MSK clinical skills Flashcards
What are the contraindications to check for with ultrasound non thermal
Active DVT
Current tissue bleeding
cancer
pregnancy
Tuberculosis
electronic implants
What are the contraindications to check for with ultrasound thermal
Active DVT
acute injury/inflammation
current tissue bleeding
impaired circulation/sensation
pregnancy
skin disease (eczema)
tuberculosis
electronic implants
What are some risks associated with ultrasound
superficial burns (with thermal)
Internal bleeding/scarring
no clinical benefit alone, needs to be used with exercise
How does ultrasound therapy work
sound waves generated by machine cause oscillation in tissue
does not increase inflammatory response but optimizes it to help move onto next stage of healing
targets mast cells which release arachidonic acid, causing an increase of prostaglandins and leukotriene which act as inflammatory mediators
best used on soft tissue injuries
What are the 3 ways ultrasound therapy helps
Micromassage
The sound waves cause the tissue to vibrate and micromassage, which heats the tissue and improves blood circulation.
Cavitation
The sound waves cause microscopic bubbles to form in the tissue, which expand and contract, creating a microstreaming effect. This microstreaming causes nearby cells to rotate and twist, which can help reduce edema.
Acoustic streaming
The sound waves cause tissue fluids to move along cell walls, which can increase cellular metabolic activity and permeability.
When are different intensities used
acute - 0.1-0.3
subacute - 0.2-0.5
chronic - 0.5-1.0
When do you use different pulse rates
continuous is for most chronic, then 1;1 , then 1;2, 1;3, etc as it gets more acute
machine offers 2ms output followed by 2ms x second number in pulse rate rest
When do you use different frequencies
1MHz - deeper applications
3MHz - superficial applications
how do you know how long to do ulltrasound for
number of times head fits into tissue to treat x pulse factor with both numbers added together =time in min
How do you use the ultrasound machine
Avoid bones, and keep moving in circular motions
What is PNF stretching
when stretched, muscle spindles activate the sensory neurons and synapse onto alpha motor neurons, causing activation and contraction of the stretched muscle to limit it. at the same time inhibitory interneurons in the spinal cord are also synapsed onto, which causes inhibitory impulses onto the antagonistic muscle to relax it. (reciprocal inhibition)
when the muscle contracts, the golgi tendon organ is activated and a type 1b afferent signal is sent to the spinal cord, where it synapes on the inhibitory interneuorns for the alpha motor neurons for the agonist muscle to inhibit the contraction (autogenic inhibition)
doing this in quick succession will lead to increased ROM
How is PNF for hamstring performed
muscle stretched to the resistance point, hold for 10s
20% strength contraction for 5s (isometric)
stretch forward and hold for 10s
strength for 5s
hold for a 30s stretch
what are the contra indications for PNF
acute inflammation
local infection
bony block
haematoma
disruption of surgical repair
increased pain
increased inflammation
what are precautions for PNF
Recent fracture
osteroporosis
elderly
recent prolonged immobilization
what is joint ROM used for
joint stiffness
immobilization
nerve injury
muscle weakness, etc
what are the 2 types of joint ROM?
Active - moving joint with no external resistance/assistance, just the use of muscles surrounding the joint
active assisted - mobility exercise performed with muscles and some external assistance (other limb, belt, towel, etc)
use active assisted when pt isnt allowed to or cannot fully activate muscles, or extra force is needed to obtain desired range
How does joint ROM help
increase ROM and maintain elasticity
reduce pain
prevent DVT
restore mechanical and structural properties of ligaments, joint capsules, and tendons
How should joint ROM exercises be performed
free from restrictive clothing
make movement as easy as possible/remove as much resistance as possible
isolated joint/movement, moving through complete ROM
short hold at 3s, 5-10 reps 3 times a day daily
what are some joint ROM contraindicationss
disruption of surgical repair
increased pain or inflammation
how can resistance be added with strength exercises
manipulating body position to alter gravity effects
consider weight of limb
free weights (less stable but more freedom)
resistance bands (not constant resistance)
ankle weights (limited by total resistance)
self resistance
machine weights (stable but locked position with less development of stabilizer and accessory muscles, so less functional strength)
what are open and closed kinetic chains
open - distal segments free to move
closed - distal segments not able to move
stronger muscles take over with a closed chain
How does resistance training increase strength
more neural activation (more motor units recruited)
hypertrophy of muscle (growth of muscle fibers after microtears are formed and regrown)
increased PCr, ATP, and glycogen content
increased glycolytic activity
decreased mitochondrial density
what is the dosage
ideally 8-12 reps per exercise, with 3-5 sets
ideal rep range for hypertrophy of the muscle, leading to strength increases while being balanced with muscular endurance.
depends on types of fibres, muscle groups mainly made up of type 1 fibres would benefit from endurance training, while type 2 fibre muscles would benefit from hypertrophy strength training
what are the contraindications to strengthening
movements shouldnt increase pain/inflammation and shouldnt disrupt healingprocess
should be careful prescribing to kids and those with CVD/hypertension
describe when and how you would use walking stick
used to take some weight of impaired leg, but nearly full WB
arm opposite to bad leg and lined up to wrist crease
stick moves with bad leg (2point)
describe when and how you would use axillary crutches
only NWB, for those who have more upper body strength
5cm below armpit, with handgrip at wrist crease height
pt should bear through the andles and not armpits to avoid nerve damage, upper portion of the ribs should. be squeezed between arms and ribs
swing to gait - More stable but slower
Pt moves both crutches forwards, has affected leg lifted up, and then the sound leg swings upto the crutches
swing though gait - Faster but less stable
Same as swing to gait but sound leg swings past the crutches and lands infront ot them
describe when and how you would use elbow crutches
pwb mainly, as they cant bear as much weight
pt must be less than 25 stone and crutches must be new
handles at wrist crease and cuff just below elbow
PWB gait consists of
Crutches, followed by affected leg and then the sound leg
describe when and how you would use zimmer frames
Can be PWB or NWB, mainly for pts who need a lot more stability compared to crutches
Cant be used on stairs
Line up handles with wrist creases
Frame, affected leg, sound leg
Ensure that the pt remains inside the base of the frame to promote stability
how do patients turn with aids
3-point turn, keeping aids in front of them at all times
how do pts go from sit to stand with aids
To stand up from a seated position, hold both crutches on affected side in h-position, extend affected leg, push up using sound leg and the other hand on the chair, not using walking aid to stand
how do pts go from stand to sit with aids
Sitting down is the exact same process, only opposite (crutches on affected side, lift up affected leg, hold chair with hand, and sit using the sound leg and hand to lower urself down)
should pts hold zimmer frames when sitting or standing
no
how do PWB pts go up and down stairs with crutches
Non affected side holds railing, other hand holds crutches in t-shape, then up with the good (good leg, bad leg, crutch
Going down stairs is the same, just opposite (crutch, bad leg, good leg)
how do NWB pts go up and down stairs with crutches
Same hand position, going up is hop up on good leg, then crutch
Going down is a crutch, then hop down good leg
How do walking aids help patients
assist in keeping pt stable and allows them to maintain the ability to continue walking with varied degrees of weight bearingg
what are the contraindications to walking aids
floor should be dry and pt should have proper footwear
aids should be new
take pts strength into account when prescribing
stay at pts side w arms ready when teaching, and have another person follow pt with wheelchair incase they feel faint
