A case study on Total Hip Arthroplasty- A breakdown on Rehabilitation process part 3

Oh!! my initial plan or so I would call it was to continue with the a post on breakdown for the rehabilitation process about 4 days ago, but life has a way letting you know you can never always be in full control of happening around you. it like a basic law of the universe, do what you have to do, but always have it in mind that the unplanned, the unprecedented can occur at any given time.

So today, we will be continue on examination and assessement.

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So on further assessment of the upperlimb, 👇👇

Sensation- His sensation were intact at both upperlimb, this usually serve as one of those pointers that there is no neurological affectation.

Pain- Pain was absent at both hands even on movement

Active Range of Motion- The active range of motion also known as AROM is basically how far upward, downward, outward or inwards he can move certain parts of the body in specific directions. In this case, we talk about flexion, extension, abduction and adduction of the upperlimb, you might want to check out these terms
For both of his upper Limbs (hands) the active range of motion was full and painless.
The AROM was full for the shoulder, elbow, wrist, and the fingers.

Passsive Range of Motion- The passive range of motion, also known as the PROM, this is slightly different from AROM. PROM is a movement not perfomed by the individuals, it is usually performed by therapist by moving the body part in question in a particular direction or in a particular plane. For this man, the PROM was full and painless.

Now in a condition where there is a resistance to movement the Range of Motion is said to be limited, and if there is pain on movement, it is said to be limited and painful.

Spasticity- Now spasticity is basically a neurological disorder which present as an involuntary resistance to passive movement, this resistance increases the faster you try to move such body part in a particular direction. Usually the faster the movement the therapist try to perform, the harder the force needed by the therapist to move such body part in a particular direction

So in the case of this man, there was no spasticity present which is actually a good thing, makes the process of management somewhat smoother. Cases where you might see spasticity are in cerebrovascular accidents also known as stroke, in which the patient affected may present with hemiplegia (paralysis on a particular side of the body), quadriplegia or paresis among others

Grip strength - This refers how strong his grip his. It is necessary because a person with a weak grip will find it difficult to use a walking such as crutches, but in this case he has a good enough grip which mean if other assessment are in line he should effectively use a pair of crutches for temporary ambulation

Clonicity - These refers to involuntary shaking of a particular body part, it is usually caused rapid contraction and relaxation which give the illusion of rapid involuntary shaking. In the case of this man, he had none at both hands

Tremor - This is an involuntary shaking of a specific body parts such as the hands and legs, especially when trying to perform coordinated and precise movements.
He had none in this case at both upper limb(hand)

Deformity - He had a deformity at the right elbow, which was from a fracture he sustained months back. The left was without a degormity

Swelling/ oedema - absent on both upperlimb ( hand)

Skin integrity- skin integrity was preserved at both lower limb

With this we are done with the assessemnt of the upperlimb

Now to the assessment of the lowerlimb.
Now the following terms that are going to be used in assessment are the same as that of the upperlimb just a few differnece

Muscle Bulk - We are already familiar with the meaning of muscle bulk in the initial upperlimb assessment
In this case, the muscle bulk was reduced at the left lowerlimb which was the area of affectation.

Muscle Tone- The muscle tone at both lowerlimb were still normal

Gross muscle power (GMP) -
Right lowerlimb- 4
Left lowerlimb- 2

Sensation - Sensation was impaired at the left lowerlimb, the leg of affectation

Pain- pain was present on the left lower limb which was the area where the arthroplasty was done

AROM - The active Range of Motion (AROM) was full on the right lowerlimb but limited on the left lower limb whuch again is the area of affectation

PROM- The passive Range of Motion (PROM) was full on the right, but limited on the left

Swelling/ oedema- This was present on the left lowerlimb alone but absent on the right

Crepitation- This basically and in simple terms refers to a cracking sound heard on either passive or active movement. This was absent at both lowerlimbs

Tremor- This was absent at both lowerlimbs

Deformity- There was a no deformity at both lowerlimbs

Clonicity- This was absent at both lowerlimb.

Tendon Achilles tightness- This was absent on both lowerlimbs

So that will be all for the assessment of the lowerlimb.

Now we proceed to the functional assessment of the patient

Functional assessment
This basically refers to what the patient can do and cannot -

He cant sit without an external support, however he could manage to sit using his hands as support, as a matter of fact, he finds it difficult to roll from side to side in bed which is a pointer that he has significant trunk weakness .

So that will be all on the assessment of the patient. So as a recap we have broken down the assessment for his upperlimb and lowerlimb and we were able to establish what exactly is wrong which will give us a general idea on what exactly we are going to be rehabilitating this patient on .

Before this week runs out , we will moving to analysis of findings, radiological finding before moving on to plan of treatment and the mean.

Stay tuned ...

Thanks for taking time to read this long, Sayonara 🖐️

References

https://www.physio-pedia.com/Muscle_Strength_Testing

https://www.prohealthcareproducts.com/blog/manual-muscle-testing-grading-and-procedures

https://www.physio-pedia.com/Total_Hip_Replacement