Lower Limb Flashcards
How much socket adduction is needed in Transtibial Bench alignment?
5 degrees socket adduction (lateral tilt)
How much socket flexion is needed in TT bench alignment?
5 degrees socket flexion (anterior tilt)
How do you find the lateral reference line on a TT socket?
Drop a plumb bob at the mid patellar tendon level..this should pass 1 1/4”ahead of the center line of the pylon attachment C-clamp (substantially taller and heavier than average 1 1/2” ahead.
How do you find the posterior reference line on a TT socket?
drop a plumb bob at the socket brim that passes 1/2” lateral to the centerline of the pylon attachment clamp. 1/4” for shorter patients
How to determine the appropriate height of the a trans tibial Prosthesis?
Establish the distance from MTP to the heel of the prosthesis and pick the appropriate pylon.
Attach the foot and shoe so that the medial border of the shoe is ________________________
Parallel to the line of progression.
The foot is inset to a ____
1/2”
The lateral reference line should fall ____ anterior to the ankle bolt
1 1/4”
Where does the TKA line fall in reference to the hip, knee and ankle/foot?
- Posterior to hip
- Anterior to knee
- Anterior to foot
A patient has lateral and distal redness what might be the cause?
Socket is too large
A patient has proximal lateral and distal medial redness what might be the cause?
-Adducted socket
Socket M/L too large
Patient is bottoming out secondary to: decreased residual limb volume what’s the reason?
Patient not donning appropriate amount of socks or the socket was made initially too big.
Patient is bottoming out secondary to: Lack of distal end contact causing what?
Verrucous hyperplasia (caused by greater proximal pressure than distal pressure)
Patient presents with fibular head redness what is the cause?
- Patient is bottoming out in the socket
- socket is too large
- Adequate relief not made for the fib head
patient presents with anterior proximal and posterior distal redness?
Insufficient initial socket flexion
Shoe change with decrease heel height?
Heel lever too short, or heel bumper/cushion too soft
What causes anterior distal pressure?
- A/P too big
- Posterior brim too low
- Insufficient relief
- Excessive use of knee extension
- Heel lever too long
- Excessive initial socket flexion
what must you do regarding the skin during the casting section of the exam?
Inspect the residual limb for any irritation and point these areas to the examiner. make sure the examiner realizes that you were not the reason of these irritations ,wounds
What must you do to protect the residuum or liner during casting?
Roll on two layers of cotton stockinette over the residual limb or apply a thin layer of plastic wrap around the residuum to prevent indelible from showing on the skin and to facilitate ease of removal of cast.
How to avoid unwanted motion of the stockinette during casting?
Apply elastic webbing around the patient’s waist. then crossing anteriorly (in an “X” pattern) and attach to medial and lateral border of stockinette using two yates clamps.
what position should you put the TT patient in to cast?
instruct the patient to maintain approximately 20 degrees of knee flexion. This is done so that bony prominences, patella tendon, and hamstrings are easily identified. ensure patient is relaxed
What measurements should you take for TT socket casting?
Knee ML, PML, AP, limb length, circumferences, shoe/foot size, and knee center to floor length of the contralateral leg
what landmarks should be delineate and mark with an indelible?
Patella, Patella tendon, Tibial crest, Tibial tubercle, Anterior distal end of tibia, medial/lateral border of tibia , medial tibial flare, medial epicondyle, head and neck of the fibula
How should the residual limb be wrapped while casting?
Either using a figure-of-8 or circumferential wrapping method. be sure to use even pressure throughout the entire casting process to prevent roping.
Where should you fingers be placed during casting?
Place thumb tips on both sides of the patellar tendon, while simultaneously using your third through fifth fingers to exert pressure onto the popliteal area. index fingers being used to prevent plaster cast swelling medially and laterally.
How to establish alignment for the cast?
Draw coronal and sagital vertical alignment lines on the outside of the cast as it is finishing hardening.
Whats the first step to take before applying plaster for a PTB-SC socket type casting?
Measure the distance from the distal third of the medial femoral condyle to the distal third of the lateral. measurement should be the length of the plaster panel
How Long should the PTB-SC panel be?
The panel should be approximately 4-6 layers thick.
Where is the placement of the thigh and corset joints:
average starting location for joint centers is 2 1/4” superior to the patellar tendon protuberance and slightly posterior to the sagittal midline
True or false
Joints must be square to each other and the same height from the floor?
True
Why are the thigh and corset joints tilted anteriorly?
So that they will not reach maximum extension until the patients knee is fully extended.
The extension stop in the joint and corset suspension is provided by a __________
Check strap
What does the check strap do?
The check strap can be adjusted to limit extension of the patient’s knee, and will prevent the joints from reaching their “stops” so they not wear out as quickly?
What is the resulting pressure of a knee center placed to distally?
Pressure will be felt on the anterior distal thigh and posterior proximal thigh.
What is the resulting pressure of knee center placed to proximally?
Pressure will be felt at the posterior distal thigh.
What are possible causes of a trans tibial prosthesis appearing higher than the sound limb when sitting.
- Posterior brim of the socket is too high
- Insufficient hamstring relief
- Incorrect length
What are causes of rapid knee flexion?
- Prosthetic socket is placed (slid) to far anterior
- Heel lever excessively long
- Patient is wearing new shoes with an increase in heel height
- Excessive stiff heel action
What are possible causes of distal limb edema or discoloration:
Lack of total contact
short prosthetic socket
What deviations should be expected when converting previous joint and corset users to a PTB Type socket?
- Excessive knee extension
- Medial lateral instability
- Patient insecurities
