ortho surgical (1) Flashcards
finger clubbing
family trait and harmless
but can be associated w lung disease, liver disease, heart disease, inflammatory bowel disease, and AIDS
red lunula associated w
Cardiovascular disease
Cardiac failure
Collagen vascular disease
Cirrhosis
Psoriasis
COPD
Carbon dioxide poisoning
Prednisone use
An Absent lunula may indicate
anemia or malnutrition
Pale nails may be a sign of:
Anemia
Congestive heart failure
Liver disease
Malnutrition
Bluish nails (cyanosis) may indicate
Raynaud’s disease
respiratory disorders
cardiovascular disorders
Splinter hemorrhage is associated with the following conditions:
Bacterial endocarditis Trauma Mitral stenosis Vasculitis Cirrhosis Scurvy Chronic glomerulonephritis
Painful, red and swollen nail fold, or skin and soft tissue that surrounds the nail, nail infection
Paronychia
Paronycha may be…
is most often caused by…
may be acute, where it develops over a few hours
or chronic, where it lasts more than six weeks
most often caused by infection, injury or irritation
or eczema or psoriasis
or diabetes or HIV
Crused fingertips:
subungual hematoma
nail bed can bleed, usually after an injury, under the nail creating a hematoma (abnormal collection of blood outside a blood vessel)
Crushed fingertips:
Fractures of the fingertip, usually of the type called a
tuft fracture (distal phalanx), usually heal well if given a chance to rest (a splint may be needed)
Zone 2
not a a lot of blood (tendon injuries here don’t heal as well because of lack of blood supply to tendon) no man’s land
Tendons don’t have what?
Tendons don’t have a good blood supply
Finger tip amputations two types?
minor injury or primary closure (revision amputation)
Finger tip amputations: minor injury
Minor injury (< 2cm skin loss) Indications: adults and children with no bone or tendon exposed
May close on its own with protective dressing and regular cleansing
Finger tip amputations: primary closure (revision amputation)
Indications: finger amputation with exposed bone and the ability to remove bone proximally without compromising bony support to nail bed,
or loss of >50% of distal phalange
Or irreparable damage to the nail matrix
Digit amputation surgical options
Full thickness skin grafting
Indication: exposed bone or tendon where rongeuring (snipping) bone proximally is not an option
Reconstructive flap may be necessary to cover the wound with new skin, as well as the fat and blood vessels underneath
Ring Avulsion injury (degloving)
Sudden pull on a finger ring (jewelry) results in severe soft tissue injury ranging from circumferential soft tissue laceration to complete amputation skin, nerves, vessels are often damaged
Fingers one of the most sensitive parts of body
Ring Avulsion injury: prognosis
extent of injury is greater than what it appears to be
poor prognosis because of associated vascular injury
advances in interposition graft techniques have improved results
Common Shoulder Surgical Procedures include the
Arthroscopic Rotator cuff repair
Rotator Cuff Repair
Surgical repair of the torn rotator cuff which often involves re-attaching the tendon to the head of humerus
A partial tear, however, may need only a trimming or smoothing procedure
Rotator Cuff Repair: Arthroscopy can assess….
Arthroscopy can assess and treat damage to other structures within the joint
Bone spurs are often removed arthroscopically
No need to detach the deltoid muscle with Mini-Open Repair
Physician’s order for rehabilitation
Immobilization - Repair needs to be protected (not stressed) while the tendon heals
Cast or splint (non-surgical immobilization)
Instructions to the patient include use a sling and avoid using arm for the first 4 to 6 weeks
Length of time of immobilization depends upon the severity of injury
Shoulder Post-op Exercises
Passive Exercise
referral to a PT for passive ROM (PROM) ex.
CPM may be ordered
In most cases, passive ROM is begun within the first 4 to 6 weeks after surgery
After 4 to 6 weeks, progress to doing active exercises
At 8 to 12 weeks, start strengthening exercise program
Complete recovery will take several months
Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery
Cut tendon that means
likely nerve is injured as well!
