biomechanics process (orthopedic conditions) exam 3

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