hand and UE disorders and injury Flashcards
(93 cards)
1
Q
Dupuytrens disease
A
- Disease of the fascia of the palm and lights
-Fascia becomes thick and contracted - results in flexion deformity of the involved digits
2
Q
Or interventions post surgery for dupuytrens
A
- wound care
- edema control: elevation above heart
- arom/prom
- scar management
- purposeful and occupation based tasks emphasizing flexion (grip) and extension (release).
3
Q
Orthosis for dupuytrens
A
- hand based extension orthosis (remove for rom and bathing)
- dorsal or volar
- ideal is full extension
4
Q
Skiers thumb (game keepers thumb)
A
Rupture of ulnar collateral ligament of the MCP joint of the thumb
5
Q
Conservative OT treatment for skiers thumb
A
- Begin with AROM (wait for physician approval), usually 2-4 weeks
- when approved, move to AAROM & lateral pinch strengthening usually 6+ weeks
- focus on ADLs that require opposition and pinch strength
- strengthening often delayed for 6-12 weeks
6
Q
Post operative skiers them OT interventions
A
- Thumb orthosis (hand or forearm based with IP joint free) for 6-12 weeks
- edema management (elevation is must )-followed by removing ortnosis for ROM (4-6 weeks)
- strengthening, when physician approved, begin with lateral pinch
7
Q
A
8
Q
Complex regional pain syndrome
A
- vasomotor dysfunction as a result of an abnormal reflex
9
Q
Complex regional pain syndrome OT interventions
A
- modalities to decrease pain
- edema management: elevation, edema mobilization, compression glove
- AROM
- ADLs
- stress loading
- orthotics to prevent contractures
- self-management
10
Q
Examples of modalities for complex regional pain
A
- Desensitization
- warm fluidotherapy
- hot packs
- TENS prior to AROM or during ADL
11
Q
Examples of stress loading
A
- weight bearing and joint distraction activities, including scrubbing and carrying activities
12
Q
Closed reduction fracture treatment
A
- Short arm cast, long arm last, orthosis, sling, or fracture brace
13
Q
Open reduction internal fixation ( ORIF) fracture treatment
A
- Nails, screws, plates, or wire
14
Q
CoIles ‘ fracture
A
- Fracture of distal radius with dorsal placement
15
Q
Smith’s fracture
A
- Fracture of distal radius with volar placement
16
Q
Carpal fracture
A
- Most common is scaphoid
17
Q
Metacarpal fractures
A
Classified by location ( head, neck, shaft, base)
- common complication is rotational deformities
18
Q
Boxers fracture and required orthosis
A
- Fracture of the 5th metacarpal
- requires an ulnar gutter orthosis
19
Q
Proximal phalanx fracture
A
- Most common with thumb and middle finger
- common complication is loss of PIP arom/prom
20
Q
distal phalanx fracture
A
- most common finger fracture; may result in mallet finger (which involves terminal extensor tendon)
21
Q
A
22
Q
elbow fracture
A
Involvement of the radial head may result in limited rotation of the forearm
23
Q
humerus fracture
A
- non-displaced versus displaced
- fracture of the greater tuberosity may result in rotator cuff injuries
- humeral shaft fractures may cause injury to the radial nerve resulting in wrist drop
24
Q
OT evaluations for fractures
A
- occupational profile
- History
- results of special tests
- edema
- Pain
- AROM (do not assess PROM or strength until ordered by a physician; exceptions are humorous fractures that often begin with PROM or AAROM)
- sensation
- engagement occupations, ADL, and activities related to roles
25
OT intervention immobilization phase
- stabilization and healing are the goal
- edema control such as elevation, manual, edema, mobilization, gentle, retrograde, massage, and compression garment
- light ADL and roll activities with no resistance, progress is tolerated (if a person is in a sling, shoulder, immobilizer, LAC, fracture, brace, or ORIF, they should be instructed in one handed techniques)
-
26
OT intervention mobilization phase
- Consolidation is the goal
- edema control, including elevation, manual, edema, mobilization, gentle, retrograde, massage, contrast, baths, and compression garment
- some will require an orthosis
- AROM (progress to AA/PROM when approved; exceptions or humorous fractures)
- light occupation based activities
- Pain management
- Strengthening and approved by the physician
27
Cumulative trauma disorders (CTDs)
-also known as repetitive strain injuries, overuse syndrome, and/or muscular skeletal disorders
28
risk factors and non-work risk factors of cumulative trauma disorder
Risk factors include repetition, static position, awkward, postures, forceful, exertion, and vibration
- Nonwork risk factors include acute trauma, pregnancy, diabetes, arthritis, and wrist, size, and shape
29
De Quervain'S (type of CTD )
- Stenosing tenosynovitis of the abductor Pollicis longus (APL) and extensor Pollicis longus ( EPB )
- pain and swelling over radial styloid
- positive FinkelStein's test
30
De quervains conservative treatment
- Thumb spica orthosis (IP joint free )
- activity/work modifications
-Ice massage over radial wrist
- gentle AROM of wrist and thumb to prevent stiffness
31
De quervains post operative treatment
-Thumb spica ortnosis and gentle AROM (0-2 weeks)
-Strengthening, ADL, role activities (2-6 weeks)
- unrestricted activity (6 weeks)
32
Lateral epicondylitis (type of CTD )
- Degenerative changes of the tendons origin as a result of repetitive microtrauma
- overuse of wrist extensors, especially the extensor carpi radialis brevis
- also called tennis elbow
33
Lateral epicondylitis conservative treatment
- elbow strap, wrist orthosis
- Ice and deep friction massage
- stretching
- Activity/work modification
- as pain decreases, add strengthening (focus on proximal strengthening and begin with eccentric exercises for the wrist extensors)
34
35
trigger finger (type of CTD)
- tenosynovitis of the finger flexors: most common is the A1 pulley
- Caused by repetition and the use of tools that are placed too far apart
36
37
trigger finger conservative treatment
- hand or finger based orthosis (MCP extended, IP joints free)
- Scar massage
- edema control
- tendon gliding
- Activity/work modification: avoid repetitive gripping activities and using tools with handles too far apart
- nerve compressions
38
OT goals for tendon repairs
- increase tendon excursion
- Improve strength
- increase joint ROM
- prevent adhesions
- facilitate resumption of meaningful roles, occupations, and activities
39
Duran protocol
Passive flexion and extension of digits
40
0 to 4 weeks of the Duran protocol
- dorsal blocking orthosis
- wrist is positioned in 10° to 30° of flexion, MCP joints in 40° to 60° flexion, and IP joints extended
- exercises in the orthosis include passive flexion of PIP joint, GIP joint and to DPC within confines of dorsal blocking orthosis
41
2.5 weeks of the Duran protocol
- passive place/active hold exercise exercises may be approved by physician
- manage edema with elevation
- massage scar to prevent adherence when incision is healed
42
4 to 6 weeks of the duran protocol
- AROM that includes wrist AROM with fingers, relaxed and tendon gliding
43
6 to 8 weeks of the Duran protocol
- gentle strengthening
44
12 weeks of the duran protocol
Return to regular functional activity
45
kleinert protocol
- not commonly used
- passive flexion using rubber band traction and active extension to the hood of the dorsal blocking orthosis
- 3-4 weeks: out of myosis and rubber band traction attached to wristband
- 6 weeks: AROM
46
early passive mobilization programs for flexor tendons
- duran protocol
- kleinert protocol
47
early active mobilization (multiple protocols) for flexor tendons
-Requires a minimum of four strands or moore used in surgical procedure
- Close communication with surgeon
- experience therapist who is knowledgeable in treating flex or tenant repairs
- dorsal blocking orthosis: position of wrist, usually neutral, and digital depend on the protocol prescribed by the surgeon
- exercise exercises in protocol followed, will be determined by the surgeon
- Under close supervision of the therapist the person may complete the following: place an active hold in flexion, tenodesis with place hold flexion, partial finger flexion with wrist in extension, tendon gliding
- 6 weeks: may begin light ADL
- 8 weeks: gentle strengthening
48
early mobilization programs for extensor tendons
zone I and II: mallet finger
zone III and IV: boutonnière deformity
zone V, VI, VII
49
mallet finger deformity (zone I and II)
- 0-8 weeks DIP extension orthosis
- 6-8 weeks: gentle AROM
- some surgeons will have ROM restrictions on how much DIP flexion will be allowed
- orthotic should be worn at night and inbetween exercises
50
buotonniere deformity (zone III and IV)
- 0-6 weeks: PIP extension orthosis (DIP free)
- AROM of DIP while in orthosis
51
zones V, VI, and VII
- types of orthosis and protocols vary
- example includes wrist extension orthosis that also includes MCPs in slight flexion and IP joints in full extension
- orthosis is adjusted to allow for IP AROM, then progress to freeing MCPs to allow for AROM
-
52
2 common types of nerve injuries
- compression/nerve entrapment
- laceration or avulsion injury
53
carpal tunnel syndrome (CTS)
- median nerve compression
- numbness and tingling of thumb, index, middle, and half of ring finger
- paresthesias at night
- often drops things
- positive tinels sign at wrist. positive phalens sign
54
carpal tunnel conservative treatment
- median nerve gliding exercises
- activity modifications (avoid extreme wrist flexion, wrist flexion with repetitive finger flexion, and wrist flexion with a static grip)
- ergonomics
54
carpal tunnel orthosis
- wrist orthosis in neutral: should be worn at night and during the day if performing repetitive activity
55
post operative treatment of carpal tunnel
- edema control: elevation, AROM, ice, retrograde massage, compression, contrast bath
- AROM: wrist and tendon gliding
- scar management
- nerve and tendon gliding
- sensory re-education/desensitization
- thenar strengthening
56
cubital tunnel syndrome
- ulnar nerve compression at the elbow. can present with sensory and/or motor problems
- numbness/tingling
- weak grip
- special tests, froments sign, elbow flexion test, and positive tinels sign at elbow
57
advanced stages of cubital tunnel
- lead to atrophy resulting in claw hand deformity
58
cubital tunnel orthosis
- elbow orthosis 30° of flexion to prevent positions of extreme flexion
59
conservative treatment for cubital tunnel
- elbow pad
- ulnar nerve glides
- activity/work modifications
60
post operative cubital tunnel treatment
- edema control
- scar management
- AROM and nerve gliding (2 weeks post op)
- strengthening (4 weeks post op)
- MCP flexion and anti claw orthosis if clawing is noted
61
radial nerve palsy
- radial nerve compression
- weakness, paralysis of extensors to the wrist, MCPs and thumb; wrist drop
62
radial nerve palsy orthosis
dynamic wrist and MCP extension orthosis
63
conservative treatment for radial nerve palsy
- work/activity modification
- strengthening wrist and finger extensors when motor functioning returns
64
postoperative treatment of radial nerve palsy
- AROM
- strengthening: 6-8 weeks post op
- ADL and meaningful role activities
65
median nerve laceration
- sensory loss of thumb to half of ring finger
66
median nerve laceration; motor loss for a low lesion at wrist
- MCP flexion of II and III
- opposition
- abduction
- flexion of thumb MCP
67
median nerve laceration; motor loss for a high lesion at or proximal to the elbow
- MCP flexion of II and III
- opposition
- abduction
- flexion of thumb MCP
- flexion of tip of index, middle fingers, and thumb
- inability to flex to radial aspect of wrist
68
median nerve laceration deformity and functional loss
- flattening of thenar eminence
- clawing of index and middle fingers for a low lesion but not obvious
- loss of thumb opposition
- pinch weakness
69
Orthosis for median nerve laceration
- dorsal protection orthosis with wrist positioned in 30° flexion if low lesion
- include elbow at 90° of high lesion
- web spacer to prevent thumb adduction contracture
- opponens to improve functioning
70
OT intervention for median nerve laceration
- A/PROM of digits with wrist in flexed position in orthosis at 5-7 days post repair
- scar management when healed
- AROM out of orthosis when approved; include elbow if high
- strengthening when approved
- sensory reeducation
71
ulnar nerve laceration
- sensory loss
- ulnar aspects of palmar and dorsal surfaces
- half of ring and little finger on palmar and dorsal surfaces
72
ulnar nerve laceration; motor loss at low lesion on wrist
- adduction and abduction of MCP joints
- MPC flexion of digits 4 and 5
- flexion and adduction of thumb
- abduction, opposition, and flexion of 5th digit
73
ulnar nerve laceration; motor loss at high lesion wrist or above
- adduction and abduction of MCP joints
- MPC flexion of digits 4 and 5
- flexion and adduction of thumb
- abduction, opposition, and flexion of 5th digit
- flexion toward ulnar wrist
- flexion of DIPs of ring and little fingers
74
deformities and functional loss of ulnar nerve laceration
- claw hand
- flattened metacarpal arch
- positive froments sign (assessment of thumb adductor while laterally pinching paper)
- loss of power grip
- decreased pinch
75
OT intervention for ulnar nerve laceration
- A/PROM of digits with wrist in flexed position in orthosis at 5-7 days post repair
- scar management when healed
- AROM out of orthosis when approved; include elbow if high
- strengthening when approved
- sensory reeducation
76
ulnar nerve laceration orthosis
MCP flexion block
77
radial nerve injury
- sensory loss: high lesions at level of humerus
- medial aspect of dorsal forearm; radial aspect of dorsal palm, thumb, and index, middle and radial half of ring phalanges
78
radial nerve injury; motor loss at low lesion at level of forearm
- loss of wrist extension due to absent or impaired innervation to the ECU
- MCP extension
- thumb extension
79
radial nerve injury; motor loss at high lesion at level of humerus
- loss of wrist extension due to absent or impaired innervation to the ECU
- MCP extension
- thumb extension
- ECRB, ECRL, and brachioradialis
- if level of axilla, loss of triceps: elbow extension
80
deformity and functional loss of radial nerve injury
- wrist drop
- inability to extend digits to release
- difficulty releasing objects
81
orthosis for radial nerve injury
- dynamic extension orthosis
82
OT intervention for radial nerve injury
- dynamic extension orthosis
- ROM
- sensory re-education
- home program
- activity modification
- neuromuscular electrical stimulation
83
OT conservative treatment for rotator cuff tendonitis
- activity modifications: avoid above shoulder level
- education in sleeping posture
- decrease pain: positioning, modalities
- restore pain free ROM
- strengthening: below shoulder level
- occupation and role specific training
84
post operative rotator cuff OT intervention
- begin with PROM (0-6 weeks); progress to AAROM/AROM (6-8 weeks)
- decrease pain: begin with ice, progress to heat
- strengthening: begin isometrics, progress isotonic
- activity modifications
- leisure and work activities at 12 weeks postop
85
rotator cuff orthosis
- sling or abduction orthosis to be worn in between exercises
86
adhesive capsulitis
- frozen shoulder
- linked to diabetes mellitus and parkisons
87
freezing stage:
shoulder becomes painful at end ranges
88
frozen stage:
less pain, but loss of motion; develops capsular pattern ( greatest limitation is external rotation, then abduction, then internal rotation, and flexion)
89
thawing stage:
pain subsides and ROM gradually returns
90
OT conservative treatments at freezing stage
- ice packs, E-stim, positioning
- gentle A/PROM: functional movements like reaching to small of back or behind head
- home exercise program
91
OT conservative treatments at frozen stage
- hot packs to begin session, conclude with ice
- A/PROM and begin gentle/pain-free stretching
- continue home exercises program to increase ROM
92
post op frozen shoulder OT intervention
- PROM immediately after surgery
- pain relief
- encourage use of extremity for all ADL and role activities
