Orthopedic Conditions

Question 1

Degenerative, “wear and tear” arthritis

Answer 1

Osteoarthritis

Question 2

This is performed from an acute trauma such as a femoral neck fracture. Pins are placed in the fracture to allow it to heal.

Answer 2

ORIF - Open Reduction Internal Fixation.

Question 3

A mechanical compression of the supraspinatus tendon, the subacromial bursa, and/or the long head of the biceps tendon, all of which are located under the coracoacromial arch

Answer 3

Impingement syndrome of the shoulder

Question 4

Decrease in the subacromial space due to glenohumeral joint or scapulothoracic issues (other musculature issues causing impingement)

Answer 4

Secondary impingement

Question 5

Shoulder flexion with internal rotation (thumbs down) leads to passage of the critical avascular zone of the supraspinatus tendon under the coracoacromial arch

Answer 5

Primary impingement

Question 6

surgical procedure to graft a piece of the patient’s own bone onto the spine (along with spinal hardware like rods and screws) to provide support and stability

Answer 6

Spinal Fusion

Question 7

Surgical procedure that removes the lamina of the vertebrae, allowing more space for the spinal nerves

Answer 7

Decompressive laminectomy

Question 8

Minimally invasive procedure to treat progressive vertebral compression fractures; involves inserting tiny balloons into the fractures, inflating them to realign the vertebra, deflating/removing the balloons, then filling the space with cement to form an internal cast

Answer 8

Kyphoplasty

Question 9

Maintenance of the normal curvature of the spine, i.e. lordosis in the cervical and lumbar regions and kyphosis in the thoracic and sacral regions (particularly important in the lumbar area since that is where most lifting injuries occur)

Answer 9

“neutral spine”

Question 10

List 3 post-surgery knee replacement precautions.

Answer 10

→ Limit twisting @ knee
→ Don’t submerge incision in water
→ possible weight bearing precautions (NWB, TTWB, PWB, WBAT)

Question 11

What 3-day protocol does this describe? POD 1: OT Eval, pt education on precautions, use of equipment, clear for discharge; (if staying) POD 2: review, family training, standing (work leg back to put more weight on), discharge

Answer 11

TKR: total knee replacement

Question 12

What 3-day protocol does this describe? POD 1: OT Eval, education on precautions and use of equipment, abduction wedge while in surgery, abduction wedge while in bed; POD 2: review precautions and equipment, family training, UE home exercises if needed; POD 3: review everything, practice with equipment, family training, discharge

Answer 12

THR: total hip replacement

Question 13

What 3-day protocol does this describe? Post-operative day 1: OT Eval, training on orthotic, equipment, and pain management; POD 2: review precautions, equipment, and pain management, family training; POD 3: review and practice, family training, clear for discharge

Answer 13

Lumbar Laminectomy

Question 14

What is the typical PT focus in knee and hip replacement cases? How does it differ from the OT role?

Answer 14

TKR: PT focuses on bed mobility, sit to stand, gait, and equipment; sees Pt POD 0-2; OT focuses on ADL ability, precautions, AE and DME, and home exercise program; sees Pt POD 1-2

THR: PT focuses on bed mobility, sit to stand, gait, and equipment; sees Pt POD 0-3; OT focuses on ADL ability, precautions, AE and DME, upper extremity strength, and home exercise program; sees Pt POD 1-3

Question 15

What surgery are these post-surgery precautions for? no straight leg lifts, no extension, no external rotation, no adduction

Answer 15

Anterior hip replacement

Question 16

What surgery are these post-surgery precautions for? no straight leg lifts, no flexion to 90deg, no internal rotation, no adduction (crossing midline)

Answer 16

Posterior hip replacement

Question 17

List 5 complications that may arise post-hip replacement surgery.

Answer 17

infection, DVT or pulmonary embolism, dislocation, loosening/degeneration, stiffness

Question 18

NWB

Answer 18

Non-Weight Bearing: Do not touch the floor with your affected leg

Question 19

TTWB

Answer 19

Toe-Touch Weight Bearing: touch the floor only for balance; do not place actual weight on your affected leg

Question 20

PWB

Answer 20

Partial Weight Bearing: you may place ____ percent of your body weight ( _____ pounds) on your affected leg

Question 21

WBAT

Answer 21

Weight Bearing As Tolerated:weight as feels comfortable on your affected leg; use pain as a guide

Question 22

FWB

Answer 22

Full Weight Bearing

Question 23

Describe transfer procedure after hip replacement: Sit in chair → stand

Answer 23

Client extends operated leg and pushes up from the armrests; Once standing, client can reach for ambulatory aid (ex. walker)

Question 24

Describe transfer procedure after hip replacement: Stand→ sit in chair

Answer 24

Client extends operated leg and reaches for armrests. Bearing some weight on arms, the client sits down slowly, maintaining some extension of the operated leg

Question 25

List some suggestions for sexual activity that will protect a replaced hip.

Answer 25

• Refrain from sexual activity for 6 weeks
• Position the operated leg during sexual activity to maintain precautions: Side-lying on non operated side; Pillows between the knees; Pillows under the knees in the supine position (prevent external rotation); Refrain from kneeling if they have weight-bearing precautions

Question 26

List some suggestions for sexual activity that will protect a person with low back pain.

Answer 26

1. Require activities that place the lower part of the back in a neutral position
2. May be most comfortable taking a passive position on their back
3. Pillows under buttocks or upper part of back can reduce ache
4. Rolled towel under lower part of back helps maintain neutral back
5. Start slowly and work up to more vigorous movements
6. Stretching muscles or taking a warm shower prior may help relax muscles/reduce pain

Question 27

How do you test for a supraspinatus tear?

Answer 27

Painful arc (AROM in abduction), Drop Arm Test (PROM shoulder abd to 90deg and ask pt to slowly lower), or Empty can test (scaption to 45deg and dump can)

Question 28

How do you test for a subscapularis tear?

Answer 28

Lift off (hand in curve of back and lift hand off back)

Question 29

Describe how to test for shoulder impingement.

Answer 29

1. Painful Arc (test for impingement vs. supra; AROM of shoulder abd)
2. Hawkins/Kennedy test (shoulder at 90, slight add, int rotation and elbow elevated)
3. Neers test (flex arm above head and push arm to ear)

Question 30

How do you compensate for shoulder impingement during functional activity?

Answer 30

Modification of activity for impingement: adjust ergonomics (e.g. forearm rests at computer, headset for answering phone); modify activities to reduce repetitive movements & sustained positions in which elbow is raised above shoulder level; “warm up”/stretch before activity

Question 31

What is the role of scapulo-humeral rhythm in shoulder impingement?

Answer 31

Scapulo-humeral rhythm refers to the functional movements of the shoulder through combination of scapulothoracic movement and glenohumeral movement. In a normally functioning arm, about the first 30 degrees of movement of the shoulder in abduction occur at the glenohumeral joint, then the scapula begins to rotate superiorly along the thoracic cage to aid upward shoulder rotation. As both the scapula and glenohumeral joint move the shoulder is able to move through full ROM (with the ratio being about 2:1 for glenohumeral to scapular movement). When this rhythm is off due to inflammation, injury, etc., the scapula will rotate improperly causing the acromion process to press into bursa and tendons that lie beneath it, causing impingement during upward arm motion above 30 degrees.

Question 32

What is the best initial treatment for a shoulder bursitis?

Answer 32

Rest, Sling & Ice; Pendular exercise

Question 33

Describe the generic timeline of rehabilitation treatment after surgery for a rotator cuff tear.

Answer 33

• 0-6 weeks immobilizer all times except for PROM
• 6 weeks start therapy progress through AAROM, AROM and Isometrics
• 12 weeks to deltoid and rotator cuff strengthening,
• 6-8mos can return to sports activity

Question 34

Describe a stepwise progression of exercise for shoulder impingement.

Answer 34

Seated row retraction; Isometric protraction, ER, IR; Standing extension to hip; Scaption; Closed chain wall push-ups; Rhythmic Stabilization

Question 35

Describe how to provide therapy for a frozen shoulder.

Answer 35

Stage One: ice, heat, positioning, meds, pendulum exercises
Stage Two: (when pt can find a pain-free position to sleep in - exercises may begin) T spine Mobility, Joint Mobilization, Stretch ERs & continuous prolonged passive stretches, Tx scapula to shoulder (proximal to distal)

Question 36

What is the difference between a standard TSR and a reverse TSR?

Answer 36

TSR is typical replacement, reverse TSR is where ball becomes socket and socket becomes ball

Question 37

List 5-7 symptoms of cervical stenosis.

Answer 37

neck pain, pain/weakness/numbness in shoulders, arms and legs, hand clumsiness, gait and balance disturbances, burning sensations/tingling, severe = loss of function, bladder, and bowel problems

Question 38

List 3 precautions for a person who is issued a cervical collar.

Answer 38

• No pushing, pulling, or lifting objects over 5 lbs (aka no BLT)
• Don’t force BMS or hold breath during activities
• Do not move head or neck without collar on

Question 39

What are some everyday activities that may be used to assess lower extremity function? Upper extremity function? (consider shoulder complex, elbow, forearm, wrist and hand)

Answer 39

Need to answer

Question 40

Your client has pain from a compressed nerve in his lumbar spine, but does not understand what’s going on. In lay terms, describe what is happening anatomically to cause the compression.

Answer 40

Your spinal cord runs down your back and is protected by bones that surround it on all sides. Between the bones are small spaces that allow nerves to travel from your spinal cord to the rest of your body. Due to your (insert injury of choice i.e. fracture, osteoarthritis, herniated disc, tumor, etc.), there is less space for the nerve to move out of your lower back and it is pressing on the bones in your spine causing your pain.

Question 41

If you wanted to set up a 6-week educational group for people with low back pain, what topics would you most want to cover (one topic per week)?

Answer 41

1. Causes of back pain
2. Medication management
3. Proper Body mechanics and posture training while performing everyday tasks
4. Energy conservation, pacing, and joint protection strategies
5. Physical agent modalities
6. Adaptive equipment

Question 42

List 3 general strategies for energy conservation

Answer 42

planning ahead, pacing oneself, setting priorities, eliminating unnecessary tasks, balancing activity with rest, and learning one’s activity tolerance

Question 43

What is the safest way for a person with low back pain to get out of bed?

Answer 43

Log roll

1. Bend at knees
2. Roll to one side
3. Move legs so they’re hanging over the edge of the bed
4. Move torso sideways to sit up

Question 44

How is active-assisted exercise used in shoulder rehabilitation? When can it be dangerous for the shoulder?

Answer 44

1. Client moves shoulder through partial ROM and therapist moves through complete ROM with the goal being to increase strength of trace or poor muscles while maintaining ROM
2. Don’t continue if client experiences pain

Question 45

List some everyday activities that incorporate: (1) passive stretching, (2) active stretching, (3) isometric exercise, and (4) resistive exercise.

Answer 45

1. Gardening (could be passive or active, whether you’re staying squatting for a time or moving around more)
2. Sitting in a chair, leaning forward and down (slowly!) to tie shoes; yoga
3. Pushing against a couch, holding a heavy door open, wall push-ups
4. Walking, swimming, yoga