Studied by 1 person
dirette ch 41
what is the aim of occupational therapy in orthopedic rehabilitation
to help patients achieve maximal musculoskeletal functioning in order to perform everyday activities
what is the ots role in the acute stage of recovery (5)
relieve pain
decrease swelling and inflammation
wound care
maintenance of joint or limb alignment
restore function at the injury site
as healing progress the ot works with the patient to restore _____
activities of daily living
the ots role is dependent on what
stage of recovery
as acute pain decreases the ot focuses on what to help the patient reach and sustain optimal occupational functioning
an individually tailored education program
what regulate the choices made during treatment planning and serve as the end point for treatment
life roles
what is deferred if the surgeon protocol requires complete rest of the injury
range of motion measurements
what is defined as active or passive movement within a predetermined safe arc
controlled range of motion
detailed strength testing with applied resistance is deferred until when
there is bony consolidation and tissue healing or acute inflammation has calmed
grip and pinch testing are deferred for how long
2-4 weeks following cast removal
why are grip and pinch testing deferred for 2-4 weeks following cast removal
the force required
assessing strength after a fracture or surgery should only be performed when
ordered by the orthopedist
what is the most important ot treatment goal in orthopedics
restoration of occupational functioning
to achieve restoration of occupational functioning the patient needs to be directed from the beginning of therapy to what
move and use all unaffected joints
what is the goal of fracture treatment
to achieve a precise and effective stabilization to return to function
how are closed fractures that are undisplaced and stable managed
protection alone (without reduction or immobilization)
how are closed fractures that are undisplaced and unstable treated
positioning and external immobilization (sling, cast, brace)
how are open fractures and some unstable closed fractures where bone fragments cannot be approximated treated
open reduction internal fixation
fracture healing status is confirmed how before what
physical examination and xrays
advancing the rehabilitation program
what is the estimated timetable for uncomplicated upper extremity fractures in adults
2-3 weeks: callus formation
4-6 weeks: union
6-8 weeks: consolidation
what is the estimated timetable for uncomplicated lower extremity fractures in adults
2-3 weeks: callus formation
8-12 weeks: union
12-16 weeks: consolidation
what are the 3 phases of fracture healing
inflammation phase
reparative phase
remodeling phase
early movement prevents the side effects of _____
immobilization
what joints make up the shoulder complex (4)
glenohumeral joint
scapulothoracic joint
sternoclavicular joint
acromioclavicular joint
the _____ is the most challenging portion of the body to rehabilitate
shoulder
the progression of therapeutic treatment of the shoulder is directed by the _____ based on what
orthopedist
radiographic imaging of the fracture site
_____ is the movement of the limb by an external force to its available end range or prescribed end range
passive range of motion
_____ is movement of the limb by an external force to its available end range then applying overpressure
passive stretching
what is contraindicated in the early stages of fracture healing
passive stretching
(conservative/nonoperative) when does shoulder motion begin in stable or minimally displaced fractures
as soon as acute pain diminishes
(conservative/nonoperative) what does therapy begin with
sling immobilization
(conservative/nonoperative) when do controlled exercises begin
1-2 weeks post injury
controlled exercise programs include what (4)
codmans pendulum exercises
prom gentle
arom of uninvolved joints
adls using one handed techniques
prom is performed in what position
supine
what are shoulder exercises in which the patient stand or sits, bends over at the hips so the trunk is parallel to the floor, and swings the arm passively or actively in various linear and circular motions
codmans pendulum exercises
(conservative/nonoperative) gentle submaximal isometrics may begin at _____ weeks
4
(conservative/nonoperative) arom may begin at _____ weeks
6
(conservative/nonoperative) arom should begin in which position and progress to what
gravity eliminated
against gravity
what should the therapist be looking for when the patient begins arom
unwanted compensatory movements
(conservative/nonoperative) what can begin at 6 weeks post injury
arom in gravity eliminated progressing to against gravity
light, nonresistive self care activities
when can a patient begin being weaned off sling use
when arom begins
(conservative/nonoperative) what begins at 8-12 weeks
sling is discarded
can begin isotonic strengthening
(conservative/nonoperative) when are sports, leisure, and work activities initiated
after 12 weeks
unstable shoulder fractures require what for fication
surgical intervention
when are codmands pendulum exercises contraindicated
if the upper extremity is edematous
(postoperative) when does strengthening start
12 weeks
hemiarthroplasty
humeral head replacement
humeral head fractures that are unstable and significantly displaced are treated how
with a hemiarthroplasty
what treatment is considered for patients with severe arthritis in combination with a proximal humerus fracture
total shoulder arthroplasty
when is a reverse total shoulder replacement used
when there is significant damage to the rotator cuff or severe arthritis of the glenohumeral joint
what is a major limitation of reverse total shoulder replacement
impaired shoulder rotation
(total shoulder arthroplasty) when does the rehabilitation program begin
within 1-2 days postop
(total shoulder arthroplasty) what is they key to satisfactory functional results
early achievement of shoulder elevation and external rotation
(total shoulder arthroplasty) what is introduced in the first 3-5 days post op
passive shoulder elevation in supine
passive external rotation
(total shoulder arthroplasty) passive external rotation may be restricted to _____ degrees
30
(total shoulder arthroplasty) when are codmans pendulum exercises introduced and at what frequency
1 week postop
4-6x/day
(total shoulder arthroplasty) what tendon may be incised during surgery that can disrupt the integrity of the rotator cuff
subscapularis tendon
(total shoulder arthroplasty) if the subscapularis tendon is incised during surgery when will external rotation be reintroduced
4 weeks
(total shoulder arthroplasty) if the subscapularis tendon is not incised during surgery when will external rotation be reintroduced
2 days postop
(total shoulder arthroplasty) at 3 weeks what are introduced
submaximal isometrics
(total shoulder arthroplasty) when is arom introduced and how should it be progressed
6 weeks
supine to sitting
(total shoulder arthroplasty) activities that emphasize what are initiated at 8-12 weeks
shoulder elevation
rotational movements
(total shoulder arthroplasty) weight bearing on the injured arm is not allowed for _____ months
6
(total shoulder arthroplasty) _____ degrees is considered functional arom of shoulder elevation and is the goal to achieve
135
(total shoulder arthroplasty) _____ degrees are the goal for internal and external rotation
50
what might be prescribed for initial treatment of closed reduction fractures of long bones
functional fracture brace
a _____ fracture brace allows for notion above and below the fracture site to prevent negative effects of immobilization
functional
there is a risk of _____ nerve damage associated with humeral shaft fractures
radial
_____ nerve injury is characterized by inability to extend the elbow, wrist, and digits
radial
_____ motion gives the individual the capacity to position the hand in space close to or far from the body for fine motor activities and to function and a stabilizer for strength activities
elbow
what motions can be accomplished at the respective elbow joints
flexion and extension at the ulnohumeral and radiohumeral joints
pronation and supination at the proximal radoiulnar joint
_____ type fractures are the most common distal humerus fractures that impact elbow function
extension
_____ and _____ are the most common types of extension fractures of the distal humerus
intercondylar and supracondylar
extension fractures of the elbow are associated with what complications (3)
malunion
peripheral nerve injury
volkmanns ischemia
what is defined as a compartment syndrome of the forearm
volkmanns ischemia
what is a complication of volkmanns ischemia
ischemic contracture
how is a nondisplaced or minimally displaced sypracondylar fracture treated
closed reduction and immobilization in a removable cast or splint
how are complex elbow fractures including displaced supracondylar and interdondylar fractures treated
oped reduction and fixation
when does active motion begin with complex elbow fractures
2-3 days postop
a complex elbow fracture is splinted in _____ because why
flexion
greater functional importance
the surgeon may restrict forearm rotation when what is also injured
collateral ligaments
(complex elbow fractures) what is initiated at 6-8 weeks (2)
gentle prom
light isotonic exercises
(complex elbow fractures) at 8 weeks there is an increased emphasis on what (2)
restoring full rom
increasing strength
severe radial head fractures require what treatment
radial head excision
what exercises are encouraged early in the treatment of radial head fractures
pronation and supination
what movement does the supraspinatus perform
humeral elevation
what movement do the infraspinatus and teres minor perform
external rotation
what movement does the subscapularis perform
internal rotation
the rotator cuff is located in the subacromial space between what 2 structures
coracoacromial arch
head of the humerus
what is the critical zone
where the supraspinatus inserts on the greater tuberosity of the humerus
the _____ is the most commonly impinged rotator cuff tendon
supraspinatus
what muscle tendon is impinged in the critical zone
supraspinatus
what condition is defined as the compression of structures found in the subacromial space
shoulder impingement syndrome
what are the structures in the subacromial space
subacromial bursa
supraspinatus
joint capsule
long head of the biceps
what are the most common causes of shoulder impingement syndrome (2)
hooked acromion
repetitive or sustained elevation of the shoulder above 90 degrees
what is the result of untreated shoulder impingement syndrome
rotator cuff tear
what is the classification system of shoulder impingement syndrome
stage 1: edema, inflammation, hemorrhage associated with inflammation of the tendons or bursa
stage 2: thickening and fibrosis of the bursa and tendons
stage 3: bone spurs and partial or full thickness tears
small rotator cuff tear
< 1 cm
medium rotator cuff tear
1-3 cm
large rotator cuff tear
3-5 cm
Note
Flashcard