Ortho: Block 1 Flashcards
Define Limb Amputation
Define Disarticulation
Removal of extremity through level of bone
Removal of extremity through level of a joint
What type of PTs don’t notice loss of function after a toe amputation?
What precaution needs to be taken to prevent Hallux Valgus
PTs w/ dysvascularity and low mobility/activity
Retention of base of proximal phalanx during isolated amputation of second toe
Elderly PTs w/ toe amputation usually signify ?
What precaution is taken with them?
High risk for ulcers/pressure problems
Shoes w/ extra depth, width protection
Following toe trauma/amputation, most PTs find comfort in what type of foot wear?
Rigid sole and wide toe box to minimize pressure on site
Define Ray Resection
What type of foot wear modifications are needed?
Removal of toe and all/part of corresponding metatarsal
Ray 2, 3, 4, 5 do well in standard shoes or DM shoes
What type of foot wear is needed for first ray or resection of more than one ray lead?
Custom multi-durometer orthosis is required to load tarsal shafts and prevent pressure on amputation site while preventing chance of re-ulceration
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?
Transmetatarsal or tarsometatarsal level
Equinus, Varus
Muscle rebalancing at surgery and post-op rehab
A widened foot at the amputation site is almost universal for what type of amputations?
What else is common here?
Midfoot
Tenderness at end of amputation
What type of footwear adjustments are needed for midfoot amputations?
Heel cup and long foot plate to prevent shoe from folding and pressing on amputation site
When is a prosthetic device enclosing the calf may be needed after midfoot amputation if ?
Hypersensitive foot
Major Sxs of balance/weakness
? and ? are common after amputations of the hindfoot
What two major bones are retained?
Poor function, Difficult prosthetic management
Talus, Calcaneous
Why are weight bearing processes difficult in hindfoot amputations?
Talus and Calcaneous pulled into equinus, puts pressure on amputation site
What does muscle rebalancing during hindfoot amputations consist of?
Reattaching anterior tendons, Complete release of Achilles
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?
Aggressive walking and impact activities
Heel pad
What is remodeled during ankle disarticulations to create smooth weight bearing surfaces?
When is a prosthetic needed and not needed for these PTs?
Bony malleoli flush w/ articular cartilage
Needed- routine walking
Not- transfer pressure, few steps in bathroom
How far up the PTs leg does the amputation socket extend in ankle disarticulations?
Why must the foot component be low profile?
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
Below the knee amputation is AKA ?
What is done during the procedure to allow for better prosthetic fitting?
Transtibial or BK amputation
Long posterior flap allows for more padding and a more cylinder shape, minimizes ulcerations
Why is amputation below the lower 1/3 of the tibia not recommended?
What walking aids are given to these PTs?
Inadequate padding below the calf muscle
Simple prosthesis and wheelchair
What are the two major draw backs of knee disarticulation prosthetic joints?
Why are knee disarticulations preferred in non-ambulatory PTs?
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
Above the knee amputation is AKA ?
What commonly happens after this surgery?
Transfemoral amputation
Contractures due to muscles pulling hip into flexion and abduction, reduced/prevented with attaching adductor and hamstring
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?
Wheel chair
Independently transfer from bed to chair
Rise from sitting to standing
Ambulate up and down parallel bars w/ one legged gate
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?
Travel short distances on parallel bars w/out prosthetic
Decubitus ulcer prevention
Independent transfer and toilet skills
What is recommended it PT w/ prosthetic limb develops ulcer/infection?
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
What is NOT used to keep prosthetic dry
What are common issues after AKA and BKA?
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
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
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
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
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
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
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
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
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
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
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
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
When is surgery indicated for OA?
Loss of joint function
Pain at rest/night
