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MSK conditions Flashcards

1
Q

What types of MSK conditions may be seen in the acute care setting?

A
  1. bone fractures including multitrauma situations
  2. surgical repair of fracture
  3. joint replacements
  4. spinal surgeries
  5. soft-tissue surgeries
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2
Q

list some types of diagnostic imaging that may be performed as part of the MSK exam?

A
  1. Radiography
  2. CT
  3. MRI
  4. bone scan
  5. myelography
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3
Q

what are radiographies primarily used for?

A

x-ray or plain films, standard for detecting injury to bone as well as evaluating the intraoperative and post-op positioning of a procedure such as a joint arthroplasty or an open reduction to internal fixation

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4
Q

what are CT scans primarily used for?

A

complex or subtle bone fractures and injuries to soft tissue

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5
Q

what are MRIs primarily used for?

A

spinal disc injuries or soft tissue injuries especially to the tendon, ligament and menisci

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6
Q

what are bone scans used for?

A

assess the bone density related to tumors and avascular necrosis

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7
Q

what are myelographies used for?

A

x-ray or CT scan with a contrast dye used to look for spinal conditions like spinal stenosis or disc compression

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8
Q

What would be included in your exam for an MSK patient?

A
  1. Observation
  2. Pain
  3. Cardiopulmonary
  4. Integumentary
  5. Sensation
  6. ROM
  7. Strength
  8. Reflexes
  9. Balance
  10. Posture
  11. Functional mobility
  12. Outcome measure tool
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9
Q

List some pain scales that may be used for MSK pts

A
  1. Numeric 0-10
  2. VAS
  3. Wong-Baker Faces
  4. Nonverbal Pain Scale (NVPS)
  5. Brief Pain Inventory
  6. McGill Pain Questionnaire
    • Regular
    • Short form
  7. Shoulder Pain and Disability Index (SPADI)
  8. Lower Extremity Functional Scale (LEFS)
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10
Q

what drives your decision making during an MSK exam?

A

what info do I need in order to assess patient ability, safety, and D/C needs?

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11
Q

List some outcome measures you may use with an acute MSK pt

A
  1. AM-PAC 6-clicks
  2. TUG
  3. Gait Speed
  4. 2MWT or 6MWT
  5. 30-seconds chair rise test
  6. Functional reach
  7. Single limb stance test
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12
Q

List several types of joint replacements

A
  1. Knee arthroplasty
  2. Total knee arthroplasty
  3. Total hip arthroplasty
  4. Total shoulder arthroplasty
  5. Reverse total shoulder arthroplasty
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13
Q

what are the subtypes of knee arthroplasty? What is the difference between them?

A
  1. unicondylar (unicompartmental) knee replacement
    • only one compartment (M/L) is replaced
    • one one side is impacted and ligaments are intact
    • preserves normal knee kinematics
    • faster recovery
  2. total knee replacement
    • replacement of the femoral condyles, tibial articulating surfaces, and dorsal surface of the patella
    • Post-op WB status usually WBAT
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14
Q

what are the usual reasons for a total knee arthroplasty?

A

severe joint degeneration resulting from OA, RA or trauma

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15
Q

What are some Post-Op concerns following a total knee arthroplasty?

A
  1. DVT, PE
  2. infection
  3. pain
  4. edema
  5. patellar tendon rupture
  6. patellofemoral instability
  7. compartment failure or loosening
  8. peroneal nerve injury
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16
Q

What are some evaluation components for a total knee arthroplasty?

A
  1. P/AROM goni
    • one of the only times you will use a goni in acute care
    • be careful if they had a nerve block (may push limb too far)
  2. Skin inspection at surgical site
  3. Immediate D/C planning
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17
Q

What are the D/C requirements to go home following a total knee arthroplasty?

A
  1. independent w/HEP
  2. safe w/household mobilization
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18
Q

Describe the general post-op protocol following a total knee arthroplasty

A

will vary depending on surgeon

  1. AROM and strengthening begins immediately
    • ISOM QS, HS, GS progressing to A/AROM
    • P/A/AROM heel slides
    • Gentle stretching knee ext/flex
    • active hip motions to faciliate improved bed mobility
  2. May/may not use knee immobilizer
  3. Typically aiming to achieve 0-90 knee ext/flex
  4. Big focus on functional mobility
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19
Q

what are the usual reasons for a total hip arthroplasty?

A

degenerated joint surface

repair of hip following a fall

20
Q

what is usually the post-op WB status for a total hip arthroplasty?

A

most often WBAT

always confirm WB status!

21
Q

List precuations for total hip arthroplasties

A
  1. Posterolateral approach
    • no hip flex past 90, no ADD past mid, no IR past neutral
  2. Anterolateral and 2-incision approaches
    • limit hip ext especially w/ER
  3. Both approaches:
    • avoid sleeping on surfical site
    • avoid sitting on low surfaces
22
Q

List some possible complications to a total hip arthroplasty

A
  1. Dislocation
  2. Aseptic loosening
  3. Hematoma formation, hetertrophic ossification
  4. Infection
  5. Nerve injury, vascular damage
  6. DVT → PE
  7. MI, CVA
  8. Leg-length discrepancy
23
Q

what are the S/S of a hip dislocation?

A
  1. excessive pain w/motion
  2. abnormal IR/ER of hip w/limited A/PROM
  3. inability to WB through LE
  4. shortened limb (leg length discrepancy)
24
Q

what are some evaluation components of a total hip arthroplasty?

A
  1. P/AROM goni
  2. skin inspection at surgical site
  3. measure leg length
  4. assess for possible neuropraxia, esp femoral and sciatic nerves
  5. immediate D/C planning
25
Q

List the D/C requirements to go home for a total hip arthroplasty

A
  1. indpendent w/HEP
  2. safe w/household mobilization
  3. Independent w/precautions
26
Q

T/F: a total hip arthroplasty pt may be required to continue PT in inpatient setting

27
Q

Describe the general post-op protocol for total hip arthroplasties

A

will vary depending on surgeon

  1. ABD wedge
  2. Possibly knee immobilizer (prevents hip flx)
  3. Adaptive equipment
    • long handled reachers
    • shoehorns
    • leg lifter
    • elevated toilet seat
  4. Prescribe appropriate AD
  5. AROM/strengthening
  6. Functional mobility
28
Q

what type of AROM/strengthening needs to be done with a total hip arthroplasty?

A
  1. Submax glut sets
  2. ISOM QS and HS
  3. Avoid SLR
29
Q

List precautions following a total shoulder arthroplasty

A

integrity of rotator cuff and deltoid muscles dictates precautions and rehab

Common precautions:

  1. avoid shoulder AROM
  2. No lifting, pushing, or pulling obj w/involved UE
  3. No excessive shoulder motion behind back, esp IR
  4. No excessive stretching, esp ER
  5. No supporting BW by hand or involved side
  6. No driving for 3 weeks
30
Q

what should the pt edu include for a total shoulder arthroplasty?

A
  1. use of ice for pain and inflammation management
  2. positioning
    • avoid lying on involved shoulder
    • use a towel roll under elbow when supine
  3. bring hand to mouth w/elbow held at side of trunk
  4. TherEx program w/HEP
  5. decrease distal edema w/hand wrist and elbow AROM and ice packs
  6. squeeze ball/sponge to maintain grip strength
31
Q

list immediate post-op exercises that should be done w/total shoulder arthroplasty

A
  1. supine passive forward flex w/elbow flexed
    • pt may passively move involved arm by using opposite hand to guide the movement
  2. supine passive ER w/arm at side and elbow flexed to no more than 30 degrees
    • pt may passively move involved arm by using a wand/cane
  3. pendulum exercises, clock/counterclockwise
32
Q

when would a reverse total shoulder arthroplasty be done?

A

usually when the pt presents with rotator cuff arthropathy failed shoulder arthropod or arthroplasty, multiple failed rotator cuff repairs w/poor function and inferior/superior instability

or if there’s been a malunion of the tuberosity after a fracture

33
Q

S/S of infection post joint replacement and trx options for infection

A
  1. S/S
    • fever, wound drainage, persistent pain, erythema
    • fluids cultured to determine type of organism
  2. Trx
    • antibiotics
    • debridement w/prosthesis retention or removal
    • 1-2 stage reimplantation
    • arthrodesis
    • amputation (life threatening conditions)
34
Q

T/F: resections may result in WB restrictions

A

TRUE

when spacers in place prior to new implantation

35
Q

List several types of spinal surgeries

A
  1. Discetomy
  2. Decompression
  3. Laminectomy
  4. Fusion
  5. Total disc replacement - alternative to fusion
36
Q

what are some complications to spinal surgeries?

A
  1. neurologic injury
  2. infection
  3. cauda equina syndrome
  4. dural tear w/CSF leak
  5. general surgical complications
37
Q

List spinal precuations following spinal surgeries

A

used most frequently w/fusions

  1. log-rolling technique for getting in/OOB
  2. avoid excessive trunk flexion while seated
  3. Limited extended periods of sitting (will increase pain)
  4. Lifting restrictions to <5-10 lbs (may vary depending on protocol)
  5. there are no LE WB restrictions
38
Q

Describe the evaluation components that should be included for spinal surgeries

A
  1. neck/trunk ROM and strength assessment may be limited by spinal precautions
  2. Emphasize functional mobility
  3. know wearing schedule of orthotic
  4. Ensure pt knows schedule and how to don/doff
  5. adhere to post-op spinal precautions
  6. emphasize properbody mechanics
  7. schedule pain meds prior to PT visit
39
Q

how are traumatic fractures typically classified?

A
  1. Skin integrity
  2. Site of fracture
  3. Classification
  4. Extent
  5. Relative position
40
Q

How are fractures typically managed?

A
  1. Nonoperatively (conservatively)
  2. Operatively
    • elective, urgent, emergency
  3. Fracture reduction
    • closed-noninvasive (ie. traction)
    • open-invasive (ie surgery ORIF)
  4. Immobilization
    • noninvasive (cast)
    • invasive (ex-fix)
41
Q

List various fracture complications

A
  1. delayed union, nonunion, malunion
  2. loss of fixation or reduction
  3. DVT, plumonary/fat embolism
  4. nerve damge (paresthesia or paralysis)
  5. arterial damage (blood vessel laceration)
  6. compartment syndrome: 5 Ps
  7. infection
42
Q

what are the 5 Ps associated w/Compartment syndrome?

A
  1. Pain
  2. Pallor
  3. paresthesia
  4. Pulselessness
  5. Paralysis
43
Q

List favorable factors for bone healing

A
  1. early mobilization
  2. early WB
  3. maintenance of fracture reduction
  4. younger age
  5. good nutrition
  6. minimal soft-tissue damage
  7. pt compliance
  8. presence of GH
44
Q

List unfavorable factors for bone healing

A
  1. tobacco smoking
  2. presence of disease, such as DM, anemia, neuropathy, or malignancy
  3. Vit deficiency
  4. Osteoporosis
  5. Infection
  6. irradiated bone
  7. severe soft-tissue damage
  8. distraction of fracture fragments
  9. bone loss
  10. multiple fracture fragments
  11. disruption of vascular supply to bone
  12. corticosteroid use
45
Q

what are the most common AEs for NSAIDs and Opioids?

A
  1. NSAIDs
    • GI (N/V, dyspepsia, ulcers, bleeding)
    • nephrotoxicity
    • hepatotoxicity
    • CV risk
    • Increased BP
  2. Opioids
    • constipation
    • respiratory
46
Q

what are some things to consider with anesthesia?

A
  1. pt may have neuromuscular weakness
    • possible prolonged drowsiness
    • potential fall risk!
    • mobilizing helps reduce abdominal distension and muscle relaxant drugs
  2. impaired airway clearance
    • depress mucocillary clearance
    • encourage pt to cough and deep breath
    • postural drainage is important

Acute Care (11 decks)

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