Orthopedics Flashcards Preview

Conditions II > Orthopedics > Flashcards

Flashcards in Orthopedics Deck (104):
1

What are Orthopedics Conditions?

Injuries, diseases and deformities of bones
and their related structures

2

What structures are involved in orthopedics conditions?

– Muscle
– Tendons
– Ligaments
– Nerves
– Fascia

3

What are the causes of orthopedic conditions?

Trauma from
– MVAs
– Falls
– Sports injuries
– Work
• Cumulative trauma
– Repetitive stress injuries
• Congenital abnormality
• AVN (avascular necrosis)
• Tumors

4

How many americans fall each year?

1 in every 3 americas (65 and older)

5

T or F The impact from falls creates fear in clients and results in
deceased participation in daily living tasks and
independence.

True

6

T or F The impact from falls is very costly
emotionally, physically, and financially.

True

7

T or F yearly costs are over $25 billion

False $19 billion

8

What is the role of OT in orthopedic conditions?

Achieve maximal function of the body to restore
occupational functioning

9

What is included in the acute stage?

– Pain management
– Decrease edema
– Wound care
– Positioning and alignment
– Restore functioning

10

What is included in the Chronic Stage?

In order to restore optimal functioning
– Life style changes
– Compensation
– Use of DME/adaptive equipment

11

What is a fracture?

Break in the continuity of bone caused by an
external force

12

T or F
Fractures are structural breaks as seen on X-rays

True

13

T or F

Immobilization encourages motion in joints above and below

14

What type of exercises should be performed for mobilization?

- AROM, AAROM, PROM
– Isometric vs. isotonic

15

T or F
Fractures occur in healthy bones only

False
Fractures occur in healthy bone or in bone
compromised by disease

16

What are phathological conditions that can affect a bone?

Spontaneous fracture in a bone weakened by a
pathological condition
• Tumor
• Osteomyelitis

17

What causes bones to be weaken?

Bones that are weakened by osteoporosis,
osteopenia, osteoarthritis

18

What are the most common Osteoporosis related fractures?

• Neck of the Femur
• Humerus
• Distal radius
• Compression
– fractures of the spine

19

What are the different types of fractures?

• Closed vs. open
• Complete vs. Incomplete
• Oblique
• Transverse
• Comminuted
• Spiral
• Greenstick
• Segmental
– Bone piece

20

What is the medical management of closed reduction fractures?

– Casting
– Splinting/ bracing

21

What is the medical management of open reduction fractures?

– ORIF (open reduction internal fixation)
– Use of screws, plates, rods, wires

22

What is the medical management of external skeletal fixation ?

– Pining
– External fixator

23

What is the medical management of traction ?

Skin or skeletal

24

What factors impede healing?

• Type of injury
• Severity of injury
• Location of injury
• Premorbid health
• Smoking
• Complications during healing

25

What are complications of orthopedic conditions?

• Abnormal healing
– Malunion—Normal time but not aligned
– Delayed Union—Increase time
– Non Union—Fails to heal
• Infection
• DVT
• Phlebitis— Inflammation of veins
• Vascular damage
• Blood loss
– decreased Hemoglobin (

26

What is the treatment during the Acute Stage?

• Rehab begins with MD order
• Begins when patient is stable for treatment or stable
enough for proposed intervention
– Acute splint/edema control
• Early mobilization prevents side effects:
– Stiff joints,
– disuse atrophy
– bed sores
– DVT
– Pneumonia
– UTI
• Assessment of capabilities to complete ADL’s

27

What is the clinical goal of fractures?

The clinical goal is to have boney union of the
fracture

28

What is the OT goal of treatment?

OT goal is to reintegrate limb into function

29

What are some of the treatments of fractures?

Watch body alignment and postural changes
• Edema control
• Modalities
• Splinting (Static vs. dynamic)
• Scar and soft tissue management
• Controlled movement usually begins in gravity
assisted or gravity eliminated plane
• Movement may be AAROM or AROM restricted
to midrange and gradually upgraded to full ROM
• Isometric contraction of muscles whose bellies
facilitate circulation and bone healing
• PROM with active hold
• UE and Sling*
• PIN maintenance

30

When looking at the "whole person" what are some characteristics to keep in mind?

• Look at comorbidities
– (why did they have a fracture in the first place?)
• Ex: Vision, balance, neuropathy, weakness, cognition
• OT’s specially trained at looking the whole person and
developing client-centered interventions
• Occupational profile
– occupational history
– patterns of daily living
– values
– problems with performance and priorities

31

T or F Shoulder fractures are easy to treat?

False
Shoulder fractures are complex to treat because the shoulder complex has
multiple joints

32

What is the goal of treatment for Shoulder fracture?

– Relive pain
– restore movement
– restore muscle strength
– allow for callus formation

33

what are some of the treatment for shoulder fractures?

– PROM, AAROM, AROM
– edema management
– light ADL’s

34

T or F there is a greater risk for radial nerve damage in humeral fractures?

true

35

What can you do during Humeral Fracture?

May splint to protect arm:
– bivalve, sarmiento

36

What is involved in Phase I of humeral fracture?

Phase I:
– Positioning
– Codmen’s (pendulum) exercises
– Passive/Assistive exercise

37

What is involved in Phase II of humeral fractures?

Phase II:
– Active and early resistive exercises

38

What is involved in Phase III of humeral fractures?

Phase III:
– Advanced stretching and strengthening
– Encourage use of UE
– FWB

39

What are the most common types of elbow fractures?

– supracondylar
– radial head fracture

40

What is usually done in elbow fractures?

Usually splinted/ casted in mid range flexion 90
degrees
– Long arm splint

41

Define Volkmann's Ischemia

Edema collecting in compartment/fascia presses radial
artery

42

T or F
In Elbow fractures PROM is preferred over AROM

False, Active ROM preferred over PROM

43

T or F
Elbow extension and forearm supination are usually the
most difficult motions to achieve

True

44

What is a Colle's Fracture?

Colle’s fracture (distal radius fracture)
– Casted above elbow
– Progress to forearm splint

45

T or F
Scaphoid fracuture are the most common wrist fractures

True
Scaphoid Fracture common fracture of the carpal
bone 60 percent of carpal fractures
– Casted with thumb included

46

What should you watch for when treating forearm/wrist/hand fractures?

Watch for development of guarded shoulder
motions, poor posture and excessive pain to
avoid CRPS and frozen shoulder

47

T or F
Hip fractures are very common in adults 55 and over

True

48

T or F
Hip fractures are more common in men than women till age 75

False
More common in women than men till age 75

49

T or F
Hip fractures might have weight bearing precautions

True

50

What procedure will be needed if hip fracture is severe?

Total Hip Replacement

51

T or F
Individuals with hip fractures fear falling

True

52

what is WBAT?

Weight Bearing as Tolerated

53

What is TTWBT?

TTWB-Toe touch weight bearing—10%

54

What is PWB?

PWB-Partial weight bearing—25-30%

55

What is NWB?

NWB-Non weight bearing—0 %

56

What is FWB?

FWB-Full weight bearing—100%

57

What are some medical equipment used for weight bearing?

Use of durable medical equipment to limit weight
on extremity
– Walkers, crutches, platform walkers, cane

58

How many weeks is Callus visible in fracture healing?

2-3 weeks UE and LE

59

How long does Union take in fracture healing?

4-6 weeks UE and 8-12 LE

60

How long does consolidation take during fracture healing?

6-8weeks UE and 12-16 LE

61

What are the two main categories of Arthritis ?

• Rheumatoid (RA)
• Osteoarthritis (OA)

62

T or F
Over 100 types of arthritis have been
documented

True

63

What is an Autoimmune disease process characterized by inflammation of the lining of the synovium of the joints

Rheumatoid Arthritis

64

What are the long term damages that Rheumatoid Arthritis can have?

Can lead to long term damage resulting in chronic pain,
swelling, fatigue, weight loss, fever and loss of function
of the joints

65

What are the two forms of RA?

– Adult RA (onset usually ages 30-50)
– Juvenile RA (onset usually toddler)

66

What is the diagnosis of RA?

• Prolonged morning stiffness
• Arthritis of three or more joint areas
• Hand joint involvement
• Symmetric arthritis
• Rheumatoid nodules
• LAB values:
– ESR – ‘sed rate’ markedly increased
– Serum rheumatoid factor positive
• Radiographic changes of wrist/ hand

67

T or F
The cause of RA is unknown and there is no cure
only treatment (not fully understood)

True

68

T or F
Females have an increased risk of having RA

True

69

What are the three stages of progression of RA?

Progresses in three stages:
1. Swelling of the lining causes warmth, pain
stiffness, and redness around the joint
2. Rapid division and growth of cells or pannus
which causes synovium to thicken
3. Inflamed cells release enzymes that may digest
bone and cartilage often causing deformity,
increased pain and loss of joint mobility

70

If RA is diagnosed early what are its advantages?

• Limits damage and can help maintain joint
alignment
• Limits loss of movement secondary to joint
contractures
• Increases the likeliness they will remain
working
• Decreases medical costs
• Decrease need for surgery

71

What are the joints most commonly involved in RA?

Wrist, MCP, PIP/DIP, Elbow, Metatarsalphalangeal, TMJ

72

What does RA cause in the wrist?

changes in the synovium, ligament laxity, and
cartilage degradation

73

What does RA cause in the MCP joint?

ulnar deviation

74

What does RA cause in the PIP/DIP joints?

– Swan neck deformities
– Boutonniere deformity
– Nalebuff deformity (CMC of thumb)

75

What does RA cause in the elbow joint?

– creptis
– nodules

76

What does RA cause in the Metatarsophalangeal
joint?

Creptis

77

What does RA cause in the TMJ joint?

clicking/ popping

78

What is the medical management of RA?

• NSAID’s
• Glucocorticoids
• Disease-modifying antirheumatic drugs
(DMARDs)
• Pain management
• Control of systemic complications

79

What is the classification of Functional Capacity in RA

• Class I: Complete function
– can carry on usual duties without handicaps
• Class II: Adequate function
– able to conduct normal activity despite handicap or
discomfort or limited mobility in one or more of joints
• Class III: Incomplete function
– performs only a few or none or usual occupations
• Class IV: largely incapacitated, bedridden or
confined to w/c

80

What is osteoarthritis (OA) ?

An inflammatory response characterized by the breakdown of the joint’s cartilage causing the bones to rub against each other, causing pain and loss of movement

81

T or F
OA is a Degenerative Joint Disease?

True

82

OA is the oldest and most common form of arthritis

True

83

T or F
OA is most common in young individuals

False
Most common in middle aged or older adults

84

T or F
OA is most common on Hand and weight bearing joints

True

85

What is the OA Diagnosis?

• Brief morning stiffness
• Unilateral joint involvement
• LAB values:
– ESR ‘sed rate’ mild- moderately increased
– Serum rheumatoid factor negative

86

What are the characteristics of the etiology of osteoarthritis ?

• Age
• Heredity
• Obesity-(knees and hips)
• Muscle weakness
• Injury and overuse-sports
• Occupations
• Nerve injury/ vascular disease process

87

What does OT treatment involve for RA and OA ?

• Occupational profile
– COPM
• Rage of Motion
– goniometer
• Joint alignment/Deformity
• Strength
– Manual Muscle testing *
• Pain
– Pain scales
• Wong
• Visual Analog scale

88

What assessments are used for RA/OA?

• Activity tolerance
– Time
• Functioning (UE based assessments)
– Moberg pick up test
– 9 hole peg test
– Purdue peg board test
– Jebsen Test of Hand function
– MAM-16
– MRMT

89

What are the OT interventions for RA/OA?

• Patient and Family Education
• Joint protection and work simplification
• Fatigue management
• Maintain joint mobility
– Tai chi programs
• Strengthening
• Modify the environment
• Recommend assistive devices

90

What are the joint protection principles?

• Respect pain
• Maintain muscle strength and joint mobility
• Use each joint in its most stable plane
• Avoid positions of deformity
• Use the largest/ strongest joint group for the job
• Frequent rest breaks
• Reduce the force (friction, leavers, simple
machines)

91

What are examples of Work Simplification?

• Rolling carts
• Prepared foods
– salads/ precut veggies/meats
• Sit vs. standing
• Smaller containers
– gallon of milk vs. pint
• With easy open lids
– medication bottles

92

T or F
Splints work when they improve function and
reduce the pain of the patient

True

93

What are some examples of splints?

• Silver ring splints
• Resting hand splints for PM
• Wrist cock-up splint
• Specific function splints
– example: typing splint, walker splint

94

What are two types of joint replacements ?

• Common types of joint replacements
– Total Hip arthoplasty (THA) and (THR)
– Total Knee arthroplasty (TKA) and (TKR)

95

What are the least common joint replacements?

– Disc replacement
– Total ankle arthroplasty
– Total Shoulder arthroplasty

96

What is a joint replacement?

Typically an elective surgery to replace the
damaged joint

97

What are failed conservative methods?

– Medication management
– Cortisone injections
– Hyaluronate injections
– Nutritional supplements (Glucosamine and
chondroitin)
– Lose weight
– Exercise

98

What are the typical precautions in Hip replacement?

– No hip flexion beyond 90 degrees
– No rotation
• No internal rotation of the hip with posterior lateral
approach
• No external rotation of the hip with anterior lateral
approach
– No crossing legs (adduction)
– Use of abduction pillow when in bed

99

What equipment is used for THR?

• Treatment includes use of adaptive equipment
and DME
• Bathing
– Long handled sponge, tub bench
• Dressing (LE)
– Reacher, sock aide, long handle shoe horn
• Bed mobility
• Functional mobility
– Use of rolling walker
• Transfers ( may need raised height)
– tub, chair, bed, commode, car

100

T or F
Precautions for knee replacement depend on the surgeon

True

101

T or F
Mobility is not important up and out of bed
(OOB) day of surgery or post op day one for knee replacement

False
Mobility is very important up and out of bed
(OOB) day of surgery or post op day one

102

T or F
Place a towel under knee after knee replacement surgery

False
Work on end range knee flexion and extension
– Never place towel under knee

103

What are the advancements of knee replacement?

• Otis Knee (custom fitted hardware)
– MRI prior to surgery molds of knee are formed
and custom ‘jigs’ are made for a more precise fit
• Unilateral knee/partial knee
– Need to have ligaments intact
• Protocols vary by institution some are more
aggressive than others
– Goal is now to get patient directly home vs. going
to rehab (typically a SAR)

104

What are the OT interventions on Hip/Knee Replacement surgeries?

• Education on Hip or Knee precautions
• ADL’s
• Energy conservation
• Strengthening exercises (develop routine)
– Glut sets, quad sets, ankle pumps, knee extension
• Pain management
• AE and DME
• Fall prevention
• Home planning (environmental context)