Musculoskeletal Conditions Flashcards
_____________ limb amputations occur 3 times more often than ___________ limb amputations.
Lower
Upper
Amputation can be congenital or caused by traumatic or surgical removal of whole or part of a limb such as leg, foot, arm, or hand.
The most common cause of upper limb amputation is __________.
The most common causes of lower limb amputation are _________ and ___________.
Upper Limb: Trauma
Lower limb: peripheral vascular disease, diabetes
An above the elbow amputation is called…
transhumeral
A below the elbow amputation is called…
transradial
A below the wrist amputation is called…
transmetacarpal
An above the knee amputation is called…
transfemoral
A below the knee amputation is called…
transtibial
A _______________ is an amputation across a joint such as hip, wrist, elbow, or shoulder.
Disarticulation
A below the ankle amputation is called…
transmetatarsal
An ankle disarticulation is called…
Syme’s amputation
Preprosthetic training occurs from postsurgery until client receives permanent prosthesis.
One of the main goals of this period is to assist the client in coping with psychological aspects of limb loss, including changed body scheme, reduced self-esteem and self-efficacy, shock, disbelief, anger, grief, guilt, denial, hopelessness, and depression.
What are at least 2 other goals?
Optimize wound healing.
Maximize residual limb shrinkage and shaping to achieve tapered distal end, the optimal shape for a prosthetic socket.
Desensitize residual limb.
Maintain or increase range of motion (ROM) and strength.
Facilitate independence in ADLs.
Explore prosthetic options (if desired)
Prosthetic training occurs after the client receives permanent prosthesis.
One goal is to teach the client to independently don and doff prosthesis.
What are at least 2 other goals?
Train the client in care of the prosthesis.
Increase the client’s wearing time to full day.
Provide prosthetic control and functional use training.
Encourage the client in independent use of the prosthesis.
What are 3 factors (including client factors) limiting performance that should be evaluated during the Post-operative and preprosthetic phase?
Pain
Skin complications, including delayed healing, necrosis, and skin graft adherence to bone
Edema of residual limb
Bone spurs
Neuroma on distal end of residual limb
Phantom limb pain, a sensation that appears to occur in the missing limb such as stabbing, cramping, burning, or throbbing
Phantom sensation, the sensation of the limb that is no longer there
What are 3 factors (including client factors) limiting performance that should be evaluated during the prosthetic phase?
Any changes in sensation in the residual limb, including hypersensitivity and sensation loss
Presence and severity of phantom sensations
Pain
Body image and self-image
Strength, flexibility, and endurance of the residual limb in preparation for prosthesis wearing; full body strength, flexibility, and endurance
Skin integrity
Performance patterns including habits, routines, and roles, that may have been affected by amputation
Pressure injury as a result of ill-fitting prosthesis socket or wrinkles in prosthetic sock
Sebaceous cysts resulting from torque of prosthetic socket
Edema resulting from ill-fitting socket or too-tight prosthetic sock
Sensory changes such as loss of sensory information as a result of missing limb, residual limb hyperesthesia (oversensitivity), areas of absent or impaired sensation, phantom limb or phantom sensations.
Name at least 2 interventions during the preprosthetic phase.
Limb hygiene
Wound care and healing
Limb shrinkage and shaping: The client is trained to wrap the residual limb in an elastic bandage to reduce and control edema and develop a tapered shape. An elastic shrinker or compression garment may be introduced with physician clearance once drainage stops.
Desensitization of the residual limb through tapping, vibration, constant pressure, and rubbing with varying textures
Joint mobility and stretching
Exercise program for ROM and strengthening muscle groups proximal to amputation and core strength
Wheelchairs: Clients with lower limb amputations require residual limb support; the large rear wheels should be placed further back to counterbalance missing limbs, and the wheelchair should have antitippers.
ADL retraining and consideration of modifications of environment and activity, as well as adaptive strategies. Change in hand dominance, if pertinent, is introduced.
Psychosocial adjustment
Exploration of optimal prosthesis to meet patient’s goals (if desired).
A _____________ attaches the prosthesis to the residual limb.
Socket
A terminal device is…
Lower limb amputation: foot
Upper limb amputation: hand
In upper limb prostheses, a _____________- is combined with the harness to transmit body forces to control the cable that operates the TD.
control system
In lower limb prostheses, a __________ is used to connect the TD to the socket.
pylon
A __________________ protects the residual limb and improves the fit of the socket
prosthetic sock or gel liner
Which prosthetic system is described below?
active prosthesis, cable driven and uses gross proximal body movements
Body-powered prosthesis
Which prosthetic system is described below?
uses muscle surface electricity to control TD, increased grip force and more natural appearance. Must have two muscle sites that fit within the prosthesis to provide signal.
Electrically powered prosthesis (myoelectric prosthesis)
Which prosthetic system is described below?
combines body-powered and electrically powered, most commonly used with transhumeral amputation.
Hybrid prosthesis
Which prosthetic system is described below?
cosmetic, static and does not have grasp.
Passive prosthesis
Which prosthetic system is described below?
designed for particular activity or task
Activity-specific prosthesis
The Initial wearing time of a prosthetic should be _______________ minutes.
15 to 30 (minutes)
The prosthesis should then be removed, and the stump examined for reddened areas.
If no reddened areas are apparent after 20 minutes, the wearing time is increased in 15- to 30-minute increments until the client wears the prosthesis for a full day.
Any reddened areas that do not disappear after approximately 20 minutes should be reported to the prosthetist so the prosthesis can be adjusted.
How often should the interior of a prosthesis be cleaned?
Clean the interior daily with mild soap and water.
Allow prosthesis to dry completely prior to donning.
__________________ is the operation of each component of the upper limb prosthesis.
Prosthesis control training
______________ is the integration of prosthesis components for efficient assist during functional use.
Prosthesis use training
___________ is the identification of the optimal position of each positioning unit (e.g., wrist, elbow) to perform an activity or grasp an object.
Prepositioning training
________________ is terminal device control during grasp activities.
Prehension training
_________________ is the control and use of the prosthesis during functional activities including incorporation of the TD as a functional assist, and focusing on a problem-solving approach
Functional training
A __________________ is the shortening of skin, ligaments, joint capsule, tendons, and muscles resulting from conditions such as burns, wound healing, muscle imbalance from peripheral nerve injury, spinal cord injury, increased muscle tone from a stroke, head injury, and cerebral palsy.
Contracture
Contractures impede normal range of motion and affect movement.
Soft tissue: responds to therapy.
Boney block: requires surgery to release.
What are the five steps (in order) to treat contractures?
- Superficial and deep heat to increase tissue extensibility
- Slow stretch
- Static splinting
- Serial, or progressive, static splinting
- Dynamic splinting.
This type of splint is used to reduce MCP hyperextension and interphalangeal (IP) flexion contractures; MCPs are splinted to block hyperextension.
Lumbrical bar splint
This typing of splinting uses fiberglass or plaster of Paris materials to position clients with increased tone and over time to stretch soft-tissue contractures.
Serial casting
This type of splint is used to maintain the wrist in neutral position or extension, the MPs in flexion, the IPs in extension, and the thumb in abduction with opposition.
Antideformity resting hand splints (burn intrinsic plus)
____________________ is a syndrome consisting of widespread pain with tenderness and stiffness that is independent of a specific injury or lesion.
Fibromyalgia
Symptoms include widespread soft tissue pain, nonrestorative sleep, fatigue, inability to think clearly, paresthesias and joint swelling, depression, and anxiety.
Name at least 3 interventions for fibromyalgia.
Client education to avoid pain triggers and manage stress
Gentle regular aerobic exercise, gentle daily stretching, strengthening activities
Cognitive–behavioral therapy
Sleep hygiene techniques
Myofascial release and trigger point treatment, massage, relaxation exercises, biofeedback
Progressive strength training
Fatigue, stress, and pain management; pacing activities; work simplification and energy conservation techniques
Memory aids
Modification of activity or environment or adaptive equipment
______________ are one of the most commonly occurring conditions in adults. Older adults are particularly vulnerable.
Osteoporosis is a significant risk factor, as is reduced mobility; both factors can be present in aging populations, particularly women.
Hip fractures
Trauma is the primary cause of fractures, often with falling as the mechanism of injury.
Osteoporosis is particularly problematic because decreased bone density occurs in the neck of the femur.
This type of hip fracture can be caused by slight trauma or rotational force; they occur most commonly in women older than age 60 with osteoporosis.
Femoral neck fractures
This type of hip fracture results from a direct trauma or force between the greater and lesser trochanter.
Intertrochanteric fractures
This type of hip fracture results from a direct trauma to the lesser trochanter; they are most often the result of a car accident or fall and occur mostly in people younger than age 60.
Subtrochanteric fractures
Explain the 5 levels of weight bearing restrictions:
- Non–weight bearing
- Toe-touch weight bearing
- Partial weight bearing
- Weight bearing at tolerance
- Full weight bearing
Non–weight bearing: No weight can be placed on the affected extremity.
Toe-touch weight bearing: The toe of the affected extremity can touch the ground for balance only; 90% of body weight is placed on unaffected leg.
Partial weight bearing: The affected extremity may bear only 50% of client’s body weight.
Weight bearing at tolerance: The client judges how much weight they can tolerate on the basis of pain response.
Full weight bearing: The client may put 100% of their weight on the affected extremity without causing damage.
Hip replacements (arthroplasty) are most often used to _______________ or _______________.
restore joint motion
address joint pain
________________, ________________, and ___________________ often precede joint replacements.
Osteoarthritis
Rheumatoid arthritis
Degenerative joint diseases
This hip replacement approach has the following precautions:
- no hip flexion greater than 90°
- no internal rotation
- no adduction of affected hip joint
Posterolateral approach
Hip precautions are dependent on the type of surgery, and failure to follow them may result in hip dislocation and further injury.
Out-of-bed activity should occur early with both approaches, traditionally 1 to 3 days post-operation.
This hip replacement approach has the following precautions:
- no external rotation
- no extension
- no adduction of affected hip joint
Anterolateral approach
Hip precautions are dependent on the type of surgery, and failure to follow them may result in hip dislocation and further injury.
Out-of-bed activity should occur early with both approaches, traditionally 1 to 3 days post-operation.
