Exam 3 Study Flashcards
A 60 year old female had a THA. What advice would you give for home?
- Precautions: No bending hip, no crossing legs, no toeing in, pillow between legs in bed, up with good and down with bad with stairs. Avoid sleeping on affected side.
- Home exercise: Walker. Ankle pumps. Quad sets. Glute squeezes. Standing Abduction. Isometric strengthening.
- Family education
You have 2 patients with s/p TKA 4 weeks . One with 60 degrees flexion and edema and the other with 90-120 Flexion with mm weakness. What HEP would you give for each?
Patient 1:
- Edema Control: PRICE, Patellar mobilization, Self Massage
- Exercises : Quad sets, Heel slides, SLR, calve pumps. Nustep.
Abduction/Abduction. Mini lunge stretch. Patellar mobilization. Soft tissue massage.
Patient 2:
- Exercises: Recumbent Bike, Standing leg curls, terminal knee Extension with TB, SLR, Abduction/Adduction, ankle pumps. Mini lunges, heal slides. Hip extensions. LAQ, SAQ.
A truck driver comes in with an ACL tear. What are his options and what would you do?
Options:
- Allograft: From a cadaver. Higher infection rates which may delay return to function and work. Wouldn’t have to recover another part of body.
- Autograph: From a hamstring/ patellar tendon. More stable. Lower infection rates. Would have to recover from hamstring tendon cadaver.
Exercises:
What would you do for Ankle sprain management?
Phase1: wbat
- PRICE
- Estim
- Joint protection
- Isometric dorsiflexion/eversion (Avoid plantarflexion/inversion)
Phase2: FWB (avoid stresses)
- PRICE
- Heel cord
- Theraband exercises
- Stationary bike
- Protection
Phase3: FWB (Protection during activities)
- Cold/Hot pack
- Running/Jumping
- Plyometric
- Balance and stability exercises on BAPS
What does achilles tendon repair/rehab depend on?
Protocol and surgery
*(Relative rest, eccentric calf stretch and strengthening, plyometrics, gradual return to activity)
What is medicine half-life? What is the reaction in older pt?
- Rate that drug clears from body
- Slower in elderly (due to slower body functions)
What can corticosteroids steroids cause? What is the truth about its application?
- Osteoporosis
- Only a little goes to bloodstream
What is not an anti-inflammatory medicine for pain?
Acetaminophen (Tylenol)
What causes a MCL injury?
Knee Valgus
When should CMP (continuous passive motion) not be used?
Vigorous exercise (During sleep)
What doesn’t have to be done with a meniscus tear?
Surgery
With THA (THR), when would you use a dislocation protection brace?
Past history of hip dislocation
What is the best bed position for THA (THR)?
Supine
What can we tell a healthy person about hip fx
Exercise and mobility can improve the prevention of a hip fx
What is it called when there is necrosis of the head and femur? How would you treat a child or hold a baby with this condition?
- Legg Calve Perthes Disease (Coxa Plana)
- Treat child with abduction orthosis, hold baby with leg abducted
What type of shoe should you give to a pronated foot pt?
Shoe last with heel-counter
What is the advantage of hip resurfacing (hemiarthroplasty)?
Less bone removal
*(Lower number of dislocation due to purposeful reconstruction of larger metal head size)
What is a stable hip fx? What is an example?
- Single fx, no disruption of pelvic ring, WB may or may not be tolerated
- Heavy compression to illiac crest
What is the function of orthotics?
Improve balance and proprioception
*(decrease pronation speed, improve shock absorbstion, normalize gait)
Why is ankle arthrosesis better than total ankle arthroplasty and vice versa?
(Better)AA:Last a lifetime
(Better)TAA: Better ROM/Short immobilization
*AA can last up to 12 weeks NWB
*TAA can have broken hardware
What should you do for plantar fasciitis?
Stretch plantarflexors (calf muscles)
- pain over medial border/tuberosity of calcaneus
- worse in the morning when walking
What is the BOSU used for?
Ankle strengthening/ROM/balance and proprioception
What is the most important task when having a diabetic foot?
Inspect foot everyday
What is the total gym not mostly used for?
Closed Kinetic Chain (CKC) exercises
What complication is associated with significant blood loss and shock following a fx?
Pelvic Fx (Unstable)
Lying on the side is bad for which soft tissue injury?
Trochanter Bursitis
What does a supinated foot need with shoes?
Shock absorption (due to excessive stability)
What is a side effect of Dantrolene?
Difficulties in breathing
What tendon is used in achilles (ankle) repair?
Peroneus Brevis (sometimes p. Tibial tendon)
What should you know about sacrococcygeal joint?
- Usually fused but can be mobile
- Mobilized from inside
How does a foot with RA look?
- Begins with Synovitis
- Hallux Valgus
- Pronated
- results in AA (fusion)
What shoe would you give a person with a high arch/supinated foot?
Curve last (shock absorption)
What should we do with pt. S/p TKA 8 weeks after surgery with edema?
?
With a ORIF hip, what should be avoided?
Flexion (and?)
How should over use injuries be treated?
With rest and gradual increase of duration/intensity/volume
What type of repair typically uses a brace for knee?
ACL Phase Min to Mod
What causes lateral epicondylitis?
Over use of extensors
With an excessive posterior trunk lean, what is weak?
Hip extensors
What is Morgan’s neuroma?
Bundle of swelling around nerves in 3rd and 4th interspace
How to get rid of Hallux Valgus?whats another name for it?
Bunionectomy (bunion)
The anterior drawer test is often used for what ligament assessment?
ACL
CPRS is also known as _______, and does what?
RSD (regional sympathetic dystrophy); is characterized by severe pain and sensitivity, swelling, and changes in the skin.
*Can happen in foot
