OTX311 Flashcards
(55 cards)
1
Q
Interventions in hand therapy (6)
A
- Splinting
- Joint mobilisation exercises (blocking exercises & place-and-hold exercises)
- Dexterity training
- Functional activities (occupations)
- Scar management
- Oedema management
2
Q
When to see a hand therapist (6)
A
- When ROM is affected
- When muscle strength is affected
- Sensation is affected
- Pain
- Dexterity is affected
- Grip is affected
3
Q
Common causes of hand injuries (7)
A
- Carelessness
- Lack of awareness
- Disregard for safety procedures
- Distractions
- Boredom
- Using tools incorrectly/ home-made tools
- Not performing a safety analysis before work
4
Q
How to avoid hand injuries at work
A
- Wear correct gloves for tasks
- Avoid moving surfaces
- Avoid wearing loose clothing/ jewellery which can get stuck in machinery
- Beware of hot surfaces
- Never put your hands near moving machinery
5
Q
Assessments to perform in hand therapy (8)
A
- ROM
- Sensation
- Vascular assessment (cap refill & compare)
- Oedema assessment
- Scar assessment (width, length &height)
- Wound assessment (3- colour concept)
- Dexterity
- Pinch and grip strength (jamar dynamometer, pinch meter)
6
Q
Oedema management (6)
A
- Massage (Manual Edema Massage)
- Elevation
- Contrast baths
- Compression
- Active range of motion
- Pressure garments
7
Q
Scar management
A
- Silicone gel
- Massage
- Pressure garments
- Vibration
8
Q
Describe the two joint mobilisation exercises
A
- Blocking exercises: Immobilization a joint so that you can move a specific one (digital cylinders for IPs & blocking splint for MPs)
- Place-and-hold exercises: to ensure patient sustains a position, without assistance, after it was placed there using PROM
9
Q
Joint protection principles (6)
A
- Maintain ROM and muscle strength
- Avoid positions of deformity or that encourage deformity
- Correct movement patterns
- Avoid prolonged static positioning
- Use larger and stronger joints
- Use joints in most stable and neutral anatomical plane.
10
Q
Stiffness of the hand is characterised by (2)
A
- Increased muscular effort to achieve end range
- Loss passive ROM
11
Q
Causes of stiffness in hand (5)
A
- Long-standing oedema (sausage effect)
- Adhesions and scarring
- Intrinsic tightness vs extrinsic tightness
- Soft tissues (eg contractures) vs bony structures
- Skin tightness
12
Q
Intrinsic tightness vs extrinsic tightness
A
- Intrinsic tightness: Muscle tightness, causing shortening of intrinsic muscles due to prolonged incorrect immobilisation
- Extrinsic tightness: muscle-tendon tightness, causing shortening of muscles/ tendons due to prolonged incorrect immoblisation
13
Q
Treatment methods for stiffness
A
- Splinting
- Mobilisation splinting
- Mobilisation techniques (joint mobilisation exercises and tendon-gliding exercises)
- Functional activities
14
Q
Disadvantages of mobilisation splinting
A
- Splint can be removed (less DERT)
- Immobilisation can prevent pumping of venous and lymphatic system
- Possibility of excess force (which causes scarring)
- Constriction increase oedema
15
Q
Types of splints (3) and differentiate
A
Serial static splint:
- Usually made out of plastic of paris
- Puts join in its end range, for a long time
- Removed and reapplied once desired end range has been achieved
Dynamic splint:
- Compensates for muscle loss/ specific movements.
- Allows for movement
- Slowly improves range of motion
Static progressive splint:
- Places joint in its end-range
- Adjusted once end-range has been achieved to accommodate new end range of joint
16
Q
Two types of ligaments of the wrist
A
- Extrinsic ligaments: found between radius, carpal bones, and metacarpals
- Intrinsic ligaments: Originate and insert between carpal bones
17
Q
Name the three carpal bones that are prone to avascular necrosis due to being dependent on a single blood supply
A
- Scaphoid
- Lunate
- Capitate (long enough to go into proximal row)
18
Q
Clinical picture after removal of immobilisation
A
- Thickened appearance
- Skin dry and flaky
- Limited motion
- Extensor lag
- Possible hypersensitivity
- Pain
19
Q
Complications of wrist fractures
A
- Stiffness
- Carpal tunnel syndrome
- Malunion
- Chronic pain syndrome
- Loss of grip strength
- Tendon adhesion
- Delayed rupture of EPL
- Palmar fasciitis (Dupuytrens)
- Post traumatic arthritis
20
Q
What to keep in mind during immobilisation
A
- Maintain web spaces
- Active and passive motion to facilitate tendon gliding
- Maintain length of intrinsic muscles by encouraging flexion of IP joints while the MP joints are actively/passively held in extension
21
Q
What qualifies a severely injured hand
A
- Crush injury
- Long standing oedema
- Multiple fractures
- Extensive tissue damage
- Multiple joint injuries
22
Q
Name the bones of the two rows of the wrist
A
- Distal row:
- Trapezium
- Trapezoid
- Capitate
- Hamate
2 Proximal row:
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
23
Q
Motions of the hand (5)
A
- Flexion
- Extension
- Radial deviation
- Ulnar deviation
- Rotation
24
Q
Name the three wrist articulations
A
- Carpometacarpal articulation
- Midcarpal articulation
- Radiocarpal articulation
25
Tendon healing phases (and weeks)
- Inflammatory phase (0-2 weeks)
- Fibroplastic phase/ fibroplasia (2-6 weeks)
- Remodelling phase (>6 weeks)
26
Flexor finger snd wrist muscles (5)
- Flexor digitor superficialis
- Flexor digitorum profundus
- Flexor pollicis longus
- Flexor carpi ulnaris
- Flexor carpi radialis
27
Which flexor muscles are innervates by median nerve?
- Flexor digitorum superficialis
- Flexor digitorum profundus (2+ 3rd digits)
- Flexor pollicis longus
- Flexor carpi radialis
28
Which flexor muscles are innervated by unlar nerve
- Flexor digitorum profundus (4th + 5th digits)
| - Flexor carpi ulnaris
29
Clinical picture after injury of flexor-tendon/muscle
- Odema
- Bleeding for an open wound or bruising for a closed wound
- Pain
- Inability or weakened flexion of digit
30
Assessments (flexor-tendon injuries)
- Odema assessment
- Pain
- ROM
- Muscle strength
- Pinch and grips
- Hand function (dexterity)
- Sensation
31
Treatment (flexor-tendon)
- Splinting
- Mobilisation exercises
- Dexterity training
- Odema management
- Scar management
- Functional activities
- Passive and active motion
32
How many zones for flexor-tendon injuries
5 zones
33
How many zones for extensor-tendon injuries and name them
8 zones (odd= joints & even= segments)
1. DIPJ
3. PIPJ
5. MCP joint
7. Carpals
2. Middle phalanx
4. Proximal phalanx
6. Metacarpals
8. Proximal wrist
34
Which nerve innervates extensor muscles
Radial nerve
35
Action of extensor digitorum communis
- Extension of digits/ interphalangeal joints (2-5)
| - Extension of metacarpophalangeal joints
36
Action of extensor pollicis longus
- Extension of interphalangeal joint of thumb
37
Treatment of extensor-tendon injuries
- Oedema management
- Scar management
- Splinting
- Mobilisation exercises
- Adhesion prevention
- Wound management
38
```
Complex Regional
pain Syndrome (definition)
```
Pain that is disproportionate to inciting event (time + severity).
39
Signs and symptoms of CRPS (5)
- Atrophy in advanced stages
- Tissue abnormalities (trophic changes, vasomotor changes, bone+joint changes)
- Motor changes (decreased ROM, weakness)
- Pain
- Heightened sensitivity
40
Assessment(4) and treatment(5) of CRPS
Assessment:
- ROM
- Muscle strength
- Sensation
- Pain assessment
Treatment:
- Pain management
- Desensitization
- Functional activities
- Oedema management
41
Dupuytrens (description)
A conditioned characterised by the inability to fully extend fingers. The usually affected fingers are the 4th + 5th fingers
(Aka palmar fasciitis)
42
Treatment of Dupuytrens
- Forearm based splint that retains extension of fingers.
- Scar management
- Oedema management
- Dexterity training
- Strengthening exercises
- Mobilization exercises
43
De Quervains (description)
- A painful condition that affects the tendons of the thumbs
- Difficulty moving fingers during functional tasks
44
De Quervains treatment
- Splinting
- Strengthening exercises
- Scar management
- Adaptation of functional tasks
45
Mallet Finger
(Aka baseball finger)
| - Characterised by a forced flexion of the DIPJ, that ruptures the extensor tendon at the base of distal phalanx
46
Treatment of Mallet Finger
- Splint that retains extension of DIPJ
- Mobilisation of uninjured joints
- Dexterity training
- Gentle active flexion of DIPJ (after 6 weeks)
47
Swan neck deformity is caused by untreated _______
Mallet finger
48
- Swan neck deformity is characterised by:
| - Causes of swan neck (3)
- Swan neck is characterised by hyperextension PIPJ and flexion of DIPJ
Causes (aetiology)
- Untreated mallet finger
- Instability of PIPJ
- Fracture of the finger that didn’t heal properly
49
Similarities and differences between Boutonniere snd Volar plate injury
The PIPJ is affected in both
50
In the hand, osteoarthritis affects which 3 sites
1. CMC joint, at the base of the thumb
2. PIPJ
3. DIPJ
51
Diiferentiate between the 2 nodes at the PIPJ and DIPJ (osteoarthritis)
- Heberden’s nodes= bony nodules at DIPJ
| - Bouchard’s nodes= bony nodules at PIPJ
52
Osteoarthritis quintet
- Heberden’s nodules
- Carpal tunnel syndrome
- Trigger finger
- OA of 1st carpometacarpal joint
- Mucoid cyst
53
Ensuring client complies with wearing the splint (5)
1. Making it look good: Use correct temperature when heating material, to avoid impressions of fingers; stroke splint into place & don’t use direct pressure; round off edges
2. Offer options: ensure process is client centred & client is part of the decision-making process || Options such as prefabricated/custom fabricated; colour of thermoplastic material, velcro
3. Empathise with client: Splints can cause discomfort, attention in public and retain swear when it’s hot
4. Lightweight: Avoid creating bulky edges; not always necessary to use 3.2mm thick material
5. Durability: Select materials that can withstand stress when client performs activities
54
Clinical pictures of osteoarthritis and rheumatoid arthritis
- Osteoarthritis: Nodules form at the PIPJ (Bouchard’s nodes) and DIPJ (Heberden’s nodes) || Swelling at CMC joint
- Rheumatoid arthritis: Radial deviation of wrist; ulnar deviation of metacarpals; Swan neck deformity of PIPJ
55
Client education (Splinting)
- How to clean and take care of a splint
- Correct application and removal of splint
- Indications of poor fit (pressure points)
- Circumstances of removing it for long periods of time
