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Boardz > Orthopedic Conditions > Flashcards

Orthopedic Conditions Flashcards

1
Q

3 orthopedic etiology classification

A

Cumulative/repetitive stress
Acquired (genetic predisposition/disease process)
Traumatic injury or surgery

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2
Q

Why are there increased ortho injuries in older adults?

A

Decreased muscle mass, bone strength, visual acuity

Increased complications due to frailty, poor nutrition, decreased cognition, and polypharmacy

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3
Q

Types of hip surgery

A

Hip pinning, ORIF
Partial/THR to tx fractures, hip pain, damage, inflammation

10% risk of hip dislocation s/p THR

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4
Q

Hip sx approaches

A

Anterior
Lateral/anteriolateral
Posteriolatet

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5
Q

Anterior Approach

A

Decreased invasiveness, muscle sparing to reduce damage to muscles

Increasingly more popular, internervous, between tensor fascia lata abdominal sartorious superficially

Decreased risk of hip dislocation, avoids hip abductor

Increased wound complications
Difficult femoral exposure
Risks lateral femoral cutaneous nerve paresthesias
Increased rate of intraoperative fx

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6
Q

Lateral/anteriolateral hip approach

A

Minimally invasive, side approach, decreased vascular complications

Least commonly used, impairs hip abductors, interval exploited at tensor fascia lata and gluteus medius

Provocative positioning = hip extension and ER

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7
Q

Posteriolateral hip approach

A

Minimally invasive, increased ease of revision, extensile

Not in a true internervous plane, dissecting gluteal maximus and fascia lata, avoids hip abductors

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8
Q

Posterolateral hip precautions

A

No bending past 90*
No adduction LE, crossing midline
No rolling on unoperated side x6 weeks
Do not twist at trunk in standing
Sleep on back x 6 weeks

Provocative position = hip flexion, adduction, IR

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9
Q

Risk factors for THA dislocation

A

Prior hip sx
Advanced age
Drug/alcohol use
Neuromuscular disease
Malposition

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10
Q

Assessment of Hip

A

Pain at rest and activity
ADLs/IADL limitations
DVT risk
Cognition-delirium common issue, cognition deficits leads to more recovery secondary to compliance with weight bearing, precautions, and HEP
Understanding/ability to follow precautions
Support/access to equipment

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11
Q

Intervention for hip injuries

A

Education/training on fall prevention, precautions, caregiver training, self management, joint protection

Home modifications

Utilizing occupation based treatment such as ADL training, functional mobility training, compensatory strategies

Beneficial activities: walking, swimming, golf, cycling, dancing

Activities to avoid: football, handball, hockey, tennis, martial artd

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12
Q

Joint protection principles

A

Avoiding excessive loads, built up handles, carrying items with 2 hands

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13
Q

Self management

A

Empowers older adults to self manage aspects of hip injury = increased physical and psychosocial outcomes

Manage fatigue, dealing with emotions, communicating with MDs, goal setting, monitor change in health status

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14
Q

Shoulder

A

4 joints and 15 muscles
Clavicle, scapula, humerus
Joints: SC, AC, GH
Ligaments: joint capsule (group of ligaments that connect humerus to sock, clavicle to acromion, clavicle to scapula)
Bursa: closed space between2 moving surfaces with lubricating fluid inside, B/N RTC and outer muscle later (subdeltoid bursa)

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15
Q

RTC

A

Tendons and muscles (SITS), holds humeral head at GH joint

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16
Q

Shoulder dislocation

A

Caused by force that separates humeral head and glenoid process

Sx: pain, swelling, bump due to ball

Sublux humeral head migrates but slips back into place

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17
Q

Shoulder Separation

A

AC joint becomes separated when ligaments attached to clavicle are torn or partially torn away from shoulder back

Sudden forceful blow to shoulder or fall

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18
Q

Bursitis

A

Tendonitis/impingement syndrome cause inflammation at bursa sacs

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19
Q

Impingement syndrome

A

Caused by excessive squeezing or rubbing of the RTC and shoulder blade, pain is from inflamed bursa over RTC and/or inflammation of RTC tendons, calcium deposits in tendons

Can lead RTC tear

Sx: pain/stiffness, sudden pain reaching overhead, may spread to arm, pain may get better with rest

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20
Q

Tendinosis

A

RTC and/or bicep tendon become worn out and inflamed secondary to being pinched by surrounding structures

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21
Q

RTC tear

A

1+ tendons becoming inflamed by overuse, aging, falling on outstretched hand, collesion

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22
Q

Adhesive Capsulitis

A

Severely restricted movements secondary to lack of use due to pain, intermittent periods of use, inflammation and adhesions grow between surfaces decreasing synovial fluids, restricted space humeral head and shoulder capsule

Initially pain with movement, later stages pain subsides ROM restrictions remain, PROM/AROM affected

1st ER, asymmetrical scapular movement, tendon/spasms at traps, palpate upper trap

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23
Q

Shoulder injury dx

A

Xray images of tissue, bones, organs
MRI of organs structures, ligaments, muscles
CT xray sliced axial images of bones, muscles, fat, or organs
emg nerve function
US internal organs
Arthroscopy minimally invasive dx and tx procedure for joint conditions, degenerative/arthritic changes, tumors, and bone d/s

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24
Q

Conservative shoulder treatments

A

Modifying activities
Rest shoulder and manage pain
Increase strength and flexibility (exercise may be contraindicated with RTC tear or dislocation)

Most surgeries need immobilization for 4-6 weeks

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25
Q

Shoulder replacement surgery

A

Remove damaged areas of bone and replace with plastic/metal

Used to tx OA, RTC injuries, fx, RA, osteonecrosis

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26
Q

Anatomic total shoulder

A

Both ball and socket replaced

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27
Q

Reverse total shoulder

A

Reverse implants of ball and socket

Preferred in severe RTC damage

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28
Q

Partial shoulder replacement

A

Only replaces humeral head, only used for humeral head damage

29
Q

Risk of shoulder replacement sx

A

Dislocation
Fx
Implant loosening
RTC fail (wear after total/partial, better with reversed)
Nerve Damage = numbness, weakness, pain
Blood clot
Infectiin

30
Q

Assessment of shoulder injuries

A

-pain/ROM (some movements may be contraindicated, ie fx/sublux)
-assess at rest looking at position of scapula, muscle bulk, bony defects, and assymetry
-assess cervical spine
-specialized/provocative test (RTC maneuvers test integrity of infraspinatus, supraspinatus, subscapularis, and teres minor)
-ability to understand sling/movement restrictions
-health literacy, language barriers
-support/access to equipment ie reacher

31
Q

Specialized shoulder test: supraspinatus test

A

Abduct BUE to 90* and 30* anteriorly with forward flexion, push up against manual resistance

32
Q

Empty can test

A

Abduct BUE to 90* and 30* anteriorly with forward flexion, push downward
Positive with pain and weakness

Also used in impingement

33
Q

Infraspinatus/ teres minor testing

A

Apply lateral resistance, flex forearms to 90* with palm supinated, ER

Positive with pain and weakness

34
Q

Subscapularis testing/internal rotation lag sign

A

Bring arm behind back, passively lift off back, actively hold away from back, unable to hold means subscapularis tear

35
Q

Lift off test

A

Test subscapularis
Ask pt to IR shoulder by bringing UE behind back with back of hand on back, actively move hand away from back against resistance

Pain with weakness test positive

36
Q

Serratus anterior testing

A

Standing lush up against wall, positive if winging of scapula noted

37
Q

Shoulder Impingement Assessment

A

Supraspinatus inflamed secondary to repetitive trauma to subacromial portion, pain at night, weakness overhead, tenderness at anterior joint line when palpating and IR

Test: Neers, empty can, Hawkins kennedy

38
Q

Neer test

A

Probate forearm, passively flex arm until overhead reducing subacromial space

Positive if painful

39
Q

Hawkins Kennedy Test

A

Elbow and shoulder at 90* flexion, examiner supports arm at elbow, passively IR and cross body adduction

Positive with pain

40
Q

Bicep Tedinopathy

A

Inflammation or degeneration of long bicep head causes anterior shoulder pain

Seen with RTC tear or impingements

41
Q

Speeds Test

A

Extend elbow and supinate forearm, flex shoulder against resistance, examiner palpates anterior joint line

Positive with pain for bicep tendinopathy

42
Q

Yergason’s test

A

Flex elbow at 90* partially pronate arm (neutral), ask to supinate against resistance, examiner palpates at origin of bicep tendon

Positive with pain

43
Q

AC Joint pain

A

C/O pain localized on AC
Pain at night in sidelying
Assessed with palpation

Crepitus, step off sensation means AC separation

44
Q

AC joint pain: scarf test

A

Place hand of the affected side on contralateral shoulder, push at elbow for cross body adduction and palpate AC joint

Positive with pain or crepitus

45
Q

AC joint disease: painful arc test

A

Abducted shoulder to 180* , pain at 150 to 180* is positive AC joint disease

46
Q

Shoulder instability

A

C/o shoulder pain with giving way sensation, humeral head partially/completely leaving glenoid fossa

Congenital hyperlaxity of capsule/ligaments
Acquired after traumatic injury

47
Q

Sulci Test

A

Shoulder instability

Apply downward pressure on humerus by pulling at wrist and observing lateral aspect at deltoid region, if sulcus appears it is positive

48
Q

Apprehension and relocation test

A

Shoulder instability
Preferably done in supine
90* elbow flexion and abducts shoulder to 90*
Examiner applies downward pressure with one hand at wrist other hand behind shoulder

If dislocates or positive with pain or discomfort

Apply downward pressure pressure on anterior aspect of shoulder, pain/apprehension disappear if instability present

49
Q

Labral tears/ SLAP lesion

A

Glenoid labrum is ring of cartilage around glenoid fossa, most commonly damaged at superior portions including part of bicep tendon

Athletes with repetitive overhead

50
Q

O’Brian Test

A

Labral tears

Pt flexes shoulder to 90* adducting 10* ask pt to bring arm upward against resistance

Positive with pain

51
Q

Crank’s Test

A

Labral tear
Passively flex elbow at 90* and abduct shoulder to 90*, one hand on shoulder and other on elbow
IR then ER

Positive with any pain or metallic sound

52
Q

Adhesive Capsulitis Intervention

A

ROM exercises, activity-based tasks incorporating ROM, joint mobilizations and steroids

Some promising evidence show benefits of exercise beyond pain threshold with end range maximizing protocol and therapeutic exercise

53
Q

Shoulder fx intervention

A

Inconclusive evidence of use of therex

Strong support of ROM for nondisplaced humeral fx required to wear sling/immobilizers

54
Q

RTC tear intervention

A

Moderate support of conservative tx (joint mobs, ROM, progressive strengthening)

Post surgical mgmt with rehab such as progressive tendon forces and continuous passive motion

55
Q

General shoulder pain intervention

A

Resistive exercise increase function and decrease pain

Shoulder conditioning program when combined with joint mobility

Moderate support for magnetic therapeutic devices and biofeedback

56
Q

Subacromial impingement intervention

A

Therapeutic exercise and activity based tasks
PAMs
Joint mobilization
Steroid Injections
Strong evidence of taping for short term decreased pain

57
Q

Complex fractures

A

Bones broken with surrounding soft tissue severely traumatized or comorbdities

58
Q

Types of fractures: stable

A

broken ends line up/barely out of place

59
Q

Types of fractures: open/compound

A

Skin may be pierced by bone or blow that breaks skin at time of fx, bone may or may not be visible

60
Q

Types of fractures: transverse fx

A

Horizontal fx line

61
Q

Types of fractures: oblique

A

Angled pattern fx

62
Q

Fracture types: comminuted

A

Bone shatters to 3+ pieces

63
Q

General medical
Tx for fractures

A

Cast immobilization, functional cast/brace (controlled movement of nearby joints), ex fix, ORIF

64
Q

OT assessment of complex fx

A

Cognitive screening for adherence to restriction, delirium post sx

Pain

Psychosocial needs

Ability to follow restrictions

Access to AE/support

ADL/IADL

65
Q

OT intervention for fractures

A

Occupation based activity to increase motivation while attending to client factors without direct focus

Decreased pain and disengagement

66
Q

Elbow fracture intervention

A

ROM exercise s/p immobilization

67
Q

Hip fx intervention

A

Multi-disciplinary approach focused on early mobilization, home modifications, education/training, fall prevention, ergonomics, safe pt handling for caregivers, functional mobility

68
Q

Shoulder fx interventions

A

Rom exercises for nondisplaced humeral fx requiring sling/immobilizer following sx

69
Q

Wrist and hand fx intervention

A

Moderate evidence for strength training non-affected extremity

Wrist early continued exercise/ROM, boxer fx (5th metacarpal =splinting and buddy taping)

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