32. Focus topics

viscosupplementation

inject hyaluronic acid directly into joint to restore viscosity of synovial fluid, maintain joint health

indications: OA

ABI 1.0-1.4

normal

ABI 0.9-1.0

acceptable

ABI 0.8-0.9

treat risk factors

some arterial disease

ABI 0.5-0.8

moderate disease

refer to vascular specialist

ABI <0.5

severe disease

refer to vascular specialist

Wagner scale Grade 0

no open ulcerations but possible existence of bone deformation or hyperkeratosis

Wagner scale Grade 1

superficial ulceration without penetration to deeper tissue

Wagner scale Grade 2

deeper extension into tendons, bone or joint capsule, which may be exposed

Wagner scale Grade 3

presence of tendonitis, osteomyelitis, cellulitis, or deeper tissue abscesses

Wagner scale Grade 4

wet or dry gangrene

often with plantar infection

Wagner scale Grade 5

extensive gangrene of the foot with necrotic lesions and soft tissue infections

amputation

monofilaments

Apply monofilament perpendicular to skin, apply enough force to bend the filament for 1-1.5s. Ask the patient to respond yes if felt. Repeat each point 2-3 times.

10 points (9 on sole, and 1 on dorsum) with eyes closed

+ = unable to feel filament and increased ulcer risk

4.7 monofilament

loss of superficial sensation if cant feel

5.07 monofilament

loss of protective sensation if cant feel

6.10 monofilament

loss of all sensations if cant feel

Modified ashworth scale 0

No increase in muscle tone

Modified ashworth scale 1

Slight increase in tone manifested with Catch and release or minimal resistance at the end of the ROM when the affected part is moved in flexion or extension

Modified ashworth scale +1

slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout the remainder (less than half)

Modified ashworth scale 2

More marked increase in muscle tone through most of ROM but affected parts are easily moved

Modified ashworth scale 3

Considerable increase in muscle tone, passive movement is difficult

Modified ashworth scale 4

Affected part(s) rigid in flexion or extension

Sodium

135-145mg/dL

potassium

3.5 -5.0mEq/L

heart rhythm

Chloride

95-105mEq/L

Calcium

9-11mEq/L

BUN

10-20

kidney

Creatine

0.5-1.2mg/dL

kidney

Carbon dioxide

20-29mEq/L

Magnesium

1.5-2.5mEq/L

Hgb

F= 12-16

M = 13-18

Hematocrit

F = 36- 46%

M = 37- 49%

AST/ALT

liver

troponin

heart attack

ESR/CRP

inflammation

uncompensated forefoot valgus: rearfoot position

neutral

if compensated it would go in the opposite direction of the forefoot

main symptoms of complex regional pain syndrome

impaired sensation

platelets

150-450000

20-10000 - ADLs, ROM, walking, NO RESISTANCE

<10000 and/or temp 100.5 hold therapy

WBC

4800-10800

>5000 light exercise and resistance

<5000 with fever no exercise, MASK

hemoglobin

w 12-16

m -13-18

> 10 resistance and aerobic exercise, ambulation

8-10 ADLs, light exercise, light weights

< 8 ADLs

hematocrit

w 36-46%

m 37-49%

>35% resistance and aerobic

25-35% ADLs, light aerobic, light weight

< 25% ADLs

benign prostatic hyperplasia

hypertrophy of the prostate glands surrounding the urethra

narrowing of the urethra

HIFUN

- hesitancy

- incontinence

- frequency

- urgency

- nocturia

kussmaul respiration

rapid deep breathing