Ortho Block 1 Flashcards
What are the types of amputations?
Toe Amputation Ray Resection Midfoot Amputation- at transmetatarsal or tarsometatarsal level Hindfoot Amputation Ankle Disarticulation - Syme ankle diart. BKA Knee Disarticulation AKA Hip Disarticulation
If Ulcer/Skin Infection occurs on an amputation stump, how is it managed?
From inadequate soft tissue envelope/poor fitting prosthetic
Stop use and modify/add non-bulky dressing
ABX only if systemic Sxs present
Resistant/lingering/exposed soft tissue=surgery
How are irritative skin conditions that develop on an amputated limb manged?
Keep dry w/ non-talcum powder/cream
Tx Folliculitis w/ warm soak/compress
Cellulitis= PO ABX
Chronic folliculitis/cystic lesions= surgery
Hyperemic/weeping- topicals, ABX and adjustment of prosthetic
What are the 4 types of sensation issues felt w/ amputations?
Non-painful- telescoping sensation
Residual- pain in remaining limb from prosthetic, spurs or Sx nerve endings; modify prosthetic or surgery
Phantom- 55-85% of ALL PTs, Tx w/ Gaba/Pregabalin and transcutaneous electrical stimulation for flare ups
Neck/Back- more function limiting than phantom or residual, Tx w/ PT, rehab and stretching
What are the leading causes of amputations:
Systemic Dz: DM, PVD, Infections
Trauma
Define OA
Where is it most commonly seen and affecting?
It’s associated with what 4 factors?
Irreversible loss of articular cartilage of lower extremities/spine
Most common arthritis and leading cause of impaired mobility of elderly PTs
Genetics, Obesity, Age, Trauma
What are the common Sxs of OA
Where is it commonly and rarely seen?
Pain*, stiffness (Loss of A/PROM), Deformity
Common= Finger, Knee, Spine Rare= Ankle, Wrist, Elbow
A knee effusion from OA will have what type of lab results returned?
What are the nodules seen on the hands form OA?
Mild Pleocytosis, Normal Viscosity, slightly elevated protein
DIP- Heberden
PIP= Bouchard
What is the most common location in the hand for OA to be found?
Where is OA commonly found in the feet?
1st carpometacarpal joint w/ swelling and dec ROM
1st metatarsophalangeal joint: Hallux valgus and rigidus
Where does OA like to reside within the knee?
What derm issue can be seen from OA?
Genuine Varum- Medial compartment between femur and fibia
Baker’s Cyst- communicates between gastrocnemius and semimembranous muscles
PTs w/ OA in their hip will demonstrate what type of walking gait?
Where will they have radiating pain to?
Toe out walking w/ limited/decreased medial rotation
Groin or anterior knee
What four findings will be seen on x-rays of PTs w/ OA
What is the Kellgren-Lawrence Grading scale for OA
Sclerosis, Osteophytes, Narrowing of joint space and Subchondral Cysts
0- no OA
1- doubtful; questionable spurs/narrowing
2- minimal; spurs and mild narrowing
3- moderate; spurs and narrowing 50% or more
4- severe; severely impaired spacing and sclerosis of subchondral bone
What are the general management strategies of OA?
Weight management* Avoidance of impact/torsion exercises PT for strength/ROM PO NSAIDs Hyaluronic injection Definitive= arthroplasty
Define Rheumatic Arthritis
What joints does it effect?
What body systems can be affected?
Autoimmune d/o of inflammation and excess of synovium around eroded capsules
Joints of hands (DIP spared), wrist, knees, feet and ankles
Pulmonary, CV, MSK, Ocular
What are the Sxs of RA that brings PTs in to be seen
What is the College of Rheumatology’s definition of RA
Pain, Morning stiffness +60m (warm up period), Swelling, Systemic Sxs
Unexplained inflammatory arthritis in one peripheral joint and short duration of Sxs that would find relief from early intervention
What will be seen upon exam in PTs w/ RA?
What are the four criteria included in the Dx of RA??
Synovial hypertrophy causing boggy feeling of joints
Joint involvement, Serology, Acute phase reactants, PT self reporting
What are common sites effected by RA?
What cervical issues can be seen due to the erosion process?
Periarticular osteopenia and erosion of joint margins that correlates to insertion site of the synovium
C1-C2 instability from erosion of ligaments holding onto the odontoid process
Caution during intubation/surgery to prevent internal decapitation
What lab tests would be seen on an RA PT?
Rheumatic factor, which is IgM Ab agonist Fc portion of IgG, will be inc x 75-90%
Anti-CCP- as sensitive as RF and more specific
CRP and ESR correlate to degree of inflammation
Elevated platelets in acute flare ups
Dec serum albumin and correlates w/ Dz
PTs w/ RA with often develop what other Ortho related Dz?
Why does this Dz present?
Osteoporosis
Dz process and non-biological DMARDs used during treatment that lower PTs immune system
What is the main treatment for RA?
Why do Seronegative Spondyloarthropathies have the term “seronegative” in the name?
Non-biological DMARDs= first line Tx choice
Negative RF
Seronegative Spond. Encompasses what four disease processes?
All of these will have PTs presenting of ? Issue?
Ankylosis Spondylitis
Arthritis associated IBDz
Psoriatic arthritis
Reiter Syndrome
Back pain- some form of SI impact that works superiorly
Enthesitis- inflammation at tendon attachment site on bone
Arthritis associated IBDz PTs will present with what Hx of issues?
How does Psoriatic Arthritis present and what caution/investigation needs to be done?
Crohns, UC, enthesitis
Skin lesion, Nail involvement, Dactylitis, Iritis, Enthesitis
Little kids shouldn’t have psoriasis at birth, check FamHx
Reiter Sydrome is AKA ?
What Hx do these PTs all have?
Reactive arthritis
Recent STI causing systemic reaction
“Can’t See, Can’t Pee, Can’t Bend the Knee”
What will be seen on x-ray of “bamboo spine”
What creates the “poker” spine?
Lab results on any of the Seronegative Spondyloarthropathies will show what results?
Anterior and Posterior vertebrae fusions
Ossification of anterior long. ligament and autofusion of facets= poke spine
Negative RF, Anti-CCP, Anti-nuclear Abs
Pos HLA-B27- genetic markers specifically for Seronegative Spond., strongest association w/ Ank.Spon at 88%