Orthopedic Occupational Therapy Assessment Quiz

UE Orthopedic Conditions and OT Interventions

• Occupational therapists (OTs) play a role in assessing and treating orthopedic conditions.
• OTs aim to restore maximal function of the body and limb, thereby restoring occupational functioning.
• Preventing injury and supporting healing are crucial aspects of OT intervention in orthopedic rehabilitation.

Learning Objectives

• Objectives include describing common upper extremity (UE) orthopedic conditions across the lifespan.
• Understanding the functional impact of these conditions on daily activities is another goal.
• The role of OTs in the assessment and treatment of orthopedic conditions.

Overview

• OTs' Role in Orthopedics - OTs address precautions, movement restrictions, and activity orders.
• Key aspects of OT and orthopedics – patient knowledge, environment.

OT Role in Orthopedic Rehabilitation

• Helping patients reach their maximum functional potential, and thereby restoring their ability to perform daily activities.
• This involves pain and anxiety relief, minimizing swelling, and supporting wound care.
• Maintaining joint and limb alignment, followed by regaining function at the injury site, are further crucial steps.

Shoulder

• The shoulder complex is often considered challenging to rehabilitate.
• Its complexity stems from the interplay of multiple components: the glenohumeral, scapulothoracic, sternoclavicular, and acromioclavicular joints.
• The shoulder complex is essential for a vast range of upper body movement. This complex structure, important for daily activities, also includes various muscles, tendons, and ligaments for varied range of motion.

Shoulder Movement - Flexion

Shoulder Movement - Abduction

Rotator Cuff Review

• The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) work in coordination to control the humeral head and maintain shoulder stability.
• The supraspinatus is responsible for shoulder abduction.
• The infraspinatus and teres minor muscles are essential for external rotation.
• The subscapularis performs the internal rotation of the shoulder.

Rotator Cuff Tear Treatment Options

• Conservative management is a non-surgical approach.
• Orthotherapy is a physical therapy approach.
• Sub-acromial corticosteroid injections may be utilized.
• Surgical repair is a possible intervention.

RTC - Surgical Candidates

• Patient physiologically younger than 60
• Failure to improve with non-operative measures for at least 6 weeks
• Full passive range of motion (ROM)
• Diagnosed full-thickness tear using clinical assessment and/or imaging

Poor Candidates for RTC Surgery

• Patients older than 60
• Long-standing rotator cuff tear history (more than 1 year)
• No history of trauma
• Smokers
• Multiple steroid injections
• Diffuse osteopenia or osteoporosis.

Rotator Cuff Surgery

• Surgery can involve open procedures or arthroscopy, sometimes including a combined approach.
• Repair options may be tendon-to-tendon, or tendon-to-bone repair.

RTC Care Path

• Immobilization phase (0 to 4 or 6 weeks) is crucial for healing and pain management.
• A specific treatment plan, depending on recommendations by a doctor and physical therapist, determines safe ADL and exercise progression.
• Criteria for progression to the next phase of treatment are described, including improved tissue healing and minimized pain.

Neer Classification of Shoulder Fractures

• Describes different types of shoulder fractures based on the location and extent of the damage to the bones. (Images of these fractures are shown).

Shoulder Arthroplasty

• The goal of shoulder arthroplasty is to improve motion and strength, enabling the patient to manage daily activities (ADLs).
• This is often chosen for pain management, and functional enhancement.
• This intervention is less common than hip/knee arthroplasty, and the reasons include severe fractures, avascular necrosis, or osteoarthritis/rheumatoid arthritis.

Shoulder X-Ray

Hardware

Rehabilitation 0-6 weeks

• No resisted/active internal rotation.
• No lifting over a certain weight limit or items heavier than a dinner plate..
• Emphasis on isometric exercises, but avoiding the internal rotation of the affected shoulder
• Pendular exercises are considered appropriate.

Rehabilitation 6-12 weeks

• No lifting above a certain weight limit or items heavier than a dinner plate is still advised.
• ROM is limited by pain.
• Gentle active-assisted range of motion (AAROM) exercises may begin but internal rotations are still avoided.
• Strength exercises are also recommened with theraband/tubing during this phase.

Rehabilitation 12+ weeks

• Further considerations for returning to ADLs are given, and appropriate ROM is essential.
• Strengthening continued, primarily focused on specific resisted internal rotations..

Case Study

• A 45-year-old female patient who had a shoulder arthroplasty needs OT intervention for daily tasks to maintain independence. ADLs include dressing, sleeping, meal prep, eating, grooming, bathing, home safety and general activities.

Dressing

Sleeping

Eating

Meal Preparation

Grooming

Bathing

Home Safety

Other Considerations

• This section addresses consideration around computer use, phone use, leisure activities and driving. Activities of Daily Living (ADLs) to consider include these specific needs when recovering from a shoulder arthroplasty.

Orthopedic OT Basics

• Understanding precautions, activity orders, and movement restrictions is vital.
• Knowing specific activity restrictions (FWB, WBAT, FeWB, NWB, bed rest, bathroom privileges, AAT) and movement restrictions (hip precautions, spinal precautions) are covered.
• Discussion of casting, bracing, slings, TLSO, and collars is included for care requirements.
• Specific information about patient assessment, including occupational, social history, patient reliability, cognition, and compliance, are presented.

Know your environment

• Assessment of the patient's environmental demands and needs is advised.
• Understanding discharge destinations and required equipment.
• Awareness of the various environments a patient frequents.

Reverse Total Shoulder Replacement

• This section deals with contraindications and indications for a reverse total shoulder replacement.
• Contraindications include non-functional deltoid muscle, severe neurologic deficiency, and refusal to modify post-surgical physical activities.
• Indications include irreparable rotator cuff tears, association with glenohumeral arthritis or instability, and failures of hemiarthroplasty or total shoulder replacement associated with rotator cuff deficiency.

When Will A Conventional Shoulder Not Work?

What Is A Reverse Total Shoulder?

Elbow Injuries

• Types of elbow injuries addressed - olecranon fractures, radial head fractures, elbow dislocations, coronoid fractures, Monteggia fractures.

Olecranon Fractures

Screw and Tension Band Wire Fixation

Plate Fixation

Wrist Fractures

Colles Fracture

Scaphoid Fracture

Scaphoid Fractures

Classification of Finger Fractures

Back Conditions

• This covers various back conditions and pain descriptions.
• Includes back pain, risk factors, treatments for acute/chronic pain, causes and treatment options for associated back conditions, such as degenerative disc disease, herniated discs, spinal stenosis, scoliosis, kyphosis, lordosis.

Degenerative Disc Disease

Herniated Disc

Spinal Stenosis

Scoliosis/Kyphosis/Lordosis

Scoliosis: Surgical Treatment

Low Back Pain

• Incidence and most common cause of low back pain in adults.
• Different aspects of pain are discussed, which include postural stress, poor sleeping/sitting postures, lifting with a rounded back, prolonged standing/sitting.
• Different considerations about returns to work and development of acute/chronic pain are noted.

OT Role in Low Back Pain

Low Back Pain: Body Mechanics

Prolonged Standing

Bending/Reaching tasks

To sit

Lifting objects from floor

Carrying loads

Spinal Fractures

Spinal Fractures - Non-surgical treatments

Back Restrictions and Precautions - Lifting/Pushing/Pulling

Back Restrictions and Precautions - No Twisting

Back Restrictions and Precautions - Spinal Movements

Back Restrictions and Precautions - Activity Modification

Avoid staying in one position for too long

General Safety

Osteoporosis

• About 2 million Canadians have osteoporosis.
• Common characteristics that include loss of bone mass, affecting women more than men, potentially beginning at any age, although often asymptomatic.
• This "silent thief" is often linked to menopause due to loss of estrogen.

Osteoporosis - Types

Osteoporosis - Risk Increases

Osteoporosis: OT role

Falls Statistics in Canada

Falls

Osteogenesis Imperfecta

• Causes, types, and treatment approaches are presented.
• This condition is about imperfectly formed bone and inability to form certain strong bones. It is a genetic disorder, and hereditary.
• Clinical presentation often includes short stature, fractured bones healing abnormally, frequent fractures, and possible respiratory issues. The severity varies among the types, and some may present with blue sclera.

Osteogenesis Imperfecta: Treatment

Summary

• The number of orthopedic conditions and surgical treatments is enormous.
• The role of an OT in solving patient daily needs through a problem-solving approach, in order to restore occupational function for patients is stressed. This includes knowledge of patient precautions, activity orders, and movement restrictions and of the patient's environment.

Test your knowledge on orthopedic conditions, treatments, and assessment practices. This quiz covers various aspects, including contraindications for surgeries, weight-bearing restrictions, and the significance of patient histories. Assess your understanding and enhance your skills in orthopedic occupational therapy.