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37 Cards in this Set

  • Front
  • Back
What types of deformities are common with RA?
-ulnar deviation and subluxation of wrsits and MCPS

Boutonnierre deformity (PIP flexion, DIP hyperextension)

Swan neck deformity: PIP hyperextension, DIP flexion
Types of bone spurs
Heberden's nodes - DIP joints

Bouchard's nodes at the PIP joints
Precautions when evaluating and treating arthritis
avoid PROM (particularly at inflammatory stage)

avoid muscle testing unless ordered by MD

Can use sphygmomanometer to assess grip strength

avoid hot packs in inflammatory stage

avoid strengthening during inflammatory stage (strength can prevent deformity otherwise)
splinting for arthritis
acute stage: resting hand splints

unlar drift splint to prevent deformity

silver ring splints for boutonniere and swank neck deformities

Dynamic MCP felxion splint with radial pull s/p MCP arthroplasy

hand based thumb splint for CMC arthritis
Following hip fracture, what determines type of device used?
WB'ing status
What is the most common approach for hip replacement?
posterolateral
Hip precautions
-no flexion beyond 90*
-do not adduct/cross legs
-do not internally rotate (if anerolateral, do not externally rotate)
-do not pivot at hip
-only sit on raised chair/toilet seat
-transfer sit to stand: keep operated hip in slight abducation and extended in front
what is a forequarter amputation?
loss of entire UE including clavicle and scapula
What is a terminal device? What are the 2 main types?
-helps an individual to grasp/hold and object s/p amputation

2 types:
- hook (voluntary open and voluntary closing varieties)
- hand

-also cosmetic devices available w/ min. function
What is a neuroma?
complication of amputations

growth occurring when nerve endings adhere to scar tissue

can be very hypersensitive and painful
complications of amputations
1. neuromas
2. skin breakdown
3. phantom limb syndrome
4. phantom limb pain
5. infection
6. knee flexion contracture (transtibial BKA)
7. psychological impairments 2/2 shock or grief
What is the appropriate way to wrap the residual limb s/p amputation?
-distal to proximal

-decrease tension as you move proximally

-figure 8 wrapping (circular wrapping is bad for circulation)
considerations for pre-prosthetic treatment
1. change dominance PRN
2. ROM to uninvolved joints
3.desensitization
4. wrapping to shrink/shape
5. skin care and ADL training
Prosthetic treatment
-functional training

-doff/donning prosthetic

-increase wearing tolerance
Treatment for LE amputations
-wrap/shape residual limb to limit swelling
-desensitize
-UE strengthening (triceps for transfers)
-transfers (stand pivot)
-ADLs, LE dressing
-standing tolerance
-W/C mob
superficial burn
1st degree
epidermis only

no blisters, minimal pain

heals 3-7 days
superficial partial thickness burn
2nd degree

epidermis and upper porition of dermis

red, blistering, wet

heals in 7-21 days
deep partial thickness burn
Deep 2nd degree burn

involves epidermis, dermis, hair follicles, and sweat glands

red, white elastic

possibly impaired sensation

may become fullthickness if infected

Heals 21 to 35 days
full thickness burn
3rd degree
involves dermis, epidermis, hair follicles, sweat glands, and nerve endings

white, waxy, leathery, non-elastic

sensation absent

needs skin graft; months to heal

hypertrophic scar
4th degree burn
inolves fat, muscle, bone

electrical burn - destruction of nerve along pathway
rule of 9's
% total body surface area (TBSA) describes burn severity

9% = head, each arm

36% = midsection/torso

18% = each leg

1% = genitals
intervention for deep partial thickness burns
-ROM 72 hrs post op
strength and sensation when wounds are healed

-Wound care and debridement, sterile whirl pool, dressing changes

gentle AROM/PROM as tolerated

edema control

splinting
Full thickness burn intervention
requires graft

evaluate ROM 5-7 days post op

First 72 hrs (emergent phase): dressing changes, splint at all times

5-7 days: AROM, light ADL, sterile whirlpool

massage when wounds are healed

order compression garment (scaring)

otoform/elastomer to control scaring
Hand splints for burns
wrist 20-30* extension
MCP 50-70* flexion
IP full extension
thumbs abducted and extended
Splinting if burns develop flexion contractures
Palmar extension splint:

wrist = 0-30* extension
MCPs neutral to slight extension and abducted
IPs = full extension
thumb abducted and extended
Anti-contracture position: anterior neck burn
tendency: neck flexion

remove pillows. neck extension collar
Anti-contracture position: Axilla burn
tendency: adduction

splint/position: 90-120* abduction
axilla splint/positioning wedges (airplane splint)

watch for brahial plexus strain
Anti-contracture position: anterior elbow burn
tendency: flexion

extension splint5-10* flexion
Anti-contracture position: dorsal wrist burn
tendency- wrist extension

support wrist in neutral
Anti-contracture position: volar wrist burn
tendency: wrist flexion

wrist cock-up, 5-10* flexion
Anti-contracture position: dorsal hand burn
tendency: claw hand deformity
Anti-contracture position: dorsal hand burn
tendency: claw hand deformity

functional hand splint
70-90* MPs
IPs extended
open webspace
thumb opposition
Anti-contracture position: volar hand burn
tendency: palmar contracture, cupping

palm extension splint
MPs in slight hyperextension
Anti-contracture position: anterior hip burn
tendency: hip flexion

position in prone
weights on thighs in supine
knee immobilizers
Anti-contracture position: knee burn
tendency: knee flexion

knee extension w/positioning/splint
prevent ER (may cause peroneal N. compression)
Anti-contracture position: foot burn
tendency: foot drop

ankle at 90* with foot board or splint

watch for signs of heel ulcer
splinting for web space burn
C-splint