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Phys Dis > Hand/UE Disorders & Injuries 2 > Flashcards

Hand/UE Disorders & Injuries 2 Flashcards

(44 cards)

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1
Q

OT tx goals with tendon repairs

A

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

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2
Q

Kleinert Protocol

A

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

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3
Q

Kleinert Protocol Early Phase

A

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

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4
Q

Kleinert Protocol Intermediate Phase

A

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

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5
Q

Kleinert Protocol Later Phases

A

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

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6
Q

Duran Protocol

A

Passive flexion/extension of digit

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7
Q

Duran Protocol Early Phase

A

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

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8
Q

Duran Protocol Intermediate Phase

A

Active flex/exten w/in limitis of spint

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9
Q

Duran Protocol Later Phases

A

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

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10
Q

Extensor Tendons Zone I & II

A

Mallet finger deformity; 0-6wk DIP extensoin splint

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11
Q

Extensor Tendons Zone III & IV

A

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

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12
Q

Extensor Tendons Zone V, VI & VII

A

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

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13
Q

Carpal Tunnel Syndrome (CTS)

A

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

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14
Q

Conservative Tx of CTS

A

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

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15
Q

Op: CT release - Post Op Tx for CTS

A

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)

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16
Q

Pronator Teres Syndrome - prox volar forearm

A

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

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17
Q

Op: Decompression - Post Op Tx for Pro Teres Synd

A

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

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18
Q

Conservative Tx of Pro Teres Synd

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A

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

19
Q

Guyons Canal

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A

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
Q

Conservative Tx of Guyons Canal

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A

Wrist splint in neutral & work/act mod

21
Q

Op: Decompression - Post Op Tx for Guyons Canal

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A

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

22
Q

Cubital Tunnel Syndrome

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A

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
Q

Conservative Tx of Cubital Tunnel Synd

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A

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

24
Q

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

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A

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

Phys Dis (15 decks)

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