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IPAP > Ortho: Block 1 > Flashcards

Ortho: Block 1 Flashcards

1
Q

Define Limb Amputation

Define Disarticulation

A

Removal of extremity through level of bone

Removal of extremity through level of a joint

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2
Q

What type of PTs don’t notice loss of function after a toe amputation?

What precaution needs to be taken to prevent Hallux Valgus

A

PTs w/ dysvascularity and low mobility/activity

Retention of base of proximal phalanx during isolated amputation of second toe

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3
Q

Elderly PTs w/ toe amputation usually signify ?

What precaution is taken with them?

A

High risk for ulcers/pressure problems

Shoes w/ extra depth, width protection

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4
Q

Following toe trauma/amputation, most PTs find comfort in what type of foot wear?

A

Rigid sole and wide toe box to minimize pressure on site

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5
Q

Define Ray Resection

What type of foot wear modifications are needed?

A

Removal of toe and all/part of corresponding metatarsal

Ray 2, 3, 4, 5 do well in standard shoes or DM shoes

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6
Q

What type of foot wear is needed for first ray or resection of more than one ray lead?

A

Custom multi-durometer orthosis is required to load tarsal shafts and prevent pressure on amputation site while preventing chance of re-ulceration

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7
Q

Midfood amputations are performed at either ? or ? levels

What are the two most common post-op contractures of the foot and how are they prevented?

A

Transmetatarsal or tarsometatarsal level

Equinus, Varus
Muscle rebalancing at surgery and post-op rehab

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8
Q

A widened foot at the amputation site is almost universal for what type of amputations?

What else is common here?

A

Midfoot

Tenderness at end of amputation

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9
Q

What type of footwear adjustments are needed for midfoot amputations?

A

Heel cup and long foot plate to prevent shoe from folding and pressing on amputation site

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10
Q

When is a prosthetic device enclosing the calf may be needed after midfoot amputation if ?

A

Hypersensitive foot

Major Sxs of balance/weakness

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11
Q

? and ? are common after amputations of the hindfoot

What two major bones are retained?

A

Poor function, Difficult prosthetic management

Talus, Calcaneous

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12
Q

Why are weight bearing processes difficult in hindfoot amputations?

A

Talus and Calcaneous pulled into equinus, puts pressure on amputation site

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13
Q

What does muscle rebalancing during hindfoot amputations consist of?

A

Reattaching anterior tendons, Complete release of Achilles

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14
Q

Despite medical advances and improved prosthetics, what activities are compromised w/ hindfoot amputations?

During ankle disarticulation procedures, what is used to cover/protect the amputation site?

A

Aggressive walking and impact activities

Heel pad

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15
Q

What is remodeled during ankle disarticulations to create smooth weight bearing surfaces?

When is a prosthetic needed and not needed for these PTs?

A

Bony malleoli flush w/ articular cartilage

Needed- routine walking
Not- transfer pressure, few steps in bathroom

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16
Q

How far up the PTs leg does the amputation socket extend in ankle disarticulations?

Why must the foot component be low profile?

A

Proximal tibia region, similar to below knee prosthesis

Amputated limb is almost as long as non-amputated limb, allows for stable gait and minimal post-op training

17
Q

Below the knee amputation is AKA ?

What is done during the procedure to allow for better prosthetic fitting?

A

Transtibial or BK amputation

Long posterior flap allows for more padding and a more cylinder shape, minimizes ulcerations

18
Q

Why is amputation below the lower 1/3 of the tibia not recommended?

What walking aids are given to these PTs?

A

Inadequate padding below the calf muscle

Simple prosthesis and wheelchair

19
Q

What are the two major draw backs of knee disarticulation prosthetic joints?

Why are knee disarticulations preferred in non-ambulatory PTs?

A

Bulky around knee area
Prosthetic attached at lower level than unaffected knee

Maintained full length thigh to maximize sitting support, improved function, and reduce skin problems

20
Q

Above the knee amputation is AKA ?

What commonly happens after this surgery?

A

Transfemoral amputation

Contractures due to muscles pulling hip into flexion and abduction, reduced/prevented with attaching adductor and hamstring

21
Q

Due to loss of knee joint and post-surgical ambulation difficulties, what is the recommended mode of transportation?

Due to difficulties, what 3 criteria must PTs have to be candidates for above the knee amputations?

A

Wheel chair

Independently transfer from bed to chair
Rise from sitting to standing
Ambulate up and down parallel bars w/ one legged gate

22
Q

What is a strong indicator of success for post above knee amputation PTs?

What is the first and second priority in PTs w/ hip disarticulations?

A

Travel short distances on parallel bars w/out prosthetic

Decubitus ulcer prevention
Independent transfer and toilet skills

23
Q

What is recommended it PT w/ prosthetic limb develops ulcer/infection?

A

Stope use until adjustment which usually relieves pressure w/ non-bulky dressings
ABX if PT has systemic Sxs
Surgery if wound fails to heal in 4-8wks, infection remains post-ABX, exposed muscle, tendon or bone

24
Q

What is NOT used to keep prosthetic dry

What are common issues after AKA and BKA?

A

Talcum powder

AKA- folliculitis in groin
BKA- folliculitis in popliteal
Tx w/ warm soaks and topical agents
If cellulitis is present- ABX
Chronic folliculits/cystic lesion- surgical excision of skin
25
Q

What issue occurs in prosthetics that don’t have a perfect fit and can mimic venous insufficiency dz

What are the nonpainful phantom limb sensations

A

Extreme swelling w/ hyperemic weeping skin
Tx w/ topicals and ABX along w/ fitting adjustment

Wrapped in cotton/present

26
Q

Define Telescoping

What meds are used to reduce Sxs?

What non-pharm Tx is used?

A

Non-painful phantom limb w/ sensation of distal movement closer to residual limb

Gabapentin/Pregabalin
Transcutaneous electrical stimulation

27
Q

How is unrelenting phantom limb pain managed?

What type of residual limb pain finding is indicative of surgery?

A

As major causalgia w/ Pain Management

Bone spurs

28
Q

When areas of painful nodules/masses cause electrical sensations on amputation sites, how are they managed?

What follow on issue/pain is common after an extremity amputation

A

Modification then surgical excision

Neck/back pain
Tx w/ rehab/stretching

29
Q

Where does OA occur?

It is the most common ? and associated w/ ?

A

Weight bearing joints of legs and back, rarely in elbow, wrist and ankle

Type of arthritis
Age, Obesity, Trauma, Altering d/o

30
Q

OA is a leading cause of impaired mobility in ?

What are the S/Sxs

A

Elderly

Stiff, pain, deformity that causes pain/spurs and reason PTs seek help

31
Q

PT w/ OA effusion will have what type of lab results?

What is a common finding seen on exam?

A

Mild pleocytosis, normal viscosity and slightly elevated protein

Crepitus from softening of articular cartilage

32
Q

Where is OA in the foot commonly seen?

Why does OA in the knees cause G. Varum/Valgum and which is more common?

A

Hallux valgus and rigidus, subtalar joints and articulations between talus, calcaneous and navicular bones

Loss of articular cartilage in medial/varum or lateral/valgum knee compartments, Varus more common

33
Q

If a Baker’s Cyst emerges, what does it connect in the knee?

If a PT has OA in the hips, how does it affect their gait?

A

Joint between interval of gastrocnemius and semimembranous muscle

Toes out walking and tilts/lurches to affected side w/ stepping

34
Q

PTs w/ hip OA may have pain where else?

How do you grade OA?

A

Radiating to groin or anterior knee and pain w/ internal rotation

0- no OA features
1- doubtful osteophytes or spacing
2- minimal, def oteophytes or minimal space lost
3- moderate- def mod steophytes and joint narrowing >50%
4- severe; severely imparied joint spacing, cysts and sclerosis of bone

35
Q

What happens to OA over time without Tx?

What are the non-surgical Tx methods for OA?

A

Stabilizes, periods of improvement, periods of rapid progression

Weight loss
PT education/assurance
No impact exercise routines
NSAIDs and Acetaminophen

36
Q

When is surgery indicated for OA?

A

Loss of joint function

Pain at rest/night

IPAP (212 decks)

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