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Hand and Upper Extremity Conditions > Preventing and Treating Stiffness > Flashcards

Preventing and Treating Stiffness Flashcards

1
Q

cycle of nonuse

A

edema - immobilization - joint stiffness/tissue adherence

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2
Q

evaluation of stiffness (10)

A
  1. Why is the stiffness occurring?
  2. Is it due to trauma?
  3. Is it due to systemic conditions (RA or scleroderma)?
  4. Is it CNS?
  5. Is is a peripheral nerve issue?
  6. Is it a neuromuscular junction problem (myasthenia gravis)?
  7. Observe the movement
  8. Are there signs of triggering?
  9. Inspect scars
  10. ROM
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3
Q

PIP stiffness (3)

A
  1. extrinsic finger extensor tightness
  2. intrinsic finger tightness
  3. capsule tightness
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4
Q

DIP stiffness (2)

A
  1. ORL tightness

2. capsule tightness

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5
Q

extrinsic finger extensor tightness (PIP)

A

MP flexion lessens available passive PIP flexion

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6
Q

intrinsic finger tightness (PIP)

A

MP extension lessens passive PIP flexion

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7
Q

capsule tightness (PIP/DIP)

A

position of other joints doesn’t influence tightness

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8
Q

ORL tightness (DIP)

A

oblique retinacular ligament

PIP extension limits passive DIP flexion

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9
Q

wrist stiffness (4)

A
  1. extrinsic finger flexor tightness
  2. extrinsic finger extensor tightness
  3. capsular tightness
  4. muscular tightness
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10
Q

extrinsic finger flexor tightness (wrist)

A

passive wrist extension that is not impaired with finger flexion, but is impaired when adding finger extension

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11
Q

extrinsic finger extensor tightness (wrist)

A

passive wrist flexion that is not impaired with fingers in extension but is impaired when adding finger flexion

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12
Q

capsule tightness (wrist)

A

passive wrist movement that is impaired but not impacted by the posture of the digits

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13
Q

muscular and capsular tightness (wrist)

A

passive wrist flexion less than the unaffected side regardless of finger or elbow posturing and further impaired by finger or elbow posturing in extension or flexion

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14
Q

differential gliding

A

???

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15
Q

alternative reasons for stiffness (2)

A
  1. edema

2. neurological tone (spasticity/flaccidity)

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16
Q

soft tissue mechanics

A

the therapist’s ability to stretch or prevent tightness relies heavily upon the relationship between stress and strain

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17
Q

stress

A

the amount of force per unit area (pressure) applied to soft tissue

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18
Q

strain

A

a result of stress and is expressed mathematically as the change in length of soft tissue/original length x 100

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19
Q

TERT

A

“total end range time”
the amount of time a contracted joint is placed at its maximal length
*longer TERT = better result

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20
Q

LLLD

A

“low load, long duration”
combined low stress, long TERT
best practice when attempting to resolve soft tissue contracture because it promotes reorganization of collagen fibers within their elastic range without undue strain

21
Q

Tips: early active mobilization

A

do whenever possible
helps with edema-disuse-stiffness cycle
*if contraindicated work distal and proximal

22
Q

Tips: most difficult ROM to get back (5)

A
  1. MP flexion
  2. PIP extension
  3. wrist extension
  4. elbow extension
  5. supination
23
Q

Tips: using blocks

A

use isolation to effect the prime mover on the target joint

24
Q

Tips: when to use orthoses

A

use when stiffness is present and use to prevent stiffness

25
Tips: Modified Week's Test
measure, heat, ROM, re-measure * if gain is 10-20: serial-static or dynamic * if gain is less than 10: static-progressive
26
Tips: duration of orthosis
depends on type of stiffness * PIP ext contracture responds 12 weeks, 6 hours TERT * PIP flex contracture responds 17 weeks, 11 hours TERT
27
frequency of assessing outcomes
ideally weekly goniometric assessments of the targeted area
28
Functional AROM - MP flexion (2-5)
61 deg
29
Functional AROM - PIP flexion (2-5)
60 deg
30
Functional AROM - DIP flexion (2-5)
39 deg
31
Functional AROM - MP flexion (1st)
21 deg
32
Functional AROM - IP flexion (1st)
18 deg
33
Functional AROM - wrist flexion
40 deg
34
Functional AROM - wrist extension
0 deg
35
Functional AROM - ulnar deviation
40 deg
36
Functional AROM - radial deviation
17 deg
37
Functional AROM - supination
60 deg
38
Functional AROM - pronation
40 deg
39
Functional AROM - elbow flexion
130 deg
40
Functional AROM - elbow extension
-30 deg
41
what to do if progress is slow-going
when improvements in joint mobility are not accomplished after 2+ weeks, it may be necessary to re-evaluate you intervention plan *last resort, refer back to physician
42
operative interventions for stiffness (6)
1. capsulectomy 2. tenotomy 3. tenolysis 4. surgical decompression of sheaths or pulleys 5. surgical release and skin grafting 6. palmar fasciotomy
43
capsulectomy
for capsular contracture that does not respond to conservative measures *early hand rehab/mobilization
44
tenotomy
to release long standing musculotendinous tightness by "lengthening" the tendon through the surgical division of a tendon
45
tenolysis
the surgical removal of scar tissue impacting slide of a tendon * pre-op therapy important for PROM * early post-op therapy recommended
46
surgical decompression of tendon sheaths or pulleys
when stenosing tenosynovitis is the culprit of joint restriction
47
surgical release and skin grafting
when cutaneous scarring is impeding joint movement
48
palmar fasciotomy
may be used when diseased palmar fascia is restricting digital extension
49
therapeutic contracture
in some cases remediating stiffness is contraindicated * joint fusion * C6 tetraplegia - tenodesis requisite for hand function and requires shortening of long finger flexors and extensors to occur

Hand and Upper Extremity Conditions (27 decks)

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