UE Amputations , Shoulder Surgery , Spine , Hips , Knees

anatomy

interscapular

transhumeral

transradial

hypersensitivity

overly sensitive to normal stimuli typically near or on residual limb

find the just right challenge

desensitization protocol

light touch -> rubbing -> tapping -> prolonged pressure

phantom limb pain interventions

mirror therapy

acupuncture

TENS

isometric exercise

relaxation techniques

pre-prosthetic phase

ADL retraining

wound/scar management

educate on prosthetic options

prepare residual limb for prosthetic

myosite testing

desensitization

limb shaping

maintain ROM and strength

basic prosthetic training

doing everything but using the prosthetic

evaluate prosthetic

wear schedule

donning/doffing

limb hygiene

prosthetic knowledge

care for prothesis

intermediate prosthetic training

learning to use, NOT with functional tasks

control training: learning and practicing controls of prosthetic

use training: practicing use of prosthetic with repetitive graded tasks

advanced prosthetic training

functional training: practicing ADLs with prothesis

4 kinds of prosthetics

body powered

electric/myoelectric

hybrid (body powered and electric combo)

passive

activity specific prosthetic

designed for a specific function or activity

SITS

supraspinatus, infraspinatus, teres minor, subscapularis

soft tissue ROM progression

(immobilize) -> PROM -> (AAROM) -> AROM -> Resistive Exercise

conservative treatment

main focus is pain

what ADLs cause pain?

pain free ROM progression

immobilize and PROM

pendulum swings

stay within protected/controlled range

AAROM

pulleys

hands on AAROM

start AAROM only when PROM is well tolerated without compensation

Resistive

light shoulder strength

Hemiarthroplasty and Arthroplasty

pendulum swings

ROM progresses slowly

reverse arthroplasty

avoid pendulums

ROM progresses fast

No BLT's

No bending, lifting, twisting

lifting

no more than 8 lbs

hold close to body

lift with legs not back

twisting

log roll for bed mobility

bending

golfer's lift to accommodate

brace

TLSO: thoracic-lumbar-sacral orthosis

LB dressing

supine dressing

sleep

pillow under knees in supine

pillow between knee in side lying

ORIF

open reduction internal fixation

managing femur fracture by holding in place with screws

Arthroplasty

hip replaced with artificial joint

weight bearing

NWB: non weight bearing

TTWB: toe touch weight bearing

PWB: partial weight bearing

FWB: full weight bearing

anterior hip precautions

NO extension, NO external rotation, NO adduction

posterior hip precautions

NO hip flexion > 90, NO internal rotation, NO adduction

pain

cryotherapy in acute recovery

balance pain and activity

positioning

precautions to promote proper healing

performance

functional ADL focus

straight forward

1. simple and straightforward

2. keep knees in extension at rest (straight)

3. avoid twisting movements

extension at rest

position the knee in full extension while at rest to avoid a flexion contracture/stiffness

place pillows distal to the knee

early movement

typically get moving early, out of bed on day 1

WBAT is common, check orders

transfers

arm rests, hand holds, grab bars

toileting: safety frame, raised seat, commode chair

bathing: non-slip strips, side step, shower chair

ADLs and AE

main problem besides mobility is reaching towards the affected LE