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Musculoskeletal

QuestionAnswer
Prosthesis control training operate each component
Prosthesis use training integration of components for efficient assist in functional tasks
Prepositioning training identify optimal position of each positioning unit (joint)
Prehension training TD control during grasp activities
Contractures fixed posture because of shorterning of skin, ligaments, joint capsule, tendon, and muscle could be from burns, wound healing, muscle imbalance because of PNI, SCI, increased muscle tone from stroke, head injury, and CP
Soft tissue contractures vs bony block contractures respond to therapy vs requires surgery to release
Treatment of contractures 1. superficial and deep heat to increase tissue extensibility 2. slow stretch 3. static splinting
Antideformity (safe position) burn splint wrist 20 deg extension MCP 90 deg flexion PIP and IP extension
Wrist extension splint prevent wrist drop, functional splint with 45 deg of wrist extension worn during the day
thumb abduction splint prevent thumb adduction contracture C-bar in web space
lumbrical bar splints reduce MCP hyperextension and IP flexion contractures
resting hand, ball, and cone antispasticity splint decrease tone in hand and UE
soft neoprene splints position thumb and forearm used with RA or CP
serial casting fiberglass or plaster to position clients iwth increased tone and over time stretch out soft tissue contractures
dynamic splinting angle of pull at 90 deg for most effective outcome
fibromyalgia widespread soft tissue pain, nonrestorative sleep, fatigue, inability to think clearly, paresthesia, joint swelling, depression, anxiety excessive tenderness in 11 of 18 trigger points
fibromyalgia intervention daily activity log education to avoid triggers gentle aerobic exercise myofascial release sleep hygiene techniques fatigue management, energy conservation, work simplification activity/environment modification
Toe touch weight bearing toe touch for balance, 90% weight on unaffected leg
partial weight bearing 50% WB
Posterolateral hip precautions no hip flexion >90 deg no internal rotation no adduction
anterolateral hip precautions no external rotation no extension no adduction
sciatic pain nerve is trapped by a herniated disc
spinal stenosis narrowing of the intervertebral foramen
facet joint pain inflammation or changes of spinal joints
spondylosis stress fracture of the dorsal to transverse process
spondylolisthesis slippage of a vertebra out of position
herniated nucleus pulposus stress tearing of the fibers of a disc, causing an outward bulge pressing on spinal nerves
Body mechanics(9) straight back-minimize lumbar lordosis bend from hip avoid twisting maintain good posture carry loads close to body lift with legs, wide BOS, in sagittal plane, and slowly
semisquat vs squat vs stoop lift safest for the back, ideal for heavy loads/preferred by people with LBP/used for light loads
Bathing for LBP shower better than bath handheld shower head bathmat items within reach
Dressing for LBP minimize bending sit while dressing, lie down to pull pants up socks by bringing foot to knee slip on shoes belts through pants prior to donning
functional mobility for LBP logrolling firm armed chairs not sit for more than 20 minutes at a time
sleep positioning for LBP pillow support neck and head without causing flexion sleeping on back: pillow under knees sleeping on side: pillow between knees sleeping on stomach: pillow under feet
chemotherapy use of toxic chemicals to kill cancer cells
radiation use of radioactive material to kill cancer cells precatuions: maintain joint ROM while avoiding pulling burned skin
hormone therapy use of hormones to decrease estrogen which can increase spread of some cancers preacution: monitor room temperature and client mood
immunotherapy use of medicine to block or heighten immune response preacutions: avoidance of scratching skin
osteoarthritis noninflammatory condition that causes a breakdown in articular hyaline cartilage common in PIP, DIP, CMC, MTP, hip, knee, cervical and lumbar
osteophytes or bone spurs- bouchards--OA PIP joint
osteophytes or bone spurs-heberdens--OA DIP joint
TKR precautions no pillow under knee while in bed rest feet on floor while seated avoid kneeling, squatting, twisting the knee
Contraindications for OA pinching exercises with CMC joint instability spica splint can help improve joint stability
Joint protection and fatigue management (9) respect pain, maintain strength/ROM, use each joint in most stable plane avoid positions of deformity use strongest joint and correct patterns of movement avoid staying in 1 position for long avoid starting activities that cant be stopped balance res
rheumatoid arthritis chronic, systemic, inflammatory condition progressive synovitis symmetric polyarticular presentation: PIP, MCP, MTP, hip, knee, shoulder, cervical spine
7 diagnostic criteria for RA need 4 morning stiffness 3+ swollen joints in 14 possible areas swollen joints of the hands symmetric swollen joints rheumatoid nodules serum rheumatoid factor radiographic changes on posterior hand
boutonniere PIP flexion, hyperextension of DIP
swan neck hyperextension of PIP, DIP flexion
mallet finger flexion of DIP
ulnar drift radial deviation of wrist and ulnar deviation of MCP joint (zigzag deformity)
mutilans deformity floppy joints with shortened bones and redundant skin most common in MCP, PIP, radiocarpal, or radioulnar joints
Type 1 pattern of thumb deformity MCP Flexion and IP joint hyperextension , similar to boutonniere
Type 2 pattern of thumb deformity CMC flexion/adduction, MCP flexion, and IP joint hyperextension, similar to boutonniere
Type 3 pattern of thumb deformity CMC subluxation, MCP hyperextension, and IP flexion (smilar to swan neck)
Type 4 pattern of thumb deformity MCP hyperextension and instability of MCP UCL (similar to gamekeepers thumb)
Type 5 pattern of thumb deformity MCP hyperextension because of a lax volar plate
Type 6 pattern of thumb deformity thumb collapse because of arthritis mutilans
Four stages of RA Might overlap acute, subacute, chronic active, chronic inactive
acute stage of RA pain and tenderness at rest that increases with movement limited ROM, stiffness, gel phenomenon (inability to move joints after rest), weakness, tingling or numbness, hot red joints, cold sweaty hands, low endurance, weight loss, dec appetite, fever
subacute stage of RA acute symptoms with reduced pain and tenderness
chronic active stage of RA low grade inflammation, decreased ROM, less tingling, pain and tenderness primarily with movement, low endurance
chronic inactive stage of RA No inflammation, pain from stiffness and weakened joints, morning stiffness related to disuse, limited ROM, weakness and muscle atrophy, contractures
Progression of RA: stage 1, early no destructive changes on x ray, possible presence of OP
progression of RA: stage 2, moderate radiographic evidence of OP, possible slight bone destruction and presence of slight cartilage destruction, no joint deformity, muscle atrophy, possible presence of lesions
progression of RA stage 3 severe radiographic evidence of OP, cartilage and bone destruction, joint deformity, muscle atrophy, soft tissue lesions
progression of RA stage 4 terminal fibrous or bony ankylosis in addition to stage 3