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Orthodics > Lesson 1 > Flashcards

Lesson 1 Flashcards

1
Q

Indications for Amputation

A 
Peripheral vascular disease
Diabetic limb disease
necrotising fascitis
trauma
infection
tumors
nerve injury
congenital anomalies
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2
Q

extended foot plate:

A

extended carbon fiber foot plate

includes incorporation of a steel shank into the sole of shoe to allownormal toe off ambulation

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3
Q

What does spring steel shank do?

A

reproduces the action of longitudinal arch offoot during ambulation

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4
Q

toe filler:

A

custom molded foam pad or lamb’s wool can fill the distal empty toeportion of the shoe
rigid rocker bottom sole

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5
Q

What does a Chopart amputation remove and save?

A

remove: forefoot and midfoot
save: talus and calcaneus

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6
Q

Benefit’s of Syme’s amputation:

A 
Distal Weight Bearing
Longer limb=less energy loss
Can ambulate without prosthesis 
Proprioception
Preservation of distal growth plate in children
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7
Q

Negative of Syme’s amputation:

A

Wound healing
Compliance
Heel pad instability

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8
Q

Tibial length not feasible for fitting:

A

3.5 inches

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9
Q

Myoplasty suturing

A

Opposing Muscle sutured together
Muscle to soft tissue
Soft tissue to soft tissue
Transtibial amputation preferred

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10
Q

Main advantage of thru knee amputation:

A

creation of endbearing stump and preservation of distal femoral physes
long active lever arm

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11
Q

Suction socket:

A

provide suspension by means of negative pressure vacuuming.

achieved by forcing air out of the socket through a one-way valve when donning and using the prosthesis

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12
Q

Myodesis:

A

suturing of muscle bone

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13
Q

Myoplasty:

A

muscle is sutured to muscle and then placed over the end of the bone before closing the wound
patients with poor vascular health, the myoplasty technique is preferred

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14
Q

PFFD’s: Proximal Focal Femoral Deficits

A

Congenital defect of the proximal femur

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15
Q

Congenital defect of the proximal femur

A

absent hip
femoral neck pseudoarthrosis
absent femur
shortened femur

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16
Q

transradial optimum level:

A

junction prox 2/3 and distal 1/3

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17
Q

Transradial shortest level:

A

3cm below biceps insertion

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18
Q

Transhumeral optimum level:

A

middle third

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19
Q

Transhumeral shortest level

A

4cm below axillary fold

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20
Q

Transfemoral optimum level

A

middle third

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21
Q

Transfemoral shortest level

A

8cm below pubic ramus

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22
Q

Transtibial optimum level

A

8cm for every metre of height(12cm

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23
Q

transtibial shortest level

A

7.5cm below knee joint

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24
Q

Transradial longest level

A

5cm above wrist joint

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25
Q

Transhumeral longest level

A

10cm above olecranon

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26
Q

Transfemoral longest level

A

15cm above knee joint

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27
Q

Krukenberg procedure

A

Separate radial and ulna rays distally

forming radial and ulna pincers capable of strong prehension and excellent manipulative ability

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28
Q

What are the three parts of the peripheral vascular system?

A

Arterial System

Venous System

Lymphatic System

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29
Q

Function of arterial system:

A

Carry oxygenated blood to the capillaries of the body organs.

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30
Q

Tunica Intima

A

endothelium, CT, basement membrane

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31
Q

Tunica Media

A

smooth muscle. The strength of the artery

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32
Q

Tunica Adventitia

A

elastic and collagenous fibers

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33
Q

Where is blood pressure greatest?

A

Muscular smaller arteries expand only slightly regardless of the pressure.

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34
Q

Lymphatics

A

facilitates movement of fluid between bloodstream (veins and arteries) and interstitium to remove wastes, extra fluid and proteins

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35
Q

Peripheral vasculature:

A

arterial
venous
lymphatics

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36
Q

Arteriosclerosis

A

hardening of arterial walls

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37
Q

Atherosclerosis

A

common form of arteriosclerosis, often plaque deposits on endothelial lining

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38
Q

Arteriosclerosis obliterans

A

atherosclerosis manifested peripherally (usually LE)

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39
Q

Thromboangiitis obliterans (Buerger’s disease)-

A

Specific arterial disease with tissue ischemia in young men who smoke

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40
Q

Raynaud’s disease-

A

disease which causes constriction in the small arteries

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41
Q

Risk factors for arterial disease

A 
Smoking
Cardiac disease (and its related risk factors)
Diabetes
High blood pressure
Kidney disease
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42
Q

Function of lymphatic system:

A

Transport interstitial fluids back to blood
Transport absorbed fat from small intestine
Lymphocytes provide immunological defenses

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43
Q

Tunics of lymphatic system:

A

Three layers, similar to veins
Close-ended tubes
Inner layer forming valves which prevent backflow of lymph.

44
Q

Movement of lymph

A

Peristaltic motion and valvular closure

45
Q

PVD Signs and Symptoms (arterial)

A 
sharp pain relieved by rest
chronic cramping w/exercises, heaviness, leg fatigue
diminished or absent pulse
absent edema
cool or cold skin
dry, shiny, scaling, thin skin
hairless
cyanotic
46
Q

PVD Signs and Symptoms (venous)

A 
aching, deep muscle pain
relieved by activity or elevation
intermittent claudication
pulses present
edema increases at end of day
warm skin, thick, toughened
dark pigmentation
varicose veins/ulcers
47
Q

Aterial Occlusive

4 major risk factors

A

Smoking
Diabetes
High-fat diet
Hypertension

48
Q

Symptoms – The Five P’s

A 
Pain
Pallor
Paralysis
Parasthesia
Pulselessness
49
Q

Peripheral arterial disease (atherosclerosis)

Pathology:

A

Slow progression
Initial injury to vessel from HTN or trauma
Fatty deposits line artery wall at injury site.
Leads to vessel narrowing and blockage followed by ischemia and tissue necrosis

50
Q

Symptoms of Chronic Arterial Disease

A

intermittent claudication
diminished/absent pulses
trophic changes
wound formation

51
Q

Buerger’s Disease

A

Similar to Acute Arterial Occlusive Disease but it occurs predominantly in young men (under age 40) who are heavy smokers
Inflammatory process in the small vessels of the feet and hands that is directly related to nicotine use
Leads to thrombus formation
Starts distally and progresses proximally
Cold extremities, pain, trophic changes, ischemia, necrosis
Smoking cessation arrests the disease

52
Q

What subjective clues will your patient give you about arterial disease during the evaluation

A

Cramping with walking (intermittent claudication)
Rest pain, relieved by dependency
Wounds may have no history of trauma

53
Q

Arterial disease: objective Signs

A

Trophic skin changes-loss of hair growth, abnormal nails, dry skin
Cool skin
Decreased pulses

54
Q

Vasculitis

A

inflammation of the vessel wall resulting from immune complex deposition or cell-mediated immune reactions directed against the vessel wall
cause unknown

55
Q

Varicose veins

A

Abnormally dilated veins resulting from intrinsic vessel wall weakness and chronic valvular insufficiency
Increased risk of thrombosis and chronic venous insufficiency

56
Q

Venous disease

A

Deep Vein Thrombosis (DVT)
Venous insufficiency-inadequate drainage of venous blood (also called venous hypertension)
Chronic venous insufficiency

57
Q

Risk factors for venous disease

A 
Aging
Pregnancy
Obesity
Long hours of standing/sitting
Lack of regular activity
Family history
58
Q

What venous disease “sounds” like (subjective information)

A

Aching, heavy legs
Sometimes relieved by elevation
Wounds may have no history of trauma

59
Q

What venous disease “looks” like- objective information

A

Swelling (unilateral or bilateral)
Skin changes: hemosiderin deposits, fibrosis (hardening) of the skin
Pulses present
Wounds with drainage

60
Q

Symptoms of chronic venous insufficiency;

A

Dilated veins, leg pain, edema, and cutaneous changes (stasis dermatitis)

61
Q

Causes of chronic venous insufficiency:

A

Venous occlusion
Valvular defects
Problems with muscle pump

62
Q

Medical Management of CVI

A

Surgical
Angioplasty
Stenting
Amputation

63
Q

Arterial wound presentation:

A 
Present anywhere distal to the ankle, often the foot/toes
Dry appearance
Pale tissue
Painful
No pulses
64
Q

Venous wound presentation:

A 
Present most often on the medial malleolus and lower leg
Large amounts of drainage
Red or dark granulation
Not always painful
Hyperpigmentation
Pulses
65
Q

Arterial wound characteristics:

A

Anywhere on leg or foot; bony prominences
Painful esp. with LE elevation
Pulses poor or absent
Minimal drainage
Blanched wound base
Well-circumscribed or “punched-out” borders

66
Q

Venous wound characteristics:

A 
Usually on medial aspect of distal 1/3 of leg
Not often painful
Normal pulses
Moderate to heavy drainage
Red wound base
Irregular borders and dark pigmentation
67
Q

Primary lymphatic dysfunction

A

Primary

Congenital – Failure of complete formation of lymph vessels

68
Q

Secondary lymphatic dysfunction

A

Secondary

Caused by trauma, surgery, parasitic infection, radiation, etc

69
Q

Pathophysiology of lymphatic dysfunction:

A

Capillaries become more permeable
Damaged lymphatic system can’t keep up
Edema develops
Can lead to soft tissue fibrosis

70
Q

Risk factors for lymphedema

A 
Hereditary/congenital factors
Breast cancer (and other cancers) with surgical and radiation therapy procedures
Long standing edema
Paralysis
Damage during surgical procedures
Filariasis
71
Q

What lymphedema “sounds like”- subjective information

A

Feelings of fullness and heaviness

Numbness/tingling

72
Q

What lymphedema “looks” like- objective information

A 
Swelling, not usually improved with elevation
Pitting  non pitting edema with fibrosis
Dermal changes: cysts, hyperkeratosis
Decreased ROM
Lymph leakage
73
Q

Neuropathy Risk Factors:

A 
Diabetes 
Spina bifida
Lupus
HIV/AIDS
Chemotherapy
MS
Vascular disease
74
Q

What neuropathy looks like-

subjective information

A

Gradual onset with tingling, numbness

Acute onset with significant pain sensory loss

75
Q

What neuropathy looks like-

objective information

A 
Loss of protective sensation
Skin changes
Inflammation
Ulceration
Infection
Foot deformity
Pulses may or may not be present
76
Q

Neuropathic wounds

A

Typically pain free
Often on the plantar aspect of the foot
Punched out appearance
Calloused edges

77
Q

Charcot’s Joint

A

Joint breakdown

Feet sensory, motor, and anatomic issues

78
Q

Process of Charcot’s joint:

A

Bone decalcification on joint surfaces
Boney overgrowth about the margins
P usually absent – some exceptions
Deformity & instability characteristic

79
Q

Physiology of Wound Healing

A

Inflammatory phase
Proliferative phase
Maturation phase

80
Q

Inflammatory phase

A

Vasodilatation, migration of leukocytes, histamine release (redness, heat, swelling, pain)
Platelet-derived growth factors facilitate migration of granulocytes and macrophages

81
Q

Proliferative phase

A

Formation of granulation tissue (collagen + vascular network), wound contraction, re-epithelialization

82
Q

Maturation phase

A

Day nine up to two years
Remodeling of new skin
Collagen re-organized & tensile strength increases
Continues even after wound closure (overlap with proliferation phase)
PT wound intervention at this stage

83
Q

Pressure Ulcer:

A

ocalized area of tissue necrosis as a result of pressure - Also called decubitus ulcers

84
Q

Venous Stasis Ulcer:

A

Wounds that arise on the lower leg as a result of venous insufficiency

85
Q

Arterial Ulcer:

A

Wounds that arise on the lower leg or foot as a result of arterial insufficiency, or lack of blood flow to the tissue

86
Q

Neuropathic Ulcer:

A

Wounds that arise in diabetic individuals as a result of insensate extremity
Also occur in persons with Hansen’s disease

87
Q

Pressure Ulcer Etiology:

A 
mechanical injury (pressure, friction, shear) or
moisture/Chemical damage
88
Q

Venous Ulcer Etiology:

A

Venous insufficiency
Edema/swollen leg
Stasis
Micro trauma

89
Q

Arterial Ulcer Etiology:

A

Lack of blood flow

Peripheral vascular disease

90
Q

Neuropathic Ulcer Etiology:

A

Diabetes/Hansen’s Disease
Peripheral Neuropathy
Insensate Extremity
Pressure

91
Q

Stage 1 Pressure Ulcer:

A

Skin intact; Involves epidermis - hyperemic response; Can’t blanche skin

92
Q

Stage 2 Pressure Ulcer:

A

Skin is broken; Involves dermis; Superficial; May appear as blisters

93
Q

Stage 3 Pressure Ulcer:

A

Full thickness loss into subcutaneous fat; May have necrotic tissue, tunneling, exudate and/or infections.

94
Q

Stage 4 Pressure Ulcer:

A

Full thickness - extends into muscle and/or bone or tendons

95
Q

Venous Stasis Ulcer Appearance/Location:

A

Pain is mild and relieved by elevation
Proximal to medial malleolus or gaiter area of leg
Shallow with irregular shape, granular base, oozing
Stasis dermatitis, hyperpigmentation, palpable pulses

96
Q

Arterial Ulcer appearance/location:

A

Pain is severe, exacerbated by elevation
Distal to medial malleolus, on dorsum of foot and toes
Irregular edge, poor granulation tissue, little bleeding
Trophic skin changes, absent pulses

97
Q

Neuropathic Ulcer appearance/location:

A

Pain Free
Along pressure points of foot, first or fifth metatarsal head
Punched out, callous edges, deep sinus, brisk bleeding
Neuropathy, warmth, variable pulses

98
Q

Risk factor for pressure ulcer:

A 
Decreased Mobility
Lack of Sensation
Impaired Nutrition/Low Body Weight
Incontinence
Impaired Hydration
Decreased Cognitive Status
Obesity
Decreased Diastolic BP
Medical Co-morbidity
Ischemia
Anemia
Age
Infection
Polypharmacy
99
Q

Venous Stasis ulcer risk factor:

A

Lymphoedema
Obesity
Pregnancy
Cancer hx

100
Q

Arterial ulcer risk factor:

A

PVD
Diabetes
CAD
Stroke

101
Q

Neuropathic ulcer:

A

Any dx with sensory loss but motor sparing

102
Q

Pressure ulcer treatment

A 
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment
Eliminate Pressure
E-stim
Patient Education
Mobility Training
103
Q

Venous stasis ulcer treatment

A 
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment Edema control - bandaging/compression
Patient Education
104
Q

Arterial ulcer treatment

A 
Remove necrotic tissue
Manage exudate
Eliminate infection
Surgical Consult
Patient Education
Increase circulation (US/PSWD/E-stim)
105
Q

Neuropathic ulcer treatment

A 
Remove necrotic tissue
Manage exudate
Eliminate infection
Maintain a moist wound environment
Pressure Relief - casting
Patient Education
E-stim

Orthodics (16 decks)

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