Hand/UE Flashcards
(65 cards)
1
Q
Avulsion Injury
A
When the tendon separates from the bone and its insertion and its insertion and removes bone material w/the tendon
2
Q
Is mallet finger an avulsion?
A
Yes - is splinted in full extension for 6 weeks
3
Q
What is boutonniere deformity?
A
Disruption of the extensor tendon with PIP flexion and DIP hyperextension. The PIP is splinted in extension and isolated DIP flexion exercises are performed.
4
Q
What is Swan Neck deformity?
A
PIP hyperextension and DIP flexion - the PIP is splinted in slight flexion.
5
Q
What are the three common phases of fracture healing?
A
inflammation
repair
remodeling
6
Q
Describe (inflammation) part of fracture healing
A
provides cellular activity needed for healing
7
Q
Describe (repair) part of fracture healing
A
forms the callus for stabilization
8
Q
Describe (remodeling) part of fracture healing
A
deposits bone
9
Q
Modalities for pain relief and tissue healing include:
A
Heat Ultrasound Cryotherapy Paraffin Transcutaneous Electrical Nerve Stimulation (TENS)
10
Q
When does controlled AROM begin after fracture?
A
3-6 weeks
11
Q
What is the most severe complication of hand fractures?
A
Complex regional pain syndrome
12
Q
Colles Wrist Fracture
A
Complete fracture of the distal radius w/dorsal displacement
13
Q
Smith’s Wrist Fracture
A
Complete fracture of the distal radius w/palmar displacement
14
Q
Bennet’s Wrist Fracture
A
Fracture of the first metacarpal base
15
Q
Median Nerve Injury is?
A
Produces carpal tunnel-like symptoms such as palmar numbness and numbness of first digit to half of the fourth digit w/generalized weakness and pain
16
Q
Ulnar Nerve Injury is?
A
Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits w/generalized weakness of the ulnar side of the hand and pain.
17
Q
Radial Head Fractures (elbow fracture) - Type 1
A
Nondisplaced
-treated w/a long arm sling
18
Q
Radial Head Fractures (elbow fracture) - Type 2
A
Displaced w/a single fragment
treated nonoperatively w/immobilization for 2-3 weeks and early motion w/medial clearance
19
Q
Radial Head Fractures (elbow fracture) - Type 3
A
Comminuted
-treated operatively, w/immobilization and early motion within the first postoperative week
20
Q
Radial Head Fractures (elbow fracture) - Interventions
A
Orthotics - for immobilization as needed
ROM within the 1st week
A sling for type 1 fractures
21
Q
Proximal humeral fractures - Interventions
A
- Orthotics (humeral fracture brace)
- ROM as early as 2 weeks
- Sling to immobilize the fracture
- ROM consists of aggressive stretching and can start 4-6 weeks after the fracture as by MD
- Home exercise program
22
Q
What is complex regional pain syndrome (CRPS) or called reflex sympathetic dystrophy?
A
pain to an injury
Symptoms
- edema
- contractures
- bluish/red shiny skin
- abnormal sweating
OT Intervention
- Gentle, pain free AROM - (NO PROM or PAINFUL TREATMENT!)
- Stress loading - scrubbing floor, carrying a weighted handbag)
- Pain control - TENS, splinting (Static then dynamic)
- Edema control
- Fluidotherapy
- Joint protection/energy conservation
23
Q
Allodynia
A
sensation misinterpreted as pain
24
Q
Hyperalgia
A
increased response to painful stimuli
25
Hyperpathia
pain that continues after stimuli is removed
26
What is cumulative trauma disorder (CTD)?
trauma to soft tissue caused by repeated force
27
Work-related risk factors of CTD
repetition, high force, direct pressure, vibration, poor posture
28
Symptoms of CTD
muscle fatigue, pain, chronic inflammation, sensory impairment
29
OT Intervention to CTD - Acute Phase
Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, Estim
30
OT Intervention to CTD - Subacute Phase
Slow stretching, myofascial release, progressive resistive stretch exercise, proper body mechanics, static splint during activity
31
OT Intervention to CTD - Return to Work
Assessment of Job site, tools, body positioning
- Work simulator, elastic bands, putty, functional activities, strengthening
- Work hardening
32
myofascial release
soft tissue therapy for pain
33
work hardening
aggressive approach focuses on the functional aspect of the job. Work stimulation tasks with small components of strength and conditioning blended in.
34
Work Conditioning
strengthening and conditioning tasks to restore function
35
OT Interventions - Extensor Tendons
- exercises to promote tendon excursion and prevent adhesions
- modalities include heat to prepare the tissue for motion, NMES to promote tendon excursion and activation.
- home exercise program
- tendon glides exercises
- ROM
- Strengthening
36
tendon excursion
the distance a tendon travels upon movement of a joint
37
OT Interventions - Flexor Tendons
-exercises promote tendon excursion and prevent adhesions
-modalities include heat, to prepare the tissue for motion, NMES to promote tendon excursion and activation.
-Home exercise program
-Tendon glides exercise
-ROM
Strengthening
38
The Duran protocol
an early passive ROM program
39
Kleinert Protocol
active extension of digits w/passive flexion via traction, typically a rubber band
40
The early active motion protocol
begins within days of surgery to prevent adhesion and promote gliding and excursion
41
tendon glides exercises
to promote circulation in the hand to reduce swelling
42
Neuromuscular electrical stimulation (NMES)
promote tendon excursion and activation
43
Radial Nerve Injury
Symptoms
-posture of hand is wrist drop, possible lack of finger/thumb extension
Nonoperative treatment
-Wrist cock-up splint with or without dynamic finger/thumb extension assist, passive/active ROM, isotonic strengthening exercises
Operative Treatment
-Static wrist extension splint 30 degrees, after 4 weeks adjust splint to 10-20 degrees
44
Radial Tunnel Syndrome
Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
Symptoms
-Burning pain the lateral forearm
- Nonoperative treatment
- Long arm splint, elbow flexed, forearm supinated, wrist netural, Massage/TENS for pain, ROM, nerve glide
Operative treatment
-Long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, then wrist cock up for 2 more weeks
45
Anterior Interosseous Syndrome
Compression to the anterior interosseous Nerve
-Results in a motor loss involving the flexor digitorum longus, flexor profundus and pronator quadratus
46
Pronator Syndrome
Entrapment of the proximal median nerve between the heads of the pronator muscles
Symptoms
-Deep pain proximal forearm w/activity
Nonoperative treatment
-Splint elbow 90-100 degrees flexion, forearm neutral, TENS for pain, gentle stretching
Operative Treatment
-Half cast, AROM all UE joints while wearing cast, muscle strengthening in 1 weeks, full AROM by 8 weeks
47
Median Nerve Injury
Causes Ape hand deformity
Symptoms
-Ape hand deformity, sensory loss in index, middle, and radial side of ring finger, loss of pinch, thumb opposition
Nonoperative treatment
-Static thenar web spacer splint
Operative treatment
-Dorsal wrist blocking splint worn for 4-6 weeks, AROM/PROM in splint for digits/thumb, tendon gliding exercises, scar massage. Discontinue splint at 6 weeks and begin strengthening exercises
48
Double crush syndrome
Occurs when a peripheral nerve is entrapped in a more than one location
Symptoms
-Intermittent diffuse arm pain and paresthesias w/specific postures
Nonoperative treatment
- avoid movements/postures that aggravate symptoms
- nerve gliding exercises
- exercises for scapular stability
- posture/core trunk strengthening
49
Carpal Tunnel syndrome
Entrapment of the median nerve as it courses through the carpal tunnel.
Sensory impairment involves numbness/tingling in the thumb/index/middle fingers
Diminished fine motor coordination
Nonoperative treatment
- Wrist cock-up splint= to relive pressure on the median nerve in the carpal tunnel and control edema.
- Nerve/tendon gliding exercises
- Activity modification=ergonomic handles, gel pads, or padding on handles
- Client education=avoidance of postures/activities that aggravate the condition (wrist flexion).
- Postural retraining/proximal conditioning exercises
Postoperative Treatment
- wound care/scare mobilization
- pain management
- splinting
- AROM of wrist, thumb, fingers (1-2 days after surgery)
- Nerve/tendon gliding exercises
- Strengthening begins 3-6 weeks
50
Cubital tunnel syndrome
Proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process.
- Sensation is decreased in the little finger/ulnar half of the ring finger
- Motor problems such as decreased grip/pinch strength
Nonoperative treatment
- Edema control
- pain management
- elbow splint
- ulnar nerve gliding
- proximal conditioning activities
- posture/ergonomic training
Postoperative treatment
-splint the elbow, wound care, edema control, pain management
51
de Quervain syndrome
cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit
Caused by forceful, repetitive thumb abduction
Nonoperative treatment
- corticosteroid injections
- forearm-based thumb spica splint w/wrist in neutral/thumb radially abducted
- computer ergonomics education
Operative treatment
- gentle ROM/tendon gliding exercises
- Splinting
- Grip/pinch strengthening begins at 2 weeks
- Scar management/desensitization techniques
52
Claw Deformity
The distal ulnar nerve compression or lesion at the wrist
Sensory loss occurs in the little finger/ring finger and the palmar ulnar hand
Nonoperative treatment
- anticlaw splint
- padded antivibration glove can be used during activity to avoid further nerve irritation
- Activity modification: ergonomic handles, gel pads, padding on handles of vibratory equipment (lawnmower)
- Client education: avoid postures, activities that aggravate the condtion
Postoperative treatment
- bulky dressing is applied for 3-10 days
- Dorsal blocking splint is used to maintain the wrist flexion.
- AROM of the wrist/hand begins at 6 weeks.
- Sensory reeducation begins at 10-12 weeks.
53
Digital stenosing tenosynovitis (trigger finger)
Treatment
- Splinting the MCP at zero degrees for 3-6 weeks.
- Protective reeducation for clients to compensate for sensory loss.
- Desensitization of applying different textures/tactile stimulation to reeducate the nervous system.
54
Cryotherapy (ice massage, ice, cold packs, cold water immersion baths)
Pain relief
decrease edema
decrease muscle spasms
decrease inflammation
Precautions/contraindications:
- clients w/impaired circulation
- peripheral vascular diseasae
- hypersensitivity to cold
- impaired sensation
- open wounds/infections
55
Thermotherapy (warm whirlpools, fluidotherapy, hot packs, contrast batths, and paraffin baths)
```
Increase blood flow
increased cell metabolism
increased inflammation
increased muscle contraction
increased oxygen consumption
decreased muscle spasms
decreased pain
```
Precautions/contraindications:
- clients w/acute inflammation
- edema
- sensory impairment
- cancer
- blood clots
- infection
- cardiac problems
- impaired cognition
56
Ultrasound heats tissue (1-5 cm depth)
Thermal effects - increase tissue extensibility and blood flood, decrease pain, joint stiffness, muscle spasms, chronic inflammation.
Nonthermal effects - increase protein synthesis and bone healing and decrease inflammation
Precautions/contraindications: avoid w/pregnancy, over eyes, pacemaker, bleeding, infections, cancer, over blood clots, cognitive impairments, sensory impairments.
57
Electrical Stimulation
NMES - wound healing, maintains muscle mass, increase ROM, decrease edema, facilitates voluntary muscle control, decrease spasm/spasticity.
TENS - controls pain
Iontophoresis - decreases inflammation and controls pain
Precautions/contraindications: do not use over pacemaker, eyes, clients w/epilepsy, cancer, infection, decreased sensation, cardiac disease/stroke.
58
Low-level laser/Light therapy
decreased pain, edema, inflammation, increased wound healing and decrease scar tissue.
-Precautions/contraindications: wear protective eyewear, eyes, infection or cancer.
59
Wound closure - Primary
Wound is closed w/sutures
60
Wound closure - Secondary
Wound is left open and allowed to close on its own
61
Would closure - Delayed primary
Wound is cleaned, debrided and observed 4-5 days before suturing it closed.
62
Wound closure - Remolding phase
wearing pressure garments helps collagen fibers realign.
dynamic splinting, serial casting, passive motion, stretching, NMES and silastic gel pads can help decrease hypertrophic scarring
63
Wound healing phases - Inflammatory Phase
clotting, vasoconstriction
-24-48 hrs to 7 days
64
Wound healing phases - Proliferative Phase
tissue forms new collagen/blood vessels
65
Wound healing phases - Remodeling Phase
collagen is broken down/remodeled
