Universidade Nove de Julho UNINOVE

2014

Apostila
Fisioterapia Ortopdica e Traumatolgica I

Prof. Andr Serra Bley

e-mail: andrebley@uninove.br

Plano de Ensino:

Prof. Andr Serra Bley

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Referncias Bibiliogrficas:
Bsica:
Hebert, S. Ortopedia e Traumatologia: princpios e prticas. Porto Alegre: Artmed. 2003
Browner, B. D. Traumatismos Do Sistema Msculo - Esqueltico: Fraturas, Luxaes, Leses e
Ligamentos. So Paulo: Manole, 2000. (volume I e II)
Souza, M. Z. Reabilitao Do Complexo Do Ombro. So Paulo: Manole 2001.
Apley, A. G. Ortopedia e fraturas em Medicina e Reabilitao. 6 ed. So Paulo: Atheneu, 2002
Gross, J. Exame Musculoesqueltico. Porto Alegre: Artmed, 2000.
Rockwood Jr., C. A. Fraturas em Adultos. So Paulo: Manole, 1994.
Boccolini, F. Reabilitao: amputados, amputaes, prteses. So Paulo. Robe, 2000.
Complementar:
Starkey, C; Ryan, J. Avaliao Das Leses Ortopdicas e Esportivas. So Paulo: Manole. 2001
Gabriel, M.R.S. Fisioterapia em traumatologia, ortopedia e reumatologia. Rio de Janeiro: Revinter. 2001
Magee, D. J. Avaliao Musculoesqueltica. 4 ed. So Paulo: Manole, 2005.
Andrews, J. R. Reabilitao Fsica das Leses Desportivas. Rio de Janeiro; Guanabara Koogan, 2000.

Observaes:

TERMINOLOGIAS ORTOPDICAS

Prof. Andr Serra Bley

Tendinite:_____________________________________________________________________________
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Tendinose:____________________________________________________________________________
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Tenossinovite:_________________________________________________________________________
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Entesite:______________________________________________________________________________
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Osteoartrite:__________________________________________________________________________
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Osteomielite:__________________________________________________________________________
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Pioartrite:_____________________________________________________________________________
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Anquilose:____________________________________________________________________________
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Sinovite:______________________________________________________________________________
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Fratura:______________________________________________________________________________
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Luxao:______________________________________________________________________________
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Subluxao:___________________________________________________________________________
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Fratura-luxao:________________________________________________________________________
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Entorse:______________________________________________________________________________
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Consolidao Viciosa: ___________________________________________________________________
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Necrose Avascular: _____________________________________________________________________
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Pseudoartrose:________________________________________________________________________
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Tenotomia:____________________________________________________________________________
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Tenorrafia:____________________________________________________________________________
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Osteotomia:___________________________________________________________________________
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Osteossntese:_________________________________________________________________________
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Enxertos:_____________________________________________________________________________
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Artrodese:____________________________________________________________________________
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Artroplastia:___________________________________________________________________________
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Artroscopia:___________________________________________________________________________
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Sinovectomia:_________________________________________________________________________
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Obs.:

Avaliao Ortopdica

Prof. Andr Serra Bley

Ficha de avaliao
1. Dados Pessoais:
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2. Queixa Principal:
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3. Histria da Molstia Atual (HMA):
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4. Intensidade da Dor
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5. Doenas Associadas e Familiares:

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6. Hbitos e Vcios:
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7. Medicamentos:
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8. Exames Complementares:
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9. Cirurgias:
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10. Exame Fsico:
Inspeo:______________________________________________________________________________
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Movimentao Ativa:____________________________________________________________________
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Palpao:______________________________________________________________________________
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Movimentao Passiva:__________________________________________________________________
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Sensao-final do movimento (end feel)___________________________________________________
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11. Testes:
Testes de flexibilidade:___________________________________________________________________
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Testes de fora para msculos especficos:___________________________________________________
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Testes especiais:________________________________________________________________________
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Avaliao sensitiva (nervos e dermtomos): __________________________________________________
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Avaliao motora (mitomo): _____________________________________________________________
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Avaliao de reflexos: ___________________________________________________________________
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Mensuraes:__________________________________________________________________________
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12. Amplitude de movimento: _____________________________________________________________

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13. Grau de Fora Muscular (grupos): _______________________________________________________
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14. Avaliao Postural: ___________________________________________________________________
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15. Avaliao da Marcha: _________________________________________________________________
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16. Diagnstico Fisioteraputico:
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17. Objetivos de tratamento:
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18. Condutas de tratamento:
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Obs.:

Reviso:
DERMTOMOS e MITOMOS:

Tabela ASIA: Imagem retirada da internet

Estabilizadores Estticos e Dinmicos:

Propriocepo:

Obs.:

FRATURAS
Definio:

Estrutura:

Imagem retirada da internet

Composio:
Parte Orgnica

Parte Inorgnica

Balano sseo / Resposta ao Estresse:

Prof. Andr Serra Bley

Classificao das fraturas:

1. Mecanismo de trauma:

2. Localizao:

3. Extenso:

4. Configurao:
- transversa
- dupla ou segmentar
- oblqua
- espiral
- em cunha
- cominutiva
- avulso
- achatamento
5. Relao com o meio externo:

6. Relao dos fragmentos / desvio:

- angular
- rodada
- distase
- impactada
- cavalgada

Imagens retiradas da internet

Oblqua Trasnversa Espiral

Cominutiva

Dupla

Avulso

Classifique a fratura abaixo:

Consolidao das fraturas:

Estabilidade x Vascularizao
Tipos:

Direta (Intramembranosa/Primria)
Indireta (Endocondral/Secundria) esboo cartilaginoso

Achatamento

Tratamento:
objetivo: reduo anatmica + estabilidade + atraumtica possvel + mobilidade ativa e indolor
- Incruento
- Cruento

Compartilhamento de estresse e sem compartilhamento de estresse:

Placa e Parafusos

Fixador Externo

Haste Intramedular

Fixador Externo Ilizarov

Placa e Parafusos

Ilizarov

Artrodese

Parafuso e Fios de Kirshner

imagens retiradas da internet

Trao Esqueltica

Trao Cutnea

Prognstico no tratamento das fraturas: idade, gravidade, local, reabilitao, ao hormonal, solicitao
mecnica
Consequncias da imobilizao:
Retraes Artrognicas

Consideraes:
- Fraturas em crianas:

Fratura em Galho Verde

- Fratura Intra-articular:

Complicaes das fraturas:

Leso da epfise de crescimento

Retraes Miognicas

Princpios do tratamento fisioteraputico:

Obs.:
Cintilografia ssea

COMPLEXO ARTICULAR DO OMBRO

1. Reviso Anatmica e Biomecnica
- osso / articulaes / ligamentos

Imagens retiradas da internet

Prof. Andr Serra Bley

- msculos

- movimentos e ADMs

- Biomecnica (imagens retiradas KAPANDJI, 2000)

Movimentos da escpula

Plano escapular

Movimentos da art. esternoclavicular

2. Patologias
- Sndrome do Impacto
Def.:

Etiologia/ Predisposio:

Patologias decorrentes da Sd. do Impacto:

Estgios da Sd. do Impacto:

Quadro Clnico:

Testes Especiais:

Exames Complementares:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Capsulite Adesiva
Definio:

Fases da capsulite:

Etiologia:

Quadro Clnico:

Exames Complementares:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Instabilidades do Ombro (Luxaes):

Def.:

Instabilidade x Frouxido ligamentar

Classificao das Instabilidades: (Mecanismo de Leso/quadro clnico/epidemiologia)

T
U
B
S

A
M
B
R
I

A
I
O
S

Leso de Bankart e Hill-Sachs

leso SLAP
Exames Complementares:

Testes Especiais:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Luxao Acromioclavicular:

- Fraturas de mero proximal

- Fraturas da difise do mero

- Fraturas de Clavcula

COTOVELO

Prof. Andr Serra Bley

3. Reviso Anatmica e Biomecnica

- osso / articulaes / ligamentos

Ligamento Colateral Ulnar (feixes)

- msculos

Ligamento Colateral Radial (feixes + ligamento anular)

- movimentos e ADMs

4. Patologias
- Epicondilite Medial e Lateral

Def.:

Etiologia/ Predisposio - Epidemiologia:

Quadro Clnico:

Testes Especiais:

Exames Complementares:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Bursite Olecraniana

Definio:
Etiologia:

Quadro Clnico:

Tratamento:

- Sndromes Compressivas:
Def.:
rea sensitiva e motora:
Nervo mediano

Nervo Ulnar

Nervo Radial

Sd. do Pronador:

Sd. do Tnel Cubital:

Sd. do Supinador:

Tratamento:

FRATURAS DO COTOVELO:
Fratura Supracondiliana:

- epidemiologia:

- mecanismo de trauma:

- Tratamento:

Fratura de olcrano:

- mecanismo de trauma:

- Tratamento:

- Fratura da cabea do rdio:

- mecanismo de trauma / epidemiologia:

- tratamento:

- Fratura-luxao de Monteggia

- Fratura de Galeazzi

LUXAES DO COTOVELO

- mecanismo de trauma/epidemiologia:

- tratamento:

Complicaes das fraturas e luxaes do cotovelo:

obs.: proximidade de nervos e artrias

osteoartrite do cotovelo

Punho e Mo

Prof. Andr Serra Bley

Reviso Anatmica e Biomecnica

- osso / articulaes / ligamentos

Tnel do Carpo

Tnel dos Extensores

Biomecnica / movimentos e ADM:

- msculos

Distribuio Sensitiva da Mo:

Distribuio Motora da Mo:

Patologias
- Sndrome do Tnel do carpo

Def.:

Etiologia/ Predisposio:

Quadro Clnico:

Testes Especiais:
Teste de Phalen

Exames Complementares:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Sndrome do Canal de Guyon

Def.:
Quadro Clnico:

- Tenossinovite de Quervain

Def.:
Etiologia:

Quadro Clnico:

Testes Especiais:
Teste de Finkelstein

Exames complementares / diagnstico diferencial:

Tratamento Mdico:

Tratamento Fisioteraputico:

- Tenossinovite do Flexores e Extensores do Punho

Obs.:

- Cisto Sinovial

Obs.:

- Contratura de Dupuytren

Def.:

Etiologia:

Quadro Clnico:

Tratamento Mdico e Fisioteraputico:

Obs.:
Deformidades (doenas reumticas):
Ndulos de Bouchard (A) e Heberden (B)

DISFUNES TRAUMTICAS DO PUNHO E DA MO:

- Fratura de Colles

- Fratura de Smith

Mecanismo de trauma:

Quadro Clnico:

Tratamento Mdico:

Complicaes:
Sinostose

Distrofia Simptico-Reflexa

- Fratura do escafide:
Mecanismo de trauma:

Complicaes:

Exames Complementares:

Tratamento mdico e fisioteraputico:

- Doena de Kienbck

Tratamento mdico e fisioteraputico:

Carpectomia

- Fratura-luxao de Bennett

Artrodese

- Luxao do Semilunar

- Fraturas dos Metatarsos:

Tratamento:

Instabilidade Escafo-semilunar (tratamento)

Observaes:

Complicaes:
Normal

Consolidao Viciosa:

- Luxao Interfalangiana / Fraturas de falanges:

Obs.:

Deformidades decorrentes de leses traumticas dos quirodctolos:

- dedo em pescoo de cisne

- dedo em botoeira

- dedo em martelo

Deformidades das mos decorrentes de leses nervosas:

Mo em garra

mo cada

mo em garra ulnar

Leses Musculares

Leses

Prof. Andr Serra Bley

Regenerao Muscular