ortho

Question 1

1.1 List the types of grips and pinches of the hand? (5)
(5)

Answer 1

grips 
1, lumbrical grip
2 spherical grip 
3. hammer grip
4. hook grip

pinch

1. tip pinch
2. tripod pinch/chuck grip
3. lateral pinch

Question 2

1.2 Identify the motor and sensory innervation of the median nerve

Answer 2

motor- flexor and pronator muscles in the anterior compartment of the forearm (exept flexi carpi ulnaris and part of flexor digitorum profundus which is innervated by ulnar) thernar muscles and lateral two lumbricals
sensory- palmar cutaneous branch which inervated the lateral aspect of the palm, digital cutaneous branch which innervates the lateral three and a half fingers on the anterior surface of hand

Question 3

Mr Smith is a 23 year old male who was involved in a motor vehicle accident. He was the driver and was not wearing a seatbelt. Due to the impact of the collision his knees hit the dashboard. He sustained an anterior acetabular dislocation. The dislocation was reduced in theatre. He was then put on skin traction for the next six weeks.

2.1 Describe the clinical deformity you will expect to see in Mr Smith. (2)

)

Answer 3

extention, abduction and exteranal rotation of the hip

Question 4

Mr Smith is a 23 year old male who was involved in a motor vehicle accident. He was the driver and was not wearing a seatbelt. Due to the impact of the collision his knees hit the dashboard. He sustained an anterior acetabular dislocation. The dislocation was reduced in theatre. He was then put on skin traction for the next six weeks.
2.2 Describe the main features you will see on x-ray in an anterior acetabular dislocation. (2)

Answer 4

the femoral head appears to be inferior to the acetabulum

Question 5

Mr Smith is a 23 year old male who was involved in a motor vehicle accident. He was the driver and was not wearing a seatbelt. Due to the impact of the collision his knees hit the dashboard. He sustained an anterior acetabular dislocation. The dislocation was reduced in theatre. He was then put on skin traction for the next six weeks.
2.3 Explain the contra-indications and precautions to be observed for the next six weeks. (4

Answer 5

avoid exessive abduction,extention and external rotation especially in combination

nwb 3/52 after the traction has been removed
maintain neutral postion of hip when doing bed exercises
modify bedpan used to avoid extention

Question 6

Mr Smith is a 23 year old male who was involved in a motor vehicle accident. He was the driver and was not wearing a seatbelt. Due to the impact of the collision his knees hit the dashboard. He sustained an anterior acetabular dislocation. The dislocation was reduced in theatre. He was then put on skin traction for the next six weeks.
2.4 Briefly discuss the role of the physiotherapist in preventing complications for Mr Smith. (10)

Answer 6

decrease pain by body position and cryo
reduce swelling, elvation, ankle movements and circulating drills
maintain rom in all other joints
maintain muscles strenghth in all joints
confirm when patient can weight bear
maintain and imporve the person function

Question 7

Mrs Lance is a 70 year old female who has sustained a fracture of her right radius. She has been managed in a below elbow plaster of paris (POP) with a sling in casualty. You are called to see her before she goes home.

Discuss the session you will spend with her. (8)

Answer 7

1. subjective assessment- access pt pain, xray, age, activity level, doctors orders,
2. objective= rom of wrists and digits, grip and forearm strenghth, bony and tissue abnormalities, skin and nerve,dvt and compatment syndrome signs
3. education of POP and sling precautions, decrease pain by cryo, decrease oedema, rom maintined in other joints, strenghth exercises using isometrics for affected, maintain highest level of function of pt, advice to come back when pop is off to regain rom, muscle strength and proprio

Question 8

Write short notes on stump bandaging of an amputee (6)

Answer 8

stump bandaging- aids healing, shrinks the stump, shapes the stump, aid stump maturation
done on closed or healed stump and circulation must not be compromised

Question 9

Mrs Smoak is a 65 year old female who sustained a Garden III fracture of the right femoral neck. The orthopaedic surgeon has inserted a dynamic hip screw and she is day two post surgery when she is referred to you for physiotherapy.
Describe a Garden III fracture. (2)

Answer 9

complete femoral fracture with partial displacment
fracture line is complete
rotation of the femoral head in the acetabulum
fracture only slightly displaced
disturbance of trabecular pattern

Question 10

Mrs Smoak is a 65 year old female who sustained a Garden III fracture of the right femoral neck. The orthopaedic surgeon has inserted a dynamic hip screw and she is day two post surgery when she is referred to you for physiotherapy.State the reason/s why early fixation indicated in this patient. (2)

Answer 10

type 3 thus more indicated to have the use of dynamic screw, there will be earlier mobilization and since the patient is old is will reduce ehr time in hospital and thus decrease complications

Question 11

Mrs Smoak is a 65 year old female who sustained a Garden III fracture of the right femoral neck. The orthopaedic surgeon has inserted a dynamic hip screw and she is day two post surgery when she is referred to you for physiotherapy.List the contra-indications and precautions to be observed during the assessment and treatment of Mrs Smoak. (5)

Answer 11

no slr
no hip flex beyond 90
no forced abduction in side lying 
twb/pwb
no forced passive movements
avoid excessive hip roatation

Question 12

Mrs Smoak is a 65 year old female who sustained a Garden III fracture of the right femoral neck. The orthopaedic surgeon has inserted a dynamic hip screw and she is day two post surgery when she is referred to you for physiotherapy.Describe the physiotherapy treatment for Mrs Smoak in the first five days post surgery. (6

Answer 12

screen for poc eg dvts
test pt balance and constult with ortho for wb status
mobilise with an assistive device and teach them how to use it
reduce oadema using cry and elevetion
maintain rom in unaffected limbs
help with pain
perom isometrics for affected and farom for other limbs
increase circulation
help patient achive highest level of funtions

Question 13

Tabulate the differences between osteoarthritis and rheumatoid arthritis under the following headings:
3.1 General features (5)

Answer 13

RA- autoimune 
genetic dipostion and envirmental 
sytemic inflammation 
many joints both sides
smaller joints

OA-degenerative
over 50 years age
localized inflamation 
1 or a few joints usually unilateral 
larger joints

Question 14

Tabulate the differences between osteoarthritis and rheumatoid arthritis under the following headings: 3.2 Diagnosis (2)

Answer 14

oa- degenrration of joint cartilage and the underlying bone, most common from middle age onwards

ra= a chronic progressive disease causing inflammation in the joints and resulting in painful defromity and immobility esp in fingers, wrists,feet and ankles

Question 15

Tabulate the differences between osteoarthritis and rheumatoid arthritis under the following headings: 3.3 Signs and symptoms (6)

Answer 15

RA- synovitis= terder,warm, swollen joints
joint
destruction= limitied rom,isolated tendon ruptures
deformity= ulnar shift of fingers,contractures and muscle wasting

OA-pain stiffness, instabilty, grating sensation

Question 16

Tabulate the differences between osteoarthritis and rheumatoid arthritis under the following headings: 3.4 Radiological features (4)

Answer 16

AO-joint space narrowing
subchondral bone sclerosis
subchrondral cysts
osteophytes

RA- soft tissue swelling
periarticular osteoprosis 
narrowing of the joint stage 2
marginal bony erosion by stage 2
articular destruction
joint deformity stage 3

Question 17

Question 1
Mr Smith is a 21 year old male who was involved in a motor vehicle accident and sustained an anterior dislocation of the shoulder. He was reduced in theatre and put on a broad arm sling for 3 weeks.
1.1 What is the mechanism of Mr Smith’s injury? (1)

Answer 17

abduction, extension and external rotation of the arm

Question 18

Mr Smith is a 21 year old male who was involved in a motor vehicle accident and sustained an anterior dislocation of the shoulder. He was reduced in theatre and put on a broad arm sling for 3 weeks. 1.2 Describe the main feature you will see on x-ray in an anterior shoulder dislocation. (1)

Answer 18

the humeral head lying anterior to or in front of the glenoid

Question 19

Mr Smith is a 21 year old male who was involved in a motor vehicle accident and sustained an anterior dislocation of the shoulder. He was reduced in theatre and put on a broad arm sling for 3 weeks.
1.3 Name four possible complications associated with this injury. (2)

Answer 19

axillary nerve damage
bankart lesion 
hill-sachs lesion
vascular injury 
fracture of greater tuberosity

Question 20

Mr Smith is a 21 year old male who was involved in a motor vehicle accident and sustained an anterior dislocation of the shoulder. He was reduced in theatre and put on a broad arm sling for 3 weeks.
1.4 List the contra-indications to be observed in Mr Smith for the next six weeks (1)

Answer 20

no abduction and external rotation 6/52
no contact sport for 6/52
no driving with a sling

Question 21

Mr Smith is a 21 year old male who was involved in a motor vehicle accident and sustained an anterior dislocation of the shoulder. He was reduced in theatre and put on a broad arm sling for 3 weeks.
1.5 Briefly discuss the role of the physiotherapist in preventing complications for Mr Smith. (3)

Answer 21

regain shoulder movement, strenghten the surrounding muscles, regain shoulder control
rehabilitate and strengthen muscles of the shoulder to prevent recurrent dislocations

Question 22

Miss Nyembe is a high school student in a rural area who sustained an oblique fracture of her right femur. She was admitted to the ward and placed on skin traction for 5 days. The fracture was then surgically managed by the insertion of an intramedullary nail.

2.1 Discuss the physiotherapy management for Miss Nyembe while she is on traction. (9)

Answer 22

maintain rom in unaffected limbs
maintain strenghth in the unaffected limbs
prevent pressure sores
prevent distal oedema
monitor new complications and report to ortho team eg dvt, chest complications
mobilise and remove secreations
treat for pain using cryo
check line of pull is parallel to shaft of fractured bone
check pins for sepsis
check pressure areas
check that ropes and weights are haning freely

Question 23

Miss Nyembe is a high school student in a rural area who sustained an oblique fracture of her right femur. She was admitted to the ward and placed on skin traction for 5 days. The fracture was then surgically managed by the insertion of an intramedullary nail.2.2 Discuss how you will manage her mobility over the next 12 weeks. (8)

Answer 23

discuss with ortho team the wb status
post op- isometric quad strengthening
measure and teach pateitn to use assisstive device
fall prevention and gait training with assisstive device
AROM/PROM of knee in sitting position
teach patient to do ADLS

phase 2 when patient can start wb 
ab/ad stretching and strenghting 
start to wean off assistive device 
quad strengthing training 
HEP 

phase 3
correct gait
start optimally loading pt lower limb muscles

Question 24

Mr Charles is a 58 year old male who has undergone a below knee amputation due to peripheral vascular disease. He is diabetic and smokes. He used to work as a landscaper. You see him for the first time day two post-surgery and it is his first contact with physiotherapy.

3.1 Define peripheral vascular disease. (2)

Answer 24

atheromatous lesions lead to stenosis or occlusions in artries-insufficient blood flow to distal limbs
pvd is a slow and progressive circulation disorder. narrowing, blockage or spasms in a blood vessel can cause pvd

Question 25

3.2 Name two risk factors for peripheral vascular disease. (2)

Answer 25

smoking and hypertension

Question 26

3.3 Briefly discuss the principles of management of Mr Charles for the first 6 weeks. (11)

Answer 26

resp physio
postioning of stump. prone to knee flexion and hip flexion,put pillow under distal tibia but not under knee,prone
circulation and pressure care
bed mobility exericises
strengthing of upper limb for walking aids
stump exercises from day 2
handling and desensitising of stump to prepare for wb
stump bandaging
mobilize patient
balance exercises
gait education, improve exercise tolerance
adl posture reducation
refer to dietitian and psyc
phantom limb pain rx

Question 27

A rugby player sustained a shoulder injury when falling on an outstretched arm. He was diagnosed with a brachial plexus traction injury and subluxation of the head of the humerus. The following was also found upon his physical assessment and interview:
The patient has suffered recurrent episodes of subluxation since the injury.
A stiff posterior capsule.
Overactivity of the superior fibres of m. trapezius during shoulder elevation.
1.1. Define the type of peripheral nerve injury that a traction injury of the brachial plexus would most likely classify under. (3)
1.2. Explain why the brachial plexus would easily be injured at this site with the mechanism indicated above. (4)
1.3. List the special questions that must be asked during the interview to determine the involvement of neurological structures. (5)
1.4. List a joint mobilisation technique and an exercise to include in this patient`s management. (2)

Answer 27

neuropraxia 
temp block to conduction and interupption of physiological funtion witout disturbance of its anataomy 
least severe 
motor loss with some sensory sparing 
presense of distal nerve conduction 
no wallerian degentration 
conduction above and below lession possible 
full spon recovery usually rapid

Question 28

Mrs Sello (63 years old) slipped and fell in her kitchen while preparing food injuring her right
ankle. She was diagnosed with a Weber type C2 fracture which was managed with an ORIF
(Ten days after initial injury). Her medical history includes diabetes and epilepsy. Her previous
surgical history included a right hip arthroplasty three years ago.
2.1 Define Weber type C2 fracture

Answer 28

weber c
pronation evertion 
1. supersyndemotic #
2. syndemosis is completely disrupted 
3. avulsion # or rupture of medial ligamaent 
4. rupture of posteior syndesmosis
types
1. fibular frac is simple 
2. fibular frac is segmental/ comminuted 
3. fibular # is very proximal

Question 29

define a weber B fracture

Answer 29

weber b
supernation and evertion
1. symdesmotic #
2. may have a rupture of the anterior syndesmosis and therefore tibio-fibular ligament rupture
3. rupture of the posterior syndesmosis
types
1. isolated fibular #
2. associated medial ligament rupture and/or #
3. associated medial ligament rupture and/or avulsion# as well as fracture of posterolateral tibia

Question 30

define a weber A fracture

Answer 30

weber A
suppernation and adduction
1. infrasyndesmotic #
2. syndesmosis is intact and tibio-fibular ligamaents are intact
3. transverse fracture of the fibula below the level of the syndesmosis
4. tension or avulsion of the lateral collateral ligament
types
1. isolated fibular fracture
2. associated # of the medial malleolus
3. medial mallelar # extends posteriorly around the tibia

Question 31

Mrs Sello (63 years old) slipped and fell in her kitchen while preparing food injuring her right
ankle. She was diagnosed with a Weber type C2 fracture which was managed with an ORIF
(Ten days after initial injury). Her medical history includes diabetes and epilepsy. Her previous
surgical history included a right hip arthroplasty three years ago.
2.22.2 Describe two exercises you would prescribe to ensure that Mrs Sello can mobilise
independently with an assistive device. 4

Answer 31

• upper limb strengthening exercises- if the patient is required to mobilise with crutches or any
  assistive device due to injury of the lower limb they will require adequate upper limb strength to
  support the body during mobilisation. The patient can do shoulder flexion, extension, abduction,
  adduction as well as horizontal movements with weights or with TheraBands. The patient should
  attempt to do 3 sets, 5-7 reps of each exercise to ensure good upper limb strength before
  mobilising. The patient can also work on elbow flexion and extension strength by doing bicep
  curls and tricep dips.
• Balance exercises- for the patient to mobilise independently with an assistive device they will
  require adequate balance as well as proprioception. Balance exercises can be done in both
  sitting and standing. The therapist can apply a force to the patient is all directions which they
  must attempt to resist. This will test as well as improve their balance. The patient can stand with
  the unaffected limb holding onto an object for support. They should do this as often as possible
  to improve their balance. they can also progress to uneven surfaces and catching objects which
  can work on both balance and proprioception to ensure they can mobilise independently.

Question 32

2.3 Describe how you will teach Mrs Sello to ascend and descend steps using elbow crutches
with the three point gait pattern.11

Answer 32

measure
balance
teach
asecending good leg bad leg crutch

decending crutch bad leg good leg

Question 33

Mrs Jones (35 years old) was involved in a motor vehicle accident and sustained a left midshaft
femur fracture as well as a minimally displaced right distal radius fracture. She was admitted to
the orthopaedic ward after having an ORIF (Intramedullary nail) for the femur fracture and a
plaster of paris (POP) cast for the distal radius fracture. She is now day one post-surgery and
you are seeing her for the first time. 15 1.1 Discuss what you would include in your assessment.

Answer 33

1.1 Discuss what you would include in your assessment.
- talk to ortho about wb and xrays
- check vitals and listen to chest
- cheack signs of dvts and compartment sydrome
- treatment plan from ortho-mdecation
- genral contous,skin, pop
-palpation
funtianal asessmetn
-balance
- neuro
-alergic reactions

Question 34

Mrs Jones (35 years old) was involved in a motor vehicle accident and sustained a left midshaft
femur fracture as well as a minimally displaced right distal radius fracture. She was admitted to
the orthopaedic ward after having an ORIF (Intramedullary nail) for the femur fracture and a
plaster of paris (POP) cast for the distal radius fracture. She is now day one post-surgery and
you are seeing her for the first time. 1.2 Discuss what you would include in your physiotherapy treatment for her upper limb (distal
radius fracture).5

Answer 34

maintain AROM exercises for elbow,wrist and fingers
reduce oadema
educate paient can not liftifing any heavy objects
decrease pain with cryo
elevation to decrease swelling

Question 35

A rugby player sustained a shoulder injury when falling on an outstretched arm. He was diagnosed with a brachial plexus traction injury and subluxation of the head of the humerus. The following was also found upon his physical assessment and interview:
The patient has suffered recurrent episodes of subluxation since the injury.
A stiff posterior capsule.
Overactivity of the superior fibres of m. trapezius during shoulder elevation.

1.2. Explain why the brachial plexus would easily be injured at this site with the mechanism indicated above. (4)

Answer 35

the axillary nerve pases laterally through the axilla and sends a branch to the teres minor and courses behind the surgical neack of the humerus and inervates the deloid, thus with the a sublaxation of the head of the humerus it can cause a pathology to the nerve as well as the person fell with an outstretched arm which can cause the bp to sterch in the upper trunk which can cause damage to the axillary nerve

Question 36

A rugby player sustained a shoulder injury when falling on an outstretched arm. He was diagnosed with a brachial plexus traction injury and subluxation of the head of the humerus. The following was also found upon his physical assessment and interview:
The patient has suffered recurrent episodes of subluxation since the injury.
A stiff posterior capsule.
Overactivity of the superior fibres of m. trapezius during shoulder elevation.1.3. List the special questions that must be asked during the interview to determine the involvement of neurological structures. (5)

Answer 36

senssory loss
numbness/pins and needles 
muscle strength 
how did the injury occur mechanism 
muscle wasting 
paraylisis

Question 37

A rugby player sustained a shoulder injury when falling on an outstretched arm. He was diagnosed with a brachial plexus traction injury and subluxation of the head of the humerus. The following was also found upon his physical assessment and interview:
The patient has suffered recurrent episodes of subluxation since the injury.
A stiff posterior capsule.
Overactivity of the superior fibres of m. trapezius during shoulder elevation.1.4. List a joint mobilisation technique and an exercise to include in this patient`s management. (2)

Answer 37

pendular exercises

Arom

Question 38

Mr Harrison, 26 years old, went to the local pub where he was involved in a fight and was cut with a bottle on the forearm of his dominant right hand. Presenting to the emergency room at his local hospital the doctor assessed the injury and diagnosed him with a neurotmesis injury of the median nerve and ulnar nerves.
1.1 Outline the physiotherapy pre-operative goals of treatment for a delayed nerve repair? (8)

Answer 38

immobilization to protect the nerve dictacted by the surgeon
minimize innflammation
minimize tension at the injured site
when allowed to begin rom to min joint contractures and adhessions
splinting or bracing to prevent deformities due to strenghth immbalances and prevent undue stress on the nerve
patient education o safe moevments and ways to protect the injury due to loss of senssation

Question 39

1.2 Name the contra-indications that need to be observed after a primary nerve repair within the first 14 days after nerve laceration. (4)

Answer 39

avoid handling hot and sharp objects
wear protective gloves
avoid sustained grasps, change use of tools frequently
redisrioute hand presssure by building up size of handles

Question 40

1.3 Mr Harrison had a primary median and ulnar nerve repair. Is immobilisation important after a nerve repair? Provide a reason for your answer. (2)

Answer 40

yes in the early stage inorder to protect the nerve, decrease inflammation, minimize tention at the injured area