Musculoskeletal Care in the Acute Setting

Question 1

Musculoskeletal Care in the Acute Setting

Fracture classifications include?

Answer 1

Question 1

Musculoskeletal Care in the Acute Setting

Common musculoskeletal conditions requiring hospitalization?

Answer 1

• Fractures
• Arthritis/DJD requiring Total Joint Arthroplasty
• Amputation
• Neck/Back pain

Question 2

Musculoskeletal Care in the Acute Setting

Favorable and unfavorable factors contributing to bone healing include?

Answer 2

Question 3

Musculoskeletal Care in the Acute Setting

Posterior hip surgical approach precautions include?

Answer 3

• No hip flexion greater than 90 degrees
• No hip adduction past midline
• No hip internal rotation past neutral

Question 4

Musculoskeletal Care in the Acute Setting

Anterior hip surgical approach precautions include?

Answer 4

• No hip extension past neutral
• No active hip abduction
• No hip external rotation past neutral

Question 5

Musculoskeletal Care in the Acute Setting

TKA Surgeon specific movement recommendations include?

Answer 5

• No twisting of LE in weight bearing position
• No sitting with legs crossed
• Avoid low soft chairs
• Do not forcefully bend operated knee
• Do not kneel on operated knee
• Use of walker (variable: days/weeks/as needed)

Question 6

Musculoskeletal Care in the Acute Setting

Total shoulder arthroplasty/ rotator cuff repair recommendations include?

Answer 6

• NWB and immobilized constantly unless receiving PROM
• Surgeon prescribed PROM of shoulder (flexion, IR/ER)
• NO ABDUCTION OR EXTENSION past neutral
• AROM elbow, wrist, hand
• Acute PT/OT ensure caregiver training and donning/doffing immobilizer
• Outpatient 5 times per week x 4 weeks is common at facilities unless family/caregiver can perform per protocol

Question 7

Musculoskeletal Care in the Acute Setting

Most common cause of LE and UE amputations = ?

Answer 7

• Vascular disease is most common cause of LE amputation.
• Trauma is most common cause of UE amputation
• Main causes of amputation are vascular disease (54%) with comorbidities like diabetes and peripheral arterial disease, trauma (45%), and cancer (less than 2%)

Question 8

Musculoskeletal Care in the Acute Setting

Amputation acute medical treatment focus includes?

Answer 8

Question 9

Musculoskeletal Care in the Acute Setting

Keys to PT management of patients with Amputation?

Answer 9

Education:

• Positioning and compression for edema control
• Positioning to avoid contractures (avoid hip and knee flexion positioning).
• Benefits of early ROM, strength, mobility training
• Begin with isometric and AAROM exercises
• Discussion of pain management, phantom pain

Question 10

Musculoskeletal Care in the Acute Setting

Most Common neck/back pain diagnoses requiring hospitalization?

Answer 10

Most Common neck/back pain diagnoses requiring hospitalization:
* Spinal nerve compression related to disc protrusion/extrusion
* Compression Fracture

What can PT do?
* Relieve, stabilize, strengthen, and Educate, Educate, Educate – No bending, lifting, or twisting of the SPINE

Question 11

Musculoskeletal Care in the Acute Setting

Removal of disc fragments that compress spinal nerve root = ?

Answer 11

Discectomy: Removal of disc fragments that compress spinal nerve root.

Question 12

Musculoskeletal Care in the Acute Setting

Removal of the part of the lamina on the back of the vertebra to decompress the spinal canal = ?

Answer 12

Laminectomy: Removal of the part of the lamina on the back of the vertebra to decompress the spinal canal.

Question 13

Musculoskeletal Care in the Acute Setting

Use of instrumentation and/or bone grafting to stabilize vertebral segments = ?

Answer 13

Fusion: Use of instrumentation and/or bone grafting to stabilize vertebral segments.

Question 14

Musculoskeletal Care in the Acute Setting

Injection of bone cement to stabilize a vertebra with a compression fracture = ?

Answer 14

Vertebroplasty: Injection of bone cement to stabilize a vertebra with a compression fracture

Question 15

Musculoskeletal Care in the Acute Setting

Percutaneously inserted inflatable balloon is used to restore some vertebral height prior to injection of bone cement = ?

Answer 15

Kyphoplasty: Percutaneously inserted inflatable balloon is used to restore some vertebral height prior to injection of bone cement.

Question 16

Musculoskeletal Care in the Acute Setting

Both percutaneous vertibroplasty and balloon kyphoplasty involve?

Answer 16

Both involve injection of bone cement via large bore needle into vertebral body but kyphoplasty inflates a balloon into the space first to elevate the height of the body prior to bone cement injection.

Question 17

Musculoskeletal Care in the Acute Setting

Following neck/back surgical intervention, what would be contraindicated?

Answer 17

• Exercise that increases intra-abdominal pressure extensively
• Exercise that weights the spine or causes extremes of spinal ROM
• NO twisting, flexing, extending

Question 18

Musculoskeletal Care in the Acute Setting

PT Intervention for patients with Discectomy/Laminectomy/Fusion?

Answer 18

• Progression of mobility is surgeon protocol specific
• Teach correct body mechanics
• May have limited sitting time restrictions
• Usually, no trunk exercises for at least 4 weeks but distal UE/LE exs allowed
• LOS usually <48 hours
• May/may not need assistive device (Any issue with unilateral support? Can a pt use a cane?)

Question 19

Musculoskeletal Care in the Acute Setting

PT Intervention for Patients with Compression Fracture?

Answer 19

• Usually seen post-operatively
• 2-4 hours bedrest (surgeon specific)
• Typically significant pain relief
• Teach safe mobility with proper body mechanics
• May discharge with an assistive device at the discretion of PT