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1
Q

Definition and symptoms of peripheral neuropathy

A

-Peripheral neuropathy affects about 20 million people in the US
-Develops from damage to the peripheral nervous system
Symptoms: range from numbness/tingling, paresthesia (prickling sensation/pins + needs), muscle weakness
-pain, allodynia -may affect internal organs (autonomic system: digestion, urination, etc.)
-may lead to paralysis, muscle sweating, organ dysfunction and failure

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2
Q

Possible causes of peripheral neuropathy

A

Physical injury/trauma

  • repetitive stress
  • cumulative damage from repetitive use
  • compression injury or entrapment neuropathies

Diseases or disorders

  • metabolic, endocrine (diabetes mellitus, hypothyroidism, etc.)
  • autoimmune disease (lupus, rheumatoid arthritis, Sjogren’s system, etc.)
  • others: kidney disease, cancer, neuromas, infections, toxins, alcohol abuse, etc.
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3
Q

Types of Peripheral Neuropathy

A

Mononeuropathy- damage to a single peripheral nerve (median nerve in CTS)
Polyneuropathy- involves multiple nerves throughout the body; malfunctions at the same time
-e.g., Guillain-Barre syndrome, diabetic neuropathy, Charcot-Marie-Tooth disease

Parts of the nerve may be damaged
-axonal damage, myelin sheet damage, both
Types of nerves may be damaged
-motor nerve damage
-sensory nerve damage
-autonomic nerve damage
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4
Q

Brachial Plexus injury (definition, causes, types)

A

Brachial plexus- network of nerves that originate in the cervical region
Branches form most of the other nerves in the upper limbs, including the shoulder
Radial, median, and ulnar nerves originate in the brachial plexus

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5
Q

Brachial Plexus Injury Causes

A

Brachial plexus injury (BPI)- an umbrella term for a variety of conditions that impair the brachial plexus nerve network; majority of injuries caused by trauma

Causes include:

  • high-speed vehicular accidents, motorcycle -blunt trauma
  • stab/gunshot wounds -inflammatory process (brachial plexitis)
  • compression -neuropathies
  • obstetric brachial plexus palsy
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6
Q

Brachial Plexus Injury types: Avulsion

A

nerve has been pulled out from the spinal cord and no chance to recover

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7
Q

Brachial Plexus Injury types: Rupture

A

nerve has been stretched or partially torn, but not at the spinal cord

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8
Q

Brachial Plexus Injury types: Neuropraxia

A

nerve has been stretched or compressed but is still attached (not torn) and has excellent prognosis but rapid recovery (transient)

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9
Q

Brachial Plexus Injury types: Axonotmesis

A

axons have been severed; prognosis moderate

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10
Q

Brachial Plexus Injury types: Neurotmesis

A

entire nerve has been divided; prognosis very poor

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11
Q

Definition of soft tissue injury

A

Soft tissue injury generally refers to musculoskeletal tissue other than bone
-Includes muscle, blood vessels, ligaments, tendons, cartilage, skin, etc.

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12
Q

contusions caused by…

symptoms?

A

sudden forceful muscle injury caused by an impact of a blunt object or force

symptoms: history of blunt trauma weakness and/or pain to muscle group
- tightness/swelling of muscle
- inability to fully flex muscle
- palpable hematoma in muscle tissue

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13
Q

strains

A

muscle-tendon unit; “pulled muscle”

  • caused by pulling or twisting injury, overuse/overstressed from heaving lifting or exertion, or by sudden stretch of a contracting muscle
    symptoms: pain, muscle spasms, muscle weakness, stiffness, swelling and local tenderness
    prevention: proper stretching, warm up, avoid over exertion
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14
Q

sprains involve the? are caused by? result in? symptoms?

A

involves the joint ligament and capsule; caused by excessive move of the joint, resulting in torn or stretched ligaments
symptoms: pain, rapid swelling, tenderness, discoloration, limited joint movement

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15
Q

elbow injuries

A

olecranon fracture- removeable cast for 3-6 weeks, depending on fracture and repair
ROM starting in the 1st week, CPM (continuous passive movement)
progressive strengthening program
precautions: no lifting or carrying with involved arm or driving until healed (6 weeks)
Progressive lifting and carrying after 6 weeks

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16
Q

lateral epicondylitis

A

“tennis elbow”
overuse or cumulative trauma, wear & tear, but can occur without injury
ECRB (extensor carpi radialis brevis) tendon inflammation and pain
common overuse syndrome between ages 30-50
symptoms: pain to lateral epicondyle area when gripping, weak grip;
worse with hand and forearm activity, and gripping

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17
Q

wrist injuries

A

wrist sprains & scaphoid- scaphoid is a retrograde blood supply; 70-80% of blood supply comes from the dorsal carpal branch of the radial artery; 20-30% of total supply come from the palmar and superficial palmar branches (radial artery) & doesn’t reach the proximal pole

Scaphoid fracture- blood flow characteristics present a problem w/ a scaphoid fracture
-with blood flow disruption, healing can be slow or not heal at all

Signs: presents with deep, dull pain in the radial side of the wrist usually worsens with gripping/squeezing
Swelling is typically present and bruising is visible
-tenderness to palpation of anatomical snuffbox

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18
Q

Shoulder Injuries: dislocation

A

anterior dislocation accounts for 95% of cases

Displaced joint, usually the result of a traumatic injury (forced out of socket)
may involve injury to nerve and blood vessels
May need x-ray for diagnosis

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19
Q

AC-joint injury

A

types 3-6; deltoid and trapezius muscles detached

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20
Q

chronic shoulder instability

A

shoulder is the most moveable joint in your body, and because of that, one of the most unstable
injury may not be complete dislocation, partial dislocation is called subluxation
once the ligaments, tendons, and muscles around the shoulder become loose or torn from repeated injury, dislocations can reoccur

Chronic shoulder instability is the persistent inability of these issues to keep the arm centered in the shoulder pocket

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21
Q

Shoulder bursitis/rotator cuff tendonitis/impingement syndrome treatment

A

occurs when the bursa and rotator cuff tendons are inflamed
often result of injury that set off inflammation

Symptoms: shoulder pain with overhead activities, at the lateral/superior aspect, catching/grating when arm is raised or rotated

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22
Q

rotator cuff tear

A

result of injury, chronic tendinopathy, or a combination of both
If a tear is suspected, ultrasound or MRI is usually recommended to confirm the tear
Initially, smaller tears are treated conservatively, with rest, ice stretching, and strengthening exercises

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23
Q

Dupuytren’s disease

A

abnormal thickening of the fascia tissue in the palm, can extend to the fingers

  • characterized by firm pits, nodules, and cords that may pull the fingers into flexion at the MP joints
  • tendons not involved, may involve skin
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24
Q

Boutonniere deformity

A

caused by forceful blow to bent finger (jammed finger)

  • rupture of central slip causes the extrinsic extension mechanism from the extensor digitorum communis (EDC) to be lost
  • prevents extension at the PIP joint
  • weakening of triangular ligament causes intrinsic muscles of the hand (lumbricals) to act as flexors at the PIP joint
  • lumbricals also extend the DIP joint without an opposing or balancing force
  • palmar migration of collateral bands and lateral bands causes lumbricals pull to become unopposed
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25
Q

Skier’s (snow)/ Gamekeeper’s thumb

A

injury to the ulnar collateral ligament of the thumb MP joint

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26
Q

fractures

A

may be simple, aligned and stable
other fractures are unstable and the bone fragments tend to displace/shift

Comminuted fractures (bone is shattered into many pieces) usually occur from a high energy force and are often unstable

Open (compound) fracture occurs when a bone fragment breaks through the skin; there is some risk of infection with compound fractures

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27
Q

may be a family trait and harmless, but if it develops, it may be associated with lung disease -inflammatory bowel disease -heart disease -liver disease -AIDS

A

Clubbing

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28
Q

associated with; cardiovascular disease, collagen vascular disease, prednisone use, cardiac failure, COPD, etc.

absent lunula may indicate…

A

red lunula

anemia or malnutrition

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29
Q

may be a sign of:

-anemia -congestive heart failure -liver disease -malnutrition

A

pale nails

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30
Q

may indicate

-Raynaud’s disease, respiratory disorders, cardiovascular disorders

A

bluish nails (cyanosis)

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31
Q

associated with bacterial endocarditis (heart valve infection), trauma, mitral stenosis, vasculitis, cirrhosis, scurvy

A

splinter hemorrhage

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32
Q

painful, red and swollen nail fold, or skin that surrounds nail

  • may be acute, few hours
  • or chronic, more than 6 weeks
  • infection, injury or irritation
  • eczema or psoriasis
A

paronychia

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33
Q

nail bed bleeds (injury), under nail creating a hematoma (blood outside BV)

-fractures of the fingertip ( tuft fracture) usually heal by rest (splint may be needed)

A

crushed fingertips- Subungual hematoma

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34
Q

sudden pull on a finger ring, results in severe soft tissue injury ranging from circumferential soft tissue laceration to complete amputation
-skin, nerves, vessels are often damaged

A

ring avulsion injury

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35
Q

Tendon Repairs

A 
1) zones: Zone 1 – 5 
zone 1: tips of fingers
zone 2: no man’s land
Zone 3: lumbrical origin 
Zone 4: carpal tunnel
zone 5: proximal to carpal tunnel

2) type of splint used for flexor tendon repair= dorsal block splint (slide 12/31)

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36
Q

Rotator cuff:

A

arthroscopic repair- benefits of arthroscopic surgery vs. traditional surgery

  • surgical repair of the torn rotator cuff which often involves reattaching the tendon to the head of humerus
  • a partial tear, however, may need only a trimming or smoothing procedure

arthroscopy can assess and treat damage to other structures within the joint:

  • bone spurs are often removed arthroscopically
  • no need to detach deltoid muscle with mini-open repair
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37
Q

Fractures fixations

A

Internal fixation- to stabilize a long bone fracture, a plate and screws outside the bone or a rod inside the bone may be used

External fixation- screws are placed into the bone above the fracture, and a device is attached to the screws from outside the skin, where it may be adjusted to realign the bone

38
Q

involves replacing the ball portion of the hip joint, not the socket portion

A

Hemiarthroplasty

39
Q

replaces the acetabulum and femoral head

A

THA

40
Q

THA indications

A

Dull ache pain to groin and buttock areas

  • pain especially at night is the principal indication
  • post op relief as early as 1 week

Functional Limitations
-walking and walking upstairs becomes difficult
-bending at hips, putting on shoes, pedicure, etc.
Stiffness- hip stiffness
-ankylosing spondylitis: abnormal stiffening of the joint due to the bones can leave patients with tremendous functional disability in the absence of pain
Age- most hip replacements performed in patients between 60-80 years old
Radiographic image- severity of radiographic changes of arthritis within the hip joint may or may not be an indication
-severity of symptoms a more important indicator

41
Q

principal indication of THA

A

pain esp at night

42
Q

Torn ACL Mechanism of Injury

A

Typically torn in noncontact deceleration that produces a valgus twisting injury
e.g., when landing on the leg and quickly pivoting in the opposite direction
Other forces can disrupt ACL with minimal injury to other structures
-hyperextension
-marked internal rotation of tibia on femur
-pure deceleration

43
Q

ACL gender differences

A
  • rate of ACL injury 2-8x higher in females than males
  • patellofemoral pain, instability, and arthritis

women have a narrow intercondylar notch width and wider Q angle ( a risk factor for patella subluxation)

44
Q

Types of ACL Injury

A

Grade 1 sprain- mildly damaged, slightly stretched, but still stabilize

Grade 2 sprain- stretched n loose “partial tear”

Grade 3 sprain- most common, complete tear to 2 pieces, unstable

45
Q

Meniscus Tears

A

Function: shock absorber, helps optimize force across the knee
-protects the cartilage at the end of the femur
Meniscus Tears- causes:
-squat, wisting, and tackle (direct force on knee)
-older ppl have degenerative meniscus tears
-cartilage weakens and wears thin over time

46
Q

Hip Fractures

A

femoral neck
intertrochanteric
subtrochanteric fractures

47
Q

femoral neck hip fractures

A

fractures of the femoral neck can entirely disrupt the blood supply to the femoral head

  • resulting in major healing complications such as fracture nonunion or avascular necrosis
  • or death of femoral head bone tissue
48
Q

intertrochanteric fractures

A

extrascapular

  • involve bone with good local blood supply
  • however, complicated by the pull of muscle attachments, which can pull fracture out of alignment
  • healing complications may include; shortening of the length of the femur or malunion
49
Q

subtrochanteric fractures

A

blood supply to subtrochanteric region not as good as the intertrochanteric region

  • heals more slowly
  • subject to competing muscular forces on the femur that tend to pull the fractured fragments out of alignment
50
Q

Late stage deformities of the hand associated with RA:

A
  • boutonniere deformity of thumb
  • ulnar deviation of metacarpophalangeal joints
  • swan-neck deformity
  • bone erosion and displacement
51
Q

Difference between osteoarthritis and RA:

A

Osteoarthritis- bone ends rub together & thinned cartilage
RA- bone erosion & swollen inflamed synovial membrane, autoimmune

52
Q

Pharmacological Treatment of RA:

A

3 classes of drugs commonly used

1) NSAIDS
2) Corticosteroids
- both have short onset of action
3) DMARDs- takes weeks or months to demonstrate clinical effect

53
Q

Types of debridement:

A
  1. Autolytic- body’s own healing process to remove tissue – moist dressing
  2. Enzymatic- chemical enzymes, such as ointment, to help slough off dead tissue- ointment- can strip away healthy tissue
  3. Surgical- surgical removal of dead tissue
  4. Mechanical- wet to dry dressing regularly changed- can strip healthy tissue away
  5. Maggot- using larvae to remove dead tissue
54
Q

most common type of chronic wound

A

ulcers

55
Q

Arterial Ulcers (poor blood supply!)

A

-poor delivery of nutrient-rich blood to the lower extremities
ex) hypertension, atherosclerosis (plugging) and thrombosis (clotting)
-where reduced blood supply leads to an ischemic state
Usually involve full thickness skin
-having a punched-out appearance with smooth edges
In some cases, ischemia (poor circulation to area) is present

56
Q

Venous Ulcers

A

account for more than half of ulcer cases, especially in lower limbs
-as associated with deep vein thrombosis, varicose veins and venous hypertension
Venous ulcers can lead to stasis- stoppage or slowdown of blood flow
shiny smooth skin w no hair
superficial, shallow and irregularly shaped with pain and edema

57
Q

Diabetic Ulcers

A

common complication is uncontrolled diabetes mellitus
-resulting in impaired immune function, ischemia, neuropathy, which can eventually lead to ulceration

Origin can be neuropathic (secondary to nerve damage)

  • where lack of sweat makes the skin dry forming callus
  • callus area can eventually form into an ulcer
58
Q

Pressure/Decubitus Ulcers

A

constant pressure and friction resulting from body weight over a localized area for prolonged duration
-can lead to breakage of skin and ulceration (bed sores)
Especially on back, ankles and feet

59
Q

Superficial burn

A

superficial/epidermal burn (first-degree)

-painful

60
Q

Superficial Partial-thickness burn

A 
superficial dermis (second-degree)
-painful to temperature, air and touch
61
Q

Deep Partial-thickness burn

A

all of epidermis and some of dermis (second-degree)

-painful to pressure only

62
Q

Full-thickness Burn

A

all of epidermis and all of dermis

-deep pressure only

63
Q

Deeper Injury

A

fascia and or muscle (fourth-degree burns)

-deep pressure

64
Q

A gold standard temporary skin substitute is

A

cadaver allografts (cells are alive or viable)- 4 weeks

65
Q

skin from a different species (pig)

A

Skin Xenografts (heterograft):

66
Q

Skin Substitute vs Skin Replacement

A

skin replacement: a tissue or graft that permanently replaces lost skin with healthy skin
Autograft (graft of tissue from one point to another of the same person’s body)
Allograft (tissue from the same species- can be from a cadaver, living related or unrelated donor)

skin substitute: a biomaterial, engineered tissue or combination of materials and cells or tissues that can be substituted for skin

67
Q

Most common cause of limb loss:

A 
-Dysvascular related amputations 
Amputation levels:
1. interscapulothoracic
2. Shoulder disarticulation 
3. transhumeral (above elbow)
4. Elbow disarticulation 
5. transradial (below elbow)
6. wrist disarticulation 
7. transcarpal (partial hand)
8. finger amputations
68
Q

No prosthesis

A
  • bad first experience -unnatural look -reactions from others
  • development of one-handedness -financial concerns
69
Q

Advantages: cosmetic, lightweight, simple, inexpensive, little maintenance
Disadvantages: no active prehension, limited function, decreased durability

A

Passive Functional/Cosmetic

70
Q

Advantages: heavy-duty construction , proprioception, less expensive, light in weight
Disadvantages: grip force is limited, ROM is limited, harness is uncomfortable, poor cosmesis

A

Body powered/conventional

71
Q

Advantages: greater functional envelope, increased cosmesis, greater grip force
Disadvantages: increased cost and maintenance, increased weight, battery

A

Myoelectric/ External Power

72
Q

Advantages: greater functional envelope, reduced weight, greater grip force, reduced harness system
Disadvantages: control harness typically required, increased weight on harness

A

Hybrid

73
Q
  • customized for a specific function or activity

- recreational and adaptive terminal devices (TD’s)

A

Adaptive

74
Q

what has great grip force?

A

myoelectric and hybrid

75
Q

no active prehension, limited function, decreased durability is found in?

A

passive functional/cosmetic

76
Q

Stages of cancer & meaning of each stage

A 
Based on size and if it has spreads
Used in research and treatment
Cancers are staged when they are first diagnosed
Stage does not change as cancer progresses
TNM:
Tumor size
Nodal involvement
Metastasis

Stages: 0-IV

77
Q

most common type; occurs when heart is working harder than usual
-has a regular pattern

A

stable angina

78
Q

doesn’t follow a pattern; may occur more often and be more severe than stable angina

  • can occur with or without physical exertion, often when sleeping/resting, surprise
  • rest/medicine may not relieve pain; very dangerous
  • a sign heart attack may happen soon
A

unstable angina

79
Q

rare; spasm in coronary artery

  • occurs while at rest at night, severe pain
  • medicine works
A

variant (Printzmetal’s)

80
Q

can be more severe and last longer than other types

-medicine may not relive this type of pain

A

microvascular

81
Q

aka heart disease;

  • coronary arteries supply heart with nutrients an oxygen by circulating blood
  • these arteries can become damaged or diseased
  • damage may be related to atherosclerosis; hardening of arteries or buildup of plaque
  • may cause heart attacks, ischemic strokes, heart failures, arrhythmias
A

Coronary artery disease

82
Q

to heart muscle due to lack of blood to heart

  • occur as a result of coronary heart disease
  • plaque can rupture, causing a blood clot to form
  • large enough clot can completely block coronary artery
  • if not treated quickly, affected portion of heart muscles begin to die
A

Heart attacks

83
Q

heart can beat too fast or too slow or irregular rhythm
too fast= tachycardia
too slow= bradycardia
Symptoms: feeling faint, light-headed, shortness of breath, chest pain, palpations
causes heart disease, infections/fever, physical/emotional stress, drugs
Two Types:
1. ventricular: starts from heart’s ventricles
2. Supraventricular: starts outside or above the ventricles (atrial fibrillation)
Atrial Fibrillation (AF or AFib)
“fibrillate” = contract very fast and irregularly
AFiB can increase the risk of forming blood clots leading to strokes, or heart failure because of blood pools in the atrium
-cause chest pain or heart failure

A

Heart arrythmias

84
Q

Heart suddenly and unexpectedly stops beating

  • an electrical malfunction of the heart
  • results in sudden cardiac death
  • not the same as a heart attack:
  • HA occurs if blood flow to the heart muscle is blocked
  • during HA, heart doesn’t stop beating
  • SCA may occur after heart attack
A

Sudden Cardiac Arrest (SCA)

85
Q

birth defects, age-related changes, infections, or other conditions cause one or more heart valves to not open fully or close; blood leaks back into the heart
-congenital heart valve disease: valves don’t form properly
many people do not have symptoms until older
3 types:
-regurgitation: (backflow) occurs if a valve doesn’t close tightly
-stenosis occurs if the flaps of a valve thicken, stiffen or fuse together
-atresia occurs if a heart valve lacks an opening for blood to pass through

A

Heart Valve Disease-

86
Q

heart failure; form of cardiovascular disease that results in decreased ability of the heart to pump blood forward or the ability to fill the heart with blood in a cyclical manner

  • if heart fails to pump blood out of arteries to vital organs, those organs will be damaged
  • fluid will start to collect in the lungs= shortness of breath & loss of good air exchange that leads to tissue damage
A

Congestive heart Failure

87
Q

Electrocardiogram (EKG/ECG)
-measures electrical activity of the heartbeat, with each beat an electrical “wave” travels through the heart
Holter Monitoring or Ambulatory ECG or Ambulatory EKG
-documents and describes abnormal electrical activity in the heart during daily activities to help doctors determine the condition of the heart
Chest X-Ray
-determines whether the heart is enlarged or if fluid is accumulating in the lungs as a result of the heart attack
Echocardiogram (echo)
-device place on the chest that uses ultrasound to produce images of heart
Cardiac tomography (CT/CAT scan)
-diagnostic-imaging tests to gather images of the heart
-creates 3D images that can show blockages caused by calcium deposits in coronary arteries
Exercise Stress Test
-treadmill test to monitor heart function while walking on a treadmill
-HR, breathing, BP and how tired you become when exercising
Cardiac Catheterization

A

Heart Disease Diagnostics

88
Q

AED- what is it used for?

A

Automated defibrillator- portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation
-delivers electrical shock to the heart to restore its normal rhythm

89
Q

percutaneous coronary intervention
-is a procedure used to open clogged heart arteries by inserting and inflating a tiny balloon to the clogged artery to widen the artery
Often combined with permanent placement of a small wire mesh tube (stent) to help prop artery open and decrease the chance of it narrowing again

A

Coronary Angioplasty

90
Q

Open chest surgical procedure- one or more blocked coronary arteries are bypassed by a blood vessel graft
-restores blood flow to the heart

A

Coronary Artery Bypass Surgery (CABS)

91
Q

Generally, once it’s determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement:

  • valve repair preserves the patient’s valve and leaflets
  • repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation
A

Heart Valve Disease Treatment

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