MSK conditions Flashcards
What types of MSK conditions may be seen in the acute care setting?
- bone fractures including multitrauma situations
- surgical repair of fracture
- joint replacements
- spinal surgeries
- soft-tissue surgeries
list some types of diagnostic imaging that may be performed as part of the MSK exam?
- Radiography
- CT
- MRI
- bone scan
- myelography
what are radiographies primarily used for?
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
what are CT scans primarily used for?
complex or subtle bone fractures and injuries to soft tissue
what are MRIs primarily used for?
spinal disc injuries or soft tissue injuries especially to the tendon, ligament and menisci
what are bone scans used for?
assess the bone density related to tumors and avascular necrosis
what are myelographies used for?
x-ray or CT scan with a contrast dye used to look for spinal conditions like spinal stenosis or disc compression
What would be included in your exam for an MSK patient?
- Observation
- Pain
- Cardiopulmonary
- Integumentary
- Sensation
- ROM
- Strength
- Reflexes
- Balance
- Posture
- Functional mobility
- Outcome measure tool
List some pain scales that may be used for MSK pts
- Numeric 0-10
- VAS
- Wong-Baker Faces
- Nonverbal Pain Scale (NVPS)
- Brief Pain Inventory
- McGill Pain Questionnaire
- Regular
- Short form
- Shoulder Pain and Disability Index (SPADI)
- Lower Extremity Functional Scale (LEFS)
what drives your decision making during an MSK exam?
what info do I need in order to assess patient ability, safety, and D/C needs?
List some outcome measures you may use with an acute MSK pt
- AM-PAC 6-clicks
- TUG
- Gait Speed
- 2MWT or 6MWT
- 30-seconds chair rise test
- Functional reach
- Single limb stance test
List several types of joint replacements
- Knee arthroplasty
- Total knee arthroplasty
- Total hip arthroplasty
- Total shoulder arthroplasty
- Reverse total shoulder arthroplasty
what are the subtypes of knee arthroplasty? What is the difference between them?
- 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
- total knee replacement
- replacement of the femoral condyles, tibial articulating surfaces, and dorsal surface of the patella
- Post-op WB status usually WBAT
what are the usual reasons for a total knee arthroplasty?
severe joint degeneration resulting from OA, RA or trauma
What are some Post-Op concerns following a total knee arthroplasty?
- DVT, PE
- infection
- pain
- edema
- patellar tendon rupture
- patellofemoral instability
- compartment failure or loosening
- peroneal nerve injury
What are some evaluation components for a total knee arthroplasty?
- 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)
- Skin inspection at surgical site
- Immediate D/C planning
What are the D/C requirements to go home following a total knee arthroplasty?
- independent w/HEP
- safe w/household mobilization
Describe the general post-op protocol following a total knee arthroplasty
will vary depending on surgeon
- 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
- May/may not use knee immobilizer
- Typically aiming to achieve 0-90 knee ext/flex
- Big focus on functional mobility
what are the usual reasons for a total hip arthroplasty?
degenerated joint surface
repair of hip following a fall
what is usually the post-op WB status for a total hip arthroplasty?
most often WBAT
always confirm WB status!
List precuations for total hip arthroplasties
- Posterolateral approach
- no hip flex past 90, no ADD past mid, no IR past neutral
- Anterolateral and 2-incision approaches
- limit hip ext especially w/ER
- Both approaches:
- avoid sleeping on surfical site
- avoid sitting on low surfaces
List some possible complications to a total hip arthroplasty
- Dislocation
- Aseptic loosening
- Hematoma formation, hetertrophic ossification
- Infection
- Nerve injury, vascular damage
- DVT → PE
- MI, CVA
- Leg-length discrepancy
what are the S/S of a hip dislocation?
- excessive pain w/motion
- abnormal IR/ER of hip w/limited A/PROM
- inability to WB through LE
- shortened limb (leg length discrepancy)
what are some evaluation components of a total hip arthroplasty?
- P/AROM goni
- skin inspection at surgical site
- measure leg length
- assess for possible neuropraxia, esp femoral and sciatic nerves
- immediate D/C planning
List the D/C requirements to go home for a total hip arthroplasty
- indpendent w/HEP
- safe w/household mobilization
- Independent w/precautions
T/F: a total hip arthroplasty pt may be required to continue PT in inpatient setting
TRUE
Describe the general post-op protocol for total hip arthroplasties
will vary depending on surgeon
- ABD wedge
- Possibly knee immobilizer (prevents hip flx)
- Adaptive equipment
- long handled reachers
- shoehorns
- leg lifter
- elevated toilet seat
- Prescribe appropriate AD
- AROM/strengthening
- Functional mobility
what type of AROM/strengthening needs to be done with a total hip arthroplasty?
- Submax glut sets
- ISOM QS and HS
- Avoid SLR
List precautions following a total shoulder arthroplasty
integrity of rotator cuff and deltoid muscles dictates precautions and rehab
Common precautions:
- avoid shoulder AROM
- No lifting, pushing, or pulling obj w/involved UE
- No excessive shoulder motion behind back, esp IR
- No excessive stretching, esp ER
- No supporting BW by hand or involved side
- No driving for 3 weeks
what should the pt edu include for a total shoulder arthroplasty?
- use of ice for pain and inflammation management
- positioning
- avoid lying on involved shoulder
- use a towel roll under elbow when supine
- bring hand to mouth w/elbow held at side of trunk
- TherEx program w/HEP
- decrease distal edema w/hand wrist and elbow AROM and ice packs
- squeeze ball/sponge to maintain grip strength
list immediate post-op exercises that should be done w/total shoulder arthroplasty
- supine passive forward flex w/elbow flexed
- pt may passively move involved arm by using opposite hand to guide the movement
- 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
- pendulum exercises, clock/counterclockwise
when would a reverse total shoulder arthroplasty be done?
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
S/S of infection post joint replacement and trx options for infection
- S/S
- fever, wound drainage, persistent pain, erythema
- fluids cultured to determine type of organism
- Trx
- antibiotics
- debridement w/prosthesis retention or removal
- 1-2 stage reimplantation
- arthrodesis
- amputation (life threatening conditions)
T/F: resections may result in WB restrictions
TRUE
when spacers in place prior to new implantation
List several types of spinal surgeries
- Discetomy
- Decompression
- Laminectomy
- Fusion
- Total disc replacement - alternative to fusion
what are some complications to spinal surgeries?
- neurologic injury
- infection
- cauda equina syndrome
- dural tear w/CSF leak
- general surgical complications
List spinal precuations following spinal surgeries
used most frequently w/fusions
- log-rolling technique for getting in/OOB
- avoid excessive trunk flexion while seated
- Limited extended periods of sitting (will increase pain)
- Lifting restrictions to <5-10 lbs (may vary depending on protocol)
- there are no LE WB restrictions
Describe the evaluation components that should be included for spinal surgeries
- neck/trunk ROM and strength assessment may be limited by spinal precautions
- Emphasize functional mobility
- know wearing schedule of orthotic
- Ensure pt knows schedule and how to don/doff
- adhere to post-op spinal precautions
- emphasize properbody mechanics
- schedule pain meds prior to PT visit
how are traumatic fractures typically classified?
- Skin integrity
- Site of fracture
- Classification
- Extent
- Relative position
How are fractures typically managed?
- Nonoperatively (conservatively)
- Operatively
- elective, urgent, emergency
- Fracture reduction
- closed-noninvasive (ie. traction)
- open-invasive (ie surgery ORIF)
- Immobilization
- noninvasive (cast)
- invasive (ex-fix)
List various fracture complications
- delayed union, nonunion, malunion
- loss of fixation or reduction
- DVT, plumonary/fat embolism
- nerve damge (paresthesia or paralysis)
- arterial damage (blood vessel laceration)
- compartment syndrome: 5 Ps
- infection
what are the 5 Ps associated w/Compartment syndrome?
- Pain
- Pallor
- paresthesia
- Pulselessness
- Paralysis
List favorable factors for bone healing
- early mobilization
- early WB
- maintenance of fracture reduction
- younger age
- good nutrition
- minimal soft-tissue damage
- pt compliance
- presence of GH
List unfavorable factors for bone healing
- tobacco smoking
- presence of disease, such as DM, anemia, neuropathy, or malignancy
- Vit deficiency
- Osteoporosis
- Infection
- irradiated bone
- severe soft-tissue damage
- distraction of fracture fragments
- bone loss
- multiple fracture fragments
- disruption of vascular supply to bone
- corticosteroid use
what are the most common AEs for NSAIDs and Opioids?
- NSAIDs
- GI (N/V, dyspepsia, ulcers, bleeding)
- nephrotoxicity
- hepatotoxicity
- CV risk
- Increased BP
- Opioids
- constipation
- respiratory
what are some things to consider with anesthesia?
- pt may have neuromuscular weakness
- possible prolonged drowsiness
- potential fall risk!
- mobilizing helps reduce abdominal distension and muscle relaxant drugs
- impaired airway clearance
- depress mucocillary clearance
- encourage pt to cough and deep breath
- postural drainage is important