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Flashcards in MSK conditions Deck (46)
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What types of MSK conditions may be seen in the acute care setting?

  1. bone fractures including multitrauma situations
  2. surgical repair of fracture
  3. joint replacements
  4. spinal surgeries
  5. soft-tissue surgeries



list some types of diagnostic imaging that may be performed as part of the MSK exam?

  1. Radiography
  2. CT
  3. MRI
  4. bone scan
  5. myelography



what are radiographies primarily used for?

x-ray or plain films, standard for detecting injury to bone as well as evaluating the intraoperative and post-op positioning of a procedure such as a joint arthroplasty or an open reduction to internal fixation


what are CT scans primarily used for?

complex or subtle bone fractures and injuries to soft tissue


what are MRIs primarily used for?

spinal disc injuries or soft tissue injuries especially to the tendon, ligament and menisci


what are bone scans used for?

assess the bone density related to tumors and avascular necrosis


what are myelographies used for?

x-ray or CT scan with a contrast dye used to look for spinal conditions like spinal stenosis or disc compression


What would be included in your exam for an MSK patient?

  1. Observation
  2. Pain
  3. Cardiopulmonary
  4. Integumentary
  5. Sensation
  6. ROM
  7. Strength
  8. Reflexes
  9. Balance
  10. Posture
  11. Functional mobility
  12. Outcome measure tool



List some pain scales that may be used for MSK pts

  1. Numeric 0-10
  2. VAS
  3. Wong-Baker Faces
  4. Nonverbal Pain Scale (NVPS)
  5. Brief Pain Inventory
  6. McGill Pain Questionnaire
    • Regular
    • Short form
  7. Shoulder Pain and Disability Index (SPADI)
  8. Lower Extremity Functional Scale (LEFS)



what drives your decision making during an MSK exam?

what info do I need in order to assess patient ability, safety, and D/C needs?


List some outcome measures you may use with an acute MSK pt

  1. AM-PAC 6-clicks
  2. TUG
  3. Gait Speed
  4. 2MWT or 6MWT
  5. 30-seconds chair rise test
  6. Functional reach
  7. Single limb stance test



List several types of joint replacements

  1. Knee arthroplasty
  2. Total knee arthroplasty
  3. Total hip arthroplasty
  4. Total shoulder arthroplasty
  5. Reverse total shoulder arthroplasty



what are the subtypes of knee arthroplasty? What is the difference between them?

  1. unicondylar (unicompartmental) knee replacement
    • only one compartment (M/L) is replaced
    • one one side is impacted and ligaments are intact
    • preserves normal knee kinematics
    • faster recovery 
  2. total knee replacement
    • replacement of the femoral condyles, tibial articulating surfaces, and dorsal surface of the patella
    • Post-op WB status usually WBAT 




what are the usual reasons for a total knee arthroplasty?

severe joint degeneration resulting from OA, RA or trauma


What are some Post-Op concerns following a total knee arthroplasty?

  1. DVT, PE
  2. infection
  3. pain 
  4. edema
  5. patellar tendon rupture
  6. patellofemoral instability
  7. compartment failure or loosening
  8. peroneal nerve injury



What are some evaluation components for a total knee arthroplasty?

  1. P/AROM goni
    • one of the only times you will use a goni in acute care
    • be careful if they had a nerve block (may push limb too far)
  2. Skin inspection at surgical site
  3. Immediate D/C planning



What are the D/C requirements to go home following a total knee arthroplasty?

  1. independent w/HEP
  2. safe w/household mobilization


Describe the general post-op protocol following a total knee arthroplasty

will vary depending on surgeon

  1. AROM and strengthening begins immediately
    • ISOM QS, HS, GS progressing to A/AROM
    • P/A/AROM heel slides
    • Gentle stretching knee ext/flex
    • active hip motions to faciliate improved bed mobility
  2. May/may not use knee immobilizer
  3. Typically aiming to achieve 0-90 knee ext/flex
  4. Big focus on functional mobility 



what are the usual reasons for a total hip arthroplasty?

degenerated joint surface

repair of hip following a fall


what is usually the post-op WB status for a total hip arthroplasty?

most often WBAT

always confirm WB status!


List precuations for total hip arthroplasties

  1. Posterolateral approach
    • no hip flex past 90, no ADD past mid, no IR past neutral
  2. Anterolateral and 2-incision approaches
    • limit hip ext especially w/ER
  3. Both approaches:
    • avoid sleeping on surfical site
    • avoid sitting on low surfaces 


List some possible complications to a total hip arthroplasty

  1. Dislocation
  2. Aseptic loosening
  3. Hematoma formation, hetertrophic ossification
  4. Infection
  5. Nerve injury, vascular damage
  6. DVT → PE
  7. MI, CVA
  8. Leg-length discrepancy



what are the S/S of a hip dislocation?

  1. excessive pain w/motion
  2. abnormal IR/ER of hip w/limited A/PROM
  3. inability to WB through LE 
  4. shortened limb (leg length discrepancy)



what are some evaluation components of a total hip arthroplasty?

  1. P/AROM goni
  2. skin inspection at surgical site
  3. measure leg length
  4. assess for possible neuropraxia, esp femoral and sciatic nerves
  5. immediate D/C planning



List the D/C requirements to go home for a total hip arthroplasty

  1. indpendent w/HEP
  2. safe w/household mobilization
  3. Independent w/precautions



T/F: a total hip arthroplasty pt may be required to continue PT in inpatient setting



Describe the general post-op protocol for total hip arthroplasties

will vary depending on surgeon

  1. ABD wedge
  2. Possibly knee immobilizer (prevents hip flx)
  3. Adaptive equipment 
    • long handled reachers
    • shoehorns
    • leg lifter
    • elevated toilet seat
  4. Prescribe appropriate AD
  5. AROM/strengthening
  6. Functional mobility



what type of AROM/strengthening needs to be done with a total hip arthroplasty?

  1. Submax glut sets
  2. ISOM QS and HS
  3. Avoid SLR



List precautions following a total shoulder arthroplasty

integrity of rotator cuff and deltoid muscles dictates precautions and rehab

Common precautions:

  1. avoid shoulder AROM
  2. No lifting, pushing, or pulling obj w/involved UE
  3. No excessive shoulder motion behind back, esp IR
  4. No excessive stretching, esp ER
  5. No supporting BW by hand or involved side
  6. No driving for 3 weeks



what should the pt edu include for a total shoulder arthroplasty?

  1. use of ice for pain and inflammation management
  2. positioning
    • avoid lying on involved shoulder
    • use a towel roll under elbow when supine 
  3. bring hand to mouth w/elbow held at side of trunk
  4. TherEx program w/HEP
  5. decrease distal edema w/hand wrist and elbow AROM and ice packs
  6. squeeze ball/sponge to maintain grip strength