Hand Eval & Intervention

Question 1

CMC OA Immobilization

Answer 1

CMC Thumb Immobilization Splint at night until the OA flare up is gone: then use PRN

Question 2

CMC OA Interventions

Answer 2

Joint protection principles
Modalities (Paraffin, MHP)
Web space Massage
Adaptive Equipment

Question 3

DeQuervains Pathology

Answer 3

Inflammation of the first dorsal compartment (EPB, APL) from overuse.

Question 4

DeQuervains Innterventions

Answer 4

Thumb Spica Splint for 3-4 weeks non-stop REST
Cortozone Shots
Work Modifications and Activity Adaption
Gentle Stretch: Opposition stretch, wrist stretch

Question 5

CTS Conservative Managment

Answer 5

Splinting at Night 
*Tendon Gliding 
*Median Nerve Gliding 
Massage 
Work modification = computer ergonomics

Question 6

CTS Post Op

Answer 6

All conservative treatments and: 
Wound care
Strengthening at 4 weeks 
Isolated tendon gliding 
Scar management 
(May take up to 2 months to return to manual labor

Question 7

Standard position for measuring grip strength

Answer 7

Elbow flex to 90, tucked in at side, forearm in neutral (thumb pointing up)

Question 8

Desensitization vs. Sensory ReEd

Answer 8

Desensitization: 1-10, soft to rough
Sensory ReEd: 10- 1
Cotton, Towels, Rice-> Pasta Noodles, Blocks, Rocks

Question 9

Tendon Glide: Muscles Involved

Answer 9

Hook: FDP & FDS

Gross Grasp & Fist: FDP, FDS, & Interossi

Question 10

Intrinsic +/-: Muscles Involved

Answer 10

Lumbericals & Interossi

Question 11

Blocking Exercises : Muscles Involved

Answer 11

PIP = FDS 
DIP = FDP

Question 12

Common Concerns w/ Metacarpal Fractures

Answer 12

Mid Phal Fx: Post traumatic arthritis malutation

Extensor Lag, Intrinsic Contractors, Tendon Adhersions

Question 13

Extensor Lag

Answer 13

The extensor does not have enough strength to pull through the scar tissue.
Due to over stretching when re-establishing flexion

Question 14

Position of Immobilization for a Recent Metacarpal Fracture

Answer 14

MP = 70 - 90
IP = 0
Wrist = 20

Question 15

Specific Interventions for Tendon Gliding after a Metacarpal Fracture

Answer 15

Isolated EDC (MP ext - Claw) 
Fist w/ wrist flexed (EDC stretch) 
Intrinsic +/- , lumbericals and interossi ( - = a stretch, + = a contraction) 
Tendon glides

Question 16

What structures will get overstretched or torn after PIP joint dislocation

Answer 16

Collateral ligaments or Volar Plate Injury

Scaring occurs on the side of the pip due to tearing of the collateral ligaments

Question 17

Trigger Finger : Location / Pathology

Answer 17

Build up on the A-1 Pully.
Tendon is unable to return to extension once flexed
Palpate at the distal palmer crease
Usually accompanied by arthritis or CTS

Question 18

Trigger Finger Interventions

Answer 18

Activity Adaptation
Splinting
Slow Tendon Glides
Delay Resistive Exercises

Question 19

RA : Physiological Changes

Answer 19

A chronic systemic inflammatory disorder that affects synovial tissues.
Increased synovial fluid causes increased pressure on the capsule which may cause permanent damage.

Question 20

RA : Interventions

Answer 20

Decrease pain and edema
Maintain stability & mobility of joints (splinting)
Maintain muscle tendon function (tendon glides and fx’l use)
No strong resistance or repetitive movements: active light uses, isometrics.
Joint protection, energy conservation

Question 21

RA : Deformities

Answer 21

Ulnar Drift
Swan neck
Boutineres

Question 22

OA : Deformities

Answer 22

Heberdens Nodes

Question 23

Dupuytrens : Pathology

Answer 23

Palmar Fascia Proliferates : flexion contracture of MP & PIP (typically the ring and little finger)

Question 24

Dupuytrens : Open Wound

Answer 24

There is an open wound after surgical release due to secondary intention healing.

Question 25

Dypuytrens : Post Op Interventions Week 1

Answer 25

Week 1: Wound care, dressing changes, edema control, gentle tendon glides, & PROM Orthosis: Dorsal MP/PIP/DIP extension immobilization splint for the involved digits plus one

Question 26

Dupuytrens : Post Op Interventions Weeks 2-3

Answer 26

``` Gentle Scar Massage Increase A/PROM Light ADL's Minimize Dressing Increase P/AROM & Move to Isometric Grip Strengthening as Indicated ```

Question 27

CPRS : Pathology

Answer 27

Characterized by extreme pain, joint stiffness, disuse edema, skin changes, and vascular instability. Result of neurochemical - controlled vasomotor phenomenon of sympathetic nervous system

Question 28

CPRS : Symptoms

Answer 28

Pain : Out of proportion to expected, increases w/ PROM Sensation: Impaired, throbbing, sharp, pressure in hand Stiffness: larger area than normal, held in a protected position. Edema : Brawny

Question 29

CPRS : Interventions

Answer 29

Stress Loading : Scrub and Carry Gentle AROM Resume Activities : Light fx'l use helps positively engage the mind. Modalities, edema control : isotoner glove provides edema control and protection Cardiovascular exercise

Question 30

Tenolysis

Answer 30

If tendon fails to recover adequate excursion due to adhesions, the surgeon may need to surgically excise the scar tissue that binds the tendon to the surrounding tissues

Question 31

Tendon Grafts

Answer 31

If a tendon is badly damaged or retracted, the choice may be to have a tendon graft. A segment of the PL, HL, or FCR is harvested and sutured to the distal and proximal ends of the tendon. It is important to slide thru pulleys.

Question 32

Distal phalanx fracture

Answer 32

Mallet Finger: Dorsal avulsion of terminal tnedon. | Must imobolized for 24hrs a day.