Week 10 - Peripheral Vascular Disease and Amputations

Question 1

What is peripheral arterial disease (PVD)?

Answer 1

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.

Question 2

What are risk factors of PVD?

Answer 2

Smoking, older age, diabetes, high cholesterol, high blood pressure, heart disease and stroke.

Question 3

What is the major cause of death of people with PVD?

Answer 3

Coronary heart disease

Question 4

What is PVD also known as?

Answer 4

Arteriosclerosis obliterans
Arterial insufficiency of the legs
Claudication
Intermittent claudication

Question 5

What caused PVD?

Answer 5

Fatty deposits or plaques build up along the walls of the arteries carrying blood to the arms and legs

Question 6

What are the symptoms of PVD?

Answer 6

• Reduced hair growth
• Cramps
• Colour changes in skin
• Sores on legs and feet that do not heal promptly
• Burning or aching in the feet at rest
• Intermittent claudication

Question 7

What is intermittent claudication?

Answer 7

Intermittent pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest.

Question 8

What is claudication?

Answer 8

Pain, commonly in the legs, caused by too little blood flow, usually during exercise. Often indicates peripheral artery disease.

Question 9

How is PVD diagnosed?

Answer 9

Physical examination
Comparing ankle blood pressure with the BP of the arm (Ankle Brachial Index)
Angiography
Magnetic resonance angiography
CTA
Blood tests

Question 10

How is PVD treated?

Answer 10

Quit smoking
Exercise regularly
Eat healthy diet
Medications
Vascular surgery and angioplasty
Amputation

Question 11

What are medications used for in PVD?

Answer 11

To reduce blood viscosity
Destroy platelets causing blockage
Lower Cholesterol

Question 12

What is the prognosis of PAD?

Answer 12

If diagnosed early, most cases of PAD will respond to lifestyle treatments

Question 13

What are the complications of PAD?

Answer 13

Tissue death - amputation
Impotence
Pain
Reduced mobility
Wounds
Infections
Heart attack
Stroke

Question 14

What are the 4 causes of upper limb amputation?

Answer 14

Trauma - 60%
Neoplasm (tumour) - 13%
Vascular - 6%
Infection - 5%

Question 15

What are the 4 causes of lower limb amputation?

Answer 15

Vascular - 70-85%
Trauma - 22-24%
Neoplasm - 4-4.5%
Congenital - 26 per 100,000 infants

Question 16

What is the highest cause of upper limb amputation?

Answer 16

Trauma

Question 17

What is the highest cause of lower limb amputations?

Answer 17

Vascular

Question 18

What is a partial foot amputation?

Answer 18

Distal to ankle joint

Question 19

What is a transtarsal amputation?

Answer 19

Through the tarsus or foot bones

Question 20

What is an amputation at the ankle joint called?

Answer 20

Ankle disarticulation

Question 21

What is a Syme’s amputation?

Answer 21

Amputation at the ankle joint with the fatty heel pad retained for cushioning

Question 22

What is an amputation between the knee joint and ankle joint called?

Answer 22

Trans-tibial amputation

Question 23

What is a knee disarticulation?

Answer 23

An amputation at the knee joint

Question 24

What is a trans-femoral amputation?

Answer 24

An amputation between the knee and the hip

Question 25

What is an amputation at the hip leaving the pelvis intact called?

Answer 25

Hip disarticulation

Question 26

What is a trans-pelvic amputation?

Answer 26

Amputation of the lower limb together with all or part of hemipelvis

Question 27

What is a fingers or partial hand amputation?

Answer 27

Distal to the wrist joint

Question 28

What is wrist disarticulation?

Answer 28

Amputation at the wrist joint

Question 29

What is an amputation between the elbow and wrist joint called?

Answer 29

A trans-radial amputation

Question 30

What is an elbow disarticulation?

Answer 30

Amputation at the elbow

Question 31

What is a trans-humeral amputation?

Answer 31

Amputation between the elbow and shoulder joint

Question 32

What is an amputation at the shoulder joint called?

Answer 32

Shoulder disarticulation

Question 33

What is a forequarter amputation?

Answer 33

An amputation at the scapulo-thoracic & sternoclavicular joints

Question 34

What are the primary impairments of amputation?

Answer 34

Loss of part of a limb Loss of part or all of support ambulation Motor loss Sensory loss - light touch, pressure and proprioception

Question 35

What are secondary impairments/co-morbidities of amputation?

Answer 35

``` Contractures Weakness Deconditioning Pain - surgical, scar, phantom, musculoskeletal Other foot compromised by PVD ```

Question 36

What is preoperative care for amputation?

Answer 36

Psychological preparation Increase strength and flexibility Increase cardiovascular fitness Management of pain

Question 37

What is immediate post-op care for amputation?

Answer 37

Care of wound | Residual limb care – bandaging to shape the residual limb for prosthesis

Question 38

What is mirror box?

Answer 38

Mirror therapy or mirror visual feedback is a therapy for pain or disability that affects one side of the patient more than the other side.

Question 39

How do you prepare amputations for prosthesis?

Answer 39

Residual limb care – Pressure sock 24 hours/day (‐shower time) - Care of scar area - massage and mobilise scar area, desensitisation Strength, flexibility and fitness specific to prosthetic use Interim prosthesis - Don & Doff socks & prosthesis - Standing in prosthesis, gait training, functional retraining - Adjustments/modification of prosthesis Psychological support

Question 40

What are 2 types of lower limb prosthesis?

Answer 40

Above the knee and foot prosthesis

Question 41

What are 3 types of upper limb prosthesis?

Answer 41

Cosmetic/passive Mechanical (cable controlled) Myoelectric