Orthopedic & Musculoskeletal Flashcards
1
Q
Cervical spine ROM
A
Flexion 0-45
Extension 0-45
Lateral flexion 0-45
Rotation 0-60
2
Q
Thoracic/lumbar ROM
A
Flexion 0-80
Extension 0-30
Lateral flexion 0-40
Rotation 0-45
3
Q
Shoulder ROM
A
Flexion 0-180
Extension 0-60
AB 0-180
Horizontal AD 0-145
Horizontal AB 0-45
IR 0-70
ER 0-90
4
Q
Wrist ROM
A
Flexion 0-80
Extension 0-70
Ulnar deviation 0-30
Radial deviation 0-20
5
Q
Elbow/forearm ROM
A
Flexion 0-150
Supination/pronation 0-80
6
Q
Hip ROM
A
Flexion 0-120
Extension 0-30
AB 0-40
IR/ER 0-45
7
Q
Thumb ROM
A
MP flexion 0-50
IP flexion 0-80
AB 0-50
8
Q
Finger ROM
A
MP flexion 0-90
MP hyperextension 0-45
PIP flexion 0-110
DIP flexion 0-80
AB 0-25
9
Q
Knee ROM
A
Flexion 0-135
10
Q
Foot/ankle ROM
A
Plantar flexion 0-50
Dorsiflexion 0-15
Inversion 0-35
Eversion 0-20
11
Q
FWN
A
No limits or restrictions
12
Q
WBAT
A
Pain to guide tolerance
13
Q
PWB
A
30-50%
14
Q
TDWB
A
10-15%
15
Q
NWB
A
0%
16
Q
Isometric contraction
A
No movement or change in angle (static holds, contract/relax)
17
Q
Isotonic contraction
A
Movement over joint with change in angle
- Eccentric
- Concentric
18
Q
Eccentric
A
Muscle lengthening (down)
- Elbow extension
- Stand to sit
19
Q
Wheelchair consideration for bilateral LE amputation
A
Large rear facing wheels with anti-tippers for residual limb support/ counter balance missing limbs
20
Q
Terminal device
A
UE: hand
LE: foot
21
Q
Passive TD
A
realistic and non functional worn for cosmetic purposes
22
Q
Active TD
A
Body-powered, externally powered through electrical signal or hybrid powered
23
Q
Prosthetic wearing schedule
A
- Initially have patient wear for 15 to 30 minutes
- Remove to check for redness
- If no redness apparent post wear increase time by 15-30
min intervals until prosthetic is worn for entire day - If redness does not disappear after 20 minutes report to
prosthetist
24
Q
Symptoms of fibromyalgia
A
Widespread pain, poor sleep, fatigue, inability to think clearly, joint swelling
25
Fibromyalgia diagnosis
of painful areas
Severity of fatigue
Presence of cognitive problems
Symptoms last for 3+ months
Symptoms not explained by other health issues
26
Common evaluation for fibromyalgia
- Daily activity log
- COPM
- Pain assessment
27
Treatment for fibromyalgia
Trigger management
Stress management
Myofascial release & trigger point massage
Daily stretching and light aerobic exercise
Progressive strengthening
Sleep hygiene
Energy conservation
28
OA
Noninflammatory condition resulting in breakdown of articular cartilage and reduced joint space causing painful bon-to-bone contact
29
Types of OA
Primary: localized or generalized joint involvement with no known cause
Secondary: related to trauma, infection or congenital abnormalities
30
Bouchard's nodes
PIP bony overgrowths due to OA
31
Herberden's nodes
DIP bony overgrowths due to OA
32
Surgical treatment options for OA
1. Arthroscopic debridement to remove broken cartilage to reduce pain and improve movement
2. Resection or perforation of subchondral bone to stimulate formation of cartilage
3. Graft to replace damaged cartilage
4. Joint fusion
5. Arthroplasty (knee, hip replacement)
33
Kyphosis
Abnormal rounding outward of upper back in thoracic region
34
Lordosis
Abnormal rounding inwards of lower back in lumbar region
35
Kyphosis impact on ADL
Deficits in eating including manipulation and swallowing
36
Osteoprosis
Progressive low bone density that leads to bone fragility and frequent fx in weight bearing bones
37
Risk factors of osteoporosis
Osteopenia, inadequate calcium intake, estrogen deficiency, sedentary lifestyle, alcoholism, diabetes, RA medications, malnutrition, post menopausal, women
38
Treatment for osteoprosis
- Anti-resorptive medications to slow bone loss
- Hormone related therapy
- Calcium supplement with vitamin D to assist with absorption
- Exercise and reduced smoking, alcohol, caffeine intake
39
Presentation of RA
Polyarticular
40
RA
Systematic and inflammatory condition with resulting in progressive synovitis of diarthrodial joints due to excessive synovial build up and joint deformities due to uneven distribution of weakened tendons and ligaments
41
Age group for juvenile RA
1-6
42
Common RA deformities
Boutonniere
Swan neck
Mallet
Ulnar deviation
Subluxation
Joint fusion
Extensor tendon rupture
Trigger fingers
Mutilans deformity
Subcutaneous nodules
Claw toe
Hammer toe
Cock-up toe
Hallux valgus (bunion)
43
Boutonniere deformity
PIP flexion DIP hyper-extnesion
44
Swan-neck deformity
PIP hyper-extenion DIP flexion
45
Mallet figner
DIP flexion
46
Ulnar drift
MCP ulnar deviation, wrist radial deviation
47
Mutilans defomirty
Very floppy joints with shortened bones and redundant skin
48
Claw toe
Hyperextension of MTP and flexion of IP
49
Hammer toe
Hyperextension of MTP and PIP and DIP flexion
50
Early phase RA
No destructive change on x-ray
Possible osteoporosis
51
Moderate phase RA
Radiographic evidence of osteoporosis
Slight cartilage and bone destruction
No joint deformity
Possible limitations with ROM
Muscle atrophy
52
Severe phase RA
Cartilage and bone destruction
Joint deformity
Expensive atrophy
Possible soft-tissue lesions
53
Terminal phase RA
Fibrous or bony ankylosis in addition to stage 3
54
Neuroma
Ball of nerve tissue when axons attempt to regrow in distal limb that is painful with pressure on residual limb
55
Sebaceous cyst
Keratin-filled sac causes by skin irritation and torque forces when prosthetic that are raised and usually painless
56
Desensitization technique for hypersensitivity
Start with least sensitive area with tolerating but irritable texture for short periods of time multiple times per day
57
Prosthesis control training
Operating each component of prosthetic, learning to open/close prosthetic
58
Prosthetic use training
Integration of prosthetic components for efficient assist during functional use
59
Pre-positioing prosthetic training
Identification of optimal position of each joint component to perform an activity
60
Prehension prosthetic training
TD control durig grasp activities
61
Functional prosthetic training
Control and use of prosthetic during functional bilateral activities using TD as functional assist
62
MMT rule for applying resistance against gravity
If patient can achieve 50% AROM antigravity therapist can apply resistance to further assess
63
When do OOB activities start post-hip replacement
24 hours post-op
64
Purpose of therapeutic exercise with arthritis
Prevent atrophy
Maintain or increase ROM
Maintain muscle strength
65
PROM > AROM
Muscle weakness
66
Splinting for recent CTS dx
Immobilization splint to rest and reduce inflammation
67
What to do during RA flareup
Avoid placing stress on joints with grip or strengthening exercises, AROM preferred but PROM is indicated if pain makes it difficulty to complete AROM
68
Arthritis compensatory interventions
Joint protection
Pacing
69
Cumulative trauma disorder compensatory interventions
Activity modification
Proper body mechanics
70
Respiratory and cardiac disease compensatory interventions
Energy conservation
Work simplification
71
Signs of cubital tunnel syndrome or nerve compression
Wartenburg's ding
Froment's sign
72
What improves the fit of prosthetic socket
Prosthetic sock or gel liner
73
Contracture
fixed position of shortening of skin, ligaments, joint capsule, tendons and muscles due to burns, wound healing, muscle imbalance
74
Types of contracture
Soft tissue: responds to therapy
Body block: requires surgical release
75
Five steps to contracture treatment
1. Superficial and deep heat to increase tissue extensibility
2. Slow stretch
3. Static splinting
4. Serial or progressive static splinting
5. Dynamic splinting
76
Posterolateral hip precautions
- No hip flexion greater than 90 degrees
- No IR
- No ADDuction
77
Anterolateral approach precautions
- No extension (do not step back with impaired side)
- No ER
- No ADDuction
78
Anterolateral approach precautions
No extension
No IR/ER
79
Static LB pain
nerve trapped by herniated disc
80
Spinal stenosis LB pain
Narrowing of intervertebral foramen
81
Facet joint pain
inflammation or changes of spinal joints
82
Spondylolysis
Age related wear and tear if cartilage and bone in the spine (degenerative arthritis of spine)
83
Spondylolisthesis
Slippage of vertebra out of position
84
Herniated nucleus pulposus
Tearing of disc fibers causing outward bulge
85
Standards of body mechanics
Maintain straight back
Bend from the hip
Avoid twisting
Maintain good posture
Carry loads close to the body
Lift with the legs
Lift with a wide base of support
Lift in sagittal plane
lift slowly
86
OA Symptoms
Joint pain
Stiffness
Limited ROM
Local inflammation
Crepitus of joint
Bone spurs
87
Factors that increase OA pain
Continues breakdown of cartilage
Osteophyte formation where ligaments attach to bone
Change in joint shape
Fluid-filled cysts near joint
Bone particles and cartilage float into loose joint space
88
Total knee replacement precautions
- No sleeping with pillow under knee while in bed
- Feet flat on the floor in sitting
- Immobilizer use as instructed
- No kneeling, squatting or twisting knee joint
89
Common interventions for OA
AROM (PROM only used if AROM is precluded)
Isometric/isotonic strengthening to tolerance
Low impact aerobic conditions
90
Contraindication for CMC OA
Pinching exercises due to stress on the joint
91
10 principles of joint protection
1. Respect pain
2. Maintain muscle strength and joint ROM
3. Use each joint in most stable anatomical plane
4. Avoid positions of deformity
5. Use the strongest joint available
6. Ensure correct patterns of movement
7. Avoid staying in on position for long periods of time
8. Avoid starting an activity that cannot be stopped immediately if it becomes to stressful
9. Balance rest and activity
10. Reduce force and effort
92
Osteopenia
Reversible weakening of bone that is a precursor to osteoporosis
93
Progression of osteoporosis symptoms
Initially no symptoms
Later in disease process clients may experience severe back pain, recurring fractures, spinal deformities such as kyphosis, loss of height
94
Big concern with osteoprosis
Falling and need for home evaluation for fall prevention
95
RA criteria for diagnosis
Four of seven diagnostic criteria:
- Morning stiffness
- 3/14 swollen joints
- Swollen joints of hands
- Symmetric swollen joints
- Rheumatoid nodules
- Serum for rheumatoid factor via labs
- Radiographic changes hand and wrist
96
Ankylosis
Abnormal stiffening or immobility due to fusion of bone
97
DMARDS (disease-modifying anti-rheumatic drugs)
98
Cognitive areas often impacted due to pain
STM, attention span, problem solving
99
How to calculate TAM
AROM MCP/PIP/DIP flexion -extension deficits
100
MMT stabilization and resistance
Proximal to the joint the muscle belly crosses over with resistance gradually applied in opposite direction of movement
101
Grip and pinch strength and testing positions
Should AD, elbow flexion to 90, forearm in neutral
102
Options for grip strength testing
- Dynamometer position #2 mean of 3 trials
- Dynamometer 1 trial in all 5 positions
- Bulb dynamometer for arthritis
103
Types of edema
1. Pitting (acute)
2. Brawny (chronic)
104
5
Full ROM against gravity with max resistance
105
4
Full ROM against gravity with mod resistance
106
4-
Full ROM against gravity with less than moderate resistance
107
3+
Full ROM against gravity with minimal resistance
108
3
Full ROM against gravity with no resistance
109
3-
Less than full ROM against gracity
110
2+
Full ROM in gravity eliminated with minimal resistance
111
2
Full ROM in gravity eliminated with no resistance
112
2-
Partial ROM in gravity eliminated
113
1
Tension palpated in muscle but no movement
114
0
No tension palpated in muscle
115
What is considered significant change with volumeter
More than 10 mL
116
Sensation testing for spinal cord injuries
Tested proximal to distal following dermatome pattern
117
Sensation testing fors peripheral nerve injuries
Distal to proximal following peripheral nerve
118
Order of return of peripheral nerve
Pain
Moving touch
Static touch
Touch localization
119
Moving two point discrimination
Starts 5-8 mm apart
Proximal to distal
Longitudinal orientation
7/10 must be correct before decreasing distance of two points
Normal = 2 mm
120
Static two-point discrimination
Starts 5 mm apart
Longitudinal orientation
Normal = 5 mm
Fair = 6-10
Poor = 11-15
Protective = one point detected
Anesthetic = no point detected
121
Propriocpetion
Position sense - therapists positions involved extremity and patient duplicate position with contralateral extremity
122
Kinesthesia
Movement sense - therapist moves segment and person responds up or down
123
Eccentric
Lengthening
124
Concentric
Shortening
125
Concentric contraction takes place..
Anytime a person moves against gravity or away from the earth they are performing a concentric contraction
126
Grocery contraction example
Lifting groceries from the car = concentric
Carrying groceries into kitchen = Isometric
Slowly lowering groceries onto table = eccentric
127
Edema reduction strategies
Elevation
Manual edema mobilization (specialized)
Retrograde massage
Compression garments
Cold pack
Contrast bath
Intermittent compression pump
128
Common contraindication for heat
Edema (but can be used cautiously if mild case in combination with elevation )
129
Contraindications for edema reduction techniques
Infection
Grafts
Vascular/circulation damage
Blood clots
Unstable fx
CHF
Cardiac edema
130
Scar management techniques
ROM /early mobilization
Massage
Compression
Scar pad
Splinting
Control edema
131
Compression garments for UE
Hand = isotoner glove
Digits = coban
Forearm = tubi grip
132
Desensitization for scar hypersensitivity
Start in periphery and move towards scar
- massage
- texture grading
- vibration
- fluidotherapy
- self times a day
133
Sensory re-education
- massage
- texture grading
- vibration
- fluidotherapy
- Education on safety precautions with loss of protective sensation
134
Strategy for improving coordination
Begin with slow gross motor activities and gradually grade up to faster fine motor activities with focus on accuracy and speed
135
What modality should you not use with RA during flare-up
HEAT!
