occur not only in the scapular muscles, but also in humeral muscles, altering the mechanics of the GH joint.
For a forward head tilt, shortened muscles are the pec minor, levator scapulae, and scalenus muscles.
Muscles that present with weakness are in the serratus anterior or trapezius muscles.
Irritation of what nerve roots may cause pain in the shoulder region? What other organs may refer pain to the shoulder?
Nerve roots C4 or C5. Heart, gallbladder, diaphragm.
What structure is at the most risk of impingement in the subacromial (suprahumeral) space?
Weak infraspinatus and teres minor muscles or inadequate external rotation may result in impingement of the soft tissues in the suprahumeral space.
Describe Bankart, SLAP, and Latarjet lesions and repairs.
A Bankart lesion involves an open or arthroscopic repair of a Bankart lesion, which is the detachment of the capsulolabral complex from the anterior rim of the glenoid commonly associated with traumatic anterior dislocation. During repair an anterior capsulolabral reconstruction is preformed to reattach the labrum to the glenoid lip.
SLAP is a tear of the superior labrum. Some SLAP lesions are associated with a tear of the proximal attachment of the long head of the bicep’s tendon and recurrent anterior instability of the GH joint. An arthroscopic repair involves debridement of the torn portion of the superior labrum, abrasion of the bony surface of the superior glenoid, and reattachment of the labrum and biceps tendon with tacks or suture anchors.
A Latarjet lesion involves transferring the tip of the coracoid process and coracobrachialis tendon to the anterior glenoid rim to provide mechanical block to humeral head of anterior motion. It has been used primarily as a salvage procedure after a Bankart repair fails to prevent recurrent instability. It can be performed as an open or arthroscopic approach, with no differences noted in outcomes between this procedure and Bankart repair.
What are some common activity limitations and participation restrictions due to shoulder disorders?
Inability to reach overhead, behind head, out to the side, and behind back leading to difficulty dressing (putting on jacket, or coat, fastening undergarments being their back for women). Reaching into back pocket of pants to retrieve wallet. Self-grooming. (combing hair, brushing teeth, washing face)
You are helping a patient with shoulder AAROM following a motor vehicle crash with no broken bones noted on the x-ray. What position should the G-H joint be in when attempting to fully abduct the shoulder?
External Rotation
Please describe appropriate shoulder positioning following
Total Shoulder Arthroplasty:
For supine, Arm immobilized in sling that is worm continuously, elbow flexed to 90 degrees. Forearm and hand resting on abdomen. Forward flexion (10 to 20 degrees), slight abduction, and internal rotation of the shoulder, head of bed elevated about 30 degrees.
Reverse Total Shoulder Arthroplasty:
The arm is positioned in the sling with the shoulder abducted to approximately 30 to 40 degrees and the elbow flexed to around 90 degrees.
Rotator Cuff Repair with abduction orthosis (pg 599):
The position and duration of immobilization of the operated shoulder after rotator cuff repair depends on many factors, including the size, severity and location of the tear and type and quality of the repair. The size of the cuff tear partially determines whether the operated arm is supported in a sling (shoulder adducted, internally rotated, elbow flexed to 90 degrees) or in abduction orthosis or splint(shoulder elevated in the plane of the scapula approximately 45 degree shoulder internally rotated and elbow flexed. Patients supported in an abduction splint may require assistance from a family member to support the operated arm in 45 degrees shoulder position when the splint is removed for exercise, dressing or bathing.
