Hand/UE Disorders & Injuries 2 Flashcards Preview

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Flashcards in Hand/UE Disorders & Injuries 2 Deck (44):
1

OT tx goals with tendon repairs

Increase tendon excursion, improve strength at repair site, increase joint ROM, prevent adhesions, facilitate resumption of occs

2

Kleinert Protocol

Tendon Repair; Flexion using rubber band traction & active extension to the hood of splint

3

Kleinert Protocol Early Phase

Dorsal block splint - wrist 20-30 flex, MCP 50-60 flex and IP extended; Passive flex/Active exten w/in limits of splints

4

Kleinert Protocol Intermediate Phase

Cont dorsal block splint w adjustments: wrist to neutral. Place/hold exercises and differential flexor tendon gliding exercises

5

Kleinert Protocol Later Phases

6-8wk: AROM, diff tendon gliding, light purpose act, D/C splint
8-12wk: Strengthening/work/leisure acts

6

Duran Protocol

Passive flexion/extension of digit

7

Duran Protocol Early Phase

Dorsal blocking splint - exercises in splint include passive flex of PIP/DIP and to DPC - 10 reps every hour

8

Duran Protocol Intermediate Phase

Active flex/exten w/in limitis of spint

9

Duran Protocol Later Phases

6-8wks: Tendon gliding/diff tend gliding, scar mngt, light occ based
8012wks: Strengthening/work acts

10

Extensor Tendons Zone I & II

Mallet finger deformity; 0-6wk DIP extensoin splint

11

Extensor Tendons Zone III & IV

Boutonniere deformity: 0-4wks PIP exten splint (DIP free) AROM of DIP while splinted; 4-6wks begin AROM of DIP/Flex of digits to DPC

12

Extensor Tendons Zone V, VI & VII

0-2wks: volar wrist splint w wrist in 20-30 exten, MCP in 0-10 flex and IP in full exten - 2-3wk: shorten splint to allow flex and exten of IP joints - 4wk: remove splint to begin active MCP flex/eten - 5wk: begin active wrist ROM & wear splint between exercises - 6wk D/C slpint

13

Carpal Tunnel Syndrome (CTS)

Median nerve compression; Numb/ting of thumb/index/mid/radial half of ring fingers, parasthesis at night, c/o dropping things, positive tinels at wrist, advanced stages can result in atrophy of thenar eminance

14

Conservative Tx of CTS

Wrist splint in neutral worn at night/during day if performing rep activities; Median nerve gliding ex/diff tendon gliding ex, activity mod, avoid extrem wrist flex & ergonomics

15

Op: CT release - Post Op Tx for CTS

Edema control thru elevation, retrograde, comp glove and/or contrast bath, AROM, nerve/tendon gliding, sensory re-edu, strengthening of thenar muscles (6wk post op)

16

Pronator Teres Syndrome - prox volar forearm

Median nerve compression between 2 heads of pro teres. Numb/ting of thumb/index/mid/radial half of ring fingers, c/o dropping things, positive tinels at forearm, aching pain in prox forearm - no night symptoms; advanced stages can result in atrophy of thenar eminance

17

Op: Decompression - Post Op Tx for Pro Teres Synd

AROM, Nerve gliding, strengthening at 2wks, sensory re-edu, work/act mod

18

Conservative Tx of Pro Teres Synd

Elbow splint at 90 w forearm in neutral & avoid activities w rep forearm pro/sup

19

Guyons Canal

Ulnar Nerve Compression at wrist. Numb/ting &motor weakness at ulnar distribution, Positive tinels at guyon canal, advanced stages can result in atrophy of ulnar-nerve innervated musculature

20

Conservative Tx of Guyons Canal

Wrist splint in neutral & work/act mod

21

Op: Decompression - Post Op Tx for Guyons Canal

Edema control, AROM, Nerve gliding, strengthening at 2-4wks w focus on power grip, sensory re-edu

22

Cubital Tunnel Syndrome

Ulnar nerve compression at elbow, 2nd most common compression; numb/ting along ulnar aspect of forearm/hand, pain at elbow w extreme flex, weak of power grip, positive tinels at elbow, advanced stages can lead to atrophy of FUC, FDP to digits 4/5 and ulnar nerve innervated intrinsic muscles

23

Conservative Tx of Cubital Tunnel Synd

Elbow splint to prevent position of extreme flex esp at night, elbow pad to decrease compression, act/work mod

24

Op: Decompression/Transpoition - Post Op Tx for Cubital Tunnel Synd

Edema control, scar mngt, AROM/nerve gliding, strengthening (4wk post op), MCP flex splint if clawing noted

25

Radial Nerve Palsy

Radial nerve compression; can result from humeral shaft fx, saturday night palsy - awkward sleeping position that affects radial nerve. Weakness/paralysis of wrist extensors, MCPs, thumb - wrist drop

26

Conservative Tx for Radial Nerve Palsy

Dynamic exten splint, work/act mod, strengthening wrist/finger exten when motor function returns

27

Op: Decompression - Post Op Tx for Radial Nerve Palsy

ROM, nerve gliding, strengthening at 6-8wks, ADL/occ acts

28

Median Nerve Laceration Sensory Loss

central palm- thumb to radial 1/2 of ring, palmar surface of thumb to radial 1/2 of ring, dorsal surface of index/mid/radial 1/2 of ring (mid/distal phalanges

29

Median Nerve Laceration Motor Loss

Lumbricals I & II - MCP flex of digits 2/3, opposition w opponens pollicus, aBduction with abductor pollicus brevis, flex of thumb MCP w flex pollicus brevis

30

Motor Loss for High Lesion at/Prox to Elbow - Median Never Laceration

Lumbricals I & II - MCP flex of digits 2/3, opposition w opponens pollicus, aBduction with abductor pollicus brevis, flex of thumb MCP w flex pollicus brevis, FDP to index.mid fingers and FPL for flex of tip of index/mid/thumb & FCR for flex radial aspect of wrist

31

Median Nerve Laceration Defomity

Flattening of thenar eminance or "ape hand", clawing of index/mid for low lesion, benediction sing for high lesion

32

Fx'al Loss with Median Nerve Laceration

loss of thumb opp/pinch weakness

33

Tx for Median Nerve Laceration

Dorsal protect splint w wrist at 30 flex if low - include elbow at 90 if high. Begin A/PROM of digits w wrist in flex at 2wk post op. Scar mngt. AROM of wrist at 4wk - and elbow if high. Strengthening at 9wks; sensory re-edu if shows diminished level of protective sens (4.31) on Sem-W.
*Consider c-bar to prevent thumb adduction contracture

34

Ulnar Nerve Laceration Sensory Loss

Ulnar Aspect of palmar/dorsal surfaces. Ulnar 1/2 of ring/lil finger on palmar/dorsal surfaces.

35

Ulnar Nerve Laceration Motor Loss - low at wrist

Palmar/doral interossei for adduction/aBduction of MCP. Lumbricals III/IV for MCP flex of digits 4/5. FPB/Adducttor pollicus for flex/adduction for thumb & ADM/ODM/FDM for aBduction/opp/flex of 5th digit

36

Ulnar Nerve Laceration Motor Loss - high wrist/above

Palmar/doral interossei for adduction/aBduction of MCP. Lumbricals III/IV for MCP flex of digits 4/5. FPB/Adducttor pollicus for flex/adduction for thumb. ADM/ODM/FDM for aBduction/opp/flex of 5th digit. FCU for flex toward ulnar wrist & FDP IV/V for flex of DIPs of ring/lil finger

37

Ulnar Nerve Laceration Deformity

Claw hand, Flattened MC arch, + Froments sigh (paper pinch)

38

Ulnar Nerve Laceration Fx'al Loss

Loss of power grip/decreased pinch strength

39

Tx for Ulnar Nerve Laceration

Sensory re-edu, MCP flex block spint, Dorsal protect splint w wrist at 30 flex if low - include elbow at 90 if high. Begin A/PROM of digits w wrist in flex at 2wk post op. Scar mngt. AROM of wrist at 4wk - and elbow if high. Strengthening at 9wks

40

Radial Nerve Laceration Sensory Loss - High at humerus

medial aspect of dorsal forearm, radial aspect of dorsal palm, thumb, index, mid and radial 1/2 of pinky phalanges

41

Radial Nerve Laceration Motor Loss - Low at Forearm

Loss of wrist exten d/t impaired ECU innervation, MCP/ thumb exten

42

Radial Nerve Laceration Motor Loss - High at humerus

Loss of wrist exten d/t impaired ECU innervation, MCP/ thumb exten, ECRB, ECRL, brachioradialis - if at axilla level, loss of triceps for elbow exten

43

Radial Nerve Laceration Fx'al loss & Defomity

Inability to extend digits to release objects/diff manipulating objects.
Deformity = wrist drop

44

Tx for Radial Nerve Laceration

Dynamic exten spint, ROM, sens re-edu if needed, home program, act mod