hand and upper extremity disorders and injuries Flashcards
Dupuytren’s disease
splint?
intervention?
-The fascia becomes thick and contracted. develops cords and bands that extend into the digits results in flexion deformities of the involved digits usually 4 and 5
-Extension splint at all times
-A/PROM progress to strengthening when wounds heal- causes wounds and scars
-Wound Care: dressing
changes.tasks that emphasize
flextion (griping) and
extension (release).
Skiers thumb (gamekeepers thumb) splint? intervention?
- Rupture of the ulnar collateral ligament of the MCP joint of the hand
- Thumb splint 4 to 6 weeks
- AROM and pinch strength at 6 weeks focus ADL that requires opposition
colle’s fracture
orthotics?
splint?
intervention?
-Fracture of the distal radius with dorsal displacement
Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.
-wrist extension splint
smith’s fracture
orthotics?
splint?
intervention?
-Fracture of the distal radius with volar displacement
Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.
-thumb splint
Klienert protocol 0-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks
Kleinert 0-4 weeks
dorsal block splint. passive flexion and active extension within limits of splint
kleinert 4-6 weeks
wristlet. place/hold exercises. scar management.
kleinert 6-8 weeks
AROM. tendon gliding and differential tendon gliding. light ADL and role activities. D/C splint
Kleinert 8-12 weeks
strengthening and work and leisure activities
Duran protocol 0-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks
passive flexion and extension of digit duran 0-4.5 weeks dorsal blocking splint. exercises in splint include passive flexion of PIP jt, DIP jt and to DPC. 10 reps every hour. duran 4.5-6 weeks active flexion and extension within limits of splint duran 6-8 weeks tendon gliding and differential tendon gliding, scar management, light ADL and role activities duran 8-12 weeks strengthening and work activities
Best modality used for UE pain
TENS unit
Complex regional pain syndrome usually come from what injury? splint? Intervention? Interventions to avoid?
- Distal radius fracture can develop after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.
- surgery to remove thickened nerve, medication injection in neck
- temperature change, severe pain, skin discoloration, edema, osteoporosis
-splinting to prevent contractures
static and dynamic splint as tolrated , volar splint in extension as tolerated, circumferential wrist might be used to avoid edema
-insertion of spinal cord stimulator to contol pain, insertion of peripheral nerve stimulator for pain, sympathetic block, removal of neuroma
-edema management, elevation, manual edema mobilization, compression glove/garment, desensitation, fluidotherapy, Gentle AROM
stress loading program ( ex. scrubbubing the floor carrying a weighted bag) and use of the upper extremity in functional activities
-PROM, Passive stretching, joint mobilization, dynamic splinting and serial casting, arm sling
de querveins
diagnosis?
splint?
pain and swelling on the radial styloid
positive Finkelstein’s test
thumb spica
carpal tunnel
diagnosis?
splint?
Positive Tinel’s test
- wrist splint in neutral should be worn at night
- immobilization splint rest and reduce inflammation
- can fabric a wrist cock up splint (can have thumb spica also) for wrist support (to inhibit wrist flexion, usually in 10-‐15 degress of wrist extension).
- nerve gliding, AROM, strenthening, ergonomics
- tinel sign tap on the median nerve at wrist to elicit symptoms
- phalens sign check changes in sesation
- Moberg pick up test picking up holding and manipulating object to test median nerve function
Arthritis symptoms? Eval? splint? Heat modality? interventions?
RA-splint?
-inflammation of a joint or joints
pain, stiffness, limited ROM
-Avoid MMT
-resting hand splint only in acute stage
wrist splint if arthritis is specific to wrist
ulnar drift splint to prevent deformity
silver ring splint to prevent Boutiniere’s and swan neck deformity
- RA functional splint or safe splint depending on stage, or intrinsic plus splint
- RA acute flare up no stress on joints no dynanometer during eval
- Use soft straps and thick padding.
- paraffin is recommended for hands
- hot packs can be used before exercise but avoid during inflammatory stages
Trigger finger
splint?
Intervention?
intervention recommended?
-Tenosynovitis of the finger flexor’s: most commonly in the A1 pulley
-caused by repetitive gripping actions and tools that are placed to far apart
-lack of smooth flexion and extension in the finger then
-gentle pull through with bending and
straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the
client is awake.
-hand based trigger finger splint splints (inhibit full digit flexion/making a tight fist) splintsusually focuses on preventing the MP to flex
-edema control, tendon gliding avoid repetitive gripping
cubital tunnel syndrome
diagnosis?
splint?
intervention?
- ulnar nerve compression at elbow can come from leaning on elbow
- positive Tinel’s sign at elbow
- elbow splint, elbow padding
- elbow splint prevent positions of extreme flexion
- avoid extension and putting pressure or leaning on elbow
- edema control, active ROM and nerve gliding
Radial nerve palsy
splint?
intervention?
-radial nerve compression/wrist drop
compression as a result of a humeral shaft fracture, or at elbow
-dynamic extension splint, Forearm-based wrist orthotic.
- you can also use Thumb Extension Splint, duran dorsal protection splint, volar splint with wrist in neutral, wrist cock up
- nerve gliding and strengthening
what time period is the flexor tendon repair the weakest and most likely to rupture?
10-12 days post surgery
Mallet finger
what happens?
splint?
Tendon separates from the bone and its insertion and removes bone material with the tendon (Avulsion injury)
-DIP extension splint for 6 weeks to prevent extensor lag
Boutonniere deformity
what happens?
intervention?
splint?
Tendon separates from the bone and its insertion and removes bone material with the tendon (Avulsion injury) isolated - DIP flexion exercises are performed. -Silver rings/ tri tip PIP is splinted in extension -PIP extension splint -oval 8
lateral and medial epicondylitis
recommendation?
splint?
intervention at least 5?
for work?
-lateral-overuse of wrist extensors, you avoid active/aggressive extension of the wrist and digits.
medial-overuse of wrist flexors, you avoid active/aggressive flexion of the wrist and digits.
- elbow strap wrist splint
- Brace recommended to provide support to the muscle/tendon while they heal.
- static splinting in acute phase
-ice and deep friction massage, and
stretching, isometric exercises, isotonic exercises, and eccentric exercises contrast baths, ultrasound, inferential
stimulation. Subacture phase:slow stretching, myofascial release,
progressive resistive exercises as tolerated, proper body mechanics,
-Activity
modification and proper
body mechanics
Adhesive capulitis
intervention
-frozen shoulder
restricted shoulder ROM
- most important to encourage use of ADL and role activities PROM and modalities for pain management
Cumulative trauma disorder
work
-also known as CTD, is defined as the excessive wear and tear on tendons, muscles and sensitive nerve tissue caused by continuous use over an extended period of time examples are - carpal tunnel and trigger finger
-Activity
modification and proper
body mechanics
MCP joint extension helps isolate?
IP joint flexion and FDP excursion
