Hand and upper extremity disorders

Question 1

Dupuytren’s Disease

Answer 1

disease of fascia and digits
Fascia becomes thick and contracted, resulting in flexion of the involved digits

Question 2

OT intervention for Dupuytren’s

Answer 2

after surgery
edema control, hand over heart
AROM and PROM
Strengthening after wounds heal (usually four weeks)
Scar management
tasks that emphasize grasp and release

Question 3

Orthosis for Dupuytrens post-surgery

Answer 3

extension orthosis
The ideal is full extension, but this is not always possible due to the severity of contraction

Question 4

Skiers/Gamekeepers thumb

Answer 4

Rupture of the ulnar collateral ligament of the MCP joint of the thumb

Question 5

OT intervention for Skiers thumb

Answer 5

Thumb orthosis Is a partial tear
Begin with AROM depending on the physician’s order, usually at 2-4 weeks, then move to AAROM and strengthening
strengthening should being with lateral pinch and opposition

Question 6

complex regional pain syndrome

Answer 6

vasomotor dysfunction, localized or spread across the extremities
severe pain, edema, discoloration, temperature changes

Question 7

OT intervention for CRPS

Answer 7

modalities to decrease pain and hypersensitivity
TENS used before AROM or ADL
edema management: compression, elevation
AROM to involved joints
Stress loading
orthtoics

Question 8

Colles Fracture

Answer 8

Fracture of the distal radius with dorsal displacement

Question 9

Smiths fracture

Answer 9

fracture of the distal radius with volar displacement

Question 10

most common carpal fracture

Answer 10

scaphoid
proximal has poor blood supply and is prone to become necrotic

Question 11

boxers fracture

Answer 11

fracture of 5th metacarpal
requires ulnar gutter orthosis

Question 12

Distal phalanx fracture

Answer 12

most common finger fracture
may result in mallet finger

Question 13

immobilization phase of fracture intervention

Answer 13

goal: stabilization and healing
AROM of joints above and below fracture
edema control
light ADL activities with no resistance, as tolerated

Question 14

mobilization phase of fracture intervention

Answer 14

Goal: consolidation
edema control
AROM, begin AAROM and PROM as indicated by physician
pain management
Strengthening when approved

Question 15

de Quervians

Answer 15

Tenosynovitis of abductor pollicis longus and extensor pollicis brevis
pain and swelling over radial styloid

Question 16

De quervians test

Answer 16

Positive finklesteins
thumb tucked into fisted grasp with ulnar deviation

Question 17

Tx for de quervians

Answer 17

thumb spica
ice massage over the radial wrist
gentle AROM of wrist and thumb
Post op: thumb spica and gentle AROm (0-2 wks), strengthing (2-6 wks)

Question 18

lateral epicondylitis

Answer 18

Overuse of wrist extensors
tennis elbow

Question 19

Tennis elbow Tx

Answer 19

elbow strap
ice and deep friction massage
stretching

Question 20

Trigger Finger

Answer 20

tensosynovitis of finger flexors, most common is A1 Pulley

Question 21

Trigger Finger Tx

Answer 21

hand or finger based orthosis
scar massage
edema control
tendon gliding
Decrease repetitive gripping activities

Question 22

Duran Early passive Mobilization Protocol for Tendon Repair

Answer 22

Passive flexion and early extenstion of digits
0-4 weeks: dorsal blocking orthosis, exercises include passive flexion of PIP DIP and DPC within confine of orthosis
2 1/2 Week: passive pace/active hold exercises
4-6 weeks: AROM including wrist with fingers
6-8 week: gentle stretching
12 weeks: return to regular activity

Question 23

Dorsal blocking orthosis for early passive mobilization

Answer 23

Wrist in 10-30 degrees of flexion
MCP in 40-60 degrees of flexion
IP joints extended

Question 24

Early Active Mobilization for flexor tendons

Answer 24

Requires a minimum of four strands used in surgery
Dorsal blocking orthosis, position depends on the surgeon
Exercises and protocol will be determined by the surgeon
6 weeks: begin light ADL
8 Weeks: gentle strengthening

Question 25

Early Mobilization for extensor tendons Zone I and II

Answer 25

mallet finger 0-8 weeks: DIP extension orthosis 6-8 weeks: gentle AROM Orthotics should be worn at night and between exercises

Question 26

Early Mobilization for extensor tendons Zone III and IV

Answer 26

Boutonniere deformity 0-6 weeks: PIP extension orthosis (DIP free) AROM of DIP while in orthosis

Question 27

Early Mobilization for extensor tendons Zone V, VI, and VII

Answer 27

Types of orthosis and protocols vary strengthening can begin when approved by the physician

Question 28

Carpal Tunnel Syndrome

Answer 28

Median nerve compression numbness and tingling of thumb, index, middle, and half of ring finger Positive Tinel's sign at the wrist and Phalen's sign

Question 29

Carpal Tunnel Conservative treatment

Answer 29

wrist orthosis in neutral median nerve gliding exercises Avoid activities with your wrist in extreme positions of flexion

Question 30

Post-operative carpal tunnel treatment

Answer 30

edema control AROM Scar management Nerve and tendon gliding sensory re-education

Question 31

Cubital Tunnel Syndrome

Answer 31

ulnar nerve compression at elbow numbness and tingling on ulnar side of forearm and hand Froment's sign, positive Tinel's at the elbow

Question 32

Conservative Cubital Tunnel Syndrome

Answer 32

Elbow orthosis at 30 degrees of flexion elbow pad when leaning on elbbows ulnar nerve glides

Question 33

Radial Nerve Palsy

Answer 33

radial nerve compression weakness or paralysis of extensors to wrist, MCPs and thumb Wrist drop

Question 34

Radial Nerve Palsy Conservative Tx

Answer 34

dynamic wrist and MCP extension orthosis strengthening wrist and finger extensors when motor function returns

Question 35

Median nerve laceration Sensory Loss

Answer 35

central palm ( thumb to radial half of ring finger) Palmar Surface of thumb, index, and radial half of ring fingers Dorsal surface of the index, middle, and radial half of the ring

Question 36

Motor loss for low median nerve laceration at wrist

Answer 36

MCP flexion for digits II and III Thumb opposition and abduction Flexion of the thumb at the MCP

Question 37

Motor loss for high median nerve laceration at or proximal to the elbow

Answer 37

Everything at low lesion plus: flexion of tip of index, middle and thumb inability to flex radial aspect of wrist

Question 38

Orthosis for median nerve laceration

Answer 38

dorsal protection orthosis wwith wrist in 30 degrees flexion for low lesion, include 90 degree elbow if high lesion

Question 39

OT intervention for median nerve laceration

Answer 39

being A/PROM with wrist flexed 5-7 days post-repair AROM (about 4 weeks) and strengthening (about 6-8 weeks) when indicated by the physician Sensory reeducation: educate on safe use of hand using vision, graded textures, vibration

Question 40

Ulnar nerve laceration sensory loss

Answer 40

ulnar aspects of palmar and dorsal surfaces The ulnar half of the ring and pinky on the palmar and dorsal surfaces

Question 41

Motor loss for low ulnar nerve laceration at the wrist

Answer 41

adduction and abduction of MCP joints MCP flexion of 4 and 5 flexion and adduction of thumb abduction, opposition and flexion of 5th digit

Question 42

Motor Loss for high ulnar nerve laceration above the wrist

Answer 42

Same as low lesion plus: flexion towards ulnar side flexion of DIP of digit 4 and 5

Question 43

Ulnar nerve laceration defromity

Answer 43

claw hand flattened metacarpal arch Positive Froment's sign