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injured hand and fractures > Preventing and Treating Stiffness > Flashcards

Preventing and Treating Stiffness Flashcards

1
Q

cycle of nonuse

A

edema - immobilization - joint stiffness/tissue adherence

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2
Q

evaluation of stiffness (10)

A
  1. Why is the stiffness occurring?
  2. Is it due to trauma?
  3. Is it due to systemic conditions (RA or scleroderma)?
  4. Is it CNS?
  5. Is is a peripheral nerve issue?
  6. Is it a neuromuscular junction problem (myasthenia gravis)?
  7. Observe the movement
  8. Are there signs of triggering?
  9. Inspect scars
  10. ROM
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3
Q

PIP stiffness (3)

A
  1. extrinsic finger extensor tightness
  2. intrinsic finger tightness
  3. capsule tightness
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4
Q

DIP stiffness (2)

A
  1. ORL tightness

2. capsule tightness

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5
Q

extrinsic finger extensor tightness (PIP)

A

MP flexion lessens available passive PIP flexion

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6
Q

intrinsic finger tightness (PIP)

A

MP extension lessens passive PIP flexion

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7
Q

capsule tightness (PIP/DIP)

A

position of other joints doesn’t influence tightness

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8
Q

ORL tightness (DIP)

A

oblique retinacular ligament

PIP extension limits passive DIP flexion

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9
Q

wrist stiffness (4)

A
  1. extrinsic finger flexor tightness
  2. extrinsic finger extensor tightness
  3. capsular tightness
  4. muscular tightness
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10
Q

extrinsic finger flexor tightness (wrist)

A

passive wrist extension that is not impaired with finger flexion, but is impaired when adding finger extension

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11
Q

extrinsic finger extensor tightness (wrist)

A

passive wrist flexion that is not impaired with fingers in extension but is impaired when adding finger flexion

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12
Q

capsule tightness (wrist)

A

passive wrist movement that is impaired but not impacted by the posture of the digits

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13
Q

muscular and capsular tightness (wrist)

A

passive wrist flexion less than the unaffected side regardless of finger or elbow posturing and further impaired by finger or elbow posturing in extension or flexion

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14
Q

differential gliding

A

???

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15
Q

alternative reasons for stiffness (2)

A
  1. edema

2. neurological tone (spasticity/flaccidity)

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16
Q

soft tissue mechanics

A

the therapist’s ability to stretch or prevent tightness relies heavily upon the relationship between stress and strain

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17
Q

stress

A

the amount of force per unit area (pressure) applied to soft tissue

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18
Q

strain

A

a result of stress and is expressed mathematically as the change in length of soft tissue/original length x 100

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19
Q

TERT

A

“total end range time”
the amount of time a contracted joint is placed at its maximal length
*longer TERT = better result

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20
Q

LLLD

A

“low load, long duration”
combined low stress, long TERT
best practice when attempting to resolve soft tissue contracture because it promotes reorganization of collagen fibers within their elastic range without undue strain

21
Q

Tips: early active mobilization

A

do whenever possible
helps with edema-disuse-stiffness cycle
*if contraindicated work distal and proximal

22
Q

Tips: most difficult ROM to get back (5)

A
  1. MP flexion
  2. PIP extension
  3. wrist extension
  4. elbow extension
  5. supination
23
Q

Tips: using blocks

A

use isolation to effect the prime mover on the target joint

24
Q

Tips: when to use orthoses

A

use when stiffness is present and use to prevent stiffness

25
Q

Tips: Modified Week’s Test

A

measure, heat, ROM, re-measure

  • if gain is 10-20: serial-static or dynamic
  • if gain is less than 10: static-progressive
26
Q

Tips: duration of orthosis

A

depends on type of stiffness

  • PIP ext contracture responds 12 weeks, 6 hours TERT
  • PIP flex contracture responds 17 weeks, 11 hours TERT
27
Q

frequency of assessing outcomes

A

ideally weekly goniometric assessments of the targeted area

28
Q

Functional AROM - MP flexion (2-5)

A

61 deg

29
Q

Functional AROM - PIP flexion (2-5)

A

60 deg

30
Q

Functional AROM - DIP flexion (2-5)

A

39 deg

31
Q

Functional AROM - MP flexion (1st)

A

21 deg

32
Q

Functional AROM - IP flexion (1st)

A

18 deg

33
Q

Functional AROM - wrist flexion

A

40 deg

34
Q

Functional AROM - wrist extension

A

0 deg

35
Q

Functional AROM - ulnar deviation

A

40 deg

36
Q

Functional AROM - radial deviation

A

17 deg

37
Q

Functional AROM - supination

A

60 deg

38
Q

Functional AROM - pronation

A

40 deg

39
Q

Functional AROM - elbow flexion

A

130 deg

40
Q

Functional AROM - elbow extension

A

-30 deg

41
Q

what to do if progress is slow-going

A

when improvements in joint mobility are not accomplished after 2+ weeks, it may be necessary to re-evaluate you intervention plan
*last resort, refer back to physician

42
Q

operative interventions for stiffness (6)

A
  1. capsulectomy
  2. tenotomy
  3. tenolysis
  4. surgical decompression of sheaths or pulleys
  5. surgical release and skin grafting
  6. palmar fasciotomy
43
Q

capsulectomy

A

for capsular contracture that does not respond to conservative measures
*early hand rehab/mobilization

44
Q

tenotomy

A

to release long standing musculotendinous tightness by “lengthening” the tendon through the surgical division of a tendon

45
Q

tenolysis

A

the surgical removal of scar tissue impacting slide of a tendon

  • pre-op therapy important for PROM
  • early post-op therapy recommended
46
Q

surgical decompression of tendon sheaths or pulleys

A

when stenosing tenosynovitis is the culprit of joint restriction

47
Q

surgical release and skin grafting

A

when cutaneous scarring is impeding joint movement

48
Q

palmar fasciotomy

A

may be used when diseased palmar fascia is restricting digital extension

49
Q

therapeutic contracture

A

in some cases remediating stiffness is contraindicated

  • joint fusion
  • C6 tetraplegia - tenodesis requisite for hand function and requires shortening of long finger flexors and extensors to occur

injured hand and fractures (21 decks)

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