Musculoskeletal Disorders Flashcards Preview

COTA Musculoskeletal Dx and Biomechanical Interventions > Musculoskeletal Disorders > Flashcards

Flashcards in Musculoskeletal Disorders Deck (43):
1

Dupuytren's Disease

A gradual thickening and tightening of tissue under the skin in the hand that results in flexion deformities of involved digits.

OT Interventions

Wound Care- dressing, whirlpool

Edema Control- elevation

Splinting

AROM/PROM

Scar Mngmnt- massage, scar pad, compression

Interventions that emphasize gripping/releasing

2

Complex Regional Pain Syndrome (CRPS

Can occur in UE/LE after injury or immobilization. Pain out of proportion to initial event/injury.

Characterized by pain, sensitivity to touch, irregular blood flow, edema, changes in skin temp and color, and decreased ROM

OT Interventions

Mod to decrease pain- hot packs, TENS

AROM

Edema Mngmnt- elevation, compression

Desensitization

Stress Loading

Splinting (prevent contractures)

Avoid PROM, joint mobilization, dynamic splinting and casting

3

Open vs Closed Fractures

Closed fracture- bone doesn't break skin.

Open fracture/compound fracture- bone pierces skin.

4

Medical treatment of fractures

Closed reduction: fixed from the outside

Stabilization: short arm cast (SAC), long arm cast (LAC), splint, sling, or fracture brace

Open Reduced Internal Fixation (ORIF): fixed from the inside. Includes nails, screws, plates, or wire

External fixation: fixed from the outside with hardware placed under the skin

Arthrodesis: fusion

Arthroplasty: joint replacement

5

Colles' fracture

fracture of distal radius with dorsal displacement

6

Smith's fracture

fracture of the distal radius with volar displacement

7

Carpal fractures

Most common carpal fractured: scaphoid (60%)

Proximal scaphoid has poor blood supply and may become necrotic

8

Metacarpal fractures

classified according to location (head, neck, shaft or base) common complication of rotational deformities

9

Proximal phalanx fractures

digits most commonly injured: thumb and index common

complication: loss of PIP A/PROM Middle phalanx fractures are uncommon

10

Distal phalanx fractures

most common finger fracture may result in Mallet Finger

11

Elbow fracture

if radial head is involved, there may be limited rotation of the forearm

12

Humerus fractures

Etiology: fall onto an outstretched UE

Fracture of greater tuberosity may result in rotator cuff injuries

Fracture of humeral shaft may cause injury to radial nerve, resulting in wrist drop

13

OT Eval of fractures

Occupational Profile, Hx

Results of special test (Xrays, MRI, CT)

Edema, Pain, Sensation

AROM Do not assess PROM or strength until ordered by MD (exception: humerus fractures which often begin with PROM or AAROM)

Roles, occupations, ADLs, activities related to roles

14

Phases of OT intervention with fractures

immobilization phase: goals of stabilization and healing

mobilization phase: goal is of consolidation

15

Immobilization phase interventions

AROM of joints above and below stabilized part

Edema control: elevation, retrograde massage, and compression garments

Light ADLs and role activities with no resistance, progress as tolerated

16

Mobilization phase interventions

Edema control: elevation, retrograde massage, contrast baths, compression garments

AROM: progress to PROM when approved by MD (4 to 8 weeks), exceptions: humerus fractures

Light functional/purposeful activity. Progress to occupation-based activities

Pain management: positioning and physical modalities

Strengthening: begin with isometrics when approved by MD

17

Cumulative Trauma Disorders (CTD)

Risk factors: repetition, static position, awkward postures, forceful exertions, vibration

Non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape

Most common types: DeQuervains, Lateral and medial epicondylitis, trigger finger, nerve compressions

18

DeQuervains

Stenosing tenosynovitis of abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

Pain, swelling over radial styloid

Positive Finkelstein's test

Conservative treatment:

Thumb spica splint (IP joint free)

Activity/work mod

Ice massage over radial wrist,

Gentle AROM of wrist and thumb to prevent stiffness

Post-op treatment:

Thumb spica splint and gentle AROM (0 to 2 weeks) Strengthening, ADLs, and role activities (2 to 6 weeks) Unrestricted activity (6 weeks)

19

Lateral and Medial epicondylitis

Degeneration of the tendon origin as a result of repetitive microtrauma

Lateral: Tennis Elbow. overuse of wrist extensors

Medial: Golfer's Elbow. overuse of wrist flexors

Conservative treatment: elbow strap, wrist splint, ice and deep friction massage, stretching, activity/work mod, and strengthening (as pain decreases)

20

Trigger finger

Tenosynovitis of the finger flexors

Caused by repetition and the use of tools that are placed too far apart

Treatment: scar massage, edema control, tendon gliding, activity/work modification

21

Carpal Tunnel Syndrome

Median nerve compression at wrist

Cause: repetition, awkward postures, vibration, anatomical anomalies, and pregnancy

Symptoms:

numbness/tingling of thumb, index, middle, and radial half of ring finger; Paresthesias at night. dropping things.

posTinel's sign. pos Phalen's sign.

Advanced CTS muscle atrophy of thenar eminence.

Treatment

Wrist splint in neutral (day/night)

Activity Modification- avoid repetition/extreme postures

Ergonomics- work station design

Surgery

Post-Op: edema control, AROM, nerve-gliding exercises, sensory re-ed, strengthening of thenar muscles, work/activity mod

22

Cubital Tunnel Syndrome

Ulnar nerve compression at elbow

Cause: pressure/leaning at elbow, extreme elbow flx

Symptoms: Numbness/tingling at ulnar side of forearm and hand, pain at elbow w/extreme flx, weakness of power grip, pos Tinel's sign

Tx: Elbow splint (block extr posit), elbow pad (decrease compression), act/work mod, sx

Post-op: edema control, scar mngmnt, AROM and nerve-gliding ex (2wk post-op), strgnth (4wk), MCP flx splint if clawing

23

Radial Nerve Palsy

Radial nerve compression

Cause: sleeping in a position that places stress on the radial nerve. Also, compression as a result of a humeral shaft fracture.

Symptoms: weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop

Tx: Dynamic ext splint, work/act mod, strgth wrist/finger extensors when motor func returns. Sx

Post-op: ROM, nerve-gliding, strgth (6-8wk/op), ADLs

24

Rotator Cuff Tendonitis

Cause: repetitive overuse, curved/hook acromion, weakness of rotator cuff, weakness of scapula musculature, ligament/capsule tightness, trauma

Interventions: act mod (avoid above shoulder lvl acts w/pain), ed in sleeping posture (avoid sleeping w/arm overhead or combined add/int-rot), decrease pain (positioning, modalities, and rest), restore pain free ROM, strngth (below shoulder level), occupation-based acts. Sx

Post-op: PROM (0-6wks -- progressing to AA/AROM), decrease pain (begin w/ice, progress to heat), strngth (6wks/op -- begin isometrics, progress to isotonic below shoulder level), act mod, leisure/work activities (8-12 wks post-op)

25

Adhesive Capsulitis

Frozen shoulder. Restricted PROM (greatest limit in ext rot, then abd, int-rot, and flx) Causes inflammation and immobility.

Linked to diabetes mellitus and Parkinsons disease

Interventions: encourage active use thru ADLs, PROM, modalities. Sx

Post-op: PROM immediately follwoing surgery, pain relief (modalities), encourage use of extremity for all ADLs and role activities

26

Shoulder Dislocations

Anterior dislocation, most common type

Cause: trauma, repetitive overuse

Interventions

Regain ROM (avoid combined abd and ext-rot with anterior dislocation)

Pain free ADLs and role activities

Strengthen rotator cuff

27

Rheumatoid Arthritis

Autoimmune: acute and non acute stages.

Thickened synovial membranes, cartilage erosion leading to joint weakness, misalignment and pain.

Symptoms: Fatigue, loss of appetite, fever, overall achiness or stiffness, swelling, weight loss.

Deformities: Ulnar deviation and sublax of wrist/MCP joints, Boutonniere (DIP hyper-ext and PIP flx), Swan neck (PIP hyper-ext and DIP flx)

28

Osteoarthritis

pain, stiffness, swelling, limited ROM, and crepitus, due to the breakdown of cartilage in the joints. NOT inflammatory or systemic. Affects weight-bearing joints

29

OT Arthritis Eval

Occupational Profile

AROM

Note deformities/nodules

Muscle strength

Grip strength

ADL/Role activities

Pain

Edema

30

OT Arthritis Interventions

Splinting

Joint Protection techniques

Energy Conservation techniques

AROM

Heat modalities

Strengthening

Purposeful and occupation-based activities (AE as needed)

31

Joint Protection

Use strongest/largest joints available

Use each joint in its most stable anatomical and functional plane

Avoid holding or staying in one position for prolonged periods of time

Avoid activities that cannot be stopped immediately if they become stressful

Do use assistive equipment and splinting

32

Osteogenesis Imperfecta

Dysfunction of one of several genes responsible for producing collagen to strengthen bones

Causes

malformed bones (brittle, irregular shaped, fracture easily), loose joints, sclera of eyes look blue/purple, brittle teeth, hearing loss, respiratory problems, insufficient collagen

33

OT OI Interventions

Activity adaption and AE

Environmental modifications

Preventive positioning and protective splinting/padding

Muscle strengthening

Health promotion ed (diet/wt, no smoking, exercise)

Caregiver ed

Fracture interventions

34

Posterolateral Hip Precautions

NO Hip Flexion greater than 90 degrees

NO Internal Rotation

NO Adduction (crossing legs or feet)

Transfer sit to stand by keeping operated hip in slight abd and extended out in front

35

Anterolateral Hip Precautions

NO External rotation

NO Abduction

NO Extension

36

Amputation Complications

Neuromas- nerve endings adhere to scar tissue causing pain/sensitivity

Skin breakdown

Phantom limb syndrome

Phantom limb pain

Infection

Contractures

37

Preprosthetic Treatment

ROM, uninvolved joints

Prep for prosthesis

Desensitization

Wrapping to shape and shrink

ADL training

Skin care ed

38

OT Treatment for LE Amputations

Wrapping- shape and decrease swelling

Desensitization

Strengthening UE (triceps)

ADL training

Standing tolerance

W/C mobility

Prosthetic training (func training w/prothesis, don/doff, wearing tolerance)

39

Myofascial Pain Syndrome

Persistent, deep aching pains in muscle, nonarticular in origin

Characterized by well-defined, highly sensitive tender spots

40

Fibromyalgia

Musculoskeletal pain and fatigue disorder that causes widespread pain accompanied by tenderness of muscles and adjacent soft tissues

41

OT Pain Intervention

PAMs and massage to prep for activities

Proper body mechanics and relaxation techniques

Splint in resting position

Gentle ROM

Modify activities

ADL training

Home modification

Alternate exercise programs (aquatic, Tai-Chi)

42

Froment's sign

occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis.

When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual.

43

Duchenne’s muscular dystrophy

progresses quickly and is characterized by weakened pelvic muscles and positive Gower’s sign.

Children with DMD often need to use a wheelchair before age 9.