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LE Amputations
Exam 2
75
Medical
Graduate
04/13/2012

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Term
There are over 185,000 amputations per year. List the sites of amputations from greatest to least.
Definition
UE
Partial Foot/Toes
Below Knee
Above Knee
Term
List the cause of amputations from greatest to least common.
Definition
Disease
Trauma
Tumor
Congenital
Term
What is the #1 disease that causes amputations
Definition
Diabetes
Term
What is the PT role prior to amputation surgery?
Definition
-Pt/Family Education
-PT Goals:
-Education (what to expect post sx, how to care for sound limb)
-Exercise (especially sound limb, gait training with assistive device as needed)
-Team Approach (made up of OT, PT, nutritionist, prosthetist, Dr, family)
-Needed info prior to sx
-Support systems prior to sx (Arkansas Act 1020)
Term
Which type of Dr often does amputation surgery, but was not required to study prosthetics?
Definition
Vascular Surgeon
Term
Which type of Dr often does amputation but did take a course in prosthetics?
Definition
Orthopedic surgeon
Term
Name 4 Goals of Amputation
Definition
1. Elimination and/or removal of the pathology
2. Optimal healing level (as low as possible to get good tissue)
3. Optimal level for prosthetic fit (not right at a joint)
4. Optimal functional level for ambulation
Term
It is almost always recommended to avoid amputation in the _____ of the tibia, as there is very little muscular tissue for padding in the distal most portion of the lower limb.
Definition
Distal 1/3 to 1/4
Term
Calves vary dramatically in thir anterior to posterior diameter, so ideally the tibia would be divided at a point where the distal edge of the appropriate length posterior flap would occur at the junction of the ___ and __
Definition
Soleus ms and achilles tendon
Term
When the transtibial amputee is standing up, the distance between the ground and the end of the residual limb allows adequate space for what 6 things?
Definition
1. Liner
2. Socket
3. Proximal Connector
4. Pylon
5. Distal Connector
6. Foot
Term
__ to __ inches of space allows for the use of most standard prosthetic feet and a pin lock suspension system.
Definition
4 - 6
Term
__ to __ inches allows for the addition of a shock absorbing component to the above standard prosthetic system.
Definition
6-8
Term
__ to __ inches is required for the use of most integrated high-impact foot/pylon/shock absorbing systems
Definition
8-10
Term
Practically, the tibial bone cut is planned to keep __ to __ length of the tibia. The exact location is based most commonly on the quality of the soft tissue envelope, the shape and size of the calf muscle, the overall height of the individual, and the location of scars, ulcerations or soft tissue defects.
Definition
1/3 to 1/2
Term
Amputation of any of one toe or more. This amputation includes toe plus metatarsal. Balance is way off if you lose your big toe. A toe plate may be placed in the shoe to help with gait.
Definition
Partial Toe / Ray Amputation
Term
Amputation through the midsection of the metatarsals (removal of the toes and distal ends of the metatarsals). Severely effects "toe off". May get a filler in shoes to help with gait.
Definition
Transmetatarsal
Term
Amputation between the tarsals and metatarsals. Must have something in shoe to fill space.
Definition
Lisfranc or Tarsometatarsal
Term
Amputation at the midtarsal level leaving only the talus and calcaneus
Definition
Chopart
Term
Heel pad is swung under and attached to the tibia and fibula to provide a weight bearing surface. No foot. Heel pad is pulled around and used as a weight bearing surface. Can walk on this for very short distances without prosthesis.
Definition
Symes/Ankle Disarticulation
Term
Amputation through the tibia and fibula. May be described as long, medium, or short depending on the length of the residual limb. A short one is hard to get a good prosthetic for.
Definition
Transtibial
Term
Amputation through the knee joint with the femur left intact. Difficult to make a prosthetic for b/c you have to make a knee joint.
Definition
Knee Disarticulation
Term
Amputation through the femur. May be described as long, standard/medium, or short.
Definition
Transfemoral
Term
Walking is possible with this type of amputation, but the prosthetic is so heavy that it may not be efficient. Many of these occur from trauma, tumors, or maybe wounds that did not heal.
Definition
Hip Disarticulation and Pelvic Amputations
Term
Name 3 types of dressing post-op.
Definition
Soft
Semi-Rigid
Rigid
Term
What is the post-op care for soft dressings?
Definition
-Sterile dressing, cotton padding, and elastic wrap.
-Provides protection, support, and gradient pressure
-Wound can be easily monitored by removing the dressing
-Dressing can be changed as needed to promote healing
-However, donning and doffing can be difficult, tension may vary with application
Term
This type of dressing is done when the wound must be very closely monitored
Definition
Soft Dressing
Term
This type of dressing is good to form the limb
Definition
Semi-Rigid
Term
This type of dressing is done more in traumatic injuries and the wound needs to have good healing potential.
Definition
Rigid
Term
Made of paste compound (unna paste) and felt or cotton padding
Definition
Semi-Rigid
Term
Made of plaster bandages or fiberglass casting with cotton or felt pads. Prevents excessive post-surgical edema and to provide a dry sterile environment for healing
Definition
Rigid Dressings
Term
Name 6 advantages of semi-rigid or rigid dressing post-operatively
Definition
1. Good support to surgical site and increased comfort
2. Improved wound healing environment (decrease edema)
3. The rigid dressing allows for early bipedal ambulation with the attachment of a pylon and foot (not full WB)
4. Allows for earlier fit of the definitive prosthesis
5. Can be made to be removed
6. Helps decrease phantom pain
Term
Name 3 disadvantages of semi-rigid and rigid dressing post-operatively
Definition
1. Requires careful application by knowledgeable individuals
2. Requires close supervision during early stage of healing
3. Does not allow daily wound inspection and dressing changes. (May have window in the distal end of the cast to allow for dressing changes or be bivalved)
Term
What does "bivalve" mean?
Definition
Cut down side to look and can put back on
Term
Name 9 Secondary Complications of Amputations
Definition
Pulmonary Complications
DVT
Infection
Formation of contractures
Physical de-conditioning
Phantom Pain
Back Pain
Wound Healing
Bowel and Bladder problems for some
Term
-Age of individual
-Physical de-condition prior to amputation
-Complications post amputation
-Prolonged bed rest
-Increased pneumonia risk
-Need to sit up in bed and mobilize ASAP
-Older people are at higher risk
Definition
Pulmonary Secondary Complication
Term
-Prolonged bed rest
-Physical de-conditioning prior to amputation
-Poor circulation pre and post amputation
Definition
DVT Secondary Complication
Term
Name 4 S&S of infection
Definition
Redness
Pus
Drainage around suture lines
Odor
Term
May occur due to poor circulation, primary diagnosis, and wound management.
Definition
Infection secondary cause
Term
Name the 3 most common areas for contracture of the LE's with transfemoral amputation
Definition
Hip Flexion #1
Hip abduction
Hip ER
Term
Name the 4 most common areas for contracture of the LE's with transtibial amputation
Definition
Knee Flexion (#1)
Hip Flexion
Hip abduction
Hip ER
Term
What ROM must you have to use prosthetic?
Definition
Extension
Term
When is the soonest after sx that you can start ROM?
Definition
Day 1
Term
After healing of the surgical site, what are 4 things, other than ROM, that you can begin doing.
Definition
1. Scar massage
2. Muscle stretching
3. Deep friction massage
4. Joint mobilization if contractures has occurred
Term
With this type of amputation, you should educate the pt to avoid positioning with a pillow under knees and prolonged sitting with knee flexed and in the fetal position. You always want knee extended.
Definition
Transtibial
Term
With this type of amputation, you should educate your patient to avoid prolonged sitting, placing pillows under residual limb and the fetal position. Encourage the prone position with hips in neutral.
Definition
Transfemoral
Term
Pain following amputation may present in 3 different ways.
Definition
Phantom Sensation
Phantom Pain
Residual Limb Pain
Term
A non-painful sensation or awareness of the body part no longer there. Usually occurs immediately post-op with varying degrees of intensity and changes over time. Described as pressure, tingling, numbness, itching, formication, general discomfort, phantom movement
Definition
Phantom Sensation
Term
What is formication?
Definition
Occurs especially in traumatic injuries. Pt feels like the limb is in the same position it was during the injury
Term
A painful sensation perceived in the missing body part. Occurs in at least 70% of all amputees regardless of age, gender, race, health, or psychological status. May be local or diffuse, intermittent or continual and may be triggered by external stimuli. May become a disabling condition decreasing the patient's rehab potential. Typically described as dull ache, cramping, squeezing, burning, shooting, stabbing, limb being pulled off, unnatural position, and pre-op pain that continues post-op
Definition
Phantom Pain
Term
Pain caused by a specific anatomical structure that can be identified. Such as pain due to the prosthesis, abnormal residual limb tissue, joint pain, soft tissue pain, soreness, etc. Tends to be more localized.
Definition
Residual limb pain
Term
Decreases hypersensitivity of residual limb through progressive tactile stimulation, sensory overload and increased weight bearing
Definition
Desensitization
Term
What is the PT intervention methods for dealing with limb sensation/pain?
Definition
Very important to evaluate the exact type of sensation or pain the pt describes in order to treat effectively
-Desensitization
-Residual limb wrapping or use of semi-rigid or rigid dressings
-WB in prosthetic
-Modalities such as heat, US, TENS
-Massage, vibration, and sensory overload
-Distraction on healed residual limb
-In cases of severe/chronic pain, surgical intervention is needed, electric shock, analgesic meds or narcotics and psychological intervention
Term
This is due to gait pattern and is most common in transfemoral amputations but can occur in any LE amputation.
Definition
Back Pain
Term
Name 5 PT treatments for back pain secondary to LE amputation
Definition
1. Normal gait pattern
2. Shock absorbing feet
3. Evaluation of proper fitting socket
4. Strengthening core muscles
5. Modalities as needed
Term
What is a PT intervention to prevent edema?
Definition
Residual limb wrapping
-Critical for those patients without semi-rigid or rigid dressings post-op. Early education to both the pt and family is essential for correct application and understanding of the importance of the wrap.
Term
Name 6 indication for residual limb wrapping
Definition
1. Decrease edema
2. Increase wound healing
3. Protection of residual limb
4. Aid in the shaping of the residual limb for better prosthetic fit (must be done quickly)
5. To decrease pain through sensory overload
6. Aid in achieving a permanent size to residual limb so prosthesis will fit
Term
Name 4 advantages to residual limb wrapping
Definition
Inexpensive
Available almost anywhere
Washable
Can vary the amount of compression
Term
Name 4 disadvantages of residual limb wrapping
Definition
1. wrap tends to loosen and slip
2. requires education to properly apply
3. reapplication is necessary throughout day
4. difficult for some clients to don/doff independently
Term
A sock-like garment fit by the prosthetist, made of elasticized material used to reduce edema in a residual limb. Not appropriate until excessive edema decreases.
Definition
Shrinker socks (residual limb shrinkers)
Term
Name 5 advantages to shrinker socks
Definition
1. Available thru prosthetist
2. Washable
3. Various Sizes
4. Can have belt suspension for added fit
5. Easier to don/doff
Term
Name 3 disadvantages of shrinker socks.
Definition
1. Expensive
2. Must go thru prosthetist to get
3. May need to change socks frequently until residual limb stabilizes in size
Term
Can you use a shrinker inside the prosthetic?
Definition
NO
Term
How often should you check the skin of your residual limb?
Definition
Every time you donn/doff
Term
Can you put residual limb into a socket if there is a wound?
Definition
NO
Term
Complications can arise secondary to surgery and bedrest especially for those pts with decreased conditioning prior to surgery
PT Intervention:
- Get the pt up ASAP
- Deep breathing exercises
- Positioning
- UBE (upper body ergometer)
- Education
Definition
Cardiopulmonary Care
Term
How long after surgery can you begin UE exercises, sound limb exercises, and trunk exercises?
Definition
Day 1 post-op
Term
Initial strengthening of residual limb should be done only within __ limits. Must take care not to compromise healing.
Definition
Pain
Term
With this level amputation, really focus on strengthening the knee extensors.
Definition
Transtibial
Term
With this level amputation, really focus on strengthening the hip musculature
Definition
Transfemoral
Term
Rehab potential greatly is greatly effected by psychosocial status. Name 3 issues.
Definition
1. Level of amputation
2. Social relationships
3. Reasons for amputation
- elimination of pain
- cancer
Term
A good prosthetic will __ energy expenditure and __ walk distance and speed
Definition
Decrease
Increase
Term
Vascular disease __ levels of O2 consumption which results in __ speed of walking
Definition
Decreases
Less
Term
Ambulation with prosthesis and crutches __ energy than ambulation with crutches and without prosthesis.
Definition
Increases
Term
The higher the level of amputation, __ waling speed.
Definition
Less
Term
Name 4 PT intervention for energy expenditure
Definition
1. Frequent monitoring of vitals
2. Provision of equipment
3. Recommended the most efficient and greatest energy return
4. Promote normal gait pattern and posture (exercises with and without prosthesis)
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