Orthopedics Flashcards
What are Orthopedics Conditions?
Injuries, diseases and deformities of bones
and their related structures
What structures are involved in orthopedics conditions?
– Muscle – Tendons – Ligaments – Nerves – Fascia
What are the causes of orthopedic conditions?
Trauma from – MVAs – Falls – Sports injuries – Work • Cumulative trauma – Repetitive stress injuries • Congenital abnormality • AVN (avascular necrosis) • Tumors
How many americans fall each year?
1 in every 3 americas (65 and older)
T or F The impact from falls creates fear in clients and results in
deceased participation in daily living tasks and
independence.
True
T or F The impact from falls is very costly
emotionally, physically, and financially.
True
T or F yearly costs are over $25 billion
False $19 billion
What is the role of OT in orthopedic conditions?
Achieve maximal function of the body to restore
occupational functioning
What is included in the acute stage?
– Pain management – Decrease edema – Wound care – Positioning and alignment – Restore functioning
What is included in the Chronic Stage?
In order to restore optimal functioning
– Life style changes
– Compensation
– Use of DME/adaptive equipment
What is a fracture?
Break in the continuity of bone caused by an
external force
T or F
Fractures are structural breaks as seen on X-rays
True
T or F
Immobilization encourages motion in joints above and below
What type of exercises should be performed for mobilization?
- AROM, AAROM, PROM
– Isometric vs. isotonic
T or F
Fractures occur in healthy bones only
False
Fractures occur in healthy bone or in bone
compromised by disease
What are phathological conditions that can affect a bone?
Spontaneous fracture in a bone weakened by a
pathological condition
• Tumor
• Osteomyelitis
What causes bones to be weaken?
Bones that are weakened by osteoporosis,
osteopenia, osteoarthritis
What are the most common Osteoporosis related fractures?
• Neck of the Femur • Humerus • Distal radius • Compression – fractures of the spine
What are the different types of fractures?
• Closed vs. open • Complete vs. Incomplete • Oblique • Transverse • Comminuted • Spiral • Greenstick • Segmental – Bone piece
What is the medical management of closed reduction fractures?
– Casting
– Splinting/ bracing
What is the medical management of open reduction fractures?
– ORIF (open reduction internal fixation)
– Use of screws, plates, rods, wires
What is the medical management of external skeletal fixation ?
– Pining
– External fixator
What is the medical management of traction ?
Skin or skeletal
What factors impede healing?
- Type of injury
- Severity of injury
- Location of injury
- Premorbid health
- Smoking
- Complications during healing
What are complications of orthopedic conditions?
• Abnormal healing – Malunion—Normal time but not aligned – Delayed Union—Increase time – Non Union—Fails to heal • Infection • DVT • Phlebitis— Inflammation of veins • Vascular damage • Blood loss – decreased Hemoglobin (
What is the treatment during the Acute Stage?
• Rehab begins with MD order • Begins when patient is stable for treatment or stable enough for proposed intervention – Acute splint/edema control • Early mobilization prevents side effects: – Stiff joints, – disuse atrophy – bed sores – DVT – Pneumonia – UTI • Assessment of capabilities to complete ADL’s
What is the clinical goal of fractures?
The clinical goal is to have boney union of the
fracture
What is the OT goal of treatment?
OT goal is to reintegrate limb into function
What are some of the treatments of fractures?
Watch body alignment and postural changes
• Edema control
• Modalities
• Splinting (Static vs. dynamic)
• Scar and soft tissue management
• Controlled movement usually begins in gravity
assisted or gravity eliminated plane
• Movement may be AAROM or AROM restricted
to midrange and gradually upgraded to full ROM
• Isometric contraction of muscles whose bellies
facilitate circulation and bone healing
• PROM with active hold
• UE and Sling*
• PIN maintenance
When looking at the “whole person” what are some characteristics to keep in mind?
• Look at comorbidities
– (why did they have a fracture in the first place?)
• Ex: Vision, balance, neuropathy, weakness, cognition
• OT’s specially trained at looking the whole person and
developing client-centered interventions
• Occupational profile
– occupational history
– patterns of daily living
– values
– problems with performance and priorities
T or F Shoulder fractures are easy to treat?
False
Shoulder fractures are complex to treat because the shoulder complex has
multiple joints
What is the goal of treatment for Shoulder fracture?
– Relive pain
– restore movement
– restore muscle strength
– allow for callus formation
what are some of the treatment for shoulder fractures?
– PROM, AAROM, AROM
– edema management
– light ADL’s
T or F there is a greater risk for radial nerve damage in humeral fractures?
true
What can you do during Humeral Fracture?
May splint to protect arm:
– bivalve, sarmiento
What is involved in Phase I of humeral fracture?
Phase I:
– Positioning
– Codmen’s (pendulum) exercises
– Passive/Assistive exercise
What is involved in Phase II of humeral fractures?
Phase II:
– Active and early resistive exercises
What is involved in Phase III of humeral fractures?
Phase III:
– Advanced stretching and strengthening
– Encourage use of UE
– FWB
What are the most common types of elbow fractures?
– supracondylar
– radial head fracture
What is usually done in elbow fractures?
Usually splinted/ casted in mid range flexion 90
degrees
– Long arm splint
Define Volkmann’s Ischemia
Edema collecting in compartment/fascia presses radial
artery
T or F
In Elbow fractures PROM is preferred over AROM
False, Active ROM preferred over PROM
T or F
Elbow extension and forearm supination are usually the
most difficult motions to achieve
True
What is a Colle’s Fracture?
Colle’s fracture (distal radius fracture)
– Casted above elbow
– Progress to forearm splint
T or F
Scaphoid fracuture are the most common wrist fractures
True
Scaphoid Fracture common fracture of the carpal
bone 60 percent of carpal fractures
– Casted with thumb included
What should you watch for when treating forearm/wrist/hand fractures?
Watch for development of guarded shoulder
motions, poor posture and excessive pain to
avoid CRPS and frozen shoulder
T or F
Hip fractures are very common in adults 55 and over
True
T or F
Hip fractures are more common in men than women till age 75
False
More common in women than men till age 75
T or F
Hip fractures might have weight bearing precautions
True
What procedure will be needed if hip fracture is severe?
Total Hip Replacement
T or F
Individuals with hip fractures fear falling
True
what is WBAT?
Weight Bearing as Tolerated
What is TTWBT?
TTWB-Toe touch weight bearing—10%
What is PWB?
PWB-Partial weight bearing—25-30%
What is NWB?
NWB-Non weight bearing—0 %
What is FWB?
FWB-Full weight bearing—100%
What are some medical equipment used for weight bearing?
Use of durable medical equipment to limit weight
on extremity
– Walkers, crutches, platform walkers, cane
How many weeks is Callus visible in fracture healing?
2-3 weeks UE and LE
How long does Union take in fracture healing?
4-6 weeks UE and 8-12 LE
How long does consolidation take during fracture healing?
6-8weeks UE and 12-16 LE
What are the two main categories of Arthritis ?
- Rheumatoid (RA)
* Osteoarthritis (OA)
T or F
Over 100 types of arthritis have been
documented
True
What is an Autoimmune disease process characterized by inflammation of the lining of the synovium of the joints
Rheumatoid Arthritis
What are the long term damages that Rheumatoid Arthritis can have?
Can lead to long term damage resulting in chronic pain,
swelling, fatigue, weight loss, fever and loss of function
of the joints
What are the two forms of RA?
– Adult RA (onset usually ages 30-50)
– Juvenile RA (onset usually toddler)
What is the diagnosis of RA?
• Prolonged morning stiffness • Arthritis of three or more joint areas • Hand joint involvement • Symmetric arthritis • Rheumatoid nodules • LAB values: – ESR – ‘sed rate’ markedly increased – Serum rheumatoid factor positive • Radiographic changes of wrist/ hand
T or F
The cause of RA is unknown and there is no cure
only treatment (not fully understood)
True
T or F
Females have an increased risk of having RA
True
What are the three stages of progression of RA?
Progresses in three stages:
1. Swelling of the lining causes warmth, pain
stiffness, and redness around the joint
2. Rapid division and growth of cells or pannus
which causes synovium to thicken
3. Inflamed cells release enzymes that may digest
bone and cartilage often causing deformity,
increased pain and loss of joint mobility
If RA is diagnosed early what are its advantages?
• Limits damage and can help maintain joint
alignment
• Limits loss of movement secondary to joint
contractures
• Increases the likeliness they will remain
working
• Decreases medical costs
• Decrease need for surgery
What are the joints most commonly involved in RA?
Wrist, MCP, PIP/DIP, Elbow, Metatarsalphalangeal, TMJ
What does RA cause in the wrist?
changes in the synovium, ligament laxity, and
cartilage degradation
What does RA cause in the MCP joint?
ulnar deviation
What does RA cause in the PIP/DIP joints?
– Swan neck deformities
– Boutonniere deformity
– Nalebuff deformity (CMC of thumb)
What does RA cause in the elbow joint?
– creptis
– nodules
What does RA cause in the Metatarsophalangeal
joint?
Creptis
What does RA cause in the TMJ joint?
clicking/ popping
What is the medical management of RA?
• NSAID’s • Glucocorticoids • Disease-modifying antirheumatic drugs (DMARDs) • Pain management • Control of systemic complications
What is the classification of Functional Capacity in RA
• Class I: Complete function
– can carry on usual duties without handicaps
• Class II: Adequate function
– able to conduct normal activity despite handicap or
discomfort or limited mobility in one or more of joints
• Class III: Incomplete function
– performs only a few or none or usual occupations
• Class IV: largely incapacitated, bedridden or
confined to w/c
What is osteoarthritis (OA) ?
An inflammatory response characterized by the breakdown of the joint’s cartilage causing the bones to rub against each other, causing pain and loss of movement
T or F
OA is a Degenerative Joint Disease?
True
OA is the oldest and most common form of arthritis
True
T or F
OA is most common in young individuals
False
Most common in middle aged or older adults
T or F
OA is most common on Hand and weight bearing joints
True
What is the OA Diagnosis?
• Brief morning stiffness • Unilateral joint involvement • LAB values: – ESR ‘sed rate’ mild- moderately increased – Serum rheumatoid factor negative
What are the characteristics of the etiology of osteoarthritis ?
- Age
- Heredity
- Obesity-(knees and hips)
- Muscle weakness
- Injury and overuse-sports
- Occupations
- Nerve injury/ vascular disease process
What does OT treatment involve for RA and OA ?
• Occupational profile – COPM • Rage of Motion – goniometer • Joint alignment/Deformity • Strength – Manual Muscle testing * • Pain – Pain scales • Wong • Visual Analog scale
What assessments are used for RA/OA?
• Activity tolerance – Time • Functioning (UE based assessments) – Moberg pick up test – 9 hole peg test – Purdue peg board test – Jebsen Test of Hand function – MAM-16 – MRMT
What are the OT interventions for RA/OA?
• Patient and Family Education • Joint protection and work simplification • Fatigue management • Maintain joint mobility – Tai chi programs • Strengthening • Modify the environment • Recommend assistive devices
What are the joint protection principles?
• Respect pain
• Maintain muscle strength and joint mobility
• Use each joint in its most stable plane
• Avoid positions of deformity
• Use the largest/ strongest joint group for the job
• Frequent rest breaks
• Reduce the force (friction, leavers, simple
machines)
What are examples of Work Simplification?
• Rolling carts • Prepared foods – salads/ precut veggies/meats • Sit vs. standing • Smaller containers – gallon of milk vs. pint • With easy open lids – medication bottles
T or F
Splints work when they improve function and
reduce the pain of the patient
True
What are some examples of splints?
• Silver ring splints • Resting hand splints for PM • Wrist cock-up splint • Specific function splints – example: typing splint, walker splint
What are two types of joint replacements ?
• Common types of joint replacements
– Total Hip arthoplasty (THA) and (THR)
– Total Knee arthroplasty (TKA) and (TKR)
What are the least common joint replacements?
– Disc replacement
– Total ankle arthroplasty
– Total Shoulder arthroplasty
What is a joint replacement?
Typically an elective surgery to replace the
damaged joint
What are failed conservative methods?
– Medication management – Cortisone injections – Hyaluronate injections – Nutritional supplements (Glucosamine and chondroitin) – Lose weight – Exercise
What are the typical precautions in Hip replacement?
– No hip flexion beyond 90 degrees – No rotation • No internal rotation of the hip with posterior lateral approach • No external rotation of the hip with anterior lateral approach – No crossing legs (adduction) – Use of abduction pillow when in bed
What equipment is used for THR?
• Treatment includes use of adaptive equipment and DME • Bathing – Long handled sponge, tub bench • Dressing (LE) – Reacher, sock aide, long handle shoe horn • Bed mobility • Functional mobility – Use of rolling walker • Transfers ( may need raised height) – tub, chair, bed, commode, car
T or F
Precautions for knee replacement depend on the surgeon
True
T or F
Mobility is not important up and out of bed
(OOB) day of surgery or post op day one for knee replacement
False
Mobility is very important up and out of bed
(OOB) day of surgery or post op day one
T or F
Place a towel under knee after knee replacement surgery
False
Work on end range knee flexion and extension
– Never place towel under knee
What are the advancements of knee replacement?
• Otis Knee (custom fitted hardware)
– MRI prior to surgery molds of knee are formed
and custom ‘jigs’ are made for a more precise fit
• Unilateral knee/partial knee
– Need to have ligaments intact
• Protocols vary by institution some are more
aggressive than others
– Goal is now to get patient directly home vs. going
to rehab (typically a SAR)
What are the OT interventions on Hip/Knee Replacement surgeries?
• Education on Hip or Knee precautions • ADL’s • Energy conservation • Strengthening exercises (develop routine) – Glut sets, quad sets, ankle pumps, knee extension • Pain management • AE and DME • Fall prevention • Home planning (environmental context)
