Orthopedics and Musculoskeletal Disorders

Sections:

• Hip Joint

• Knee joint

• Guidelines for lower body surgeries and fractures

• Shoulder

• Guidelines for upper extremity fractures and surgery

• Rib fractures

• Musculoskeletal and immunological disorders

Orthopedics definition: branch of medicine that deals with bones, muscles, joints, ligaments, and tendons.

Occupational therapy’s main role in orthopedics in the acute setting:

1. Regain ability to perform important daily occupations by using adaptive equipment

2. Environmental adaptations

3. Compensatory strategies

4. Splinting

5. Positioning

6. Education about symptom management

Hip Joint

• The hip is the major weight bearing joint in the body, attaching the largest and strongest bone, the femur, to the pelvis.

• The hip is a multi-axial, synovial ball and socket joint with the femoral head being the ball and the acetabulum being the socket.

• The femoral head is connected to the rest of the femur by a short section of bone called the femoral neck. The greater trochanter is a small bump of bone that juts out from the top of the femur, near the femoral neck. The greater trochanter is the attatchment site for many of the major hip muscles.

• The acetabulum and the femoral head are covered in articular cartilage, which reduces friction and absorbs shock, allowing the bony surfaces to move against each other without causing damage.

• The hips allows range of motion in all planes. Hip motions include flexion, extension, abduction, adduction, medial (internal) rotation, lateral (external rotation), and circumduction.

Conditions, Diseases, and Disorders

• Avascular necrosis: a condition that results from poor blood supply to an area of bone, causing bone death. Also known as aseptic necrosis or osteonecrosis. It has been associated with alcoholism, cortisone medication use, Cushing’s syndrome, radiation exposure, sickle-cell disease, pancreatitis, Gaucher disease, and systemic lupus erythematosus.

• Rheumatoid Arthritis: a chronic systemic inflammatory disorder that causes synovitis of multiple joints.

• Hip dysplasia: a developmental abnormality in which the hip joint is not formed properly. The socket is shallow, and the head of the femur is not well rounded, which increases local stresses on the cartilage.

• Hip fractures: a break in the upper part of the femur.

Surgical Interventions

Hip Arthroplasty: all or part of the hip joint is replaced with an artificial device. This surgery was first performed in 1960.

1. Involves three parts:

   1. Stem: fits into the femur; usually made of titanium-based or cobalt-chromium-based alloys

   2. Ball: replaces the femoral head; made of cobalt-chromium-based alloys or ceramic materials and polished smooth to allow easy rotation in the hip socket

   3. Cup: replaces the hip socket; can be made of plastic, metal, ceramic, or ultra-high molecular-weight polyethylene, or a combination of polyethylene backed by metal