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
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
Extreme swelling w/ hyperemic weeping skin Tx w/ topicals and ABX along w/ fitting adjustment Wrapped in cotton/present
26
# Define Telescoping What meds are used to reduce Sxs? | What non-pharm Tx is used?
Non-painful phantom limb w/ sensation of distal movement closer to residual limb Gabapentin/Pregabalin Transcutaneous electrical stimulation
27
How is unrelenting phantom limb pain managed? What type of residual limb pain finding is indicative of surgery?
As major causalgia w/ Pain Management Bone spurs
28
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
Modification then surgical excision Neck/back pain Tx w/ rehab/stretching
29
Where does OA occur? It is the most common ? and associated w/ ?
Weight bearing joints of legs and back, rarely in elbow, wrist and ankle Type of arthritis Age, Obesity, Trauma, Altering d/o
30
OA is a leading cause of impaired mobility in ? What are the S/Sxs
Elderly Stiff, pain, deformity that causes pain/spurs and reason PTs seek help
31
PT w/ OA effusion will have what type of lab results? What is a common finding seen on exam?
Mild pleocytosis, normal viscosity and slightly elevated protein Crepitus from softening of articular cartilage
32
Where is OA in the foot commonly seen? Why does OA in the knees cause G. Varum/Valgum and which is more common?
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
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?
Joint between interval of gastrocnemius and semimembranous muscle Toes out walking and tilts/lurches to affected side w/ stepping
34
PTs w/ hip OA may have pain where else? How do you grade OA?
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
What happens to OA over time without Tx? What are the non-surgical Tx methods for OA?
Stabilizes, periods of improvement, periods of rapid progression Weight loss PT education/assurance No impact exercise routines NSAIDs and Acetaminophen
36
When is surgery indicated for OA?
Loss of joint function | Pain at rest/night