INFLAMMATORY/INFECTIOUS CONDITIONS OF NEUROMSK SYSTEM Flashcards
what is osteomyelitis?
What is it normally caused by?
Inflammatory response due to infection in bone
Usually a staph aureus infection
In which bones does osteomyelitis normally occur in?
Children - long bones
Adults - vertebrae, feet (if diabetic_
Who is osteomyelitis must common in
Male
Children
Immunosurpressed pts
Osteomyelitis S&S
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
Osteomyelitis Rx
o Antibiotics
o Surgery if in joint remove dead bone
o Maintain joint function
o Cast care
tendonitis vs tendinosis?
Tendonitis: Tendon inflammation d/t repetitive microtrauma
Tendinosis: Chronic tendon dysfunction
Bursitis causes:
overuse
Trauma
Gout
Infectoin
Bursitis S&S:
Pain with rest
Decreased AROM/PROM
Bursitis Rx
Flexibility
Manual therapy
Thermal agents
Amputation causes
- Diabetes mellitus
- Peripheral Vascular disease
- Trauma
- Congenital/correction of deformity
- Tumors
- Infected TKR
Toe amputation: Effects + Prosthesis?
- Decreased push off power
- Dec. balance, dec. proprioception, dec BOS
Prosthesis: Orthoses or filler, AFO to help with energy return at toe off
Partial foot amputation: Effects + Prosthesis?
- Lose forefoot level
- Dec. balance
- Inc. pressure on remaining WB surface = inc. risk of tissue breakdown
Prosthesis:
- molded insole (shoe filler)
- AFO
- Complete prosthesis
Ankle amputation: Effects + Prosthesis?
- Distal tib-fib intact = good functional outcome
- High risk of skin breakdown
Prothesis:
- Partial patellar WB possible
- Trap door to fit over malleoli
Transtibial amputation: Effects + Prosthesis?
- 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)
Knee disarticulation (no knee) amputation: Effects + Prosthesis?
- Potential WB through stump - thigh mm preserved
Prosthesis: trap door for condyles
Transfemoral amputation: Effects + Prosthesis?
- 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
- Pressure sensitive
Gait deviations seen in transfermoral amputation?
- 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
How much more energy is needed to ambulate with a hip disarticulation amputation
210%
What is a hemipelvectomy? what would cause the need for this?
- High level pelvic amputation
- likely due to osteosarcoma, chondrosarcoma
What are 6 areas of PT education needed following amputation
- Contractures
- Prosthesis fit
- Pain management for residual limb pain, phantom pain/sensation
- Edema control + shaping
- Falls prevention
- Foot care
What are typical contracture following:
Transtibial amputation
Transfemoral amputation
Transtibial: Knee flex, hip flex
Transfemoral: Hip flex, hip abduction
How do you prevent contractures post amputation
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
What is the purpose of wearing a sock with a prosthesis
- Ensure proper fit
What is the shank/pylon of a prosthesis
Connects socket to foot, provides height
What are some pain management methods for residual limb pain, phantom pain/sensation
Exercise Relaxation/visualization Compression/massage TENS Farabloc
what are some tools for edema control + shaping?
compression bandage, shrinker sock, silicon/gel liners, elevation
When should you remove a compression bandage, shrinker sock, silicon/gel liners
If pain, throbbing sensation or it feels cold
What are two things you would educate a new amputee pt on regarding falls prevention
- Night time strategies
- Stump protector
What would you educate a new amputee pt on regarding foot care
- 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
