Sub acute Ortho content for final

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Questions and Answers

What types of assessments will be used in the subacute written exam?

Short and long cases, still images, and/or videos.

What type of questions can students expect in the exam?

  • Multiple choice
  • Short answer
  • True/false
  • All of the above (correct)

The exam will consist only of multiple choice questions.

False (B)

What are some indications for doctor referral as a treating physiotherapist following different surgeries?

<p>Progressive neurological symptoms, infection.</p> Signup and view all the answers

Match the following conditions with their appropriate management options:

<p>ACL injury = Surgical repair or conservative bracing Meniscal tear = Arthroscopy or conservative rehabilitation Achilles rupture = Surgical repair or conservative management Hip OA = Surgery or exercise therapy</p> Signup and view all the answers

For an ACL reconstruction, autografts are preferred over ______.

<p>allografts</p> Signup and view all the answers

Surgery is always better than conservative treatment for ACL injuries.

<p>False (B)</p> Signup and view all the answers

What is a major reason for choosing surgical intervention for an ACL injury?

<p>Knee instability.</p> Signup and view all the answers

What is the main purpose of rehabilitation after a meniscus repair?

<p>To support the meniscus healing (B)</p> Signup and view all the answers

Match the following conditions with their absolute and relative indications:

<p>Ankle fracture = Weber C – unstable syndesmosis ruptured Achilles rupture = Insertional tear Total Hip Replacement (THR) = Pain: OA, RA, Post-traumatic arthritis, Avascular necrosis Hip fracture = Displaced # + &gt; 60 yrs = THR or hemi Anterior Cervical Discectomy and Fusion (ACDF) = Progressive cervical myelopathy Lumbar Spine Fusion (LSF) = Similar to ACDF Shoulder surgery = Atraumatic, degenerative full thickness cuff tear</p> Signup and view all the answers

What considerations should be made during rehabilitation for LSF?

<p>Teach precautions, log roll, breathing techniques.</p> Signup and view all the answers

What is a common risk factor for an ACL injury?

<p>Female sex (B), Young age (D)</p> Signup and view all the answers

The surgical option for a midportion Achilles tendon tear is ___

<p>Insertional surgery</p> Signup and view all the answers

A hamstring autograft is considered a cost-effective option for ACL surgery.

<p>False (B)</p> Signup and view all the answers

What is a management consideration for Weber A fractures?

<p>Typically don’t need to be casted (C)</p> Signup and view all the answers

What is a primary exercise for early rehab in Grade 3 Achilles tendon rupture?

<p>Toe scrunches</p> Signup and view all the answers

Full weight-bearing is allowed immediately after Total Hip Replacement (THR).

<p>False (B)</p> Signup and view all the answers

The main characteristic of non-displaced hip fractures is ___

<p>internal fixation is required.</p> Signup and view all the answers

Match the types of ACL surgeries with their characteristics:

<p>Autograft = Tissue from patient's own body – more cost-effective Allograft = Tissue from a donor – most commonly used for revision surgery Patella tendon = Increased risk of patellofemoral pain and post-op stiffness Hamstring = Easier surgery, less post-op knee pain and stiffness</p> Signup and view all the answers

Which of the following is NOT a risk factor for Osteoarthritis?

<p>High physical activity (A)</p> Signup and view all the answers

What must be checked prior to seeing a patient on day 1 following surgery?

<p>Surgeon's notes, baseline assessment prior to surgery, past medical history, contraindications/precautions, weight-bearing status, vital signs, and pain tolerance/medications.</p> Signup and view all the answers

What type of management is typically more appropriate for extrascapular femoral fractures?

<p>Casting (D)</p> Signup and view all the answers

What does modern evidence suggest about the effectiveness of traction following hip fractures?

<p>Modern evidence suggests limited effectiveness of traction, favoring early surgical intervention for better outcomes.</p> Signup and view all the answers

What are the recommendations to avoid surgical revision following total knee replacement (TKR)?

<p>Pursue low-moderate intensity exercise such as walking and swimming, avoid high intensity exercise, and avoid running, contact sports, and heavy lifting.</p> Signup and view all the answers

What is the purpose of TKR?

<p>To allow resumption of normal activities (A)</p> Signup and view all the answers

Physical therapy after TKR is scheduled for 1 hour, 2 times a week for 12 weeks.

<p>True (A)</p> Signup and view all the answers

In conservative management strategies for knee osteoarthritis without comorbidities, which of the following is NOT recommended?

<p>Contact sports (D)</p> Signup and view all the answers

What are the precautions and instructions following ACDF surgery in the first two weeks?

<p>Wearing a cervical collar if requested, consulting with a doctor for signs of complications, and avoiding lifting items heavier than 1.5L of milk.</p> Signup and view all the answers

What are absolute indications for ACDF surgery?

<p>Cervical myelopathy due to spinal cord compression.</p> Signup and view all the answers

What is NOT a red flag indicating the need for further referral/testing?

<p>Pain in the left leg (B)</p> Signup and view all the answers

List one factor that may influence the length of time for surgical precautions.

<p>Cigarette smoking.</p> Signup and view all the answers

What is the primary concern regarding excessive motion at the fusion site?

<p>Leads to excessive callus formation (C)</p> Signup and view all the answers

What advice should be given to a patient struggling to perform movements?

<p>BRP: Bend, roll, and push.</p> Signup and view all the answers

What is a common cause of rotator cuff injury?

<p>All of the above (D)</p> Signup and view all the answers

Younger patients generally recover faster after surgery.

<p>True (A)</p> Signup and view all the answers

Why are scapula exercises important in rehabilitation?

<p>They support movement, mobility, force, proprioception, and stability.</p> Signup and view all the answers

What is the expected recovery time after TKR for younger patients?

<p>Typically faster recovery and better function.</p> Signup and view all the answers

Flashcards

Subacute Written Exam

A written assessment using cases, images, and videos, focusing on evidence-based management plans.

Evidence-Based Management

Management plans based on scientific evidence and best practice guidelines.

Impairments/Limitations/Restrictions

Problems in body function/structure, activity, and participation, respectively.

Objective Assessments

Measurements and observations of a patient's condition.

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ACL Surgery

Surgical treatment for anterior cruciate ligament injuries.

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Meniscal Tear

Injury to the meniscus, a cartilage pad in the knee.

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Ankle Fracture

A break in the ankle bone(s).

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Achilles Rupture

A tear in the Achilles tendon.

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Hip/Knee OA

Osteoarthritis in the hip or knee.

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Hip Fracture

A break in the hip bone.

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Spinal Surgery

Surgical procedure on the spine, often for conditions like spinal stenosis.

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Shoulder Surgery

Surgical repair or treatment of a shoulder condition, like rotator cuff tears.

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Surgical vs Conservative Management

A comparison of surgical and non-surgical approaches to treatment.

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Doctor Referral

Referring a patient to a medical doctor for further evaluation or treatment.

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Post-op Rehabilitation

Physical therapy and exercise following a surgical procedure.

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Indications for Surgery

Reasons or criteria for recommending surgical intervention.

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Weber C Ankle Fracture

An unstable ankle fracture involving the syndesmosis.

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Achilles Insertional Tear

An Achilles tendon tear at its connection point to the heel bone.

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THR Absolute Indication

Factors that absolutely require a total hip replacement (e.g.severe hip pain, etc).

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Hip Fracture Relative Indication

Factors influencing the type of treatment for a non-displaced hip fracture (e.g. age, displacement).

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ACDF Progressive Myelopathy

A serious condition where compression of the spinal cord in the neck worsens.

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Lumbar Spine Fusion

Surgery to permanently join two or more vertebrae in the lower back.

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Full Thickness Cuff Tear (Atraumatic)

A shoulder injury involving the rotator cuff that is not caused by trauma (e.g. degenerative).

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Grade 3 Achilles Tendon Rupture Rehab

Rehabilitation phases for a severe Achilles tendon tear, focusing on controlled progression.

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Lower Limb ACL Injury Risk Factors

Conditions that increase the chance of injuring the anterior cruciate ligament in the knee.

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Meniscectomy

Surgical removal of damaged meniscus cartilage in the knee.

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Meniscus Repair

Surgical repair of a damaged meniscus in the knee.

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ACL Autograft

ACL repair using tissue from the patient's own body.

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ACL Allograft

ACL repair using tissue from a donor.

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Weber A Fracture

A stable ankle fracture, typically not requiring casting.

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Weber B Fracture

An ankle fracture requiring specific weight-bearing protocols (e.g. NWB or PWB).

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Surgical vs. Conservative Achilles Tendon Mx

Comparison of surgical and non-surgical treatments for a grade 3 Achilles tendon rupture.

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Hip Osteoarthritis Risk Factors

Conditions that increase the risk of developing hip osteoarthritis.

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Post-Sx Day 1 Check

Pre-Sx assessment, including baseline measurements, medical history, contraindications, weight-bearing status, vital signs, pain tolerance, and medications, is crucial for determining appropriate post-surgical care

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Extrascapular Femoral Fractures Mx

Conservative management (casting) is typical for extrascapular femoral fractures, but surgery may be necessary if the fracture is displaced or the patient cannot follow post-operative precautions.

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Hip Fracture Traction

Modern evidence suggests early surgical intervention for hip fractures is preferable to traction, as traction has limited effectiveness.

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TKR Revision Prevention

Low-moderate intensity exercise (walking, swimming) is advised after TKR to enhance strength and enable patients to resume normal activities. Running, contact sports, and heavy lifting should be avoided.

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TKR + PT vs PT Outcome

Surgical TKR, combined with physical therapy, is more effective than physical therapy alone, specifically for moderate to severe osteoarthritis, but has a greater risk of adverse effects.

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Knee OA Conservative Mx

Conservative approaches for knee osteoarthritis, not accompanied by comorbidities, encompass biomechanical interventions, intra-articular corticosteroids, topical NSAIDs, walking aids, selective NSAIDs, and paracetamol.

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ACDF Post-Op Precautions

Post-ACDF surgery precautions include using a cervical collar (if prescribed), avoiding lifting heavy objects, strenuous exercise, or getting the surgical site wet until healed.

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Cervical Radiculopathy Surgery

ACDF (anterior cervical discectomy and fusion) may be indicated for cervical radiculopathy, if conservative treatment (at least 6 weeks) fails, or in case of progressive neurological deficits.

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Healing Time Influences

Bone healing time is affected by smoking, age, nutrition, comorbidities (like diabetes), steroid use, and radiation/chemotherapy.

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LSF Post-Op Precautions

Post-LSF (lumbar fusion surgery) precautions include limitations on bending, lifting, twisting, prolonged sitting, pushing, pulling, driving, lasting for 6 weeks.

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Movement Difficulty Advice

Use the BRP (bend, roll, push) technique to assist with pain-free movement when struggling during rehabilitation.

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Referral Indications

Red flags like cauda equina syndrome (Urinary retention, anal sphincter tone), pseudoarthrosis, infection, and severe radiating low back pain prompt urgency for referral and testing.

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Spinal Stenosis Mx Comparison

Surgical (LSF) and conservative management (physical therapy/medication/activity modification) are both options for spinal stenosis; however, surgery might yield better outcomes in certain situations.

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Moderate RC Repair Precautions

0-4 weeks post-moderate RC repair (deltoid entry), avoid pushing/pulling/lifting, overhead activities, and forceful deltoid contractions. 5-8 weeks: avoid heavy lifting/carrying, excessive overhead motion. 8+ weeks: no resisted exercises for a longer time.

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Rotator Cuff Injury Causes

Rotator cuff injuries are categorized into four types: referred pain (from other sources), stiffness (e.g., frozen shoulder), instability (like subluxation or dislocation), and problems with supporting tissues (tendons, bursae).

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