Orthopedic/Musculoskeletal Disorders Flashcards

1
Q

Parts of the musculoskeletal system

A

Bones
Muscles
Joints
Cartilage
Ligaments
Tendons
Nerves
Skin/scars

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2
Q

Joints

A

space between 2 articular surfaces

Types:
- Synarthrosis
- Amphiarthrosis
- Diarthrosis
* ball and socket (greatest degree of freedom)
* condyloid
* gliding
* hinge
* pivot
* saddle

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3
Q

Cartilage

A

Lines articular bones
Protects against impact and friction
Gets blood through osmosis, so it doesn’t easily heal, if at all
No nerves, so it doesn’t hurt when you tear it
Thickening of cartilage in the knee - meniscus or disc
Types:
- Hyaline cartilage: most common; found in nose and ribs
- Fibrocartilage: found in intervertebral disks, joint capsules, and ligaments

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4
Q

Ligaments

A

Connect articulating bones
Prevent movement
Have very little vascular supply
Take a long time to heal
Ulnar collateral ligament of MP joint of thumb
- Gamekeeper’s thumb or skier’s thumb
- AKA medial collateral ligament

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5
Q

Grades of ligament sprains

A

Grade I: stretch the ligament causing mild swelling and pain with stress testing, but no laxity
Grade II: partial tear resulting in more moderate swelling and pain along with some laxity on stress testing; have definitive endpoint with stress testing
Grade III: complete tear with a lot of pain, swelling, and gross laxity on stress testing without any definitive endpoint
Grade IV: not really a sprain; avulsion fracture

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6
Q

Types of muscle movement

A

Isotonic
- eccentric: lengthening of muscle
- concentric: shortening of muscle
Isometric
- muscle contraction, not shortening or lengthening
- happens with co-contraction of flexors and extensors

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7
Q

Energy metabolism of muscles

A

METS (metabolic equivalent task score)
Primary engine that burns calories

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8
Q

What to muscles do?

A

Move the body
Energy metabolism
Generate body heat
Atrophy and hypertrophy

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9
Q

What is muscle atrophy?

A

muscle wasting, often with age

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10
Q

Muscle fibers

A

All or none
- motor unit: motor neuron and its end plate
- recruitment

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11
Q

Muscle spasm or cramp

A

Painful condition of muscle contraction (temporary)
Reason is varied and unknown

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12
Q

Muscle spasticity

A

Involuntary, intense, and sometimes painful contraction due to inappropriate CNS neural signs
Not strength
Ashworth’s scale

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13
Q

Muscle contracture

A

Muscle shortening from being stationary

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14
Q

Muscle fatigue

A

Decreased blood supply
Exhaustion of ACT
Accumulation of lactic acid (most common)

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15
Q

Myalgia

A

Muscle strain
RICE
Bleed and bruise

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16
Q

Chronic fatigue syndrome

A

Extreme fatigue lasting for at least 6 months and can’t be explained by any other medical cause

Symptoms:
- Post-exertional malaise
- Unrefreshing sleep
- Brain fog
- Muscle and joint pain
- Headache and light sensitivity
- Chills
- Stomach pain, bloating, nausea
- Sinus problems, swollen glands, tender lymph nodes, sore throat

No known cause or cure

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17
Q

Fibromyalgia

A

Often triggered by physical or emotional stress
If you have lupus or rheumatoid arthritis (RA), you are more likely to develop fibromyalgia.

Symptoms:
- Fatigue, cognitive and memory problems, headaches, diziness, trouble sleeping
- Vision problems
- Tender points
- Nausea
- Urinary problems, dysmenorrhea in women
- Restless leg syndrome
- Joint pain and stiffness
- Skin problems
- Muscle pain
- Jaw pain

Medication and stress reduction can help symtoms.

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18
Q

Bones

A

Provide structure
Reservoir of calcium and phosphate
Site of hematopoiesis
- RBC creation
Haversian canals (blood vessels in bones)
- avascular necrosis
- Kienbock’s disease: lunate (high risk for avascular necrosis)
Epiphyseal plates
- harden at 18 for women and 22 for men
- bone mass decreases at 40-60
Constant rate of uptake and production
- osteoblasts and osteocytes produce
- osteoclasts absorb
Wolfe’s law

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19
Q

What is Wolfe’s law?

A

Soft tissue (musculoskeletal tissue and bone) responds to the forces placed on it.
- Weight bearing can decrease the affect of the disease
- Osteoporosis can begin 6 weeks after spine injury

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20
Q

Rickets (Osteomalacia)

A
  • bad bones
  • due to vitamin D and E deficiency
  • common in children outside the US
  • bowing is caused by bodyweight
  • can be corrected
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21
Q

Nerves

A

Get impinged or compressed by soft tissue or neuromuscular structures
- can get compressed against humerus when sleeping funny

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22
Q

Radial nerve

A

Innervates extensor wad
Responsible for wrist, thumb, and MP extension

Clinical presentation:
- Weakness of wrist dorsiflexion and finger extension, causing wrist drop and MP drop

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23
Q

What happens if there is damage to the axilla?

A

All radial-innervated muscles are involved
- anconeus and triceps
Decreased sensation
Arm drop
Limp and uncoordinated self-feeding
Very jerky

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24
Q

What happens if there is damage to the spiral groove?

A

All radial-innervated muscles distal to the triceps are weak
- extensor wad in forearm

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25
Q

What happens if there is damage to isolated posterior interosseous lesions (PIN)?

A

Sensation is spared and motor involvement occurs in radial muscles distal to the supinator
Lose a little bit of thumb and sensation

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26
Q

Innervation of the radial nerve

A

The radial n. innervates motor outside the hand in the extrinsic muscles of the forearm. Once it crosses over into the hand, it only functions in sensory.

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27
Q

Posterior interosseous nerve coarse

A
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28
Q

Ulnar nerve

A

Ulnar n. in ulnar groove - funny bone
- innervates adductor pollicis long head
- flexes intrinsic and ulnar half of lumbricals
- Guyon’s tunnel
- when power comes from

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29
Q

Ulnar nerve palsy

A

Occurs due to compression at the elbow (cubital tunnel) or at the wrist (Guyon’s tunnel)
Muscle weakness and atrophy predominate the clinical presentation
If it gets trapped at the cubital tunnel, there will be numbness and tingling
Can cause ulnar claw hand
- caused by an imbalance between strong extrinsic muscles and weakened intrinsic muscles
- MCP hyperextension
- PIP and DIP flexion

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30
Q

Ulnar innervated muscles

A

Forearm:
- flexor carpi ulnaris (C7, C8, T1)
- flexor digitorum profundus III and IV (C7, C8)

Thenar:
- hypothenar muscles (C8, T1)
- adductor pollicis (C8, T1)
- flexor pollicis brevis (C8, T1)

Fingers:
- palmer interosseous (C8, T1)
- dorsal interosseous (C8, T1)
- III and IV lumbricles (C8, T1)

Digiti minimi:
- abductor digiti minimi (Quinti) (C8, T1)
- opponens digiti minimi (C8, T1)
- flexor digiti minimi (C8, T1)

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31
Q

Median nerve

A

Injury at elbow or wrist
Commonly compressed at the wrist causing carpal tunnel syndrome
Deformity or ape-like hand
- flat thenar eminence and adducted thumb
Opposition and abduction aren’t possible leading to loss of pincer-like action of hand
- difficulty with fine motor tasks like buttoning

Cause:
- paralysis and wasting of the muscles of the thenar eminence
- adductor pollicis is unopposed since it is supplied by ulnar n.
- opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis

Big driver of thumb flexion and adduction, except for deep adductor pollicis
If anterior interosseous n. injury is present, the patient will be unable to bring together the distal phalanx or thumb and index finger to make the OK sign.

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32
Q

Carpal tunnel

A

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.
Causes numbness and tingling

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33
Q

Tendons

A

Connect muscle to bone
Covered in a sheath which provides nutrients

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34
Q

Tendonitis

A

Micro tear from lifting off the bone
Types:
- Epicondylitis
- Lateral: tennis
- Medial: golfers

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35
Q

DeQuervain’s Tenosynovitis

A

Affects abductor pollicis longus and extensor pollicis brevis
Use the Finklestien’s test

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36
Q

Intersections Syndrome

A

Abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi radialis longus and the extensor carpi radialis brevis

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37
Q

Trigger finger

A

Affects the pulleys of the finger
- Annular (A 1-5)
- Cruciate (C 1-3)
If caught at or before 30 days, can be treated with injection and splinting.

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38
Q

Dupuytrens’ disease

A

Non cancerous tumor that grows around tendons and causes contractures
30º contracture at MP joint
Any contracture at PIP joint
Flat hand test
Z plasty to prevent straight line scar the pulls into flexion

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39
Q

Bursitis

A

Potential space filled with fluid
Found in areas where bone approaches another surface
May be removed or drained

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40
Q

Ganglion cysts

A

A fluid filled sac that grows out of the tissues surrounding a joint or tendon.
Ganglion cysts are common in the soft tissue along the back of the wrist, as 60% to 70% develop along the front or back of the wrist.
Can be associated with rheumatoid arthritis or osteoarthritis
Usually right on the carpal bones
If you pop it, theres a 50% chance it won’t grow back.

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41
Q

Joint disorders

A

Osteoporosis
Osteopenia
Heterotropic Ossification
Arthrogryposis multiplex congenita
Ankylosing spondylitis

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42
Q

Osteoporosis

A

Decreased bone density
Silent disease until there is a fracture
Loss of balance between production and uptake
Kyphosis
Dowager’s hump
- not fixable by a therapist
Frequently a comorbidity or RSD/CRPS, spinal cord injuries, or astronauts

Causes:
- age (over 50)
- hereditary
- poor diet
- alcohol
- prolonged steroid use
- cigarettes
- vitamin D (rickets)
- non weight bearing

Symptoms: none, fractures, shrinking
Dual energy x-ray obsorptiometry (DEXA)

Treatment:
- weight bearing
- medication
- diet

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43
Q

Osteopenia

A

Reversible weakening of the bone
- fracture without trauma (standing while washing dishes and hip suddenly just breaks)
“Pre” osteoporosis
- pathological fracture

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44
Q

Heterotopic ossification

A

Growing bone where you shouldn’t be growing bone
- more likely to happen where there’s already bone on bone (elbow)
- burns
- head injury
- spinal cord

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45
Q

Fracture vs. break

A

SAME THING
Break is the lay term for fracture

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46
Q

Fractures

A

Can be open (bone sticking out) or closed
Complete or partial
Compression
Pathological
- osteoporosis, rickets

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47
Q

What is a “bad” fracture?

A

Position: if it doesn’t stay by the other piece of bone; if it moves and causes tissue damage
Age
Fragments
Soft tissue
Fat emboli: fat escapes from marrow and can result in a stroke
Other diseases: like osteoporosis

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48
Q

Volkman’s ischemia

A

Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling, called compartment syndrome.

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49
Q

Types of union after a fracture

A

Delayed union: couldn’t put the bone back together quickly, possibly because of an infection
Malunion: poorly healed
Non Union: ends of the bones heal, but not together

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50
Q

Types of fractures

A

Greenstick: almost always in children; most don’t need surgery, just a cast; pressure on one side, break on the other
Spiral: only way it can occur is by twisting really hard, so if this happens in a child, CPS will be called
Comminuted: crush, shattered; non-stable
Transverse (oblique): complete or partial
Compound: total
Compression: bone is stable; will heal on its own
Delayed union: complete; a midshaft humeral fracture is inherently unstable and will result in surgery

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51
Q

Common fractures

A

Distal radius
- also called Bennett or Colles
- fall on outstretched hand
- CRPS?

Hip
- pelvis or femur
- usually results in hip replacement

Humeral
- elbow or shoulder
- risk to radial n.

Scaphoid

52
Q

Treatment for fractures

A

Casts
External fixator
ORIF: Pins, screws, plates

53
Q

When to start AROM vs PROM

A

AROM first so you don’t sheer soft callus. Pt will know when to stop on their own. If PROM the OT may cause more damage.

54
Q

Dislocation vs subluxation

A

Shoulder
- sulcus sign, you can see the separation
Nursemaid’s elbow
- reduction: apply pressure at radial head, grasp wrist and apply slight traction, supinate wrist while flexing elbow to 90º
Apprehension test
- abduction and external rotation

55
Q

Compartmental syndrome

A

Excessive inflammatory response
Volkman’s ischemia or ischemic contracture
- any place there is a compartment
* shin splings
- treated with fasciotomy if excessive

56
Q

Osteoarthritis vs. rheumatoid arthritis

A
57
Q

Osteoarthritis

A

Degenerative joint disorder (DJD)
Crepitus
Herberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Often develops in hip, knee, or CMC

58
Q

Interventions for osteoarthritis

A

Joint protection
Replacement
Symptom mangagement
- edema control
- heat/ice
- modalities
- meicine

59
Q

Rheumatoid arthritis

A

System, RH factor
- severe joint inflammation, changes in the synovial lining
* pannus: corrosive agent that breaks down cartilage in bone
- more than just joints
- autoimmune
- leading cause of disability worldwide
- any age (JRA), adults 40-70
- all races and ethnic groups
- hereditary component

60
Q

Symptoms and issues of rheumatoid arthritis

A

Moves from acute to chronic
- active vs inactive (flares)
Ulnar deviation
- wind swept or ulnar drift
- swan neck: hyperextension of PIP and flexion of DIP
- boutonnière: flexion of PIP and hyperextension of DIP

61
Q

Swan neck deformity

A

Hyperextension of PIP and flexion of DIP
Points palmar
LB - dorsal

Injury outside of RH:
- injury to terminal ligament (mallet or jersey finger)

62
Q

Boutonnière deformity

A

Flexion of PIP, hyperextension of DIP
Points dorsal
LB - anterior

Injury outside of RH:
- injury to central slip (buttonhole deformity)

63
Q

Classification criteria for rheumatoid arthritis

A

Criterai:
1. morning stiffness (at least 1 hour)
2. arthritis in 3+ joint areas
3. arthritis of hand joints (1+ swollen)
4. symmetric arthritis
5. rheumatoid nodules
6. serum RF
7. radiographic changes (erosions) on x-rays of hands

Applicable for: all arthritis patients

Results in: classification of RA (yes/no)

Positive in case: 4/7 criteria must be present; criteria 1-4 must have been present for at least 6 weeks

Test characteristics: sensitivity of 79-80% and specificity of 90-93% for established RA; 77-80% and specificity of 22-77% for early RA

64
Q

Intervention for osteoarthritis and rheumatoid arthritis

A

Meds to slow/control the disease:
- Disease modifying anti-rheumatic drugs (DMARDs)
* Methotrexate (can cause nausea, low blood count, increase risk of infection)
- Biological agents
* suppress the immune system to decrease inflammation
* Humira, Enbral

Treat symptoms:
- Steroids and corticosteroids
* Prednisone (increases risk of infection, weight gain, swelling)
* short term use only

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • less irritating than aspirin, but patients who can’t take aspirin may not be able to take these either
  • primarily an anti-inflammatory but also analgesic (pain reliever)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Naprosyn)
  • Meloxicam (Mobic)
  • Diclofenac (Voltaren), oral and as a topical skin gel (first one for OA)
  • Side effects: GI Bleeding (black poo), Hepitatis, Tinnitus, photosensitivity, rashes
65
Q

Intervention for RH

A

Joint replacements
- hip
- knee
- shoulder
- digits
- CMC

66
Q

RH related arthritis

A

Juvenile rheumtoid or idiopathic arthritis (JRA or JIA)
Psoriatic arthritis
Gout

67
Q

Juvenile rheumtoid or idiopathic arthritis (JRA or JIA)

A

Before 16 years old with a minimum 6 week duration

Types:
- oligoarticular
- polyarticular
- systemic

Differences:
- F:M :: 2:1
- Oliogarthritis is more common
- systemic (fever, rash) more usual
- large joints
- no rheumatic nodules and rheumatic factor
- pathogenesis: similar to RA
- outcome: 70-90% fully recover

68
Q

Gout

A

Due to hyperuricemia (uric acid) in blood and tissues
Presents as a painful form of arthritis
Frequently affects the large joint of the big tow, although any joint can be affected
Acute gouty arthritis is sudden onset of joint pain caused by an inflammatory reaction to precipitated uric acid deposits in a joint
Occurs predominantly in men
Tends to run in families
Red, swollen joint

Treatment:
NSAIDs, lifestyle change

69
Q

Medications associated with osteoarthritis

A

Acetaminophen (Tylenol): preferred first line treatment
- Mild to moderate pain-it does NOT decrease inflammation
- Doesn’t upset stomach, few side effects, non addictive
- If taken with alcohol can cause renal failure, rash

Salicylate drugs: oldest drugs known to man
- Aspirin (Bayer, Ecotrin) (acetylsalicylic acid or ASA)-analgesic and anti-inflammatory
- Irritate the stomach
* Long term use can cause gastric ulcers
- Tinnitus (ringing in ears)
- GI Bleeds, thinning of blood
- Some companies coat the aspirin (enteric-coated) to help with this

NSAIDs

70
Q

Arthroplasty

A

Fancy word for joint replacement
Joints commonly replaced:
- knee
- hip
- shoulder
- CMC
- MP
- IP
Reasons:
- fractures into joint space
- arthritis

71
Q

Complex regional pain syndrome

A

Used to be called reflexive sympathetic dystrophy (RSD)
Cardinal signs: pain outside the norm associated with that injury, swelling outside the norm associated for that injury, temperature change, stiffness or motor changes
Complete overreaction of the system to an injury
Can occur anywhere in the body, but most commonly in the arm after a distal radial fracture
Many different symptoms associated with it
Narcotics don’t affect the pain
Extremely hypersensitive to ice
6-12 weeks in, an x-ray will show osteoporotic changes in the affected limb

72
Q

Duchene’s muscular dystrophy

A

Weakness in pelvic and shoulder girdle
Difficulty in rising
Hypertrophy of calves
Mental retardation
Early onset
Wheelchair confinement
Death by 20 years
Gower’s sign

73
Q

Becker’s muscular dystrophy

A
74
Q

Facioscapulo-humeral muscular dystrophy

A
75
Q

Limb-girdle muscular dystrophy

A
76
Q

Myotonic dystrophy

A
77
Q

Developmental hip discplacia (ADD)

A

Also congenital
Seen in children
Galeazzi sign
Trendelenburg sign
Ortolani test

Osgood Schlatter’s Disease

Legg-Calve Perthes Disease

78
Q

Spinal issues

A

Lordosis
Kyphosis
Scoliosis
- any lateral deviation, even 1º
- anything 15º+ needs intervention like bracing or surgery
- can be postural or birth
- 30º-40º can impact respiratory status, child bearing ability, liver and digestive function

79
Q

Ankylosing Spondylitis

A

Spondylolisthesis: occurs when there’s bilateral defects in the vertebral pars intrarticulariss which permit the vertebral body to slip anteriorly; usually occurs at level L5, S1

Spondylolysis: the most common cause for spondylolisthesis; it’s a unilateral or bilateral defect in the vertebral pars interarticularis result from stress fracture

80
Q

Myasthenia gravis

A

Weakness and exhaustion of skeletal muscles (droopy eye)
Autoimmune, motor nerves and muscles are OK
Less aggressive than MD, ALS
More common in women than men

81
Q

Amyotrophic lateral sclerosis (ALS)

A

Degeneration of the nerve, spinal cord, and muscle

82
Q

Muscular dystrophy

A

break down in myelin

83
Q

Chronic, progressive neuromuscular diseases

A

Myasthenia gravis
ALS
MD

84
Q

Weight bearing status on the operated leg

A

NWB
TDWB
PWB
WBAT
FWB

85
Q

Total hip precaustions

A

No bending hip past 90º
No rotation of surgical leg
No adduction of surgical leg (crossing)
No lying on uninvolved side because the surgical leg will adduct

86
Q

Hip vs. knee replacement

A

Touch down weight bearing after hip surgery
Knee is full weight bearing or weight bearing as tolerated after surgery

87
Q

Bone cancer and cysts

A

Children and adults
Osteosarcoma - malignant
“sarcoma”

88
Q

Criteria for complex regional pain syndrom

A

Budapest Criteria is the definitive way to diagnose CRPS

Criteria:
- The pt. has continuing pain that is disproportionate to any inciting event
- The pt. has a least 1 sign in 2 or more categories
- The pt. reports at least 1 symptom in 3 or more categories below
- No other diagnosis can better explain the signs and symptoms

  • A sign is an objective measure (ROM, swelling, temperature)
  • Symptom is something the patient says, can’t take a picture of it

Categories
1. Sensory: allodynia (pain to light touch, temperature, deep pressure, and/or joint movement; hyperalgesia (pinprick)
2. Vasomotor: temperature asymmetry, skin color changes, and/or skin color asymmetry
3. Sudomotor/edema: edema, sweating changes, and/or sweating asymmetry
4. Motor/trophic: decreased ROM, motor dysfunction (weakness, tremor, dystonia), and/or trophic changes (hair, skin, nails)

  • Sensory category is going to be a symptom
  • Vasomotor, sudomotor, and motor/trophic are signs
89
Q

Complex regional pain syndrome STAMP

A

Sensory
- allodynia
- hypo/hyperalgesia
- hypo/hyperesthesia

Trophic
- skin, hair, nail changes

Autonomic
- swelling
- edema
- sweating

Motor
- weakness
- contractures
- atrophy

Pain

90
Q

Low back pain

A

One of the most common musculoskeletal complaints with 80% of people experience it.
People that are inactive are at higher risk for back injury.
Typically have tight hamstrings, causing posterior tilt
Limited ROM when 4+ vertebrae are fused

Causes:
- muscle pain/strain
* often linked to tight hamstrings
* pelvic position
* posture
* it hurts “here,” true back pain
* ergonomic intervention
- lumbar radiculopathy (pinched nerve)
* bone, cartilage, degenerative disease of spine, bone spur, disc
- herniated or ruptured disc
- degenerative disc

91
Q

Herniated vs ruptured intervertebral disc

A

Herniated (bulging)
- symptoms will occur down the distribution
- by correcting pelvic positions and strengthening muscles you can reverse the effects
- therapy can fix it

Ruptured
- the nucleus pulpous begins to exit the disc and may compress a nerve
- same symptoms as herniated disc
- surgery is the only way to fix the disc
- controversial that therapy can help

Either of these can be asymptomatic if the spinal nerve isn’t being compressed.
Can’t tell the difference in X-rays, need to get MRI.

92
Q

Spondylolisthesis

A

Vertebra slide or displace over each
condition of spine in which forward displacement of one of the lower lumbar vertebrae over the vertebrae below it

93
Q

Spondylosis

A

also known as spinal arthritis
an age-related condition that affects the joints and discs in your neck and back

94
Q

Spondylitis

A

Facet joint syndrome
an inflammation of any of the joints between the vertebral spine
may occur in osteoarthritis, RA, or ankylosing spondylitis

95
Q

Spinal stenosis

A

Narrowing of one or more spinal openings or foramina due to
- osteoarthritis and bone spur growth
- degenerative disc disease
- ossification of spinal ligaments

Usually caused by general wear and tear related to aging
Can also be caused by things like tumors, herniated discs, spinal injuries, and bone diseases

Sometimes there are no noticable symptoms.
Can include pain, weakness, numbness, bladder and bowel problems, craping or pain in legs
Symptoms generally worsen over time

ADD TREATMENT

96
Q

Intervention for low back pain

A

Medication
Therapy
Surgery (fusion)
- Spondylolisthesis

97
Q

Amputation

A

Birth or trauma
Developmental aspect
- Appropriate age for prosthetic use for upper limb is 6 months and for lower limb for 6-9 months.

98
Q

New and old terminology for amputations

A

The terms long and short refer to the residual limb
Scapula and shoulder amputation is forequarter

The terms in ( ) are new

99
Q

Aging and musculoskeletal system

A

Joint aging
Bones
Role of exercise/activity

100
Q

OT’s in musculoskeletal intervention

A

Exercise goal is function
ADL
Splinting
Adaptations
Prosthetics
Re-training
Rehab
Pain control

101
Q

Who do we work with?

A

PT
Doctors
- orthopedics
- general
- neurologist
- rheumatologist
ATC, coaches, parents, nurses, case workers, personnel managers

102
Q

What is the purpose of skin?

A

Protective covering
Retards loss of water and fluid
Regulates body temperature
Houses sensory receptors
Synthesis of chemical (vitamin D)
Excretes waste
Cosmetic

103
Q

Epidermis

A

Most superficial layer of skin
Made up of stratified squamous epithelium
Houses melanin (color)
Keratin “seals the skin” and prevents dehydration. IT also makes us waterproof.
Has no blood supply
Sloughs off every 15-30 days
Has a basement membrane (zone or basal)
- located between the dermis and epidermis
- collagen fibers connect the two
- poor at birth and degenerates with age which can cause shearing injuries

104
Q

Dermis

A

Second layer of skin
Thick
Made up of
- fibrous connective tissue
- epithelial tissue
- smooth muscle tissue
- nerve tissue
- blood
- support system for hair follicles
Has sebaceous glands that continuously produce sebum to keep the skin moisturized.
- Age decreases sebum production.
Sudoriferous glands act on demand to produce sweat.

105
Q

Subcutaneous

A

Deepest layer of skin
Fibrous connective tissue
Adipose tissue
Anchors to the muscle

106
Q

Primary skin lesions

A

Arise from normal skin
Types:
- macule (freckle or hyperpigmentation
- tumor greater than 2 cm
* nodule - smaller tumor
* fibroma (fibrous sac), lipoma (fat sac), melanoma, hemangioma (blood vessels)
- cysts
- scale
- vesicle (blister)
- pustule (zit)
* sterile or infected

107
Q

Secondary skin lesions

A

Results from injury
Irritation
Invasion
Healing of a primary lesion

108
Q

How does a shallow injury heal?

A

Epithelial cells along the margin are stimulated and fill in the wound from margins to center and from the bottom up.

109
Q

How do injuries to the dermis or subcutaneous layer heal?

A
  1. Blood escapes and cleans the wound. It brings in clotting factor to form a scab.
  2. Scab forms.
  3. Fibroblasts migrate and begin to form collagenous fiber from the bottom up and sides to middle.
  4. Blood vessels send out new branches below the scab.
  5. Phagocytic cells remove dead cells.
  6. Scab sloughs off.
  • If depth is greater than width, you will need to pack the wound
110
Q

What are the 4 phases of wound healing?

A

Hemostasis: day 1-3, stop bleeding and fluid loss
Inflammation: day 3-20, new framework for blood vessel growth; swelling, redness, heat
Proliferation or granulation: Week 1-6, pulls the wound closed, looks like sand, tissue regenerates and wound begins to close
Remodeling or maturation: week 6-2 years, final proper tissue

111
Q

Scarring

A

Scar occurs if excessive connective tissue is needed

112
Q

Types of scars

A

Hypotrophic: doesn’t affect function, flat and smooth
Hypertrophic: stays in the perimeter of the wound, can occur from picking a scab
- keloid: doesn’t stay in the perimeter, skin thickness and race can cause keloid development
- not a lot can be done about keloids: acid injection, surgery
- raised, hard, adhesions

113
Q

Granulations

A

Small rounded masses consisting of new blood vessels and a cluster of connective tissue to nourish the blood vessel
Red, sandy appearance

114
Q

Causes of burns

A

Thermal: sun, curling iron, hot sidewalk
Chemical: clorox
Electrical: always has an entry and exit
- follows the nerve and vessel system
- fasciotomy or amputation are often required
- can cause a microstoma

For every percent of the body covered in burn, you lose 1% chance of survival

115
Q

Classification of burns

A

First degree:
- superficial
- red with mild edema
- don’t scar
- self resolving

Second degree:
- partial thickness
- epidermis and dermis
- blistering
- red to a waxy white
- heals spontaneously
- non scaring if it heals well
- no grafting
- doesn’t matter if you pop it
- MUST pop if it covers a joint, it has become cloudy or bloody, or it impacts function

Third degree:
- full thickness
- destroys the dermis, epidermis, and accessory organs
- dry/leathery - read to black to white
- non blanching (when you poke it, it turns white then red)
- not painful, but the area around it hurts because it is probably a 2nd degree burn
- healing
* margins in only
* grafting if bigger than 50¢
* severe scaring

Fourth degree:
- muscle and bone

116
Q

Eschar

A

Crust or drainage and sloughed cells
Non productive scab
Black in color
No sensation
HAs to be debreided

117
Q

Other areas a burn can affect

A

Respiratory
Inhalation injury
Temperature regulation (can’t shiver or sweat)
Hypermetabolism
- increase by up to 40%
- need for more calories
Dehydration
- burn shock: due to fluid loss
Infection
- difficult to diagnos

118
Q

Burn treatment

A

Sterile for 48-72 hours
Topical treatments
Debridement
- Mechanical
* hydrotherapy
* whirlpool
* tanking
* manual
- Surgical
*usually first 48 hours
* bad apple principle: cut until you get to good skin
* infection
* scar release: not good because it creates more scar tissue, but okay in children because they grow
* enzymatic (chemically)

119
Q

Burn grafts

A

Homograft: human skin the comes from someone else, often a cadaver
Autograft: comes from the individual, often their inner thighs
Zenograft: not human skin, often pig skin; currently they are working on creating skin in the lab

120
Q

What are the 2 methods to classify burns?

A

Rule of 9s
Lund-Brower

121
Q

Possible burn disabilities

A

Loss of muscle strength
Nerve involvement
Wasting
Loss of sensation
Loss of a body part
Loss of motion due to scaring
- contractures
Disfigurement
Blindness
Lung/respiratory
Fractures

122
Q

Abuse and burns

A

When to suspect abuse:
- story doesn’t fit
- shape
* cigarette
* iron
- area doesn’t fit
* stocking burn
* genitals
- amount of time before reported
- more than one story

123
Q

How to prevent burns?

A

Education
Safety
Fire retardant material

124
Q

Who is on the burn team?

A

Nurses
Doctors
- ortho
- plastics
- neuro
- podiatrists
- internist
Psychiatrist
Social worker
Nutritionist
OT/PT
Respiratory
Vocational rehab

125
Q

Burn prognosis

A

Less than 20% burn, excellent survival rate
Sent to burn unit:
- any full thickness burn
- burns on hands, face, or genitals
- joints are involved
- electrical burns
- severe chemical burns
- inhalation injury
- high risk or other mobidities

126
Q

Burn precautions

A

Shearing
Removal of graft
Infection
Contractures
Psychosocial problems

127
Q

OT and burns

A

Burn unit
Inpatient/Outpatient rehab
Wound care
Exercise in water
Pressure garments
Prevent deformities
Increase function
Adaptive equipment
Developmental issues
Psychological issues