Musculoskeletal Assessment 4

Question 1

Degenerative Joint Disease-Osteoarthritis-

Answer 1

Progressive deterioration/loss of articular cartilage

Question 2

Degenerative Joint Disease-Osteoarthritis- risk factors

Answer 2

Aging; Obesity; Joint hyperextensibility; Occupations of mechanical stress to joints

Question 3

Clinical Manifestationsof DJD

Answer 3

Joint pain; Crepitus: Stiffness; Usually NOT present is inflammation; Characteristics - Heberden’s nodes, Hip pain, Knee deformity (Valgus–bowlegged, Varus—knocked-knee)

Question 4

Post Op Care forJoint Replacement: hip

Answer 4

wound care, drainage, limiting of leg, length of extremities

Question 5

Post Op Care forJoint Replacement: knee

Answer 5

Position/CPM machine; Wound care (Incision, drain); Activity; Pain control; Discharge instruction

Question 6

Rheumatoid Arthritis Theories

Answer 6

Autoimmune, viruses

Question 7

Rheumatoid Arthritis Pathophysiology

Answer 7

Inflammation of synovium; collagen breakdown; loss of articular surfaces

Question 8

Rheumatoid Arthritis Clinical Manifestations

Answer 8

Pain, joint swelling, erythema, warmth, tender

Question 9

Characteristics of RA

Answer 9

Involvement of proximal joints of hands, feet, wrist; Muscle spasm contribute to deformity (Ulnar deviation (ulnar drift), Swan neck (cervical involvement), “cock up” toe); Guarding of painful joints results in muscle atrophy; Subcutaneous nodules (painless, round, moveable)

Question 10

Degenerative Diseases of the Spine

Answer 10

Herniated nucleus pulposus (HNP); Osteophyte formation; Spinal stenosis

Question 11

Herniated nucleus pulposus (HNP)

Answer 11

Degeneration of cartilage→loss of elasticity

Question 12

Osteophyte formation

Answer 12

“spurs” →fusion of vertebrae with pressure on nerve and limited motion

Question 13

Spinal stenosis

Answer 13

Narrowing on the intervertebral spaces due to DJD or RA

Question 14

Signs and Symptoms of Spinal Problems

Answer 14

Back Pain; Sciatic pain radiating down leg/groin; Straight leg raising→pain; Numbness, tingling; Weakness in extremities; Muscle wasteness

Question 15

Weight Bearing

Answer 15

Amount of weight borne on lower extremity during standing or ambulation; Dependent on patient’s condition/medical management; Amount controlled by type of assistive device used

Question 16

Non-weight bearing (NWB)

Answer 16

No weight bearing of involved lower leg; Not permitted to touch ground

Question 17

Toe touch

Answer 17

Rest toes of involved leg on ground for balance, but not weight bearing

Question 18

Partial weight bearing (PWB)

Answer 18

Limited amount of weight bearing (ie. 5 lbs) for lower leg or minimal weight bearing

Question 19

Weight bearing as tolerated (WBAT)

Answer 19

Patient determines amount of weight bearing; Varies from minimal to full

Question 20

Full weight bearing (FWB)

Answer 20

Full weight bearing permitted; assistive devices not used to ↓ weight, but may be used for balance

Question 21

Handle

Answer 21

usually placed at greater trochanter or radial process of wrist; Allow a 20-30 degree flexion of elbow when handle gripped

Question 22

Cane

Answer 22

tip should be 6” from side of toes

Question 23

crutch

Answer 23

axillary piece should be 2-3 finger breaths from axillary area to avoid pressure on brachial plexus; measure with crutch 6 “ out from patient’s heel

Question 24

crutches increase

Answer 24

mobility; not used as often with elderly

Question 25

Don’t hang on crutches by

Answer 25

armpits; pressure can damage brachial plexus

Question 26

Types of crutches

Answer 26

Forearm (persons with cerebral palsy); Axillary (padded curved surface at top of crutch)

Question 27

Ascend stairs

Answer 27

Unaffected leg always goes up first; Followed by crutches (or cane) with affected leg together; “the good go up”

Question 28

Descend stairs

Answer 28

Crutches (or cane) with the affected leg go down first; Followed by the unaffected leg; “the bad go down”

Question 29

Walkers

Answer 29

Walkers provide wide base of support, provide increased lateral and anterior stability, can reduce weight-bearing on one or both lower extremities

Question 30

Types of walkers

Answer 30

Folding (collapsible) & seated walkers; Standard walker; Rolling walker

Question 31

Folding (collapsible) & seated walkers

Answer 31

facilitate mobility in the community

Question 32

Standard walker

Answer 32

Lifts walker forward & places on floor; advance affected leg to middle of walker; followed by unaffected leg; Caution not to step too close to front crossbar as this ↓ balance

Question 33

Rolling Walker

Answer 33

Walker remains in contact with floor throughout gait; Rolls walker forward; advance affected leg first; followed by unaffected leg; Stability is reduced, but facilitates walking as a continuous movement; helps patients who are unable to lift standard walker

Question 34

No Weight Bearing (NWB) gait patterns

Answer 34

Advance crutches with affected leg forward; then unaffected leg follows by stepping slightly past crutch tips

Question 35

Other weight bearing gait patterns

Answer 35

Advance crutches then the affected leg applying only the specified weight; followed by the unaffected leg, which is placed slightly past the affected leg

Question 36

“Swing to” gait

Answer 36

Both crutches advanced forward together; weight shirted onto hands; both legs swung forward to meet crutches

Question 37

“Swing through” gait

Answer 37

Both crutches advanced forward together; weight shifted onto hands; both legs swung through beyond point of crutch placement

Question 38

Continuous Passive Motion Machine

Answer 38

is a postoperative treatment method designed to aid recovery after joint surgery; “Passive” means the joint moves without patient’s muscles being used Outcomes - ↓soft tissue stiffness, ↑ ROM, ↓ muscle, atrophy & contractures, Lessens scar, tissue formation, Prevents venous stasis and thromboembolism, Can ↑bleeding

Question 39

Sequential Compression Devices

Answer 39

Thrombo-gards, Plexi-pulses

Question 40

Sequential Compression Therapy Effects

Answer 40

safe, effective, and noninvasive; helps prevent DVT in surgical patients; Uses a wavelike, milking motion to promote; venous return; Compliments antiembolism; stockings (TED hose)