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Acute Care > Msk System > Flashcards

Msk System Flashcards

1
Q

Examination Definition

A

Examination findings from history, systems review, and tests and measures should drive the decision making process

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2
Q

Components of an Examination

A

Patient History

Medical record review

  • diagnostic test review: imaging
  • medication review
  • coordination w/ other providers

Pt interview

Tests and Measures

  • mental status
  • observations
  • integumentary
  • pain
  • ROM & Strength
  • Posture
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3
Q

How is pt history obtained

A

– Medical record
– The patient
– The pt’s caregivers

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4
Q

What does pt history include

A

General demographics
Social history
Employment/work
Growth & development
General health status
Family history
Medical/surgical history
Current condition(s) & CC
Functional status & activity level
Medications
Clinical tests

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5
Q

Activity Status

A

Complete bedrest
Bedrest /c bathroom privileges
Dangle
Up in chair /c assist
BRP when A&O
Up in hall
Up as tol
Up ad lib (up as desired)
Walk /c assistance
Activity as tolerated
Walk /c assistance

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6
Q

Diagnostic Tests Review

A

Radiography (X-ray)
CT Scan
MRI
Bone Scan
Mylegrophy

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7
Q

Radiography (X-ray)

A

good for fractures, bone loss and foreign bodies. It is cheaper and faster than other imaging

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8
Q

CT Scan

A

a more detailed X-ray, enhanced x-ray imaging

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9
Q

MRI

A

Good for soft tissue, nerves. More accurate than CT and xray but takes longer and is more expensive

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10
Q

Bone Scan

A

metabolic status of the skeleton. Subtle fracture by comparing the metabolic status of one part of the bone to the other

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11
Q

Mylegrophy

A

Image of Spinal cord, nerve root, dura mater w/ contrast dye. Spinal stenosis or compression that may be a result of disk rupture

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12
Q

Medication Review
Residual effects of general anesthesia

A

Pt could be woozy, confused, delirious, and/or weak.

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13
Q 
Medication Review 
Pain medications (opioid analgesics)
A

•Type of pain medication, its side effects, and dosing schedule.

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14
Q

Medication Review
Anticoagulant (heparin, warfarin)

A

o Antiembolism stockings
o Pneumatic compression devise

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15
Q

Interventions:
General PT goals

A

– Decrease pain and/or muscle guarding.
– Prevent circulatory & pulmonary complications.
–Prevent ROM & strength deficits.
– Improve functional mobility while protecting the involved structures.

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16
Q

PT considerations w/ interventions

A

– Physician orders.
– Need for equipment use during mobilization activities.
– Medical status, social support system, & ability to abide by all safety precautions.

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17
Q

Traumatic Fracture Classification

A
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18
Q

The classification of the fracture

A
  • Linear fx: parallel to the long axis of the bone.
  • Oblique fx: diagonal to the long axis of the bone.
  • Spiral fx: encircles the bone.
  • Transverse fx: horizontal to the long axis of the bone.
  • Comminuted fx: two or more fragments (ex: wedge-shaped)
  • Segmental fx: 2 or more fxlines at different levels of the bone.
  • Compression fx: the bone is crushed (common in the vertebrae).
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19
Q

Factors Contributing to Bone Healing

A

Favorable
• Early mobilization
• Early weight bearing
• Maintenance of fracture reduction
• Younger age
• Good nutrition
• Minimal soft tissue damage
• Patient compliance

Unfavorable
• Presence of growth hormone

  • Tobacco smoking
  • Presence of disease (DM, anemia, neuropathy, or malignancy)
  • Vitamin 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
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20
Q

Fracture: Immediate complications

A
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21
Q

Delayed complications

A
  • Loss of fixation or reduction.
  • Delayed union (due to unfavorable healing factors).
  • Nonunion (failure of fxto unite).
  • Malunion (angular or rotary).
  • Pseudarthrosis (false joint at fxsite).
  • Posttraumatic arthritis.
  • Osteomyelitis.
  • Avascular necrosis.
  • Complex regional pain syndrome.
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22
Q

Fracture Fixation Methods

A
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23
Q

Fx According to Body Region (UE)

A

Shoulder girdle fx
Proximal humerus & humeral shaft fxs.
Distal humeral & proximal forearm fxs.
Fxs of the shaft of the radius and ulna.
Carpal, metacarpal, & phalangeal fxs.

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24
Q

Fx According to Body Region (Pelvis & LE)

A

Pelvic fx
Acetabulum fx
Proximal Femur fx
Femoral Shaft fx
Distal Femur fx
Patella fx
Tibial Plateau fx
Calcaneal fx

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25
Q

Fx According to Body Region (Spine)

A

Less frequent than fxsto the extremities.
~ half sustain spinal cord or peripheral nerve root injuries.

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26
Q

Spine Fx primary goal

A

Primary goal is preservation of neurologic function.

Mechanical stability must be provided to unstable segments.

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27
Q

Spine Fx Standard treatment

A

Standard treatment: closed reduction & stabilization (external

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28
Q

Spine Fx PT management

A

PT management:
– Goal: protecting the fracture & surgical site during all functional mobility activities.
– “Cleared” for mobility?
– Teach proper “logroll” techniques, posture, body mechanics and use of orthotics.
– Strengthening and ROM exercises (based on clinical presentation)

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29
Q

What is a Joint Arthroplasty?

A

Surgical reconstruction of articular surfaces w/ prosthetic components (elective).

30
Q

Indications of a Joint Arthroplasty

A

Indication:
– Painthat is no longer responsive to conservative measures.
– Loss of function & motion.

31
Q

Joint Arthroplasty PT to consider

A

• PT to consider:
– Preoperative history (medical & rehab management).
– Impairments & activity limitations.
– Surgical technique, prosthesis type, fixation method.
– Soft-tissue disruption & repair.
– Type of anesthesia.

32
Q

What is a Hip Arthroplasty

A
  • Replacement of the femoral head, the acetabulum, or both (most common) with prosthetic components.
  • Due to severe hip arthritis, avascular necrosis, hip infection, or congenital disorders.
33
Q

Hip Arthroplasty complications

A

Complications: fx, loosening, hematoma, heterotopic ossification, infection, dislocation, nerve injury, vascular damage, PE, MI, CVA, & limb-length discrepancy.

34
Q

Hip Arthroplasty Cemented vs. Cementless

A
35
Q

Hip Arthroplasty Surgical Approaches

A

Posterior: Dislocates w/ excessive flex, add, & int. rotation

Anterior: Dislocates w/ excessive ext, add, & ext. rotation

36
Q

PT After Hip Arthroplasty

A
  • Early postoperative functional mobility training, patient education about movement precautions during ADLs, and strengthening of hip musculature.
  • Early mobilization: to prevent DVT
  • All peripheral innervations should be examined
  • Achieve safe functional mobility (i.e., bed mobility, transfers, and ambulation with AD).

• Educate the patient about hip dislocation precautions and activity restrictions.
– Movement of the operated hip can decrease postop pain

37
Q

THA Common activity restrictions

A

– Avoid hip motion into prohibited ranges based on dislocation precautions dictated by the surgeon
– No sitting on low surfaces
– No sleeping on operative side

38
Q

THA Posterolateral or Posterior Dislocation Precautions

A
  • No hip flexion beyond 90 degrees
  • No internal rotation past neutral
  • No hip adduction past neutral
39
Q

THA Anterolateral or Anterior Dislocation Precautions

A
  • No hip extension and external rotation
  • In some cases, no active hip abduction
40
Q

THA Therapeutic Exercise

A
  • Deep breathing
  • antiembolism exercises (ankle pumps)
  • PROM, AAROM, AROM
  • Isometrics for glutes in supine
  • Isometrics for quads supine
  • strengthen noninvolved limbs
  • aerobic exercise program
41
Q

THA Transfer Training

A
  • Use appropriate assistive device.
  • Elevation of the bed can facilitate sit-to-stand transfers.
  • Use proper height chair to facilitate transfers (hip precautions).
42
Q

THA Gait Training

A
  • Use appropriate AD.
  • Avoid pivoting on the operated extremity (small steps when turning).
  • Stairs training before discharge.
43
Q

What is a Knee Arthroplasty

A
  • Replacement of the articular surfaces with prosthetic implants.
  • Indications: end-stage arthritis w/failed conservative measures.
44
Q

Unicompartmental(UKA)

A

– Osteoarthritis or osteonecrosis confined to one compartment.
– Intact cruciate & collateral ligaments.
– Goal: preservation of the articular cartilage of the healthier compartment.
• Shorter recovery.
• Maintain the normal kinematics.

45
Q

What is a Total Knee Arthroplasty (TKA)

A

Replacement of femoral condyles, the tibial articulating surface, and the dorsal surface of the patella.

46
Q

TKA (Surgical techniques)

A
  • Anterior midline incision (common)
  • Parapatellar retinacular approaches
  • Subvastusapproach
  • Midvastusapproach
47
Q

TKA Complications

A

Complications: thromboembolism, infection, joint instability, fractures, patellar tendon rupture, patellofemoral instability, component failure or loosening, and peroneal nerve injury.

48
Q

TKA Patient Edu

A

•Patient education should include:
–Proper positioning
• Avoid the use of pillows directly under the knee. Why?
• Use of continuous passive motion (CPM), if ordered.
• Use of knee immobilizer, if ordered.
– Activity restrictions & WB limitations
– Therapeutic exercise program

49
Q

TKA PT Postop

A

– Improving knee ROM & strength.
– Maximizing independence & safety with all mobility activities.
– PT to confirm restrictions on weight bearing or any activity/movement precautions with the surgeon.

50
Q

TKA Strengthening exercises

A

– Isometric -> active-assisted -> active quadriceps & hamstring exercises through the full available ROM.

51
Q

TKA Therapeutic exercises

A

• Deep breathing & antiembolism exercises (e.g., ankle pumps).
• PROM, AAROM, and AROM.
– Knee extension & flexion (e.g., heel slides)

  • Isometrics for gluteal, quadriceps, & hamstring muscles in supine
  • Straight-leg raises with isometric quad setting to ensure full knee-extension ROM
  • Active exercises for hip abduction & hip adduction in supine or standing
52
Q

Minimally Invasive Hip & Knee Arthroplasty

A

Minimally invasive surgery(MIS) refers to a variety of procedures & techniques that are used to decrease the amount of soft-tissue injury during surgery.

  • significant clinical advantage of MIS over conventional surgery has notbeen supported in the literature.
53
Q

What is a Shoulder Arthroplasty

A

• Indicated for pts w/ severe pain & limited ROM

• Total shoulder arthroplasty (TSA): replacing both the humeral & glenoid surfaces.
– Better outcomes (pain, ROM, function, and revision rates).

• Hemiarthroplasty: replacing only the humeral head.

54
Q

THA Most Commonly used Prosthesis

A

Unconstrained type

55
Q

Success of TSA is associated w/ …

A

– Accurate surgical placement of the prosthesis.
– Reconstructing the anatomic congruency of the joint.
– Proper orientation of the prosthetic components and preservation of structural length and muscular integrity.

56
Q

TSA complications

A
  • RC tear
  • GH instability
  • humeral fracture
57
Q

TSA Common Precautions

A
  • Avoid AROM
  • No lifting, pushing, pulling
  • No excessive shoulder extension and IR
  • No excessive stretching ex) ER
  • No weight beraing on TSA arm
  • No driving for 3 weeks
58
Q

TSA PT (pt edu)

A
  • Use of ice for the management of pain & inflammation
  • Proper positioning for comfort & procedure integrity
  • Avoid lying on the involved shoulder
  • Use a towel roll under the elbow when supine
  • Bringing the hand to the mouth w/ the elbow held at the side of the trunk
  • Therapeutic exercise program
59
Q

Reverse Total Shoulder Arthroplasty (rTSA)

A

Indications:
– Rotator cuff arthropathy.
–Failed shoulder arthroplasty.
– Multiple failed rotator cuff repairs.
– Malunion of the tuberosity fracture.
• Center of rotation is more inferior & medial.
• Shoulder stability & function to rely heavily on the deltoid muscle.
• The new position of the deltoid allows it to elevate the arm in the presence of rotator cuff deficiency.

60
Q

Spine Surgeries

A
  • Fusion:
    • Purpose- Stabilization of hypermobile or unstable joints
    • Procedure- Use of internal fixation (e.g., Harrington rods)
  • Laminectomy
    • Purpose- Relieve pressure on neural structures
    • Procedure- Removal of the lamina
  • Discectomy
    • Purpose- Excision of protruding or herniated interdiscalmaterial
    • Procedure- Removal of a portion of or the entire intervertebral disk
  • Corpectomy
    • Purpose- Removal of part of the vertebral body
    • Procedure- Use of special instruments to remove fragments of the vertebral body
  • Total disk replacement
    • Purpose- Replacement of deranged vertebral disk
    • Procedure- Removal of damaged vertebra disk and replacement with artificial implant
61
Q

Spinal surgery PT

A
  • Early mobilization, education on proper body mechanics, & gait training
  • Educate on movement precautions if applicable (see next slide)
  • Coordinate treatment w/ the administration of pain medication
  • Educate relaxation techniques or breathing exercises pain management
  • The amount of time in sitting is limited to 30 minutes
  • Check orders for brace or any restrictions on activity
  • Braces when OOB, but applied in supine. Educate proper donning & doffing
62
Q

Spinal Surgeries Precautions

A

Microdiscectomy/laminectomy

  • 10-lb lifting precaution recommended by the surgeon.
  • Mobilize as tolerated & avoidany excessively painful motions.

Fusion

  • Minimizing bending & twisting with activity.
  • Lifting restrictions per the surgeon.
  • Use of braces or corsets if prescribed.

Anterior approach surgeries

  • Splinting pillow to promote deep breathing & coughing.
  • A corset may be prescribed to aid patient comfort with activity.
63
Q

Kyphoplasty & Vertebroplasty

A

Vertebral augmentation is a surgical intervention used for progressive symptomatic osteoporotic vertebral compression fractures.

64
Q

Kyphoplasty

A

golden standard for compression fracture restores height of the vertebrae. Insert inflatable balloon to allow placement of polymethylmethacrylate cement

65
Q

Vertebroplasty

A

Injecting a polymethylmethacrylate (PMMA) cement into the vertebral space to stabilize the compression fracture.

66
Q

PT after Vertebroplasty or Kyphoplasty

A
  • immediately postoperatively is to increase functionalmobility.
  • walkingprogram is the primary source of exercise immediately postoperatively.
  • Consult with the surgeon for any activity restrictions
  • Encourage the use a logroll technique when getting in and OOB
  • Good body mechanics
67
Q

What are Casts

A

A cast is a circumferential rigid external dressing used to maintainoptimal skeletal alignment of a stable fracture.

68
Q

Cast Complication

A

•Complications:
– Nerve compression.
– Skin breakdown.
– Compartment syndrome.

69
Q

What are External Fixators

A

Aluminum or titanium percutaneous pins or wires inserted into the long axis of a bone that connect externally to a frame.

70
Q

Purpose of External Fixators

A

– Severely comminuted fractures
– Unstable pelvic fractures
– Fxs w/ severe soft-tissue or vascular injuries
– Significant bone loss

•Allows for early functional mobilization

71
Q

What is Traction

A

A system of weights & pulleys restores the alignment of bone & muscle.

Most commonly used for femur fx(internal/external fixation has become the preferred method of stabilization).

Acute Care (7 decks)

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