week 13 Flashcards
protective orthosis
offers proper positioning, is lightweight, and may be removed for hygiene
used in the treatment of flexor and extensor repairs in the hand and forearm
a dynamic wrist and MCP
extension orthosisextension orthosis
will promote grasp/release and normal movement patterns
while awaiting nerve return
Static
Does not have movable parts and is usually designed to protect, restrict motion, and provide proper positioning
Static progressive
Uses inelastic parts to position a joint at the available end ROM
with the intent of improving passive range of motion (PROM).
Dynamic
Has movable or elastic parts and is used to improve motion,
provide controlled motion, or compensate for loss of motion
Static Principles
For fractures, one joint above and one joint below the injury
should be stabilized to restrict motion at the injured joint
Static Progressive Principles
A static progressive orthosis is used for
▪Decreasing joint stiffness
▪Improving PROM
▪ Static progressive splinting is now considered more advantageous
compared with dynamic splinting for improving ROM
Dynamic Principles
to improve motion,
provide controlled motion, or compensate for loss of motion.
▪Requires a solid base with an outrigger
High-profile outriggers
are attached to the orthosis; however, they are designed to come up and away from the splint to ensure the proper angle of pull during mobilization.
Low-profile outriggers
also ensure the proper angle of pull; however, they tend to be smaller and are designed to be more streamlined. Are more aesthetically pleasing, they will require more frequent adjustment because they may not be able to maintain the proper angle of pull once changes in ROM are made
Client Education Regarding Wear and Care
Improper use of an orthosis can result in negative outcomes, including skin breakdown and progressive worsening of joint stiffness.
▪Therefore, it is important that the client understands the rationale behind orthosis use and its significance.
Properties of Thermoplastic Materials Drape
Drape refers to the ability of the material to conform to structures (when
heated) without too much handling
Rigidity
refers to the strength of the material when exposed
to repeated stress
Adherence
is the ability of the material to bond to itself
Casting
used for positioning and protection after fractures;
however, casting is beneficial for a variety of other conditions as well
Radiculopathy
-Any compression of the nerve root in the foramina opening
-Can cause pain and neurological symptoms to
radiate along the path of the nerve and into the arm or leg
Spondylolisthesis
-a forward or backward displacement of one of the vertebra, often occurs in the lumbosacral
▪ In between the vertebrae, the intervertebral discs serve as
shock absorbers and facilitate movement of the spine.
▪ degenerate over time and become a source of pain
-The soft inner core of the disc can extrude, called a herniated
or ruptured disc, and inflame a nearby nerve root.
Ankylosing spondylitis
- a type of arthritis that causes inflammation between the vertebrae and in the joints between the spine and pelvis.
▪Over time, the vertebrae can fuse together, limiting movement.
Spinal stenosis
causes narrowing of the spinal vertebrae.
▪The narrowing puts pressure on the nerves and spinal cord and can cause pain,
numbness, paresthesia, and loss of motor control.
Osteomyelitis
-an infection of the bone caused by a bacteria or fungus
spread from the bloodstream, open fracture, or surgery.
▪ Causes severe back pain
Spinal fusion
is surgery to join, or fuse, two or more vertebrae so there is no
movement between them
Laminectomy
a decompression surgery that enlarges the spinal canal to
relieve pressure on the spinal cord or nerves.
foraminotomy
a decompression surgery that is performed to enlarge the
foramen (passageway where a spinal nerve root exits the spinal canal).
Discectomy
surgery to remove herniated disc material that is pressing on a nerve root or the spinal cord.
Artificial disk replacement
a newer surgical procedure for
relieving low back pain.
▪Much like hip or knee joint replacements, the intervertebral disk in the spine is replaced with a mechanical device
interlaminar implant
U-shaped implant that fits between the spinous processes located in the lumbar region of the spine
kyphoplasty
creates space in a compressed or collapsed vertebrae with a balloon-type device and injection of a special cement to restore the damaged vertebra’s height to relieve pain
Pelvic Injuries
-caused by falls in older adults or motor vehicle crashes
-use crutches or a walker, and will not be able to put all of
their weight on one or both legs until the bones are healed
Traction
-Unstable pelvic fractures may require temporary traction
or an external fixator
-involves using the mechanical force of weight and pulleys set up on a bed frame to put tension on the displaced
bone to put it back in position and keep it stable
external fixator
has long screws that are inserted into the
bones on each side and connected to a frame outside the body to stabilize the pelvis.
Pelvic Injury Management
-incorporate proper body mechanics
-precautions may be
specified by the physician
-sit on cushioned chairs that are at a higher level and have armrests to assist with pushing up
-avoid bending and twisting, crossing and lifting their legs
knee surgery
-not pivot on your affected knee
-Do not place a pillow under the knee while the patient is in bed. This leads to contracture.
Aquatic Therapy
-The properties of water can be used to increase or decrease the demand on the muscles
-Water buoyancy decreases the weight-bearing on joints.
Tendinosis
-Damage to the rotator cuff happens when the mechanical stress on the tissue exceeds its tensile strength
-May range from degenerative inflammation to partial or complete tears
Shoulder Impingement
- the tendons and bursa becoming irritated, trapped, or compressed by movements at the shoulder.
▪May also accompany the tendinitis or tendinosis
Scapular Instability
Weakness and damage to the components of the rotator cuff cause muscle imbalance and instability to the GHJ muscle imbalance and instability to the GHJ, especially during
overhead motions
Rotator Cuff Tear
Tears to the rotator cuff may be acute or chronic in nature and may be full or partial.
▪ Chronic tears of the rotator cuff are typically an extension of the shoulder impingement where microtears (tendinosis) leads to larger tears.
▪Acute tears are associated with a singular, accelerating traumatic event
Frozen Shoulder (Adhesive Capsulitis)
The synovium of the GHJ becomes inflamed (synovitis), and the soft tissue becomes thick with fibrous adhesions (fibrosis).
▪These, in turn, cause pain and significant loss in shoulder range of motion
Stage 1
▪May mimic other rotator cuff diseases
▪Marked by pain at end-range of shoulder motion
Stage 2
“Freezing” stage, where a client complains of significant pain and discomfort and at least 25%
loss of range of motion (ROM) in two planes
Stage 3
“Frozen” stage, where the shoulder is significantly stiff, but with lesser discomfort
Stage 4
“Thawing” stage, where the stiffness remains, but the joint may be stretched with the least
amount of discomfort
Fractures
Treatment of fractures depends on the number of segments and
whether or not surgical repair was necessary
Brachial Plexus Injuries
Dysfunction, intervention, and prognosis relate to mechanism and severity of injury
Cervical Radiculopathy
Compression of the spinal nerve roots originating from cervical area; i.e a pinched nerve
Arthroscopy
Involves small incisions through which a scope (miniature camera) and miniature surgical instruments are inserted into the joint.
Arthroplasty
Joint replacements
▪ Total (conventional or reversed) or partial (hemiarthroplasty)
Thermal capsulorrhaphy
Procedure specifically developed for shrinking the glenohumeral capsule
through the use of a heat probe and is often indicated for nontraumatic shoulder instability or frequent dislocations
Bear Hug Test
patient places the palm of the affected side on the opposite shoulder, with fingers extended and elbow anterior to the body.
Belly Rub Test
place affected arm over belly button and MMT
Supine Impingement Test
Bring the patient’s shoulder into 90-110 degrees of abduction, 10-15 degrees of extension, and maximal external rotation
Supraspinatus Test (Empty Can Test)
the patient is positioned with the arm at 90° elevation in the scapular plane and full internal rotation (empty can position), and the examiner applies downward pressure at the elbow or wrist to evaluate for pain or weakness.
Infraspinatus Test
The patient is positioned in standing with arm neutrally rotated, elbow flexed to 90 degrees, and adducted to the trunk.
The examiner applies an internal rotation force along the patient’s forearm while the patient resists.
Hawkins-Kennedy Test
To perform the test, the patient is positioned with the shoulder flexed to 90 degrees and the elbow flexed to 90 degrees.
-The examiner then internally rotates the arm while applying overpressure.
