Amputation Flashcards
(89 cards)
1
Q
What are the considerations with amputations?
A
the boundaries of dead or diseased tissues
considering prosthesis
possible mobility and function
cosmesis
2
Q
What is myodesis?
A
muscle secured to the bone by suturing the distal tendon through holes thats been drilled in the bones
- most often in BL/AKA to help with deformities of the residual limb
3
Q
What is a myoplasty?
A
attaching sectioned muscle to opposing muscles
4
Q
What is the difference between a minor and major amputation?
A
minor - toe or partial amputations
major - proximal to tarsometatarsal joints
5
Q
What are the primary indications for amputations?
A
- peripheral vascular disease
- diabetic wounds
- trauma (MVA or gunshots)
- infections
- tumor/cancer
- congenital
6
Q
How is balance affected by an amputation?
A
decreased balance if ankle joint is gone = loss of somatosensory, decreased WB, reduced confidence, limits of daily activities
loss of ankle joints changes postural control = increase reliance on other balance strategies
7
Q
What is a partial foot amputation?
A
transmetatarsal
8
Q
How does transmetatarsal amputation assist with balance?
A
Keeps ankle integrity
9
Q
What is the most common amputation?
A
partial foot amputation - transmetatarsal
10
Q
What is the return for tranasmetatarsal amputation?
A
use of prosthetic or standard foot wear
11
Q
What are the effects of gait for partial foot amputation?
A
loss of power generation
12
Q
What is symes?
A
removal of foot
- medal and lateral malleoli is removed
- heel pad relocated to distal tibia
13
Q
What is chopart?
A
disarticulation between the navicular/cuboid bones and the talus/calcaneus bones
14
Q
What is lisfranc?
A
tarsometatarsal joint amputation
15
Q
What is transmetatarsal amputation?
A
midshafts of MTs
16
Q
What is a transtibial amputation?
A
“BKA” - below-knee amputation
- this preserves the knee
- loss of muscular control of LE groups and foot/ankle (well man aint no more there tf)
17
Q
What are the gait characteristics?
A
- decreased gait velocity
- shorter step length
- increased stance phase
- increased time on sound limb
- asymmetrical stance phase duration
18
Q
What is transfemoral?
A
“AKA” - above-knee amputation
- preserves hip joints
- loss of joints below and impaired muscular below pelvis
19
Q
UE amputation
Interscapular thoracic
A
whole ahhh upper limb with clavicle and scapula
20
Q
UE amputation
Shoulder disarticulation
A
whole ahhh upper limb through shoulder joint
21
Q
UE amputation
Transhumeral
A
through humerus
22
Q
UE amputation
Elbow disarticulation
A
thru elbow joint
23
Q
UE amputation
Transradial
A
thru radius and ulna
24
Q
UE amputation
Wrist disarticulation
A
thru wrist joint and removing carpal bones
25
# UE amputation
What is amputated with a partial or full removal?
hand, metacarpal, thumn and phalangeal
26
# UE amputation
What is trans-radial?
"below elbow" amputation
27
# UE amputation
What is trans-humeral?
"above elbow" amputation
28
What is the prevalence of UE amputations?
>80% of UE amputations are because of trauma
- common in men ages 15-45
- followed by cancer/tumor
## Footnote
Risk increases with age
29
What age is at the greatest risk of UE amputation?
age 65 and over
30
What is the general goals for post-op amputations?
- promote wound healing in residual limb
- pain management
- optimize ROM and strength
- protect residual limb
- functional sitting/standing balance
- train for safety with bed mobility and transfers
- ambulation training with AD
- proper sitting and bed positioning education
- discuss next phases of rehab
31
When looking at shape, what are we looking at?
cylindrical shape
bulbous
"dog ears"
bone length
32
What should we be careful when measuring strength?
pressure on the surgical site
grade of test
33
Where are some common contracture sites?
hip flexion
hip abduction
hip ER
knee flexion
ankle PF
34
What are some considerations for stump pain and skin checks?
Look at the wound site
skin integrity
depending on healing - it can either slow or increase healing rate
delayed healing because of infection or non-compliance
35
What is phantom limb pain?
Its the perception of pain in the missing limb
- described as tingling, prickling, pins and needles
- the severity gets less with more stimulation
more common in women than men
36
What is the pain management for the residular limb?
- medication
- compression
- breathing and relaxation techniques
- massage, biofeedback and TENS
37
How is the total length including soft tissue measured?
taken from an easily identified bony landmark to the palpated end of the long bone, incision line or end of soft tissue
38
How is the circumference measured?
medial tibial plateu or tibial tubercle and at equally spaced points to end of limb
39
What is the post-op amputee rehab goals?
- contraction prevention
- pain mangement
- emotional care
- post-op edema
- early ambulation
- residular limb protection
- bed mobility and transfers
- fall prevention
- trunk stabilization
- desensitization while loading of distal stump progressively
- scar management and mobilization
40
What are the precautions/contraindications for PT?
Signs and symptoms:
- excess drainage through bandages or rigid dressings
- sharp local pain on stump
- fever
- foul odor = infection
## Footnote
Hold PT and resume when pt is stable
41
41
What are the clinical considerations?
- cognitive dysfunction
- comorbidities
- cardio-pulm conditions
- ulcers or infection
- flexion contractions
- age
- psychoscial factors
42
# Post-op dressing options
What are the advantages of ace wrap?
- edema control
- wound access
- inexpensive
43
# Post-op dressing options
What are the disadvantages of ace wrap?
- does not protect wound/residual limb from external environment
- hard for patient to apply
- difficult for proper application and maintain even compression
- will not prevent contracture
44
# Post-op dressing options
What are the advantages of a shrinker?
- edema control
- wound access
- inexpensive
- even compression layers
45
# Post-op dressing options
What are the disadvantages of shrinker?
- may catch on staples/suture lines
- may increase pain during application
- does not protect wound/residual limb from external environment
- will not prevent contraction
46
# Post-op dressing options
What are the advantages of rigid dressing?
- residual limb protection
- best edema control option
- residual limb protection in a fall
- BKA contracture prevention
47
# Post-op dressing options
What are the disadvantages of rigid dressing?
- high risk of infection = pose barrier to non-removal type
- bulky, heavy
- needs to monitor closely
- limited wound access
48
# Post-op dressing options
What are the advantages of an elastic roller bandage?
* readily available and accessible
* inexpensive
* easy to access to incision
49
# Post-op dressing options
What are the disadvantages of elastic roller bandage?
- cabe hard for patients and family to get proper pressure
- can produce areas of high pressure that can impair healing
- needs frequent rewrapping
- increased likelihood of knee flexion contracture with transtibial amputation
50
# Post-op dressing options
What are the advantages of semirigid dressing?
* better edema control than soft dressing
* RL protection
51
# Post-op dressing options
What are the disadvantages of semirigid dressing?
- needs frequent changing
- can't be applied by patient
- no access to incision
52
# Post-op dressing options
What are the advantages of IPOP?
- excellent edema control
- excellent stump protection
- control of stump pain
- decreased time to fit with prosthesis
53
# Post-op dressing options
What are the disadvantages of IPOP?
- no access to incision
- more expensive than other dressings
- needs proper traning for use
- needs skilled practioner for frequent reapplications and fittings
- patient needs to carefully adhere to all procedures
54
What are the causes of residual limb edema?
* possible delayed healing
* stump break down because of fitting hardships
* poor venous return
* other associated disorders
* arterial disease
55
What are some pre-prosthetic considerations?
- edema management
- skin care
- contracture positioning prevention
- mobility, strength, function and balance
- equipment needs
- vascular assessment
56
What is the goal for joint mobility strengthening and function?
- maintain or restore ROM above amputation
- prevent joint contractions (proper positioning)
- gait training
57
What is the gold standard for outcome measures?
Ampute mobility predictor
58
What is the MDC for amputee mobility predictor?
3.4-point change
59
What are the considerations for stump wrapping?
- from distal to proximal
- figure 8 pattern
- partial overlap of the layer before
- no gaps
- cylindrical shape
- even pressure = no wrinkles or creases
- with tape securing it
60
What are the bandages used for a BKA?
2 4-inch bandages
61
What are banadages used for AKA?
1 4-inch
1 6-inch
62
How often should bandages be removed?
Every 4 hours hours or sooner if it loosens up
63
Why is compression so important for all amputees?
- reduce edema
- pain control
- increase wound healing
- protects incision during functional activity
- faciliate prosthetic placement preparation by shaping it and desensitizing
64
# Compression bandaging
When is a rigid banadage applied?
Applied surgeon in the OR
- removed in 3-4 days
- can put new IPOP = lets limited TTWB in 2-3 days by the prosthetist
65
# Compression bandaging
What is rigid bandage not good for?
for patients with higher risk for infection because of wound status
- can't really it unless its removed
66
# Compression bandaging
When is a semi-rigid applied?
By the prosthetist with a negative mold or when rigid is removed in 3 days post op
67
# Compression bandaging
What kind of materaial is semi-rigid made of?
Polyethylene making it lightweight, easy to clean and more durable than plaster
68
# Compression bandaging
When is soft bandaging applied?
once a suture line is healing (10-21 days)
- using shrinker TT/TF
- Jobst for TF (???????)
69
What are the principles of Ace-wrapping?
- distal pressure should exceed proximal
- pressure applied on oblique turns only - no wrinkles
- reapplied every 4 hours
- no metal clips dummy
- remove if aching, burning or numbness
- wear 23 hrs of the day (remove it to clean it bro)
- continue until pt. has definitive prosthesis and pt can leave stump unwrapped overnight and don it easily
70
What are the strategies of phantom limb pain?
- patient education (them boys be standing thinking they got both)
- look for neuroma or infection
- compression
- prosthesis use
- desensitization techniques (rub that thang)
- heat
- some medications (wack stuff frfr)
71
What are the pain management when it comes to PT treatments?
- give time for pain meds (dey be complainin)
- education on imagery and relaxation
- TENS = wound and relaxation methods
- US (america??)
- cold therapy
- massage (rub that thang)
- wearing prosthesis/compression bandages
72
What is the most common contractures to prevent for transtibial (BKA)?
hip flexion
knee flexion
73
Why are BKA contractions happening?
* long periods of sitting in w/c and bed = flexion is position of comfort
* protective flexion withdrawl is associated with LE pain
* muscle imbalances
* loss of sensory input from foot in WB
74
What are the contractures common in transfemoral amputations?
hip flexion
hip abduction
hip lateral rotation
75
# Contraction management
How do you keep the knee in extension in bed?
avoid using pillows under the residual limb
76
# Contraction management
How do you keep the knee in extension in the W/C?
using an amputee board, elevated amputee hanger
- avoid long periods of sitting
77
# Contracture management
What are other forms of management?
- prone
- PNF
- manual stretching
- mobility
- AROM
- PROM
78
# Strengthening Principles
What is the reason for UE/LE/trunk strengthening and endurance?
- safety
- energy efficient prosthetic gait
- contraction prevention
- mobility
79
# Strengthening Principles
What kind of exercises for post-op muscle strengthening?
isometric contraction with limited ROM @ proximal joint to prevent stress across incision
- no valsalva
progression of wound healing = longer arc of motion, active resistive exercise, the reg ya know?????
80
What are other POC considerations?
- hip ext, abd, add and knee ext
- overall strengthening
- aerobic to increase endurance
- mobility
- posture COG shifted up, back and toward remaining leg (feeling bad frfr)
- skin integrity
- balance
81
# Medicare functional classification scale
K0
not able to ambulate or transfer without assistance
82
# Medicare functional classification scale
K1
Use of prosthesis and walks mainly on level surfaces or fixed cadence
- household ambulator
83
# Medicare functional classification scale
K2
uses prosthesis and walks in limited community distances, uneven surfaces, curbs and stairs
84
# Medicare functional classification scale
K3
Use prosthesis and waks community ambulation distances
- can traverse most barriers in environment
- variable cadence
85
# Medicare functional classification scale
K4
potential for prosthesis and walks without any limitations
- exceeds basic abilities/demands for gait
- can handle high-impact activity
86
who/when to prescribe a prosthesis to a TTA?
- patient has their own knee power
- prosthesis helps w/ transfer
- prosthesis helps with STS
87
Who/when to prescribe a prosthesis to a TFA?
- patient has no knee power
- prosthesis has no knee power
- transfers - often easier without prosthesis
- STS - prosthesis makes it more challenging
88
What should the patient master before a TF prosthesis?
- transfer independently
- STS independently
- walks in parallel bars or walker for at least 6-8 meters
