Upper Extremity conditions Flashcards
(149 cards)
1
Q
Carpal Tunnel Syndrome: condition and cause
A
caused by compression of the median nerve where it passes through the carpal tunnel. Caused by inflammation or repetitive motion with poor positioning
2
Q
Symptoms of carpal tunnel
A
- palmar numbness and numbness of first digit to half of fourth
- generalized weakness and pain, including pain at night.
3
Q
OT treatment for conservative management of carpal tunnel
A
- wrist splint with wrist positioned in neutral (causes less pressure on the carpal tunnel compared with extension)
- median nerve gliding exercises
- activity modification
- ergonomic modification
4
Q
OT treatment for post-surgical management of carpal tunnel syndrome
A
- edema and pain control
- AROM, nerve/tendon gliding exercises
- sensory reeducation
- strengthening
- activity modification
- Pillar pain is pain on either side of the carpal tunnel release surgery side (source of pain is unknown and may be ligamentous or muscular in origin)
5
Q
Contraindications for carpal tunnel
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- avoid repetitive motion at the wrist
- avoid vibration to volar wrist
6
Q
Cubital tunnel syndrome: condition and cause
A
- caused by compression of the ulnar nerve at the elbow
- result of repetitive pressure on the elbow or repetitive or sustained bending of the elbow
7
Q
Symptoms of cubital tunnel
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- numbness and tingling along ulnar aspect of forearm/hand
- pain at elbow with extremely weak power grip
- Tinel’s sign at elbow (examiner taps lightly at elbow with reflex hammer of their finger- patient is asked if they feel any tingling or paresthesias)
8
Q
OT conservative treatment for cubital tunnel syndrome
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- elbow pad or elbow splint to decrease compression of nerve
- Activity modification
9
Q
OT treatment post-surgical management
A
- edema control
- AROM
- nerve glides
- strengthening
- MCP blocking splint if clawing is noted
10
Q
Contraindications for cubital tunnel syndrome
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Avoid movements or postures that aggravate symptoms
11
Q
Double crush injury: condition and causes
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- occurs when a peripheral nerve is entrapped in more than one location
12
Q
Symptoms of a double crush injury
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- intermittent diffuse arm pain and paresthesias with specific postures
13
Q
OT conservative treatment management for double crush injury
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- treat according to protocols for each nerve syndrome involved
14
Q
Post-surgical OT management for double crush injury
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- Treat according to protocols for each nerve syndrome involved, following the surgeon’s orders
15
Q
Guyon’s canal syndrome: condition and causes
A
- occurs when the ulnar nerve is compressed as it passes through Guyon’s canal at the wrist
- Caused by inflammation or other irritation to the ulnar nerve at the wrist
16
Q
Guyon’s canal symptoms
A
- numbness and tingling in ulnar nerve distribution of hand
- motor weakness of ulnar nerve innervated musculature;
- positive Tinel’s sign at Guyon’s canal
17
Q
OT conservative treatment for Guyon’s canal
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Work activity modification, wrist splint in neutral
18
Q
OT post-surgical management Guyon’s canal
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- edema control
-AROM - nerve glides
- Sensory re-education
- strengthening
19
Q
Pronator Teres Syndrome: condition and causes
A
- occurs when the median nerve is compressed between the two heads of pronator teres
- caused by trauma to the forearm or repetitive overuse, especially against resistance (turning a manual screwdriver)
20
Q
Symptoms of pronator teres syndrome
A
- palmar numbness of first digit to half of the fourth digit
- Generalized weakness and pain
- aching pain in the proximal volar forearm
- no pain at night
21
Q
OT conservative treatment for pronator teres syndrome
A
- pain control techniques
- activity modification
- adaptations
- elbow splint at 90 degrees with forearm in neutral
22
Q
OT post-surgical treatment of pronator teres syndrome
A
- AROM
- nerve gliding exercises
- sensory re-education
- strengthening at 2 weeks post-op
- activity modification
- adaptations at work
23
Q
Contraindications for pronator teres syndrome
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Avoid repetitive forearm pronation and supination
24
Q
Radial Nerve Palsy: condition and causes
A
Decreased conduction of the radial nerve
- causes include compression, fractures, and laceration
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Radial nerve palsy symptoms
- weakness/paralysis of extensors to wrist, MCPs, thumb
- Wrist drop
- Saturday night palsy
- Slow nerve regeneration
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OT conservative treatment of Radial nerve palsy
- ROM
- Nerve gliding exercises
- Strengthening
- Thumb extension splint
- Duran dorsal protection splint
- Volar splint with wrist in neutral
- Dynamic extension
27
OT post-surgical treatment of radial nerve palsy
- Scar management
- PROM and AROM
- Edema control
- Sensory and motor re-education
- Strengthening per surgical protocol
- Activity modification
* compression caused by fractures is usually treated surgically due to the risk of bony fragments lacerating the nerve
28
Radial tunnel syndrome: condition and causes
- compression of the radial nerve in the proximal forearm
- Caused by inflammation, repetitive motion, injury to the lateral side of the elbow, or tumors
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Radial tunnel syndrome: symptoms
- dull ache and burning sensation along the lateral forearm
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OT conservative treatment Radial Tunnel Syndrome
- long arm splint, with the wrist in extension, elbow in flexion, and forearm in neutral rotation
- Massage of TENS for pain management
- Pain-free ROM
- Nerve gliding
- Activity modification
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OT post-surgical management of Radial Tunnel Syndrome
- Long arm splint with the wrist in extension, elbow in flexion, and forearm in neutral rotation for 2 weeks, then wrist cock-up splint for 2 more weeks
- PROM and AROM for pronation and supination
- hand strengthening exercises at 3 weeks
- resistive exercises at 6 weeks
32
Contraindications for Radial Tunnel Syndrome
Avoid forceful wrist extension and supination
33
Thoracic outlet syndrome: condition and causes
Occurs when excess pressure is placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles
- Caused by repetitive motion in the upper arm and shoulder, injury, poor posture, anatomical defects, tumors, or pregnancy.
34
Thoracic outlet syndrome symptoms
Vascular symptoms: swelling or puffiness in the arm or hand, bluish discoloration of the hand, feeling of heaviness in the arm or hands, pulsating lump above the clavicle, deep, boring toothache-like pain in the neck and shoulder region which seems to increase at night, easily fatigued arms and hands, superficial vein distension in the hand
Neurologic symptoms: paresthesia along the inside forearm and the palm (C8, T1 dermatome), muscular weakness and atrophy of the gripping muscles (long finger flexors), and small muscles of the hand (thenar and intrinsics), difficulties with fine motor tasks of the hand, cramps of the muscles on the inner forearm (long finger flexors), pain in the arm and hand, tingling and numbness in the neck, shoulder region, arm and hand.
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OT conservative treatment of Thoracic outlet syndrome
- Modalities to reduce inflammation (ultrasounds or neuromuscular electrical stimulation.
- Strengthening of the muscles around the cervical spine and scapula.
- Wrist splints for postural retraining.
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OT post-surgical management of Thoracic outlet syndrome
- AROM and PROM
- Edema control
- scar management
- muscular reeducation to compensate for any muscles removed
- postural retraining
- Activity modification
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Contraindications for Thoracic outlet syndrome
- avoid heavy lifting, working with arms overhead, direct weight bearing on shoulder
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Ape hand deformity: condition and causes
- high or low median nerve injury
- ability to abduct and oppose thumb will be lost d/t paralysis of the thenar muscles
- This is seen only after the thenar muscles have atrophied
- Ape hand is the default position of the injured hand at rest
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Ape hand symptoms
- loss of thumb abduction
- sensory loss in the index, middle and radial side of the ring finger
- loss of pinch, thumb opposition, index finger MCP and PIP flexion
- decreased pronation
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OT conservative management of Ape hand deformity
- PROM
- prolonged stretch to counteract deformity
- Strengthening exercises to build atrophied muscles of thenar eminence, hand and forearm.
- C-bar splint with thumb positioned in opposition and fingers in a C position (used to maintain integrity of web space
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OT post-surgical treatment for Ape hand deformity
- Gentle AROM
- Tendon gliding exercises
- Scar management
- Soft tissue mobilization
- Splinting per tendon transfer protocols
- PROM and strengthening added about 2 months after surgery
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Contraindications for Ape hand deformity
- no PROM or strengthening post-surgery until authorized by physician, per tendon transfer protocols
- Strengthening too early can cause damage to transferred tissues.
43
Brachial Plexus Injury condition and causes
- brachial plexus is a network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column (or spine), to the shoulder, arm, and hand.
- These nerves originate in the 5th, 6th, seventh and eighth cervical (C5-C8), and T1 spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand.
- Brachial plexus injuries, or lesions are caused by damage to those nerves- can occur as a result of shoulder trauma, tumors, or inflammation.
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Brachial plexus injury symptoms
- pain, including avulsion pain (a burning pain in the injured nerve area), loss of sensation distal to the brachial plexus, muscle weakness, partial or total paralysis of the affected upper extremity.
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OT conservative treatment for Brachial plexus
- PROM and AROM
- Sensation retraining including techniques to reduce tactile sensitivity
- neuromuscular reeducation as motor function returns
- A flail arm splint provides the needed stability at both the shoulder and elbow for functional positioning of the hand
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OT post-surgical management for brachial plexus injury
- Edema control
- PROM and AROM
- Neuromuscular re-education to help the patient learn to recruit muscles in a different way, may use biofeedback training
- Strengthening 4-6 weeks after surgery
- May require several surgeries
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Contraindications for brachial plexus injuries
- ROM is important to keep the affect limb mobile as recovery may take years
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C5 Spinal cord injury: condition and causes
the SC is partially or completely severed at the level of the 5th cervical vertebrae
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Movements possible with C5 spinal cord injury
Shoulder flexion and abduction and extension
- and elbow flexion, supination
- scapular adduction and abduction
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OT conservative treatment of C5 SC injury
- AROM and strengthening of innervated muscles
- PROM and splinting of hands to maintain functional position and prevent contracture
- Wrist cock-up splint with universal cuff
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OT post-surgical treatment of C5 Spinal cord injury
- positioning
- PROM and AROM
- strengthening following any type of surgery performed
- Address any return of function following surgery
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Contraindications for C5 SC injury
- monitor for muscle tightness and spasticity, initiate ROM and splinting before onset of contracture
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C6-C7 spinal cord injury: condition and causes
- SC is partially or completely severed at the level of the 6th or 7th cervical vertebrae
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Movements possible with C6 SC injury
- scapular protraction (partial horizontal adduction), forearm supination
- radial wrist extension (TENODESIS GRASP
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Movements possible with C7 SC injury
- elbow extension, ulnar/wrist extension (TENODESIS GRASP)
- Finger extension
- Thumb flexion, extension, and abduction
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OT conservative treatment for C6/C7 SC injury
- allow the proximal IP joints to develop a contracture to facilitate functional grasp
- Ranging the hand (wrist extension combined with finger flexion and wrist flexion combined with finger extension) --> this will preserve the functional tenodesis grasp while encouraging PIP flexion contractures.
- Tenodesis splint (active wrist extension drives a hinge mechanism in the splint that allows thumb to fingertip pinch)
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OT post-surgical management of C6-C7 SC injuries
- positioning
- PROM and AROM
- strengthening following any type of surgery performed
- address any return of function
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Contraindications for C6-C7 SC injuries
- monitor muscle tightness and spasticity, but allow partial contracture to develop in PIP joints for tenodesis grasp
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Erb's Palsy: condition and causes
- paralysis of the arm caused by injury to the upper group of the arm's main nerves (specifically the severing of the upper trunk C5-C6 nerves)
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Symptoms of Erb's palsy
- arm hangs limp with the shoulder rotated inward due to atrophy and paralysis of biceps, deltoid, brachialis, and brachioradialis muscles. Significantly limits functional movement
- paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.
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OT conservative treatment for Erb's palsy
- PROM
- contracture management
- elbow lock splint stabilizes the elbow to enable the individual to position the hand closer to or away from his/her body for function use
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OT post-surgical management for Erb's palsy
- edema control
- scar management at surgical site
- positioning
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Contraindications for Erb's palsy
Monitor for subluxation of the shoulder, frozen shoulder, contractures
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Long Thoracic nerve palsy: conditions and causes
- long thoracic nerve sustains damage, causing pain and limited movement in the shoulder (branches off of C5)
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Long thoracic nerve palsy symptoms
- innervates the serratus anterior nerve, which causes scapular protraction, therefore, abnormal protruding or winging of scapula will occur
- shoulder pain
- limited overhead movement of the shoulder
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OT conservative treatment for long thoracic nerve palsy
- pain management techniques
- scapular mobilization
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OT post-surgical management for Long thoracic nerve palsy
scapulothoracic fusion surgery may be completed if the nerve is permanently damaged, which will fuse the scapula to the thorax for stability
- sling may be used post surgery to immobilize shoulder
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median nerve injury : condition and causes
trauma to the median nerve
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Median nerve injury symptoms
- causes ape hand deformity
- sensory loss in index, middle, and radial side of ring finger
- loss of pinch, thumb opposition, index finger MCP and PIP flexion
- decreased pronation
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OT conservative treatment for median nerve injuries
- static thenar web spacer splint
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OT post-surgical treatment for median nerve injury
- AROM and PROM in splint for digits and thumb
- Tendon gliding exercises
- scar massage
- discontinue splint use at 6 weeks and begin strengthening exercises
- Dorsal wrist blocking splint in 30 degrees of flexion worn for 4-6 weeks.
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Median nerve laceration: condition and causes
the median nerve is partially or completely severed
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median nerve laceration symptoms
- results in loss of thumb opposition, weak pinch
- Clawing of index/mid fingers occurs in low level lesions (hand of benediction sign)
- Ape hand deformity (flattening of thenar eminence)
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OT conservative treatment of median nerve lacerations
- A/PROM
- scar management
- strengthening, sensory re-education
- dorsal protection splint (30 degrees of wrist flexion if low lesion, 90 degrees elbow flexion at elbow if high lesion)
- C bar splint to prevent thumb adduction contracture
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OT post-surgical treatment for median nerve laceration
- edema control
- scar management
- nerve gliding exercises
- AROM
- sensory re-education including treatment for tactile sensitivity
- strengthening per post-op protocol
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Contraindications for median nerve laceration
- hypertrophic scarring may lead to compression of the median nerve and additional scarring
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Median and ulnar nerve injury: condition and causes
- injury to both the median and ulnar nerves results in an impairment of function
- caused by car accidents and glass injuries
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Median and ulnar nerve injuries: symptoms
- loss of sensation to the volar surface of all digits
- loss or impairment of finger flexion, thumb opposition
- clawing of all digits
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OT conservative treatment for median and ulnar nerve injuries
-A/PROM
- scar management
- Strengthening
- Sensory re-education
- Figure of eight splint to prevent MP hyperextension or dynamic MCP flexion splint
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OT post-surgical management of median and ulnar nerve injuries
- edema control
- scar management
- nerve gliding exercises
- AROM
- sensory re-education including treatment for tactile sensitivity
- Strengthening per post-op protocol
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Radial nerve laceration: condition and causes
the radial nerve is partially or completely severed
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Radial nerve laceration symptoms
inability of the digits to release objects; difficulty manipulating objects
- wrist drop
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OT conservative treatment for radial nerve laceration
- ROM
- Sensory re-education
- home programming
- activity modification
- dynamic extensor splint
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OT post-surgical management of radial nerve laceration
- edema control
- scar management
- nerve gliding exercises
- AROM
- sensory re-education including treatment for tactile sensitivity
- strengthening per post- op protocol
- Dynamic extension splint
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Contraindications for radial nerve laceration
- hypertrophic scarring may lead to compression of the radial nerve and additional damage
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Ulnar nerve injury: condition and causes
Trauma to the ulnar nerve
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Symptoms of ulnar nerve injury
- results in ulnar claw deformity and numbness of the ulnar side of the hand and the 5th and half of the fourth digits
- generalized weakness of the ulnar side of the hand and pain
- trouble cutting with small knife
- Trouble with power grip and lateral pinch
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OT conservative treatment of ulnar nerve injury
- sling is used for type 1 fractures for comfort or if the client has pain and is nervous in public places
- Ulnar nerve injury splint
- Dynamic/static splint to position MP's in flexion
- MCP dorsal blocking splint
- If it is a low-level ulnar nerve injury, then a splint that prevents hyperextension of the mCP joints and allows MCP flexion
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OT post-surgical treatment of ulnar nerve injury
- orthotics used for immobilization as needed
- dorsal protection splint with wrist in 30 degrees of flexion
- ROM is begun early (within 1 week if medically cleared)
- edema control
- scar management
- sensory re-education
- nerve gliding exercises
- strengthening per post-op protocol
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De Quervain's Tenosynovitis: Condition and Cause
Inflammation of the thumb muscle/tendon unit. Caused by cumulative microtrauma, repetitive motion
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De Quervain's Tenosynovitis Symptoms
pain, swelling, limited motion in the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist
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OT conservative management of De Quervain's Tenosynovitis
- ergonomic adaptations to work station
- patient education
- strengthening exercises
- Forearm based thumb spica splint with wrist in neutral and thumb radially abducted for three weeks (after three weeks, client can progress to a soft splint and isometric exercises)
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OT post-surgical treatment of De Quervain's Tenosynovitis
- Gentle ROM
- Tendon gliding exercises
- Isometric strengthening exercises
- grip and pinch strengthening after 2 weeks
- scar management and desensitization techniques
- Splint with wrist in 20 degrees extension
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Contraindications for De Quervain's Tenosynovitis
Nonoperative treatment: activity modification to avoid pinching during activities
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Lateral Epicondylitis: condition and causes
inflammation of the tendons of the wrist extensors at the insertion points on and around the lateral epicondyle. Caused by repetitive motion
Also called tennis elbow
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Lateral epicondylitis: symptoms
Ice/deep friction massage, stretching, activity modification, strengthening. Lateral epicondylitis brace, also called a tennis elbow brace.
- Splint rests the muscle and tendon and protects against pain with activity
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OT conservative treatment for tennis elbow
- ice/deep friction massage
- stretching, activity modification
- eccentric loading exercises
- brace that rests the muscles and tendons and protects against pain with activity
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OT post-surgical treatment for lateral epicondylitis
- Edema control
- modalities for circulation
- AROM and PROM
- Activity modification
- Gentle strengthening and stretching per post op protocol
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Contraindications for lateral epicondylitis
control of edema and gradual increases in movement post surgery needed to prevent re-injury to affected area
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Medial Epicondylitis: Condition and causes
- inflammation of the tendons of the wrist flexors at the insertion points around the medial epicondyle.
- caused by repetitive motion
- also cause golfer's elbow
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Medial epicondylitis: symptoms
- pain
- inflammation
- limited movement of wrist flexors
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Medial epicondylitis: OT conservative treatment
- ice/deep friction massage
- stretching
- activity modification
- strengthening
- medial epicondylitis brace
- splint rest the muscle and tendon and protects against pain with activity
- Eccentric loading exercises
103
Post-surgical treatment of medial epicondylitis
- Elbow immobilizer 1-3 weeks post surgery
- edema control, modalities for circulation
- gentle ROM once immobilizer is removed
- Strengthening of flexor and pronator muscles 6 weeks post-op
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Contraindications for medial epicondylitis
Activity modifications may be necessary to avoid re-injuring the area due to the same types of activity
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Rotator cuff tendonitis: condition and causes
- inflammation of the tendons of the shoulder that attach to the muscles that make up the rotator cuff
- caused by repetitive motion, chronic joint inflammation
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Rotator cuff tendonitis: symptoms
- activity modification
- education in sleeping posture (avoid arm overhead)
- pain management
- Codman exercises/pendulum exercises
- strengthening
- shoulder support sling or neoprene shoulder support cuff
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Rotator cuff tendonitis: OT conservative treatment
- Shoulder immobilizer
- Codman's exercises (pendulum) for two weeks post op, then PROM or AAROM
- AROM and strengthening can begin 6 weeks post op
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Contraindications for rotator cuff tendonitis
no AROM for 6 weeks post surgery due to risk of injuring affected areas
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Trigger finger: condition and causes
- tenosynovitis of the finger flexors.
- caused by cumulative trauma
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Trigger finger: symptoms
- most commonly occurs in the A1 pulley
- Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger
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Trigger finger: OT conservative treatment
- MCP joint blocked by splinting (to rest the tendon the tendon and prevent from snapping as the tendon pulls through the finger pulleys)
- gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the client is awake
- edema control
- tendon gliding
- activity/work modification
- Hand-based TF splint (MCP/PIP splinted and DIP is free)
- splint to support the MCP joint in extension
112
Post-surgical OT treatment of trigger finger
- edema control
- tendon gliding exercises
- AROM
- activity modification
- blocking splints to protect the released tendon while it is healing
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Contraindications of trigger finger
-no active strengthening of the flexor tendons
- no forceful grip while recovering from tendon release surgery
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Wrist tendonitis: condition and causes
- inflammation of the tendons of the wrist
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Wrist tendonitis: symptoms
- Pain
-inflammation
- limited ROM of wrist
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OT conservative treatment of wrist tendonitis
- Dexamethasone is most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties
- AROM
- therapeutic activities
- Joint protection and work simplification
- wrist forearm support splint
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Post-surgical OT treatment of wrist tendonitis
- Edema control
- tendon gliding exercises
- gentle AROM
- strengthening 6 weeks post op
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Contraindications of wrist tendonitis
- no forceful grip
- no using affected hand to carry heavy objects for 6 weeks post surgery due to risk of injuring tendons
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Avulsion injuries (i.e. avulsion fractures) condition and causes
a bone fragment is pulled away from the main bone by a ligament or tendon; happens due to sudden force (fall, kick, or change in direction)
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OT post-surgical management for avulsion injuries
scar management at surgical site if graft if completed; tendon gliding exercises, functional activity as tolerated; begin strengthening when surgical site is healed or per physician's protocol.
119
Avulsion injuries: OT treatments for conservative management
icing the affected area, controlled ROM, and gradual strengthening exercises. Splinting may be required
120
Extensor tendon injuries: condition and cause
- injury to the extensor digitorum communis or extensor indicis proprius; most likely caused by a direct trauma such as a deep cut across the back of the hand or fingers, jamming a finger forcefully (often leading to mallet finger), or a blunt impact to the back of the hand.
120
Avulsion injuries: symptoms
-Mallet finger is an example of an avulsion fracture
- deformity of the finger
- pain
- swelling
- poor/absent ROM
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Extensor tendon injury: symptoms
- affected finger is unable to extend and rests in flexion.
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OT post-surgical treatment for extensor tendon injury
- tendon gliding exercises promote tendon excursions and prevent adhesions.
- modalities include heat, to gradually prepare the tissue for ROM
- NMES to promote tendon excursion and activation
- use of modalities begins once cleared by the prescribing physician
- strengthening is usually not initiated until the late phase of repair, usually 8-12 weeks after surgery.
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Contraindications for extensor tendon injury
- Overuse of the tendon too early after surgery can result in rupture.
124
Flexor Tendon Injury: condition and causes
- affected finger is unable to flex, and rests in extension
- a deep cut on the palm side of the fingers, hand, wrist, or forearm can damage the flexor tendons.
- A flexor tendon injury can make it impossible to bend the fingers or thumb.
125
OT post-surgical treatment for flexor tendon injury
- flexor tendon protocol using controlled passive motion
- passive extension of the distal IP joint if the MC and proximal phalangeal joints are flexed.
- The distal interphalangeal joint and proximal interphalangeal joint can be passively extended if the other joints of the digit are flexed to initiate tendon glide and prevent scarring of the tendon.
- Zone II of the flexor tendon system has been called no man's land because excessive scarring makes it difficult to get good results from a repair
- Zone 4 consists of the transverse carpal ligament, and the median nerve runs under this ligament
- Zone 5 is distal to this ligament and thus contains the median nerve branch.
126
Contraindications for flexor tendon injury
- Strengthening must not be initiated until cleared by the surgeon completing the tendon repair.
- overuse of the tendon too early after surgery can result in rupture of the tendon.
127
Mallet finger: condition and causes
- avulsion of the terminal tendon
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OT conservative treatment for mallet finger
- splint the client's DIP joint in full extension continuously for 6 weeks
- DIP terminal tendon is delicate and requires continuous splinting to prevent extensor lag of the tendon; older injuries may be splinted continuously up to 6 months.
129
Contraindications for mallet finger
be careful not to hyperextend the DIP joint when splinting or skin breakdown can occur over the dorsal surface of the digit.
130
Cumulative trauma disorder: condition and causes
trauma to soft tissue caused by repeated force
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Symptoms of cumulative trauma disorder
- muscle fatigue, pain, chronic inflammation, sensory impairment, decreased ability to work
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OT conservative treatment for cumulative trauma disorder
- Acute phase: reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, inferential stimulation,
- Subacute phase: slow stretching, myofascial release, progressive resistive exercises as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment
- return to work, functional capacity evaluation, work hardening
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OT post-surgical management for cumulative trauma disorder
- dependent on location and severity of the condition
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Contraindications for cumulative trauma disorder
- activity modification and proper body mechanics are essential for long-term control of an inflammatory cumulative trauma disorder
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MCP flexion limitation: condition and cause
- difficulty flexing the MCP's due to tightness in the ligaments (The MCP joints are condyloid (formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges) with the exception of the thumb which is a hinge joint.
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OT conservative treatment for MCP flexion limitation
- joint mobilization
- A/PROM
- therapeutic activities
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OT post-surgical treatment for MCP flexion limitation
- edema and scar management
- gentle AROM
- tendon gliding exercises
- joint mobilization and strengthening when surgical site is healed
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contraindications for MCP flexion limitation
- follow surgeon's protocol for joint mobilization and strengthening after surgery.
139
Proximal interphalangeal (PIP) flexion contracture: condition and causes
shortening and tightening of the tendons and ligaments surrounding the PIP joint due to injury
140
OT conservative treatment for PIP flexion contracture
- splinting, buddy taping, A/PROM, therapeutic activities, PIP extension splint
- A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint
141
OT post-surgical management for PIP flexion contracture
- surgery is only done when all conservative management techniques have been trialed
- Serial casting or external fixation for prolonged stretch are preferred methods of management.
142
Skier's Thumb (Gamekeeper's thumb): condition and causes
- rupture of the ulnar collateral ligament of the MCP joint of the thumb (skiing with the thumb held in a ski pole)
143
OT conservative treatment for Skier's thumb
- wear thumb spica splint at all times
- AROM and pinch strength at 6 weeks
- ADLs that require opposition and pinch strength
- PROM at 8 weeks and strengthening at 10 weeks
144
OT post-surgical treatment for Skier's thumb
- immobilized in thumb spica cast for first 4 weeks
- then thumb spica splint for 2 additional weeks
- may begin AROM at 6 weeks
- unrestricted use of hand is allowed at 3 months
145
Contraindications for SKier's thumb
- no motion for 4 weeks following surgical repair
- failure rate of conservative management is 50%
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Arthritis
