Hand AND UE: Disorders and Injuries

Question 1

Dupuytren’s Disease

Answer 1

Disease of the fascia of the palm and digits
1. fasica becomes thick & contracted (shortens over time)
2. develops cords and bands that extend into the digits (often affects 4th & 5th)

Question 2

Treatment for Dupuytren’s Disease

Answer 2

1. wound care
2. edema control
3. AROM/PROM; strengthening when healed
4. scar management (massage, scar pad, and compression garment)
5. splint/occupation-based task

Question 3

Splint for Dupuytren’s Disease

Answer 3

Extension splint

1. Ideally splint should be in full extension (consult with surgeon for

Hand-based splint can be dorsal or volar

Question 4

What should the occupation-based task for Dupuytren’s emphasize on?

Answer 4

Purposeful and occupation-based tasks that emphasize flexion (gripping) and extension (release)

Question 5

Skier’s Thumb

or Game keeper’s Thumb

Answer 5

Rupture of the ulnar collateral ligament of the MCP joint of the thumb; hyperabduction trauma of the thumb

Etiology: most common cause is a fall

Question 6

Treatment for Skier’s thumb

Answer 6

Conservative treatment:
1. splint (for 4-6 weeks)
2. AROM and pinch (at 6 weeks)
3. ADLs that require certain hand motions

Post-op:
1. splint (for 6 weeks), followed by AROM.
2. PROM (begin at 8 weeks)
3. strengthening (at 10 weeks)

Question 7

Splint for Skier’s Thumb

Answer 7

UCL hand based thumb splint

Thumb IP and CMC free

Question 8

Focus on ADLs that require _________ and __________ for Skier’s thumb.

Answer 8

1. opposition
2. pinch strength

Question 9

Complex Regional Pain Syndrome (CRPS)

Answer 9

1. Characterized by continuous, severe burning pain that may have resulted from trauma (Colles’ fracture), postsurgical inflammation, infection, or laceration to an extremity causing a cycle of vasospasm and vasodilation
2. Primary and most severe complication of distal radial fractures

Vasomotor dysfunction from an abnormal reflex

Question 10

What are the 3 stages of CRPS?

Answer 10

Stage 1: Traumatic Stage
Stage 2: Dystrophic Stage
Stage 3. Atrophic Stage

Stage 1:
Pain, pitting edema, discoloration;
may last up to 3 mo.

Stage 2:
Pain, brawny edema, stiffness, redness, heat, bony demineralization, may last an additional 6-9 mo.; ** pain peaks in this stage**

Stage 3:
Thickening around joints,fixed contractures, swelling appears hard, appears pale, dry, and cool, substantial dysfunction, pain decreases.

Question 11

Treatment for CRPS

Answer 11

1. Edema management
2. AROM to involved joints
3. ADLs to encourage pain-free active use
4. Stress loading (WBing/joint distraction activities; carrying/scrubbing)
5. Splinting
6. Avoid or to proceed with caution include PROM, joint mobilization, dynamic splinting, and casting
7. pain management (TENS)
8. Desensitization (fluidotherapy)
9. blocked exercises, tendon glinding
10. joint protection, EC

Question 12

Colles’ fracture

Answer 12

fracture of the distal radius with DORSAL displacement

Question 13

Smith’s fracture

Answer 13

fracture of the distal radius with VOLAR displacement

Question 14

Boxer’s fracture

description, splint, treatment post-op

Answer 14

1. fracture of the 5th metacarpal
2. forearm-based ulnar gutter splint w/ 4thand 5th MCP 60d
3. Begin active/passive tendon glides for wrist and digit mobility; positioning, and/or light massage to promote edema control

Metacarpal fractures are classified based on location (head, neck, shaft, or base).

Question 15

Bennett’s fracture

Answer 15

an intraarticular fracture of the thumb metacarpal bone (base of MCP thumb)

Question 16

Which type of fracture is most common with thumb and index?

a] Proximal phalanx fracture
b] Middle phalanx fracture
c] Distal phalanx fracture
d] Carpal fracture

Answer 16

a] Proximal phalanx fracture

A common complication is loss of PIP AROM/PROM

Question 17

Which type of fracture is most common with finger fracture?

a] Proximal phalanx fracture
b] Middle phalanx fracture
c] Distal phalanx fracture
d] Carpal fracture

Answer 17

c] Distal phalanx fracture

May result in mallet finger (which involves terminal extensor tendon

Question 18

Which type of fracture is not a commonly fractured?

a] Proximal phalanx fracture
b] Middle phalanx fracture
c] Distal phalanx fracture
d] Carpal fracture

Answer 18

b] Middle phalanx fracture

Question 19

What results with an elbow fracture?

Answer 19

limited rotation of the forearm

radial head involved

Question 20

What type of fracture is most common with carpal fractures?

Answer 20

Proximal scaphoid

1. 60% of carpal fractures
2. poor blood supply

Question 21

What is a common complication of metacarpal fractures?

Answer 21

Rotational deformities

Question 22

Radial head fx

treatment, 3 types

Answer 22

1. most common elbow fx caused by FOOSH)
2. Types:
   a. Type I (nondisplaced)-long arm sling
   b. Type II (displaced with single fragment): nonoperative; immobilization for 2-3 weeks; early motions with medical clearance.
   c. Type III (comminuted)-operatively, immobilization; early motion within first week post op.

Question 23

FOOSH

Answer 23

1. Caused by fall onto the wrist
2. Fall on an outstrectched hand (FOOSH)
3. Results in limitations in wrist flexion and extension; pronation and supination (from involvement of distal radioulnar joint)

Question 24

FOOSH treatment

Answer 24

Conservative
1. Closed reduction and cast immobilization: used if stability of fracture can be acheived/maintained
2. Long arm cast exending past the elbow (2-3 weeks) to prvent mobility of forearm rotation and wrist)
3. Switch to shorter cast with elbow free (additionally 4-6 weeks)

Post op: ORIF
1. Early motion of wrist when cleared by surgeon
2. Wrist orthosis
3. AROM (forearm rotation to wrist in all planes and to the unaffected fingers to prevent joint stiffness
4. Gradually decrease wear of orthosis at 3-6 weeks
5. Motion, strength, and return to ADLs

Question 25

Proximal humeral fx ## Footnote Treatment (non-op, op), orthrosis

Answer 25

1. **humeral fx brace** 2. ROM (**2 weeks**) for non op 3. **sling (non-op)** 4. ROM aggressive stretching (**4-6 weeks**) 5. home exercise program 6. sling for sleep (first weeks PRN]

Question 26

Kienbock's disease | Description, treatment

Answer 26

1. a condition where the blood supply to one of the small bones **(lunate)**in the wrist is interrupted 2. Immobilzed for 6 weeks 3. control of edema with early motion, good support will minimize stiffness and pain

Question 27

What fracture may result in rotator cuff injuries?

Answer 27

Humerus fracture at the greater tuberosity

Question 28

What injury may occur with a humeral shaft fracture?

Answer 28

Radial nerve injury resulting in wrist drop

Question 29

What contraindication should we be aware of when evaluating a fracture?

Answer 29

Do not assess PROM or strength until ordered by physican | Exceptions for humerus fx. (begin with PROM or AAROM) ## Footnote AROM is OK

Question 30

What are the 2 phases of intervention for fractures?

Answer 30

1. **Immobilization phase: Stabilize and heal** - AROM of joints above and below stabilized part - edema control (elevation, manual edema mobilization, gentle massage, compression garments) - Light ADLs/role activities (no resistance/as tolerated) - one-handed techniques if in sling/brace/ORIF) 2. **Mobilization phase:** -edema control splint -AROM, PROM/AAROM (with approval) -light purposeful activities -pain management -strengthening (with approval)

Question 31

de Quervain's

Answer 31

1. Stenosing tenosynovitis of the APL, EPB 2. Pain and swelling over radial styloid

Question 32

What test is used to diagnosis de Quervain's? a] Tinel's sign b] Froment's sign c] Finkelstein's test

Answer 32

c] Finkelstein's test

Question 33

What splint is used for de Quervain's?

Answer 33

Thumb spica splint

Question 34

When should strengthening, ADLs, and role activities start with de Quervain's?

Answer 34

2-6 weeks | 6 week: unrestricted

Question 35

# True/False AROM should not occur before 2 weeks post-op for de Quervain.

Answer 35

**False**: Gental AROM should occur 0-2 weeks post-op.

Question 36

Lateral epicondylitis (Tennis elbow)

Answer 36

Overuse of wrist extensors (ECRB (mostly involved, folled by EDC), ECU, ED) Assessment: Cozen test, Mills Test

Question 37

Medial epicondylitis (Golfer's elbow)

Answer 37

Over use of wrist flexors (PT, FCR, PL, FDS)

Question 38

Conservative Treatment for Lateral/Medial Epicondylitis

Answer 38

1. Elbow strap (takes tension off wrist insertion at the lateral elbow), wrist splint (decrease use and loading of the wrist extensors by immobilizing the wrist) 2. Ice and deep friction massage 3. Stretching 4. Activity/work modifications 5. Exercise | Lateral: Volar wrist cock-up; splint should only used during any activit

Question 39

For a conservative treatment to lateral/medial epicondylitis, as pain decreases we should add strengthening by beginning: a] Isotonic exercises and then progress to isometric exercises and eccentric exercises b] Isometric exercises and progress with isotonic exercises and eccentric exercises c] eccentric exercises and progress with isometric exercises and isotonic exercises

Answer 39

b] Isometric exercises and progress with isotonic exercises and eccentric exercises Isotonic muscle contracts and shortens Isometric muscle contracts, but does not shorten | It is proposed that isometric exercise be used at the beginning of treat ## Footnote https://www.mdpi.com/2077-0383/12/1/94

Question 40

Trigger finger

Answer 40

Tenosynovitis of the finger flexor (A1 pulley); caused by repetition and use of tools too far apart

Question 41

Along with scar massage, edema control, and tendon gliding, what type of splint treatment should be used for trigger finger?

Answer 41

Hand-or finger-based splint (MCP extended, IP joints free) ## Footnote 3-6 weeks

Question 42

An OTR is working with a client who presents with digital tenosynovitis in the index finger, or "trigger finger." After the OTR fabricates a splint to support the metacarpophalangeal joint in extension, which exercise should the OTR advise the client to perform FIRST? A] Hook fist with splint on B] Hook fist with splint off C] Full fist with splint on D] Full fist with splint off

Answer 42

Solution: The correct answer is A. A: Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, 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. B: The MCP joint is not supported if the hook fist exercise is performed with the splint off, resulting in increased tendon inflammation. C: A client wearing the MCP extension splint will be unable to make a full fist with the splint on. D: Making a full fist without the splint on will increase tendon inflammation and edema.

Question 43

What are the 2 types of isotonic contractions? What are the difference?

Answer 43

**Concentric contraction**: the **muscle tension rises** to meet the resistance then remains stable as the muscle shortens. Works against force of gravity. **Eccentric contraction**: the **muscle lengthens** as the resistance become greater than the force the muscle is producing. Works with force of gravity

Question 44

Kleinert

Answer 44

Passive flexion using rubber band traction and active extension to the hood of the splint ## Footnote Early mobilization for flexor tendons

Question 45

Kleinert Protocol (early phase) ## Footnote treatment, splint

Answer 45

0-4 weeks: **dorsal block splint** **wrist**: 20 deg- 30 deg flexion **MCP joints**: 50 deg- 60 deg flexion **IP joints**: extended Passive flexion and active extension within limits of splint

Question 46

Kleinert Protocol (intermediate phase) ## Footnote treatment, splint

Answer 46

4-7 weeks: 1. Continue dorsal block splint but adjust the ***wrist to neutral*** 2. Flexor tendon gliding exercises 3. Scar management

Question 47

Kleinert Protocol (final phases)

Answer 47

6-8 weeks: 1. ROM 2. Tendon gliding 3. Light purposeful activities 4. D/C splint 8-12 weeks: 1. strengthening, work, and leisure activities

Question 48

Duran

Answer 48

passive flexion and extension of digit ## Footnote Early mobilization for flexor tendon

Question 49

Duran Protocol ## Footnote treatment, splint

Answer 49

0-4.5 weeks: 1. dorsal blocking splint (passive flexion of PIP joint, DIP joint and to DPC 10rep/hr) 4.5-6 weeks: 1. active flexion and extension within limits of splint 6-8 weeks: 1. tendon fliding and differential tendon gliding 2. scar management 3. light purposful activities 8-12 weeks: 1. strengthening 2. work activities

Question 50

Mallet finger deformity ## Footnote treatment, splint

Answer 50

DIP flexion Zones I and II 0-6 weeks: DIP extension splint (static orthosis holding the **DIP joint in slight HYPEREXTENSION**) 6-8 weeks: Electrical stimulation and ultrasound to facilitate extensor tendon gliding **avoid gripping activities to prevent further tendon damage initially.** ## Footnote later swan neck deformity (PIP hyperextension, DIP flexion)

Question 51

Boutonniere deformity ## Footnote treatment, splint

Answer 51

PIP=flex, MCP=hyperextension Zones III and IV 0-4 weeks: 1. PIP extension splint (DIP free)-oval 8 2. AROM of DIP while in splint 4-6 weeks: 1. begin AROM of DIP and flexion of digits to the DPC

Question 52

Zones V, VI, and VII ## Footnote splint

Answer 52

0-2 weeks: 1. volar wrist splint with wrist in 20 deg-30 deg of extension 2. MCPs in 0 deg-10 deg of flexion 3. IP joints in full extension 2-3 weeks: 1. shorten splint to allow flexion and extension of IP joints 4 weeks: 1. remove splint to begin MCP active flexion and extension 5 weeks: 1. begin active wrist ROM 2. Wear splint in between exercise sessions 6 weeks: 1. D/C splint Zone VI: over MCP (most common zone of injury) Z VI: MCP(most common) VII: tendon&rectinaculm overwrist

Question 53

Swan neck deformity ## Footnote splint

Answer 53

injury to the metacarpophalangeal (MCP), PIP, or DIP joints characterized by PIP hyperextension and DIP flexion SPLINT: the PIP is splinted in slight flexion.

Question 54

Carpal tunnel syndrome

Answer 54

A median nerve compression resulted by repetition, awkward postures, vibration, anatomical anomalies, and pregnancy Symptoms: numbness and tingling of the thumb, index, middle, and radial half of the ring fingers 1. Paresthesias usually occurs at night 2. c/o dropping things 3. Advanced stage can result in muscle atrophy of the thenar eminence

Question 55

Testing for Carpal Tunnel Syndrome ## Footnote carpal tunne;

Answer 55

1. Positive Tinel's sign at wrist 2. Phalen's sign 2. press doral hands/fingers together with flexed 3. Moberb Pickup Test 4. Semmes-Weinstein | 1. tap nerve location

Question 56

Conservative Treatment for Carpal Tunnel ## Footnote Splint

Answer 56

1. Wrist splint in neutral (at night & day w/ repetitive activity) 2. Median nerve gliding (gentle sliding, should not place tension on nerve) 3. Differential tendon gliding 4. Activity modifications (avoid finger/wrist flexion) 5. Ergonomics

Question 57

Operative Treatment for Carpal Tunnel Syndrome

Answer 57

1. Edema control (elevation, retrograde massage, compression glove, and/or contrast bath) 2. AROM 3. Nerve and tendon gliding exercises 4. Sensory re-education 5. **Strengthening of thenar muscles (6 week, post-op**) 6. Work/activity modification ## Footnote Post op: Carpal tunnel release

Question 58

Pronator Teres Syndrome ## Footnote Description, assessment, splint

Answer 58

1. Median n compression 2. Positive Tinel's sign 3. Elbow splint at 90 deg with forearm in neutral (non-op); avoid repetitive pro/sup; half cast (post-op) 4. post-op: AROM/nerve glide; strengthening (2 weeks); act. mod | operative treat: AROM all UE; strengthening (1wk); full AROM (by 8 wk)

Question 59

Guyon's Canal ## Footnote Description, symptoms, assess, splint, post-op

Answer 59

1**. ulnar n. compression at wrist** 2. numbness/tingling 3. motor weakness/can lead to **atrophy** 4. Positive Tinel's sign 5. **Splint: wrist in neutral** 6. Post op: AROM/nerve glide, strengthening **(2-4 weeks)/focus: power grip**; sensory re-ed

Question 60

Cubital Tunnel Syndrome ## Footnote Description, symptoms, assess, splint, post-op

Answer 60

1. ulnar n. compression at elbow (2nd common; leaning on elbows/extreme elbow flexion) 2. **Weak powergrip**, pain, numbness/tingling 3. **Positive Tinel's Sign; Froment's sign (flex IP thumb when lateral pinch is attempted; Wartenberg's sign{5th Abducted); elbow flexion test {hold for 5 mins with wrist neutral)** 4. Advanced: atrophy of FCU, FDP to digits IV to V, and ulnar nerve-innervated intrinsic muscles of the hand 5. Splint: **Elbow splint at 30 deg flexion** (prevent extreme flexion)[esp. at night] **MCP flexion anti-claw splint if clawing noted** 6. Post-op: AROM/nerve gliding (2 weeks); strengthening (4 weeks)

Question 61

A high-level ulnar nerve injury may result in which characteristic deformity? A] Flexion of the ring and small finger metacarpophalangeal (MCP) joints because of loss of the extension-controlling forces of the third and fourth lumbricals B] Hyperextension of the index and middle finger MCP joints because of loss of the extension-controlling forces of the first and second lumbricals C] Unchecked abduction of the ring and small finger MCP joints because of lack of motor innervation of the third and fourth lumbricals D] Hyperextension of the ring and small finger MCP joints because of loss of the extension-controlling forces of the third and fourth lumbricals ## Footnote AOTA

Answer 61

Solution: The correct answer is D. The third and fourth lumbricals and palmar interossei that flex the MCP joints of the 4th and 5th digits are innervated by the ulnar nerve. Loss of flexor tone in the third and fourth lumbricals and the palmar interossei leads to hyperextension of the ring and small finger MCP joints due to their inability to provide counter force to the extensor digitorum communis, creating “claw hand” deformity. A, C: The third and fourth lumbricals are prime flexors of the MCP joints. A high ulnar nerve injury would result in the inability to use the lumbricals for flexion. B: The first and second lumbricals are innervated by the median nerve and therefore are not affected in ulnar nerve injuries.

Question 62

A 10-year-old child sustained a Zone 2 flexor digitorum profundus tendon laceration and underwent primary repair. Which flexor tendon repair protocol represents best practice standards? A] Active mobilization approach B] Immobilization approach C] Passive mobilization approach D] Controlled early active mobilization approach ## Footnote AOTA

Answer 62

Solution: The correct answer is B. Children younger than age 12 are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols. A, C, D: Immediate or early mobilization protocols involve glide of the tendon in the early phases of postoperative healing. Children under age 12 may not have the maturity level or ability to understand precautions and adhere to exercise guidelines

Question 63

An OTR® in an outpatient setting is treating a client who underwent repair of multiple flexor tendons in Zones 2 and 3 approximately 6 weeks ago. The dorsal blocking splint has been removed, and the client is beginning to actively move the digits. The client is eager to return to work as a carpenter, and the OTR is revising the goals with the client. Which goal for this time period is MOST appropriate? A] Increase passive wrist and digit composite extension to improve flexor tendon length B] Increase digital active range of motion to facilitate holding a washcloth during bathing C] Increase grip strength to maintain grasp on woodworking tools D] String 25 beads of various sizes and shapes to improve fine motor coordination

Answer 63

**Solution: The correct answer is B.** Setting realistic, meaningful goals and revising them as the client progresses is a critical component in treating traumatic injuries. At **6 weeks** after operative tendon repair, the client may be **ready for light, nonresistive functional activities that promote active flexion**. A: Adding too much force at this stage may result in rupture of the repairs. C: At 6 weeks after repair of flexor tendons, strengthening is contraindicated. D: This goal has no functional component or intrinsic value to the client.

Question 64

Radial Nerve Palsy ## Footnote Description, symptoms

Answer 64

1. radial n compression 2. **Saturday Night Palsy (wrist drop)**, weeknea/paralysis of extensors to the wrist, MCPs, and thumb [from sleep/humeral shaft fx.]

Question 65

Conservative treatment of Radial N. palsy ## Footnote inc. splint

Answer 65

1. Splint: [non-op] **wrist cock-up splint with or without dynamic finger and thumb extension; isotonic strengthening and MCP extension** [op] ***static wrist extension splint 30d; after 4 weeks, adjust splint to 10-20d extension*** 2. Work/act mod 3. **Strenthening wrist and finger extensors** when motor function returns

Question 66

Post-op intervention for Radial nerve palsy

Answer 66

Post op: Surgical decompression 1. AROM 2. **Strengthening (6-8 weeks)** 3. ADls/meaningful activities 4.m**Avoid combined forearm pronation, elbow extension, and wrist flexion** (can put tension on n.)

Question 67

Sensory Loss for Median Nerve Laceration (Low lesion/at wrist & high lesion)

Answer 67

Sensory Loss: 1. central palm (#1-half of #4) 2. Palmar surface (#1-half of #4) 3. dorsal surface (#2-half of #4 middle and distal phalanges)

Question 68

Motor Loss for Median Nerve Laceration (Low lesion at wrist)

Answer 68

Motor Loss: 1. Lumbricals I and II (MCP flexion of II and III) 2. Opponens pollicis (opposition) 3. APB (thumb abduction) 4. FPB (thumb MCP flexion)

Question 69

Motor Loss for Median Nerve Laceration (High lesion, at/proximal to elbow)

Answer 69

Motor Loss: 1. Same as [low lesion] 2. FDP to #2-#3, and FLP (flexion of tip of #1-#3) 3. FCR (inability to flex to radial aspect of wrist) [Low lesion] Motor Loss: 1. Lumbricals I and II (MCP flexion of II and III) 2. Opponens pollicis (opposition) 3. APB (thumb abduction) 4. FPB (thumb MCP flexion)

Question 70

Deformities of Median Nerve Laceration

Answer 70

1. Ape hand (flattening of thenar eminence; loss precision pinch, thenar opposition, and theability to flex digits #2#3; injury at elbow/proximal forearm) 2. Claw hand (#2-#3, low lesion) 3. Benediction sign (high lesion)

Question 71

Claw Hand

Answer 71

1. Inability to extend digits #2-#3 to 2. Injury to lumbricals #1-#2 (extrinsic flexors) 3. Low lesion of median nerve

Question 72

Benediction Sign

Answer 72

1. Inability to flex #1-#3.5 when making a fist 2. High lesion median nerve

Question 73

Ape hand

Answer 73

1. inability to oppose and abduct the thumb' 2. Impaired thenar muscle functions 3. D/t injury of high/low median n.

Question 74

Functional Loss of Median nerve laceration ## Footnote Functional loss

Answer 74

1. loss of thumb opposition 2. weakness of pinch

Question 75

Splinting conseration for Median nerve laceration

Answer 75

1. Non-op: C-bar to prevent thumb adduction contractures 2. Post-op: dorsal wrist blocking splint (4-6 wks), AROM/PROM in splint for fingers; discontinue splint (6 wks)

Question 76

Sensory re-education should begin (d/t*** MEDIAN/ULNAR nerve injury***) ____ .

Answer 76

when an individual demonstrates a level of diminished protective sensation **(4.31) on Semmes-Weinstein**

Question 77

Ulnar nerve laceration (Sensory Loss)

Answer 77

Sensory Loss: 1. Ulnar aspects of palmar & dorsal surface 2. Ulnar half of #4-#5 on palmar and dorsal surfaces

Question 78

Ulnar nerve laceration (motor loss: low lesion at the wrist)

Answer 78

Motor Loss 1. palmar and dorsal interossei (adduction & abduction of MCP joints) 2. Lumbricals #3-#4 (MCP flexion of digits #4-#5) 3. FPB & adductor pollicis (flexion/add at thumb) 4. ADM, ODM, FDM (abduction, opposition, and flexion of #5)

Question 79

Ulnar nerve laceration (high lesion wrist or above)

Answer 79

Motor Loss: 1. same as low lesion, including FCU (flexion toward ulnar wrist) 2. FDP #4-#5 (flexion of DIPs) [Low lesion motor loss] 1. palmar and dorsal interossei (adduction & abduction of MCP joints) 2. Lumbricals #3-#4 (MCP flexion of digits #4-#5) 3. FPB & adductor pollicis (flexion/add at thumb) 4. ADM, ODM, FDM (abduction, opposition, and flexion of #5)

Question 80

Deformity and Functional Loss of Ulnar Nerve Laceration

Answer 80

Deformity: 1. claw hand 2. flattened metacarpal arch 3. Positive Froment's sign (assessment of thumb adductor while laterally pinching paper) Functional Loss: 1. loss of powergrip 2. decreased pinch strength

Question 81

Splinting considerations for Ulnar nerve laceration

Answer 81

MCP (extension) block splint ## Footnote Claw hand

Question 82

Treatment for Median/Ulnar Nerve Laceration ## Footnote Splint

Answer 82

Treatment: 1. dorsal protection splint w/ wrist positioned in 30 deg flexion (low lesion); include elbow 90 deg flexion (high lesion) 2. A/PROM of digits w/ wrist in flexion (2 weeks post-op) 3. Scar management 4. AROM of wrist (4 weeks); include elbow if high lesion 5. Strengthening (9 weeks)

Question 83

Sensory Loss for Radial Nerve Injury (high lesions at the level of the humerus)

Answer 83

1. Medial aspect of dorsal forearm 2. Radial aspect of dorsal palm, thumb, and index, middle and radial half of ring phalanges

Question 84

Motor Loss for Radial Nerve Injury (low lesion/at forearm)

Answer 84

Motor Loss: 1. loss of wrist extension d/t absent/impaired innervation to ECU 2. EDC, EI, EDM (MCP extension) 3. EPB, EPL, APL (thumb extension)

Question 85

Motor Loss for Radial Nerve Injury (high lesion/at humerus)

Answer 85

Motor Loss: 1. same as all [low lesion]; including ECRB, ECRL, and brachioradialis 2. If level of axilla: loss of triceps (elbow extension) [Low lesion loss:] 1. loss of wrist extension d/t absent/impaired innervation to ECU 2. EDC, EI, EDM (MCP extension) 3. EPB, EPL, APL (thumb extension)

Question 86

Functional Loss for Radial Nerve Injury

Answer 86

1. Inability to extend digits to release objects 2. Difficulty manipulating objects

Question 87

Deformity of Radial Nerve

Answer 87

Wrist drop

Question 88

Treatment for Radial Nerve Injury ## Footnote splint

Answer 88

1. Dynamic extension splint/wrist cock-up) 2. ROM 3. Sensory re-education PRN 4. Instruct in home program 5. Activity modification 6. Neuromuscular electrical stimulation (NMES) for muscle re-education ## Footnote Wrist drop

Question 89

Zones of Flexor Injuries

Answer 89

Question 90

Rotator Cuff Tendonitis ## Footnote treatment, splint

Answer 90

Loss of/weakness: AB/Flex; ER/IR Impingement site; rep. overuse/trauma Treatment: 1. modify activity 2. sleep position (avoid arm overhead/combined ADD/IR) 3. Sling/aduction orthosis inbetween exercises 4. dec. pain: ice>heat Post op: 1. 0-6 weeks: PROM 2. 6-8 weeks: AARM/AROM 3. 8-12 weeks: strengthening [begin with isometrics, progres to isotonice (below shoulder level)

Question 91

Adhesive Capulitis ## Footnote treatment, splint

Answer 91

Frozen shoulder @ joint capsule: restricted passive shoulder ROM [limitation: greatest: ER, ABD, IR, Flex] Treatment: 1. Active use ADLs 2. PROM 3. modalities 4. Post op: PROM immediately, pain relief (modalities), use of extremeit of all ADLs | Link to diebetes mellitus and PD

Question 92

Shoulder dislocation ## Footnote treatment

Answer 92

1. regain ROM 2. pain-free ADLs 3. strengthen rotator cuffs ## Footnote anterior most common

Question 93

What two muscle actions should be avoided with an anterior dislocation?

Answer 93

combined abduction and external rotation

Question 94

Cumulative Trauma Disorder (CTD)

Answer 94

1. trauma to soft tissue caused by repeated force 2. Diagnoses: Tendinitis; nerve compression syndrome; myofascial pain; cervical, thoracic, and lumbar osteoarthritis or nerve root impingement; thoracic outlet syndrome; rotator cuff tear; bursitis; epicondylitis; cubital tunnel syndrome; carpal tunnel syndrome; de Quervain syndrome

Question 95

Treatment for CTD (acute phase)

Answer 95

Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, and high-voltage electric and interferential stimulation

Question 96

Treatment for CTD (subacute phase)

Answer 96

Slow stretching, myofascial release, progressive resistive exercise as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment with flareups; static splint during activities that cause pain

Question 97

Modalities used for tendon injuries

Answer 97

1. heat, to gradually prepare the tissue for motion 2. neuromuscular electrical stimulation (NMES) to promote tendon excursion/activation (begin when cleared)

Question 98

Assessment used for CTS for dysfunction

Answer 98

ADL checklist

Question 99

Splinting is used to prevent rupture because the repaired tendon is at its weakest ___ to ___ days postsurgery.

Answer 99

the repaired tendon is at its weakest 10 to 12 days postsurgery

Question 100

Cozen's Test

Answer 100

The affected elbow is stabilised at 90degrees flexion, forearm pronated (palm down), hand clenched and in radial deviation. The patient attempts to extend the wrist (lift the hand up) while the examiner resists the movement. Pain at the lateral epicondyle indicates a positive test for lateral epicondylitis

Question 101

Mill's Test

Answer 101

The examiner palpates the lateral epicondyle, pronates the patient’s forearm, fully flexes the wrist and extends the elbow. Pain over the lateral epicondyle indicates tennis elbow

Question 102

Maudsley's Test

Answer 102

The examiner places their finger over the tip of the patient’s middle finger and resists finger extension. Pain over the lateral epicondyle is positive for tennis elbow

Question 103

Zones of Extensor Injuries

Answer 103

Question 104

An OTR is advising a client who has had a flexor tendon repair on the timing for resuming ADLs. During what time period is the flexor tendon repair the weakest and most likely to rupture? A] 1–3 days postsurgery B] 4–9 days postsurgery C] 10–12 days postsurgery D] 4–8 weeks postsurgery

Answer 104

Solution: The correct answer is C. A tendon repair is typically at its weakest 10–12 days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair. A, B: At 1–9 days postsurgery, the tendon is still newly repaired and has the strength of the original suture. D: The period 4–8 weeks postsurgery is considered the intermediate phase, during which the tendon gains strength

Question 105

An OTR® is working with a client who has been in a motor vehicle accident. The client presents with a median nerve injury and has loss of sensation in the index and middle finger with difficulty touching thumb to index finger. Which flexor tendon zone corresponds to this client’s injuries? A] Zone I B] Zone II C] Zone III D] Zone IV

Answer 105

Solution: The correct answer is D. D: Zone IV consists of the transverse carpal ligament, and the median nerve runs under this ligament. A, B, C: In order for both the index and the middle finger to be affected by the nerve injury, it would have to occur in Zone IV, before the nerve branches.

Question 106

Salter Harris Fracture ## Footnote define, treatment

Answer 106

1. proximal IP joint fracture that's slightly malaligned 2. buddy tape to an adjacent finger

Question 107

During an assessment, an OTR asks the client to pinch a pinch gauge and notices increased flexion of the thumb interphalangeal joint. What term is used to describe this type of pinch? A] Froment’s sign B] Wartenberg’s sign C] Jeanne’s sign D] Ulnar claw

Answer 107

**Solution: The correct answer is A.** **Froment’s sign** occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. **When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual.** B: Wartenberg’s sign is the little finger held in abduction. C: Jeanne’s sign is hyperextension of the proximal phalanx of the thumb when pinching. D: Ulnar claw refers to hand posture with ulnar nerve injury.

Question 108

Question An OTR® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client? A] Resting hand splint B] Intrinsic plus splint C] Cone antispasticity splint D] Dorsal flexor tendon repair splint

Answer 108

Solution: The correct answer is B. Burns to the dorsum of the hand require the metacarpophalangeal joints to be **splinted in 50°–70° of flexion to prevent clawing** of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an **antideformity splint** or a safe position splint. A: A resting hand splint is for support or immobilization. C: A cone antispasticity splint is used for clients with cerebrovascular accident, traumatic brain injury, or cerebral palsy. D: A dorsal flexor tendon repair splint is used for clients with flexor tendon repair.

Question 109

Intrinsic plus (or Edinburg) position

Answer 109

the safe position for hand splinting. The hand can be immobilized in this position for long periods of time without developing as much stiffness as would occur if the digits were positioned differently.

Question 110

An OTR has been working with a client diagnosed with carpal tunnel syndrome. The client's symptoms have diminished, but now the client reports more pain at the elbow in the median nerve area. When a client reports dual sites of impingement of a single nerve without a history of trauma, what condition is MOST likely the cause? A] Thoracic outlet syndrome B] Double crush syndrome C] Ulnar tunnel syndrome D] Cubital tunnel syndrome

Answer 110

Solution: The correct answer is B. B: Over time, diminished blood flow to a peripheral nerve can result in serial impingements, called double crush syndrome. A: Thoracic outlet syndrome involves the shoulder region. C: Ulnar tunnel syndrome involves the ulnar nerve. D: Cubital tunnel syndrome involves the ulnar nerve.

Question 111

An OTR® is describing a client with a hand injury to an occupational therapy student. The OTR® states that the client presents with burning and stabbing pain in the hand, shiny skin, very stiff joints, and abnormal sweating and hair growth. What medical condition does this client MOST likely have? A] Fibromyalgia B] Carpal tunnel syndrome C] Neuroma secondary to index proximal interphalangeal amputation D] Complex regional pain syndrome

Answer 111

Solution: The correct answer is D. Symptoms of complex regional pain syndrome often include pain, swelling, stiffness, and sudomotor and trophic changes. A: Fibromyalgia presents with pain, fatigue, and tender trigger points. B: Carpal tunnel syndrome presents with numbness and tingling in the thumb and index and middle fingers. C: Neuroma is hypersensitive and painful to touch

Question 112

An OTR® has been working with a client recently diagnosed with complex regional pain syndrome of the upper extremity secondary to an improperly casted distal radius fracture. Which modality is BEST to reach the treatment goal of pain control for this client? A] Cold spray B] Neuromuscular electrical stimulation (NMES) C] Transcutaneous electrical nerve stimulation (TENS) D] Iontophoresis

Answer 112

Solution: The correct answer is C. A TENS unit will best aid the client in reaching the treatment goal of pain control. A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit. B: NMES is best used to facilitate muscle contraction. D: Iontophoresis is used to control inflammatory conditions.

Question 113

An OTR® is seeing a client in the upper extremity outpatient clinic. During the initial assessment, the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing? Radial tunnel syndrome Pronator syndrome Carpal tunnel syndrome Anterior interosseous nerve syndrome

Answer 113

Solution: The correct answer is A. Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. B: Pronator syndrome is compression of the median nerve and causes diffuse pain along the medial aspect of the forearm. C: Carpal tunnel syndrome is median nerve compression with pain and numbness into the hand and fist through half of the fourth digit. D: Anterior interosseous nerve syndrome is motor loss of function without sensory disturbance.

Question 114

An OTR is working with a client who has sustained injuries in a knife attack. The injury to the flexor tendon is in what is known as "no man's land." The stitches in the fingers are between the distal palmar crease and the proximal interphalangeal joints. In what flexor tendon zone are the injuries located? Zone I Zone II Zone III Zone IV

Answer 114

Solution: The correct answer is B. Zone II of the flexor tendon system has been called no man's land because excessive scarring makes it difficult to get good results from a repair. A, C, D: Zones I, III, and IV of the flexor tendon system do not have the overlap of the flexor digitorum profundus and the flexor digitorum superficialis to increase scarring and decrease tendon gliding.

Question 115

A client fell while skiing downhill and sustained a Type III fracture of the radial head. Which treatment would be MOST appropriate for this type of fracture? Long arm cast for 6 weeks Therapy alone Open reduction and internal fixation (ORIF) followed by a long arm cast for 3–4 weeks ORIF followed by a long arm splint for 3–4 weeks

Answer 115

Solution: The correct answer is D. ORIF is often used to treat a Type III fracture of the radial head; it is a surgical procedure to hold the fragments of bone in place with wires, screws, pins, or metal plates attached to the outer surface of the bone. Splints are worn for 3–4 weeks after surgery to ensure proper healing and support, but early range of motion is important to prevent long-term mobility issues. A: A long arm cast for 6 weeks would not be appropriate because that time frame would lead to greater stiffness. B: Therapy alone would not be sufficient for a Type III injury. C: Immobilization in a cast for 3–4 weeks would lead to greater stiffness.

Question 116

An OTR® is designing treatment sessions for a client with Type I complex regional pain syndrome (CRPS). Which occupational therapy treatment activities for the affected upper extremity would be MOST appropriate for this client? Instruction in PROM and application of joint mobilization techniques Use of cold packs followed by application of ultrasound Instruction in a stress loading program and incorporation of use of the upper extremity in functional activities Serial casting

Answer 116

Solution: The correct answer is C. The most recognized treatment of complex regional pain syndrome is a stress loading program and use of the upper extremity in functional activities that promote occupational engagement. A: PROM increases pain and swelling and is often contraindicated. B: People with CRPS are often cold intolerant. D: Serial casting does not increase active ROM and may add to joint stiffness.

Question 117

An OTR® is working with a client who fractured the distal radius 3 weeks ago. Within what time frame can controlled AROM be initiated if the fracture is healing secondarily? 1–3 weeks postinjury 3–6 weeks postinjury 6–9 weeks postinjury 9–12 weeks postinjury

Answer 117

Solution: The correct answer is B. Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate. A: The fracture may not tolerate AROM this early, and edema and pain will result if AROM is initiated. C, D: These time ranges may be too late to prevent scar adhesions from forming at the fracture site.

Question 118

A blocking splint fabricated to maintain the metacarpophalangeal (MCP) joints in extension can be useful to isolate which joint movements? MCP joint flexion and flexor digitorum profundus (FDP) excursion Interphalangeal (IP) joint extension and FDP excursion IP joint flexion and FDP excursion Proximal IP joint extension and FDP excursion

Answer 118

Solution: The correct answer is C. MCP joint extension helps isolate proximal and distal IP joint flexion and allows maximum FDP excursion. A: This splint holds the MCP joints in extension, not flexion. B: FDP excursion occurs with distal IP joint flexion, not extension. D: Proximal IP joint extension is facilitated when the MCP joints are blocked in flexion, not extension

Question 119

90.0% complete Question An OTR is providing education to a client who has undergone surgical nerve repair to the median nerve. The client has a medical background, so when the OTR explains nerve regeneration, which sensation should the OTR indicate is likely to return FIRST? A.One-point moving B.One-point discrimination C.Two-point moving D.Two-point discrimination

Answer 119

Solution: The correct answer is A. In the realm of nerve healing and testing, the order in which recovery occurs is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination. B, C, D: In nerve healing and testing, the order in which recovery can be seen is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination.

Question 120

A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician’s order for full-time splinting. Which orthosis would the OTR® be MOST likely to fabricate? Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°–90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°–90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension

Answer 120

Solution: The correct answer is D. Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments. Hand-based thermoplastic splints may also be used for this type of fracture. A: A dorsal hood splint does not offer adequate protection for the fractured metacarpal. B: Maintaining the MCP joint in extension may lead to collateral ligament shortening and decreased ability to flex the MCP joint after the fracture is healed. C: Maintaining the MCP joints in extension may lead to shortening of the lateral bands and joint contractures.