Musc Flashcards
What are the 3 discharges after acute hospital inpatient?
Subacute inpatient
Home
Residential aged care
What are indications for joint athroplasty?
OA, RA, trauma, tumour, hip dysplasia
When is someone eligible for TJA?
Extreme pain/stiffness, limits everyday activity, exhausted all conservative treatments
Ideally not obese or younger than 60
What are the different types of hip TJA?
THR- replace femoral head and acetabulum
Hemiathroplasty- femoral head only
Hip re-surfacing- articulating surface only
Revision- removal/replace prosthesis
What are precautions for each of the hip approaches?
Posterolateral- through ITB, no hip F >90, adduction past midline, IR > neutral
Anterior- muscle sparing, limit active hip E above neutral, hip ER >45
Direct lateral- TFL retracted, limit hip abd.
What are the different types of knee TJA?
TKR- Femoral and tibial condyles
Partial- medial or lateral femorotibial compartment
Revision
What are the different types of shoulder TJA?
TSR- glenoid and humeral head, primary aim reduce pain
Partial- replace humeral head
Revision
What are the different shoulder approaches?
Deltopectoral- b/n deltoid and p major
Anterior
Superior
What is involved in pre-operative preparation?
Subjective
Preop requirements (e.g. fasting)
Pre-empt D/C plan
Preop education
Set goals
What is the RAPT?
Gives indication D/C type and time
<6 extended inpatient
6-9 additional intervention e.g. home rehab
9+ directly home
What are precautions for TSR?
Sling, limit elevation and ER >20-30
What are some complications of TJA?
Loosening, fracture, dislocation, infection, DVT, pain
What are the different classifications of fracture?
Transverse- horizontal
Oblique- 2D diagonal
Spiral- 3D diagonal
Segmental- 2 fractures
Comminuted- cracks no clean break
Butterfly- part horizontal fracture then triangle fragment
Compression- e.g. neck crushed inward
What is diastasis?
Separation at syndesmotic joint
What is the difference between primary and secondary healing?
1- Rigid fixation, no connective tissue or fibrocartilage before bone development, no hard callus formation, mostly on bone resorption and formation
2- Absence
What are the stages of secondary bone healing?
Haematoma, influx of inflammatory cells, no strength/stability 0-2 weeks
Soft Callus (Fibrocartilaginous), chrondroblasts and fibroblasts, mainly fibrous tissue and cartilage 1-2 weeks
Hard Callus (Woven Bone), osteoblasts, stability, completion of this stage is union 2 to 6-24 weeks depending on fracture type and site
Remodelling (Lamellar Bone), resorption and formation, normal strength, 6-24 to 12-48 weeks depending on fracture type and site
What are the union times?
Spiral UL- 6 weeks
What are some complications of fractures?
Fat embolism, non/malunion, stiffness, avascular necrosis, OA
What factors affect fracture healing time?
Type of bone (cancellous fast, cortical slow)
Age, time down as age increases
Mobility
Infection
Properties of bone (clavicle nonunion rare, tibia union very slow)
What are the 3 principles of fracture management?
Reduction- restore fragments to anatomical position
Immobilization- casts or fixation
Preserve function
When can you go to WBAT to FWB after LL fracture?
6-12 weeks
What are subjective signs of general illness?
Fever, chills, unexplained weight loss, appetite loss, temperature
What are subjective signs of GI problems?
Abdominal pain, nausea, vomiting, indigestion, change in bowel habits
What are subjective signs of CV problems?
Dyspnoea, chest pain, palpitations
What are subjective signs of resp problems?
Cough, dyspnoea, wheeze, night sweats
What are subjective signs of gynaecologic problems?
Bleeding, discharge, irregular menses
What are subjective signs of neurologic?
Headaches, visual disturbances, vertigo, memory, unsteadiness
What are subjective signs of psychologic problems?
Sleeping pattern, stress, depression
What are subjective signs of endocrine and metabolic problems?
Hair/nail changes, fatigue, muscle/bone pain, oedema
What are subjective signs of rheumatological problems?
Joint pain, stiffness, muscle pain, skin/eye/bowel disorders
What are cancer early warning signs CAUTION?
Change in bowel/bladder habit
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious wart or mole change
Nagging cough
What are the stages of RA?
Normal
1: Early, Synovitis
2: Intermediate, Destruction
3: Late, Deformity
What is the presentation of RA inflammation?
Insidious onset
Prolonged stiffness
Worse at night
Improve with activity
Fever, malaise, weight loss
What are symptoms of RA?
Malaise
Weight loss
Pain
Swelling
Stiffness
Reduced function
What are signs of RA?
Joint tenderness
Heat
Effusion
Low ROM
Muscle wasting
Deformity
What are physio treatments for RA?
Pain relief (ice, heat, taping)
Increase movement, muscle strength
Aerobic, weights, functional
Posture
Gait advice
What is mallet finger?
Ruptured extensor tendon, drops DIP joint. Occurs in sports or older degenerated
How is mallet finger treated?
Immobilization 6-8 weeks, wean slowly
What is swan neck deformity?
Lateral bands have slid dorsally, if left unmanaged cannot flex
What is a central slip?
Extensor mechanism ruptured in centre, affects PIP, unable to straighten.
Immobilize DIP and PIP 1/52, remove splint at 5/52
What is trigger finger?
FDP and FDS tendons rupture don’t stay close to bone. Limited ROM and strength
Finger can flex but MCP stay straight
Splint 6/52, tendon gliding exercise, taping
What is DeQuervain’s Tendinopathy?
APL, EPB sheath, pain at base of thumb
Hurts when catheter inserted
Splint, surgery, gradual eccentric loading
What is Dupuytren’s disease?
Contracture of fascial bands in palm
Can’t get hands flat on table, hands in pocket
Can be caused by fracture
Putty, weights, glides
What is Skier’s thumb?
MCPJ UCL
When does Scaphlolunate ligament injuries usually occur and what is the result?
FOOSH, Pain dorsal hand, secondary stabilizer, scaphlolunate instability
What is wrist injury treatment?
2-6/52 splinting
AROM
Describe TFCC injury?
FOOSH or torsion
Ulnar wrist pain, reduced rotation
Describe carpal tunnel syndrome?
Compression of median nerve, paresthesia lateral 3.5 fingers, pain and weakness
Splint
Describe Complex Regional Pain Syndrome and how is it treated?
- Chronic pain after injury or surgery
- Medications, education, hydrotherapy
What is patellofemoral pain?
Anterior or retropatellar pain in the absence of other pathology
What are the symptoms of PFP?
Non-traumatic, diffuse ache, exacerbated by loading, ache with sitting
What structures is PFP felt in typically?
Anterior fat pad and joint capsule
What are potential pathways of PFP?
Patella malalignment- quad weakness, weak hip m, lateral tightness
Altered joint kinematics- altered hip/foot kinematics, weak ankle m
What is the function of the patella?
Increases lever arm of quads, protects deeper knee structures
How does the patella move on the trochlea in movement?
Full extension sits laterally, F moves medially until >130 then moves laterally
What can cause patella tracking?
Tight lateral retinaculum and ITB
move, weak VMO laterally
How does gluteus medius and femoral anteversion contribute to patella tracking?
Increased hip IR -> tight ITB, increased lateral quad moment, changed femoral trochlea orientation
How does hamstrings and gastrocnemius affect PFP?
Decreased length, increased knee F moment, increased PFJ reaction force and PFP
What is the main objective assessment to rule in PFP?
Squat
How do you manage PFP?
Educate (contributing factors to PFP, expectations, weight loss advice)
Vasti retraining (contract VMO), quad/gluteal strengthening (quarter squat, step down, 6 week programme), movement pattern, hip abd/ER strengthen
Patellar taping
Stretching tight structures
How do quads and soleus work in single limb landing?
Load absorbers. Quads and soleus oppose each other, quads more breaking, calves propel midstance. Synergy to decelerate
How do muscles act when jumping off box?
Quads/gastroc pulls tibia forward, gastroc due to fixed tibia
Hamstring opposes, protects ACL