PTY1011 HIP + general Flashcards
(193 cards)
1
Q
Who developed the transtheoretical or stages of change model?
A
Prochaska and DiClemente in the late 1970s
2
Q
What are the 6 stages of change?
A
Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse/Termination
3
Q
What stage do people recognise the behaviour needs to change?
A
Contemplation
4
Q
What stage do people have no intention to change?
A
Pre-contemplation
5
Q
What stage do people start taking small steps to change and create goals or change?
A
Preparation
6
Q
What stage to people modify their behaviour and work towards their big goal?
A
Action
7
Q
What stage involves avoiding old behaviours and continuing with modified behaviours?
A
Maintenance
8
Q
4 strategies that promote reflective learning
A
Conversational reflection, Reflective journal use, ask mentor or critical friend,? tba
9
Q
What are some difference diagnoses for Patellofemoral pain?
A
Patellar tendinopathy, chondromalacia patallae, OA, referred pain from hip or lumbar spine
10
Q
What are the 2 major joints that make up the knee?
A
tibiofemoral and patellofemoral joints
11
Q
What are the ligaments of the knee?
A
Medial Collateral, Lateral collateral, Anterior Cruciate, Posterior Cruciate
12
Q
Function of ACL
A
Resists anterior translation + rotatory forces of the tibia on the femur
13
Q
Function of PCL
A
Resists posterior translation of tibia on femur
14
Q
What is a Q angle?
A
Quadriceps angle- resultant line of force of the quadriceps, made to the mid-point of the Patella.
15
Q
What are the normative values of women and men for Q angle in standing and 90 deg KF?
A
Women: < 22 degrees ; < 9
Men: < 18 degrees ;< 8
16
Q
An increased Q angle increased what force on the patella?
A
lateral- increasing abnormal load on PFJ
17
Q
True/False: PFPS may be caused by a traumatic incidence
A
False
18
Q
What is the typical onset of PFPS?
A
Insidious onset, may be caused by overload event (excessive stair climbing, longer distance)
19
Q
What aggs PFPS?
A
Stair climbing, squatting, kneeling, returning from squat, sitting
20
Q
What else may contribute to PFPS?
A
Decreased hip and knee strength (glutes, quads (esp. VMO), calves), altered position of patella
21
Q
Common interventions for the treatment of PFPS
A
Quad strengthening (VMO- ball squeeze), patellar taping, hip and knee exercises (pain free), orthotics
22
Q
Is swelling the same as inflammation the same as edema?
A
No. Swelling and edema occur during inflammation. All edema causes swelling but not all swelling is caused by edema.
23
Q
Three phases of tissue healing and time frames
A
Inflammatory phase - 2-3 days
Repair (reconstructive/Proliferation) - 2-3 days to 2 - 6 weeks
Remodelling (Maturation) - 3weeks to 6-12 months
24
Q
Inflammatory phase description
A
Vasodilation + increased capillary permeability. Mast cells release chemical mediators (histamine, kinins, prostoglandin). Irritates local sensory nerves, attracts more WBCs to area (phagocytosis/necrosis)
25
Proliferation (repair) phase description
Destruction of original clot framework. Fibroblasts deposit collagen. Initially immature with no structure.
26
Remodelling phase description
Cont. of reconstruction. reorientation of collagen. Scar formation (avascular, tensile strength but no functional characteristics of original tissue).
27
VAS is a measure for pain. What does it stand for and is it an objective or subjective measure?
Visual Analogue Scale. Subjective.
28
Common characteristic of OA
Pt older than 45yrs, activity related joint pain, AM stiffness >30mins, crepitus on arom, bony enlargement, no detectable warmth,
addit. periarticular or joint-line tenderness, pain on patellofemoral compression
29
Is imaging always needed for suspected OA? Why?
No.OA can be diagnosed clinically, and imaging is not needed but could be considered for atypical presentations.
Radiographic changes and meniscal tears are an almost universal finding in people with OA, and are typically
just age-related abnormalities and not related to symptoms
30
Intervention options for OA
Warm-up and range of motion
Land-based exercise (tai-chi, walking, muscle strengthening, stretching/ROM, yoga, aerobic, balance, cycling), hydrotherapy
31
What scale grades the severity of OA?
Kellgren Lawrence grading system
32
What are the grades of the Kellgren Lawrence grading system for OA?
grade 0 (none): definite absence of x-ray changes of osteoarthritis
grade 1 (doubtful): doubtful joint space narrowing and possible osteophytic lipping
grade 2 (minimal): definite osteophytes and possible joint space narrowing
grade 3 (moderate): moderate multiple osteophytes, definite narrowing of joint space and some sclerosis and possible deformity of bone ends
grade 4 (severe): large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone end
33
What orthotic may assist with foot drop?
foot-up splint or solid AFO
34
What are some compensatory movements for foot drop?
Circumduction, drag forefoor on ground, increase hip flexion
35
5 cardinal signs of inflammation
heat, redness, swelling, pain, loss of function
36
Is ice used to minimise swelling or inflammation?
To minimise swelling. Inflammation is necessary for repair and healing.
37
Difference between micro and macro trauma?
Macro: Acute. Impact/contact injury resulting in tissue damage.
Micro: Chronic. Overuse or Cyclic or friction injury cause my low-grade stress that wears away tissue overtime e.g. stress #
38
What are the therapeutic effects of massage? (6)
-increase circulation in immobile limbs
- decrease swelling & improve circulation (lymphoedema)
- reduce muscle spasm and tone
-limit and reduce soft tissue adhesions
-encourage sensory recovery
-facilitate remodelling of connective tissue
39
what are some emotional effects of massage?
improve anxiety, depressions and perceived well-being
40
massage and relation to LBP
beneficial when combined with exercise and education. Short term effect on pain but not function
41
Contraindications for massage (7)
-open wound/bleeding
-recent scar
-acute inflammation
-inadequate circulation (thrombophlebitis (superficial vein DVT)
- infection/fever
- undiagnosed cancer and undiagnosed swelling
- un-united #
42
Precautions of massage (6)
Skin conditions (psoriasis and dermatitis)
- unstable joints
- varicose veins
-sensory impairments
-early pregnancy
- full stomach
43
What are some massage mediums?
oil
powder
lanolin
44
Holey and Cooks 4 basic massage techniques
Effleurage (superficial/deep)
Petrissage (kneading, wringing, rolling, picking up)
Tapotement (clapping, hacking, pounding)
Frictions
45
What massage technique aims to increase local circulation, decrease pain, mobility scar tissues and mobilise consolidated edema? hint: no/minimal medium
Frictions
46
What massage technique involves deep stroking technique with slow sustained pressure, using heel/side of hands in opp. direction?
Myofacial release
47
What are the aims of a tapotement massage technique?
stimulate local circulation
improve muscle tone
stimulatory effect
48
What are the aims of petrissage? (3)
improve venous and lymphatic return
aid fluid movement in tissues
increase mobility and extensibility of muscle and subcutaneous tissues
49
What are the aims of effleurage? Superficial vs. deep
Superficial:Accustom client to touch, induce relaxation, reduce pain
Deep: Improve circulation & move swelling/oedema
50
Difference b/w sign and symptoms
Sign: observable (swelling)
Symptom: experienced/interpreted by patient (pain, feeling unstable)
51
Difference between mechanical and inflammatory behaviour
Mechanical: better in AM, better w/ rest, worse w/ movement
Inflammatory: better w/ movement, worse w/ rest, worse in PM
52
Red flag Qs
General health
medications
steroids (effects bones)
unexplained weightless (cancer)
cord or cauda equina involvement
vertebral artery questions (cervical spine problems)
imaging/investigations
53
What are Yellow flag Qs
psychosocial factors that may predispose person to chronic symptoms
pain beliefs, anxiety, poor self-efficacy, depression, poor social support, psychological distress
54
What does Dr Craig's ESSENCE stand for?
Education
Stress management
Spirituality
Exercise
Nutrition
Connectedness
Environment
55
What is a close packed position of the hip?
Extension, slight IR + ABduction
56
loose/open packed position of hip?
Flexion (mid rnage), slight abd + mid range ER
57
In babies with hip dysplasia, what position of immobilisation is often taken and why?
Flexion, abduction and ER- maximises bony contact at the hip joint
58
Ligaments of the hip joint capsule?
iliofemoral, pubofemoral, and ischiofemoral ligament
59
which way does pelvis tilt with hip F
anterior
60
which way does pelvis tilt with hip E
posterior
61
the interrelationship of movement that occurs between the pelvis, lumbar spine and hip joint is known as?
lumbopelvic rhythm
62
Provide examples of skin acute and chronic sporting injuries
Acute: Laceration, abrasion, puncture wound
Chronic: Blister, Callus
63
Provide examples of nerve acute and chronic sporting injuries
acute: neuropraxia
chronic: entrapment, nerve irritation, adverse neural tension
64
Provide examples of bursa acute and chronic sporting injuries
acute: traumatic bursitis
chronic: bursitis
65
Provide examples of tendon acute and chronic sporting injuries
acute: tear
chronic: tendinopathy
66
Provide examples of muscle acute and chronic sporting injuries
acute: strain/tear (grades I-III), contusion, cramp, acute compartment syndrome
chronic: chronic compartment syndrome, delayed onset muscle soreness, focal tissue thickening/fibrosis
67
Provide examples of ligament acute and chronic sporting injuries
acute: sprain/tear (grades I-III)
chronic:inflammation
68
Provide examples of joint acute and chronic sporting injuries
acute: dislocation, subluxation
chronic: synovitis, OA
69
Provide examples of articular cartilage acute and chronic sporting injuries
acute: osteochondral/chondral #, minor osteochonral injury
chronic: chondropathy (e.g. softening, fibrillation, fissuring, chondromalacia)
70
Provide examples of bone acute and chronic sporting injuries
acute: fracture, periosteal contusion
chronic: stress #, osteitis, periostitis, apophysitis
71
is cartilage hard or soft tissue?
hard
72
the terms strain and sprain apply to which soft tissue structure?
Sprain: ligament
Strain: muscle
73
Describe the 3 grades of ligament sprains and muscle strains
Grade 1: mild injury-tearing few fibres
Grade 2: moderate injury-considerable portion of fibres torn
Grade 3: complete tear/rupture
74
Describe end feel and pain level of Grade 3 ligament sprain
empty/no end feel
pain either significant or absent
75
Describe end feel and pain level of Grade 2 ligament sprain
Pain on stress
increased joint laxity, end feel still present
76
Describe end feel and pain level of Grade 1 ligament sprain
Normal end feel, pain on stress/load
77
Describe location, pain, strength level and visual sign of Grade 3 muscle strain
often tears at musculo-tendinous junction, very painful, loss of function, visual and palpable deformity
78
Describe pain, strength level and visual sign of Grade 2 muscle strain
pain esp. during muscle contraction + stretch, swelling, loss of strength
79
Describe pain and strength level of Grade 1 muscle strain
focal pain, no loss of strength
80
repair vs. regeneration + examples of structures (tissue healing)
repair: replacement with scar tissue (ligament, tendon)
regeneration: restoration of tissue to previous function (muscle, bone)
81
When and what is involved in early optimal loading post injury (lig sprain+ muscle strain)?
after 3 days (72hrs)
Manual mobs + ROM exercises (PAIN FREE)
Gentle strengthening (PAIN FREE)
Stretches
82
Are NSAIDS recommended for inflammation after tissue injury?
No. Inflammation necessary for healing process to take place
83
Role of hip
Supports head, arms and trunk (HAT)
- WB + mobility
84
Active stabilisers of the hip joint
ER muscles (joint compression)
Hip Abductor (stance phase)
Glutes
85
What is the angle of inclination of the head and neck of femur? What is its relation to coxa vara and valga?
125 degrees.
Coxa valga > 125 deg.
Coxa vara <125 deg.
86
What is the center edge angle and its alternate name?
The degree of femoral head coverage by the acetabulum. Also called Wibergs angle.
87
What are the implications of Wibergs angle?
Smaller: decreased coverage of head- change of superior dislocation or dysplasia
Larger: too much coverage- pincer FAI, impingement
88
What represents magnitude of anterior orientation of the head of femur? What is its relation to joint stability?
acetabular anteversion. increases associated with decreased stability.
89
List 3 potential causes of hip dysplasia
- Coxa valga
- Femoral anteversion
- Shallow acetabulum
90
What is and what is the result of hip dysplasia? (what is the individual prone to?)
Reduced congruence of the hip joint
Prone to dislocation, labral tears and impingement (e.g. FAI)
91
What is the management in babies for developmental hip dysplasia? Rationale?
- Braces – Pavlik harness to put baby in “Frog leg position”
- Maintains hip joint flexion, abduction and external rotation to improve articular contact
92
How may osteoarthritis arise from hip displasia?
stress distribution in concentrated area for prolonged time
93
What is the long-term management of hip dysplasia?
hip arthroscopy
hip resurfacing
hip replacement
94
What is hip resurfacing
femoral head trimmed and capped w/ smooth metal + damaged cartilage and bone in socket is removed and replaced with metal shell
95
What is hip arthroscopy
camera to see inside joint + clean out damaged tissue and/or reshape bone
96
What is Perthes' disease?
Osteochondrosis (disorder affecting growing skeleton) whereby too little blood is supply to the femoral head- becomes weak and #s easily.
97
What age group does Perthes' disease occur in and what gender?
children 3-10years. males
98
What is the HOPC, signs and symptoms of Perthes' disease?
Insidious onset
Hip/groin/knee pain
Limited hip IR and ABd
Antalgic gait,
99
Conservative management of Perthes' disease?
Specialist input (paediatrician)
NWB to allow revascularisation & healing.
12 months away from loaded sport
Low load activities increase ROM and strength (e.g. cycling, hydrotherapy).
100
What is it called when femoral head slips down from acetabulum?
slipped capital femoral epiphysis
101
What might you find on a physical examination of a 'stable' SCFE?
Antalgic gait
reduced hip IR, F, ABd ROM
Leg length discrepency
Muscle atrophy
Hip/groin/thigh/knee pain
ER of hip
102
What might you find on a physical examination of an unstable SCFE?
Unable to walk
hip held in F, ER and ABd (similar to #NOF)
Passive hip F moves into F, ABd and EW
103
Are x-rays necessary for a suspected slipped capital femoral epiphysis?
Yes. AP and lateral view.
104
What is the rating of slip severity of a SCFE?
mild: <1/3 displacement
mod: 1/3-1/2 displacement
severe: >1/2 displacement
105
Management of SCFE?
NWB (Crutches, wheelchair)
Surgery: Internal fixation (pinning) with central screw or multiple pins
106
WB status post-op SCFE rehab
4-6/52 touch WB
107
Prognosis of SCFE?
Generally good. Increased risk of OA and avascular necrosis
108
What age group does SCFE occur in?
early teens/ late adolescent
109
What movement usualy results in an acetabular labral tear?
rotational or pivoting motion under load
110
Where may pain be referred to with acetabular labral tear?
deep inside hip (58%)
groin (51%)
outside of hip (45%)
low back pain (42%)
111
List common hopc factors for acetabular labral tear (4)
- Common in athletes, cyclists, truck drivers- sustained hip F
- describe 'giving way' sesnsation and acute pain
- describe audible click on IR and ADD of hip
- common cause of chronic back pain
112
Extrinsic causes of acetabular labral tears (5)
MVA (motor veh. accident)
Lateral impact
Lifting/twisting/squatting/bending injuries
Passive impingement (truck drivers, horder riders)
Active impingement (dancers, cyclists, martial arts, water polo)
113
Intrinsic causes of acetabular labral tears
Hip dysplasia
Low tone
Ligamentum teres tears
Old SCFE ('pistol grip' deformity)
Femoral bossing/Ganz (CAM) lesions/FAI
114
What is a Cam/Ganz lesion?
formation of extra bone on head of femur
115
What is a femoro-acetabular impingement FAI?
Where extra bone grows along one or both of bones that form hip joint (acetabulum or femur), causing impingement b/w neck and acetabulum
116
What are the 3 main types of FAI?
Cam (Ganz)- Growth on femoral neck
Pincer- acetabulum is overly deep
Mixed
117
Management of labral tears
trial conservative- stretch, strength
may require arthroscopic surgery (e.g. debridement)
good prognosis
118
What is the purpose of bursae?
Fluid filled sacks designed to reduce friction between bone and soft tissues
119
What may cause trochanteric bursitis?
Excessive friction or trauma
Glute med irritation via overloading (irritate tendon and bursae)
-often co-exists with gluteus medius tendinopathy
120
HOPC of trochanteric bursis/glute med tendinopathy
often in distance runners
gradual onset of pain
Aggs: activity + lying on affected side
24/24: inflammatory signs
121
What would be seen on physical examination of trochanteric bursitis/glute med tendinopathy? (5)
Pain on palpation greater trochanter and common glut tendon
- Pain on glute med stretch
- pain on resisted hip abduction
- pain on SLS, hip hitching and hopping
-may have +ve trendelenburg sign
122
What is management of trochanteric bursitis/glute med tendinopathy?
Load manage-pool running
Strengthen glute med and lumbo-pelvic stabilisers (glutes, Hip F, lat dorsi, core)
local cortisol injection into bursa
123
WHY do many females of age 84 acquire NOF#
Post menopausal decrease in oestrogen - decreases bone density (cortical bone > cancellous bone mass) + Falls = #
124
What is the most common mechanism of NOF #?
falls
125
Risk factors of NOF # (6)
Reduced bone density
decrease gait speed
decreased confidence
decreased reflexes
decreased muscle strength
reduced balance
126
What may be present on physical examination of NOF #? (4)
- Apparent shortening of leg on affected side (Er leg)
– Acutely painful on AROM and PROM
– Acutely painful on WBing
– XRay confirm # diagnosis
127
What are the 3 common areas of nof #? and 2 not so common?
1. Sub capital (junction of fermoral head and neck)
2. Transcervical (middle of neck)
3. Intertrochanteric (b/n greater and lesser trochanter)
--
Subtrochanteric (below trochanters)
Trochanteric (greater or lesser trochanter)
128
What classification is used for #NOFs?
Garden's Classification
129
What are the 4 levels of Garden's classification?
1. Incomplete #, valgus Impacted, best outcome
2. Complete #, not displaced
3. Complete #, partial displacement
4. Complete # total displacement
130
What blood supply may be compromised in NOF#? What does this result in?
medial and (lateral) circumflex arteries - avascular necrosis of femoral head.
131
Management of NOF#
Active person
Older, less active person
Intertrochanteric #
Subtrochanteric #
Open reduction internal fixation (ORIF)
- DHS (compression screw); keep own fem head
-Hemiathroplasty or THR
-Compression screw
-Intramedullary nailing
132
Management of NOF#
Garden I & II
Garden III & IV
- Typically w/ DHS (best outcome as least disruption to bony alignment and circulation)
- Hemiarthroplasty (e.g. Moore's Thompson's) - femoral head replaced
- if severe acetabular damage, may require THR
133
What is the medullary cavity?
The hollow part of bone that contains bone marrow.
134
General Mx of NOF# INC. hip precautions (
-Early Mobilisation
- Follow protocols from surgeon (FWB or PWB)
- Gait education
- Hip precautions may include >70-90 hip F, ER, Adduction
- Hip ROM
- Hip strength in supine and standing
135
What is the most common cause of hip joint pain?
OA
136
HOPC of OA in hip (3)
- Pain- mechanical and inflammatory behaviour (pain on loading, pain and severe stiffness in AM)
- Loss of mobility of hip joint (bony changes, capsular irritation & thickening, muscle tightness)
- Restriction of gait, sport and ADLs
-progressive worsening
137
What 2 movement of hip would be particularly painful and restricted in OA?
IR and Extension
138
What may be found in physical examination of hip OA?
-muscle atrophy/weakness
-altered gait (antalgic, decreased stride length)
-muscle tightness
139
Difference b/w stride length and step length
Stride length: length b/w same leg
Step length: length b/w alternating leg
140
What will be seen hip OA x-ray?
- Reduced joint space
- Osteophytes
- Sclerosis (hardening of bone-more white on x-ray)
- Subchondral bone cysts (fluid-filled sac that forms in one or both of the bones that make up a joint)
141
Non-pharmalogical modalities for hip OA
- Education (weight reduction)
- Exercise: land-based, aquatic therapy, graded activity
- joint protection (gait aid, reduce load, weight reduction, activity advice)
-TENS (Transcutaneous Electrical Nerve Stimulation)- short term pain control
142
What is acetaminophen?
can be used as effective initial oral analgesic to mild-mod pain in knee or hip OA
143
Can NSAIDs be used for hip OA?
Yes, oral and topical but long-term use avoided.
144
What pharmalogical treatment may be considered if NSAIDS do not work?
IA injections w/ corticosteroids or hyaluronate (not immediate effect but lasts longer).
145
If pharamlogical and non-pharm do not prove effective for hip OA, what action is then considered?
joint replacement surgery.
146
Options for surgical mngmt of hip OA (4)
- Total hip replacement (THR)
- Hemi arthroplasty (femoral head)
- Cemented (cement or glue to bind
prosthesis to bone)
- Non-cemented (biological fixation with
porous surfaces allowing bone to ‘take’) - Generally younger, more active individual. Longer rehab.
147
THR precautions are for what THR approach? What are they and for how long?
Postero-lateral approach
Hip F >90
Hip Add past midline
Hip IR past neutral
6-8 weeks
148
What is the purpose of hip precautions?
minimise risk of dislocation
149
What does the PAR-Q stand for and what is it for?
- Physical Activity Readiness Questionnaire
- 7 self-screening Qs (around cardiovascular symptoms) to determine whether a client should have a complete medical evaluation before participating in vigorous or strenuous exercise.
150
Why is a modified sit and reach test better than a traditional sit and reach test
traditional: people with long arms and/or short legs would get a better result
modified: controls for this- the zero mark is adjusted for each individual, based on their sitting reach level
151
What does the modified sit and reach measure?
extensibility of hamstrings and low back
152
What is the 3 min step test? How is it conducted?
Evaluation of recovery to a functional activity (aerobic fitness)
- Step height used for this evaluation is 12" (30cm)
- Metronome at 96 BPM (24 steps/min)
- 3 min duration
- Record heart rate + BP before and HR after test for full 60secs
153
What does a pedometer do?
Counts steps and estimated distance walked
154
Normal ranges for BP
S: 90-120 (135)mm Hg
D: 60-90mm Hg
155
Normal range for Resting HR
60-100 bpm
156
Pros (3)/cons (3) of pedometer
Pros:
simple, easy to wear, non invasive
Cons:
some only measure hip movement
can be tampered with
sometimes not accurate with running (walking only)
157
Pros/cons of PAR-Q
Pros:
quick and easy
Cons:
Depends on clients honesty
may change over time
looks mainly at cardiovascular/joint. Other issues may contribute to risks assoc. w/ PA
158
Reliability vs validity
Reliable: Extent outcomes are consisted when experiment is repeated again
Valid: Extent to which intruments use measure exactly what you want them to measure
159
PAR Q vs PAR Q +
PAR Q is simple 7-step Qs for ages 15-69
PAR Q + is for every + more detail of what Qs mean. If answers yes, needs to compeltes more Qs to be more specific about existing diagnoses
160
A tool that is reliable cannot be considered to be as valid- true or false?
true!
161
Steps to lifetime fitness by Corbin 3 overarching themes 6 steps
1. Dependence: (healthy lifestyle + achieving fitness health & wellness w/ direction of others)
2. Decision making: (self assess fitness, health etc + learning self management and planning skills)
3. Independence: (practising self-directed healthy lifestyle + achieve lifelong fitness etc)
162
Test to measure flexibility of hip flexors
Thomas test
163
What is a positive thomas test?
When unaffected leg is flexed to chest, the affected leg is unable to stay flat on plinth and hip is slightly flexed-indicated tight hip flexors (psoas)
164
What are the primary hip flexors?
rectus femoris, iliacus, psoas, iliocapsularis, and sartorius muscles
165
What nerve would refer pain to knee from hip?
Saphenous nerve (branch of femoral)
-innervates anterior cutaneous and medial knee joint
166
Risk factors of OA
Joint injury/ overuse
Age— increases with age.
Gender—Women >50 (Menopause)
Obesity—more stress on joints
Genetics
167
What exercise might be taught in pre-admission class for THR?
Deep breathing (airway clearance)
foot and ankle pumps (prevent DVT)
use of crutches/frame
Hip exercise (mini STS, shallow squats, calf raises Hip abd, knee in/out in crook lying, step-ups, side step ups, knee E)
168
What pillow may assist with hip recaution durring sleep?
Charnley pillow
169
what are TED stockings
TED stockings – thrombo-embolic deterrent stockings
170
What type of attachments might someone have post THR operation?
Intravenous therapy (IVT) (prevent dehydration, maintain homeostasis)
In-dwelling catheter (IDC) (drains urine from bladder)
Redivac drain (prevent blood/fluid collecting)
PCA insitu.
171
Normal Hb levels for males and females
Males: 130-180 g/L
Females: 120-160 g/L
172
If client is anaemic (Hb 80-120g/L) what should PT look out for?
need close and ongoing monitoring of their heart rate, oxygen saturation levels, and dyspnea levels during exercise session
173
What Hb level is PT contra-indicated?
<80g/L
174
What side to get out of bed post THR?
Affected side.
175
How to get out of bed post THR
Bend non-affected leg, push with heel to left and turn bottom to direction of bed side, supporting trunk on elbows and keeping affected leg extended.
Can assisted affected leg movment w/ leg lifter or therapist
176
Term for low blood pressure that happens when standing after sitting or lying down due to blood vessels failing to constrict
Orthostatic/postural hypotension
177
Name 3 muscles of hamstring from lateral to medial to superficial
biceps femoris, semimembranosus, semitendinosus
178
Why might excessive anterior pelvic tilt and lumbar lordosis increase risk of hamstring injury?
APT: hamstring muscle group at longer lengths
Lumbar: Tight Psoas may exacerbate postural defects during straight leg activities
- Lengthened hamstring +concurrent hip F and knee E, = mechanical limits of the muscle or lead to the accumulation of microscopic muscle damage.
179
Which hamstring muscle is more commonly injured and why?
Biceps femoris due to stretch being felt most in musculo-tendon junction = higher injury (more tension + increased length)
180
What activties are hamstrings strains common in and why?
Sprinting and kicking due to high tension and length of muscle during this activities.
181
Charactersistics of hamstring tear (7)
- sudden, minimal to severe pain in the posterior thigh
- "popping" or tearing impression can be described
- *Pain *Tenderness *Loss of motion *Decreased strength on isometric contraction *Decreased length of the hamstrings
182
Grade 1 (mild) of hamstring strain (how many fibres, pain, weakness, gait, loss of motion)
G1: few fibres of the muscle are damaged. Pain day after the injury (varies). Stiffness , able to walk, small swelling, but the knee can still bend normally.
2:
3:
183
Grade 2 (mod) of hamstring strain (how many fibres, pain, weakness, gait, loss of motion)
G2: half of the fibres are torn. acute pain, swelling, mild case of function loss. Antalgic gait. Pain reproduced by palpating muscle or bending the knee against resistance.
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Grade 3 (severe) of hamstring strain (how many fibres, pain, weakness, gait, loss of motion)
more than half of the fibres ruptured to complete rupture of the muscle. massive swelling and pain. full loss of function + great weakness.
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Outcome measures for hamstring strain
1. FASH: Functional assessment scale for acute Hamstring injuries (self-administered questionnaire that looks at pain and function).
2. LEFS: Lower Extremity Functional Scale
3. VAS
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Evidence around hamstring rehab
- progressive agility and trunk stabilization exercises is more effective than isolated hamstring stretching and strengthening
- eccentric strengthening exercises at long muscle had a positive effect
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Example of hamstring rehab Phase 1 (time frame + exercises, goals)
Phase 1 (0-3 weeks):
- ice, isometric, SLS, bike, Knee F (pain free), hip Strength
- Protect healing tissue, minimize atrophy and strength + ROM loss
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Example of hamstring rehab Phase 2 (time frame + exercises, goals)
Phase 2 (3-12 weeks):
-ice post exercise,
-pain-free strength, full ROM, treadmill, isotonic (not at full length), nordic hamstring, hamstring curl
- neuromuscular control of trunk and pelvis preparing for functional movements
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Example of hamstring rehab Phase 3 (time frame + exercises, goals)
Phase 3 (12+ weeks)
-Symptom-free during all activities, Normal strength through full ROM and speed, return to full capacity
- Plyometric jump training, sport-specific drills that incorporate postural control, eccentric: squat jumps, split jumps, bounding (BL/SL) zigzag hops, plyometric box jumps, eccentric backward steps, eccentric lunge drops.
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Physical examination procedures for hamstrin tear
Observation, palpation
AROM /PROM
SLR (no DF, can add to see if pain increases)
Knee F strength
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What type of medication is frusemide?
Diuretic. Used for fluid build-up due to heart failure or kidney disease. May be used for treatment of high blood pressure.
192
What type of medication is Cephazolin?
Antibiotic
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Rehab post femoral fracture includes?
- Early Mobilisation
- progressive quadriceps strengthening, improving hip and knee ROM, and gait and transfer practise.
