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Phys Dys > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Hip Precautions: Posterolateral Approach

A
  1. No hip flexion greater than 90 degrees
  2. No internal rotations
  3. No adduction (crossing legs or feet)
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2
Q

Hip Precautions: Anterolateral Approach

A
  1. No external rotation
  2. No adduction (crossing legs or feet)
  3. No extension
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3
Q

How long before a ct with a hip prosthesis (hemiarthroplasty) can begin limited out-of-bed activity (with MD’s approval)?

A

1-3 days after surgery

Weight precautions may be indicated

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4
Q

When can a ct begin out of bed activities post: Femoral Neck Fx with hip pinning?

A

Limited out-of-bed activities within 1-3 days

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5
Q

How long may there be weight bearing restrictions: Femoral Neck Fx with hip pinning?

A

6-8wks

Weight-bearing restrictions may include aide of walker or crutches

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6
Q

What’s special about femoral head fx’s? What fx’s does this category include?

A

Included: Subcapital, Transcervical, & Basilar

Within the articular capsule - may have poor blood supply, osteoporotic bone, & thin periostium covering the bone

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7
Q

What is hemiarthroplasty?

A

AKA hemipolar arthroplasty - femoral head is surgically removed & replaced by an endoprosthesis

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8
Q

What’s the preferred method for treating a intertrochanter fx? How long do weight-bearing restrictions apply? How long before the ct can get out of bed?

A

ORIF
Up to 4mos
1-3 days post surgery

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9
Q

What’s the main cause of intertrochanter fx?

A

Direct trauma (fall). In persons over 60.

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10
Q

What’s the main cause of femoral head fx?

A

If the bone is osteoporotic, the slight trauma or rotational force may cause fx. In persons over 60.

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11
Q

What’s the preferred method for treating a femoral head fx?

A

Hip pinning (application of compression screw & plate) - used when hip displacement is minimal-moderate & blood supply is intact

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12
Q

What does ORIF stand for?

A

Open Reduction Internal Fixation

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13
Q

What does reduction of a fx refer to? What are the two methods for performing this?

A

Restoring the bone fragments to normal alignment

  1. Closed (manipulation)
  2. Open (surgery)
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14
Q

What’s the procedure for closed reduction external fixation?

A

MD performs closed reduction (manipulation) by applying force opposite to what produced the fx & externally maintaining the alignment via cast, traction, or skeletal fixation

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15
Q

What’s the procedure for Open Reduction Internal Fixation?

A

MD performs reduction via open reduction (surgery) & holds fragments in place via screws, pins, a plate, nails, or a rod. Further immobilization via casting or brace

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16
Q

Are weight bearing precautions typically indicated with closed reduction or ORIF?

A

Yes, because the site usually must be protected from excessive forces

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17
Q

What’s the main cause of subtrochanteric fx?

A

Direct trauma (falls, MVA). Occur in persons under 60.

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18
Q

What’s the preferred tx of subtrochanteric fx?

A

Skeletal traction followed by ORIF - internal fixation via nail with long sideplate or an intramedullary rod (through central shaft)

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19
Q

Disease processes that lead up to hip arthroplasty?

A
  1. RA
  2. OA
  3. degenerative changes secondary to trauma, congenital deformity, or disease that attacks articular cartilage
  4. lupus
  5. cancer
  6. some medications (e.g. corticosteriods i.e. prednisone)
  7. osteoporosis
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20
Q

What are positions of instability post anterolateral hip replacement? (4)

A
  1. External rotation
  2. Adduction
  3. Extension
  4. Possibly abduction
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21
Q

How does a ct typically need to follow hip precautions post anterolateral hip replacement?

A

6-12wks

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22
Q

What can result if hip precautions are not followed?

A

Hip dislocation

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23
Q

When can ct’s begin out of bed activity post total hip replacement?

A

1-3days

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24
Q

What about weight bearing post total hip arthroplasty?

A

Most do not restrict weight-bearing postoperatively.

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25
Q

What if biologic fixation is used?

A

Restriction on weight bearing for 6-8wks post-operation

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26
Q

Weight bearing precautions with total joint surface replacements

A

no weight-bearing restrictions

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27
Q

Knee replacements - Weight bearing restrictions with cemented prosthesis?

A

Ct’s are usually able to weight bear as tolerated on the operated leg

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28
Q

Knee replacements - Weight bearing restrictions with NON-cemented prosthesis?

A

Initial weight-bearing is usually avoided for 1-3 days after surgery

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29
Q

What motion should be avoided after knee surgery? For how long?

A

Rotation for up to 12wks post surgery

Usually no restriction on bending the knee

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30
Q

What motion should be continued after surgery?

A

Bending the knee - important to maintain adequate mobility for healing

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31
Q

How is pain treated after TKA?

A

Meds, superficial cold modalities, proper positioning (use of knee immobilizer)

32
Q

What does TKA stand for?

A

Total Knee Arthroplasty

33
Q

What are common complications post LE joint replacements? (5)

A
  1. Dislocation
  2. Degeneration of parts
  3. Fx of bone next to implanted parts
  4. Loosening of parts
  5. Infection
34
Q

What is the emphasis on rehab post LE arthroplasty? (4)

A
  1. Maintaining or increasing ROM
  2. Slowly increasing strength of surrounding musculature
  3. Decreasing swelling
  4. Increasing ct independence in all occupations, especially ADLs
35
Q

What is the overall general goal of OT in LE tx?

A

Maximize ct performance skills in daily occupations with all mvmt precautions observed during activities

36
Q

What is the overall general role of the OT?

A

Teach the ct ways & meanings of performing daily occupations safely

37
Q

Specific OT Interventions for LE fx’s & replacements (overview) (3)

A
  1. Ct education (e.g. pre-surgery or fall prevention)
  2. Specific training techniques
  3. Special equipment
38
Q

Common adaptive equipment for ct’s hip LE fx or arthroplasty (11)

A
  1. Dressing stick
  2. Sock aid
  3. Long-handled sponge
  4. Long-handled shoe horn
  5. Reacher
  6. Elastic shoelaces
  7. Leg lifter
  8. Elevated toilet seat
  9. 3-in-1 commode
  10. Shower chair or bench
  11. Walker bags
39
Q

Recommended positions/procedures post HIP replacement: Bed Mobility (6)

A
  1. Supine: abduction wedge or pillow
  2. Sidelying: sleep on operated side; sleeping on non-operated side, need abduction wedge or large pillow btwn legs to prevent adduction or rotation
  3. Getting out of bed: AVOID ADDUCTION past midline
  4. Leg lifter may help move operated leg across surfaces
  5. Supine to sit: Prop self on elbows, slowly rotate to lower legs off edge of bed, maintain knee & hip extension while pushing self into sitting
  6. TIP: Always have ct observe technique before trying
40
Q

Recommended positions/procedures post HIP replacement: Chair Mobility (4)

A
  1. Firmly based chair w/ armrests is recommended
  2. Stand to sit: back up to the chair, extend operated leg forward, reach back for armrests, slowly lower into sitting
  3. Sit to stand: Extend operated leg forward, then push up on armrests (lean back)
  4. Firm cushions or blankets can be used to increase height of the chair
41
Q

What to avoid sitting on post HIP replacement?

A

Low chairs, soft chairs, reclining chairs, & rocking chairs

42
Q

What’s a helpful device for toileting post HIP replacement?

A

3-in-1 commode - can be adjusted so front legs are shorter then back, which promotes following hip precautions for posterolateral procedure (no hip flexion greater than 90 degrees)
Anterolateral precautions can most likely use reg toilet

43
Q

Hygiene & maintain HIP precautions

A

All ct’s should wipe btwn their legs in sitting position or from behind in standing position with caution not to flex hip or rotate the hip. Stand up and face toilet to flush to avoid hip rotation.

44
Q

What bathing method is prohibited post HIP replacement?

A

No taking a bath sitting on the floor of the tub!

45
Q

Recommended positions/procedures post HIP replacement: Car Mobility (5)

A
  1. Bucket seats in small cars should be avoided
  2. Move seat back as far as it will go & recline to help preserve hip precaution
  3. Ct backs up to the seat, holds onto a stable part of the car, extend operated leg, then slowly sits in the car while leaning back, then scoots toward driver’s seat
  4. Firm pillows may be needed to increase height of the seat
  5. Prolonged sitting should be avoided
46
Q

Recommended positions/procedures post HIP replacement: LE Dressing (5)

A
  1. Ct in chair w/ arms or on edge of bed
  2. NO CROSSING LEGS
  3. Adaptive equipment may be needed to observe precautions
  4. In general, dress operated leg first
  5. Education on clothing options - slip-on shoes with non-skid sole may be best
47
Q

Recommended positions/procedures post HIP replacement: Bathing (5)

A
  1. Sponge bath is indicated until surgeon ok’s showers, typically 7-10 days post surgery
  2. Long-handled bath sponge or soap-on-a-rope
  3. Towel wrapped on reacher to dry legs
  4. Hand-held shower head is recommended
  5. Ct needs help washing hair (friend or salon) or can wash at kitchen sink
48
Q

Recommended positions/procedures post HIP replacement: Homemaking general (4), specific modifications (9)

A
  1. No heavy housework initially
  2. Kitchen activities in therapy
  3. Modifications/techniques:
    a. use apron with large pockets
    b. slide items across counter
    c. utility cart
    d. bag/basket on walker
    e. fanny pack around waist
    f. reacher for low items
    g. items in frig on higher shelves
    h. no oven use (only stovetop or microwave)
    i. top level of dishwasher
  4. Energy conversation techniques
49
Q

Recommended positions/procedures post KNEE replacement: Bed Mobility (6)

A
  1. Supine = recommended
  2. Leg slightly elevated
  3. Don’t sleep on operated side
  4. Wedge or pillow btwn legs when sleeping on nonoperated side
  5. Continuous Passive Motion (CPM) machine may be used
  6. No restrictions on how to get in/out of bed
50
Q

What are precautions for TKR?

A
  1. Internal rotation at hip
  2. External rotation at hip
  3. Knee flexion greater than comfortable ROM permits
51
Q

Recommended positions/procedures post KNEE replacement: Transfers (2)

A
  1. May use same procedures as hip precautions for comfort

2. Shower chair/bench recommended for safety due to lower standing endurance

52
Q

What’s a Hemovac?

A

The plastic drainage tube & portable suction machine used post surgery for 2 days. Cannot disconnect for any activity.

53
Q

Abduction wedge?

A

Rectangular foam wedge used to maintain legs in abducted position while ct is in supine

54
Q

Balanced suspension?

A

Used for ~3 days post surgery
Balances the weight of the elevated leg by weights placed at the opposite end of the pulley systems. Supports affect LE. Can be taken out for exercise only.

55
Q

Sequential compression devices (SCDs)?

A

Used postoperatively to reduce risk of deep vein thrombosis - they are inflatable, external leggings that provide intermittent pneumatic compression of the legs

56
Q

Antiembolus hose?

A

Thigh-high hosiery that are worn 24hrs/day & removed only during bathing to assist circulation, prevent edema, & reduce risk of deep vein thrombosis

57
Q

Client-controlled administration IV?

A

Patient-controlled analgesia (PCA) via IV or Patient controlled epidural analgesia (PCEA) via epidural

58
Q

Incentive spirometer?

A

Portable breathing apparatus used to encourage deep breathing & prevent the development of postoperative pneumonia

59
Q

Continuous passive motion (CPM) machine?

A

Mechanical device support a joint & can be set to move slowly through a designated ROM to promote controlled mvm in the operated joint

60
Q

Lower Back Pain (LBP): What should the OT discuss w/ the ct? (6)

A
  1. Anatomy
  2. Pathology
  3. Back stabilization
  4. Ergonomics
  5. Body mechanics
  6. Pacing
61
Q

What must the OT plan include re: Lower Back Pain (LBP)? (4)

A
  1. Ct understanding
  2. Ct practice
  3. Ct demonstration
  4. Ct incorporating learned info into current & future occupations
62
Q

OT Interventions for Lower Back Pain (LBP) (8)

A
  1. Education re: normal back anatomy & physiology of back mvmt as they relate to perf of occ.
  2. Use of neutral spine back stabilization in occupational perf. to reduce pain
  3. Education in basic body mechanics
  4. Training in use of AE to modify tasks
  5. Task analysis/ergonomic design to modify enviro
  6. Energy conversation
  7. Use of occupations to increase strength & endurance
  8. Education in strategies for pain mgmt, stress reduction, & coping
63
Q

Key lifting positions for Lower Back Pain (LBP) (3) & key principles (2)

A
  1. Squat
  2. Diagonal lift
  3. Golfer’s lift
    KEY PRINCIPLES:
    Keep a neutral spine
    Bring items close to the body for lifting
64
Q

Principles of Body Mechanics (7)

A
  1. Maintain a straight back
  2. Bend from the hip
  3. Avoid twisting (turn around the perform activities)
  4. Maintain good posture
  5. Carry objects close to the body
  6. Lift with legs
  7. Use wide base of support
65
Q

Common AE for Lower Back Pain (LBP) (7)

A
  1. Long-handled sponges
  2. Reachers
  3. Long-handled shoe horns
  4. Sock aids
  5. Elevated commode/toilet seat
  6. Hand-held shower
  7. Footstools
66
Q

Principles of energy conservation (6)

A
  1. Plan ahead
  2. Pace oneself
  3. Set priorities
  4. Eliminate unnecessary tasks
  5. Balance activity w/ rest
  6. Learn one’s activity tolerance
67
Q

What are contraindications for ultrasound use? (9)

A 
malignant tumors
joint cement
thrombophlebitis
pregnancy
plastic components
eyes
CNS tissue
pacemakers
reproductive organs
68
Q

Who is E-Stim contraindicated for?

A

E-stim is contraindicated for patients unable to provide clear feedback regarding the level of stimulation applied.

69
Q

Post rotator cuff surgery: What can a ct do at 4 Weeks?

A

At week 4, patient starts PROM/AROM exercises beginning with gravity eliminated position positions and progress to against gravity movements.

70
Q

Post rotator cuff surgery: What can a ct do at 6 Weeks?

A

Patient start the strengthening exercises at week 6 with isometric exercises for the rotator cuff and scapula stabilization exercises.

71
Q

Post rotator cuff surgery: What can a ct do at 8 Weeks?

A

At week 8 after surgery patient progresses to isotonic exercises using Theraband and free weight.

72
Q

Post rotator cuff surgery: What can a ct do at 12 Weeks?

A

At week 12, patient can begin resistive occupational tasks (taking off jacket)

73
Q

what is a common secondary diagnosis that can decrease a patient’s grip strength post humerus fracture?

A

Radial Nerve Palsy

74
Q

Can electrical stimulation be applied to an area with active cancer?

A

NO

75
Q

What is the Intrinsic Plus Position?

A

wrist in 20-30 degrees’ extension, MCPs in 40-60 degrees’ flexion, IPs in extension and thumb in abduction

Phys Dys (6 decks)

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