INFLAMMATORY/INFECTIOUS CONDITIONS OF NEUROMSK SYSTEM

Question 1

what is osteomyelitis?

What is it normally caused by?

Answer 1

Inflammatory response due to infection in bone

Usually a staph aureus infection

Question 2

In which bones does osteomyelitis normally occur in?

Answer 2

Children - long bones

Adults - vertebrae, feet (if diabetic_

Question 3

Who is osteomyelitis must common in

Answer 3

Male
Children
Immunosurpressed pts

Question 4

Osteomyelitis S&S

Answer 4

suspect if patient has localized swollen joint w/ NO trauma hx or NO other affected joints - ER!!
o	Prominent night pain
o	Effusion in/around joint
o	Weight loss
o	Appetite loss
o	Malaise

Question 5

Osteomyelitis Rx

Answer 5

o Antibiotics
o Surgery if in joint  remove dead bone
o Maintain joint function
o Cast care

Question 6

tendonitis vs tendinosis?

Answer 6

Tendonitis: Tendon inflammation d/t repetitive microtrauma
Tendinosis: Chronic tendon dysfunction

Question 7

Bursitis causes:

Answer 7

overuse
Trauma
Gout
Infectoin

Question 8

Bursitis S&S:

Answer 8

Pain with rest

Decreased AROM/PROM

Question 9

Bursitis Rx

Answer 9

Flexibility
Manual therapy
Thermal agents

Question 10

Amputation causes

Answer 10

• Diabetes mellitus
• Peripheral Vascular disease
• Trauma
• Congenital/correction of deformity
• Tumors
• Infected TKR

Question 11

Toe amputation: Effects + Prosthesis?

Answer 11

• Decreased push off power
• Dec. balance, dec. proprioception, dec BOS

Prosthesis: Orthoses or filler, AFO to help with energy return at toe off

Question 12

Partial foot amputation: Effects + Prosthesis?

Answer 12

• Lose forefoot level
• Dec. balance
• Inc. pressure on remaining WB surface = inc. risk of tissue breakdown

Prosthesis:

• molded insole (shoe filler)
• AFO
• Complete prosthesis

Question 13

Ankle amputation: Effects + Prosthesis?

Answer 13

• Distal tib-fib intact = good functional outcome
• High risk of skin breakdown

Prothesis:

• Partial patellar WB possible
• Trap door to fit over malleoli

Question 14

Transtibial amputation: Effects + Prosthesis?

Answer 14

• NO WB through end
• Gait deviation: Stance: foot flat, foot slap, knee hyperextension or buckling, early heel rise. Swing: change in stride length, toe drag, lat/med whip, vaulting

Prothesis:
- Socket: total surface bearing OR patellar tendon bearing. Pressure areas:
o Sensitive: anterior/distal tib ends, fibular head/end, stump
o Tolerant:post mm mass, patellar tendon, medial/lateral flares
- Suspension: supracondylar, suprapatellar cuff, sleeve (need dexterity + strength), locking pin, suction (1 way valve)

Question 15

Knee disarticulation (no knee) amputation: Effects + Prosthesis?

Answer 15

• Potential WB through stump - thigh mm preserved

Prosthesis: trap door for condyles

Question 16

Transfemoral amputation: Effects + Prosthesis?

Answer 16

• No WB on end: WB through ischial tuberosities + hydrostatic loading
• Req. 60% more energy to ambulate with prosthesis (vs. able body walking)
• Prosthesis
  - Manual lock, mechanical/friction, hydraulic/pneumatic/microprocessor
  
  • Pressure sensitive
    • Residual limb end, adductor tendon

Question 17

Gait deviations seen in transfermoral amputation?

Answer 17

• Gait = asymmetrical
• Gait add may be needed
• Stance: ABD, Lat trunk shift, increase trunk lordosis, hip flexion, decreased stance time
• Swing: Med/lat whips, circumduction, hip hike, vaulting w/ good leg

Question 18

How much more energy is needed to ambulate with a hip disarticulation amputation

Answer 18

210%

Question 19

What is a hemipelvectomy? what would cause the need for this?

Answer 19

• High level pelvic amputation

- likely due to osteosarcoma, chondrosarcoma

Question 20

What are 6 areas of PT education needed following amputation

Answer 20

• Contractures
• Prosthesis fit
• Pain management for residual limb pain, phantom pain/sensation
• Edema control + shaping
• Falls prevention
• Foot care

Question 21

What are typical contracture following:
Transtibial amputation
Transfemoral amputation

Answer 21

Transtibial: Knee flex, hip flex
Transfemoral: Hip flex, hip abduction

Question 22

How do you prevent contractures post amputation

Answer 22

No: 
- pillows under legs/hips in supine 
- TF – pillows btw legs
- Raising of foot of bed
Yes:
- lying flat, prone position if possible 
In chair: 
- Transtibial: amp board with cushion
- W/c - firm seat base

Question 23

What is the purpose of wearing a sock with a prosthesis

Answer 23

• Ensure proper fit

Question 24

What is the shank/pylon of a prosthesis

Answer 24

Connects socket to foot, provides height

Question 25

What are some pain management methods for residual limb pain, phantom pain/sensation

Answer 25

Exercise 
Relaxation/visualization 
Compression/massage 
TENS 
Farabloc

Question 26

what are some tools for edema control + shaping?

Answer 26

compression bandage, shrinker sock, silicon/gel liners, elevation

Question 27

When should you remove a compression bandage, shrinker sock, silicon/gel liners

Answer 27

If pain, throbbing sensation or it feels cold

Question 28

What are two things you would educate a new amputee pt on regarding falls prevention

Answer 28

• Night time strategies

- Stump protector

Question 29

What would you educate a new amputee pt on regarding foot care

Answer 29

• No bare feet, diabetic socks, shoes w/ dec. seams
• protect from heat/cold
• check feet w/ mirror + wash daily
• use lotion, not btw toes
• trim nails straight across
• Increase circulation = no smoking, inc. ex, eat well
• regular HCP visits