Upper extremity Injuries

Question 1

Paresthesia refers to a _______ or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching

Answer 1

burning

Question 2

__ ________ syndrome is caused by cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist.

Answer 2

de Quervain

Question 3

Protective reeducation educates clients to _______ compensate for sensory loss and to avoid working with machinery and temperatures below 60°.

Answer 3

visually

Question 4

Discriminative reeducation uses motivation and ________ in a vision–tactile matching process in which clients identify objects with and without vision.

Answer 4

repetition

Question 5

For sensory reeducation after nerve injury, sensory recovery begins with pain perception and progresses to _______ of 30 cycles per second, moving touch, and constant touch.

Answer 5

vibration

Question 6

Desensitization is a process of applying different _______ and ________ stimulation to reeducate the nervous system so clients can tolerate sensations during functional use of the upper extremity.

Answer 6

textures

tactile

Question 7

PAMs are considered a ________ method for the therapeutic use of occupations or purposeful activities

Answer 7

preparatory

Question 8

Cryotherapy
Indications, contraindications, and precautions: Avoid use with clients with impaired circulation, peripheral vascular disease, ____________ to cold, impaired ________, open wounds, or infections.

Answer 8

hypersensitivity

sensation

Question 9

Thermotherapy
Indications, contraindications, and precautions: Avoid use with clients with _____ inflammation, edema, _______ impairment, cancer, blood clot, infection, cardiac problems, and impaired cognition.

Answer 9

acute

sensory

Question 10

Phonophoresis is the use of ________ to promote absorption of topically applied medication to accelerate tissue repair and decrease inflammation.

Answer 10

ultrasound

Question 11

Ultrasound
Indications, contraindications, and precautions: Avoid use with clients who have cancer; are pregnant; or have a ___________, bleeding, or an infection. Avoid use over the eyes, blood clots, and growth plates of bones in _______. Be cautious when using with inflammation, fractures and breast implants and with clients who have cognitive, language, or _______ impairments.

Answer 11

pacemaker
children
sensory

Question 12

NMES, TENS, and iontophoresis
Indications, contraindications, and precautions: Do not use over _________, carotid sinus, pregnant uterus, and eyes or with clients with epilepsy, cancer, infection, decreased ________, cardiac disease, and stroke. With iontophoresis use, be aware of possible drug allergies.

Answer 12

pacemakers

sensation

Question 13

Resting hand splints maintain the wrist at 20°–30° ________, thumb at 45° palmar ________, MCPs at 35°–45° _______, and PIPs and DIPs in slight flexion.

Answer 13

extension
abduction
flexion

Question 14

Antideformity resting hand splints (burn intrinsic plus) maintain the wrist at 30°-__° extension, thumb at 45° palmar abduction, MCPs at 70°- __° flexion, and PIPs and DIPs in full __________.

Answer 14

40
90
extension

Question 15

Ball or ____ antispasticity splints are ulnar or volar based and provide thumb palmar or radial abduction, a hard surface in contact with finger ______, and serial casting for the wrist, elbow, knee, or ankle to decrease soft tissue contractures.

Answer 15

cone

flexors

Question 16

Wrist cock-up splints (dorsal or volar wrist immobilization) maintain hand arches, full thumb movement, and full MP ______.

Answer 16

flexion

Question 17

Thumb spica splints (volar thumb or radial gutter thumb immobilization) are used on the long or short opponens to provide CMC __________.

Answer 17

immobilization

Question 18

Finger splints include PIP ________ (i.e., Boutonniere, Capener, prefabricated dynamic extension assist, and serial casting) splints, PIP flexion splints, PIP hyper________ block (swan neck) splints, DIP ________ (mallet finger, serial casting) splints, DIP flexion splints, and silver ring splints.

Answer 18

extension
extension
extension

Question 19

Nerve injury splinting

Carpal tunnel syndrome: Wrist in _______ to 10° _________.

Answer 19

neutral

extension

Question 20

Nerve injury splinting

Ulnar nerve at wrist: Block fourth and fifth MCPs to 30°–45° ______ to prevent ____________.

Answer 20

flexion

hyperextension

Question 21

Nerve injury splinting

Radial nerve injury: _____-__ splint, with dynamic finger extension assist optional

Answer 21

Cock-up

Question 22

Nerve injury splinting

Radial tunnel syndrome: Wrist in 30° ________, forearm ________, elbow in 90° _______.

Answer 22

extension
supinated
flexion

Question 23

Nerve injury splinting

Anterior interosseous: Forearm ______, elbow in 90° _______

Answer 23

neutral

flexion

Question 24

Nerve injury splinting

Pronator syndrome: Forearm and wrist ______, elbow in 90° ______

Answer 24

neutral

flexion

Question 25

Dynamic splints are designed to correct contractures, increase _______ motion, protect recent surgery, or substitute for lost _______ motion.

Answer 25

passive | active

Question 26

A soft, _____________ orthosis improves client compliance with wearing it. Carpal tunnel wrist support Anti-vibration gloves Neoprene wrap thumb support for CMC osteoarthritis and de Quervain syndrome Forearm bands for medial and lateral epicondylitis MCP anti–ulnar deviation splints for rheumatoid arthritis Buddy taping Neoprene tube digit extension splint Pediatric neoprene thumb abductor and supinator TheraTogs (TheraTogs, Inc., Telluride, CO; Gabriel et al., 2015)

Answer 26

circumferential

Question 27

Wound Closure | Primary—Wound is closed with _______.

Answer 27

sutures

Question 28

Wound Closure | __________—Wound is left open and allowed to close on its own.

Answer 28

Secondary

Question 29

Wound Closure | _______ primary—Wound is cleaned, debrided, and observed 4 to 5 days before suturing it closed.

Answer 29

Delayed

Question 30

Wound Healing Phases The acute phase lasts 24–48 hours to __ days, and the subacute phase lasts 7 to __ days. Local signs include redness, swelling, heat, and pain; systemic signs are fever and leukocytosis.

Answer 30

7 | 14

Question 31

Wound Healing Phases The inflammation phase includes the _____acute phase which lasts 24–48 hours to __ days, and the subacute phase lasts 7 to __ days. Local signs include redness, swelling, heat, and pain; systemic signs are fever and leukocytosis.

Answer 31

acute 7 14

Question 32

The three phases of wound healing are?

Answer 32

Inflammation Proliferative Remodeling

Question 33

___________ resurfaces the wound, tissue granulation forms new collagen and blood vessels, and myofibroblasts connect to the wound margins.

Answer 33

Epithelization

Question 34

In the _________ phase of wound healing, wound contraction lasts 5 days to 2–__ weeks. Linear wounds heal quickly, rectangular wounds moderately quickly, and circular wounds the most slowly.

Answer 34

proliferative | 3

Question 35

In would healing, the _________ phase lasts __ weeks to 1–2 years. If collagen synthesis exceeds collagen lysis, hypertrophic and keloid scars can form.

Answer 35

remodeling | 2

Question 36

Dynamic splinting, serial casting, continuous passive motion, positional stretching, NMES, and silastic gel pads can help decrease __________ scarring.

Answer 36

hypertrophic

Question 37

Finger metacarpal fractures: Base shaft, neck, head, such as a _______ (4th and 5th finger) fracture. Thumb fractures: Base fracture is Bennett’s fracture; shaft and neck fractures; _____ ligament is skier’s thumb.

Answer 37

boxer's | torn

Question 38

Avulsion injuries occur when the ______ separates from the bone and insertion and removes bone material with the tendon. a. Mallet finger is avulsion of the terminal tendon and is splinted in full ________ for 6 weeks.

Answer 38

tendon | extension

Question 39

b. Boutonniere deformity is disruption of the central slip of the extensor tendon characterized by proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hyperextension; the PIP is splinted in ________, and isolated DIP flexion exercises are performed. c. Swan neck deformity is injury to the metacarpophalangeal (MCP), PIP, or DIP joints characterized by PIP hyperextension and DIP flexion; the PIP is splinted in slight _______.

Answer 39

extension | flexion

Question 40

The three common phases of healing are __________, repair, and remodeling. ___________ provides the cellular activity needed for healing, repair forms the callus for stabilization, and remodeling deposits _____bone.

Answer 40

inflammation Inflammation bone

Question 41

Interventions for fractures of the hand. Early _________ mobilization. Therapeutic exercises provide motion to further enhance performance and function to ultimately improve ADL performance. Controlled active range of motion (AROM) begins __–6 weeks after fracture if fixation is stable. Consider intrinsic tightness versus extrinsic tightness versus joint capsule tightness

Answer 41

controlled | 3

Question 42

Interventions for fractures of the wrist. ROM is allowed in the early phases of healing and repair. True or false?

Answer 42

True

Question 43

Interventions for fractures of the wrist. Orthotics are used to protect the extremity from ______ or allow for protected _______; later, dynamic or static-progressive orthotics can be used after the fracture is healed to increase ROM.

Answer 43

motion | motion

Question 44

Interventions for fractures of the wrist. Exercises are used to facilitate movement and improve performance of the upper extremity; examples include AROM with wrist ________ and fingers ________; blocking exercises; tendon and nerve gliding exercises; stretching exercises and later strengthening exercises (e.g., use of therapy putty, hand exercises)

Answer 44

extended | flexed

Question 45

Radial head fractures are the most common of elbow fractures. These fractures are usually caused by a fall on an __________ hand (FOOSH).

Answer 45

outstretched

Question 46

Interventions for fractures of the forearm a. Orthotics are used for _________ as needed. b. ROM is begun early, within the 1st week if medically cleared. c. A sling is used for Type I fractures or comfort if the client has pain and is nervous in public places. d. Be watchful of stiff elbow.

Answer 46

immobilization

Question 47

Intervention for CRPS 1. Gentle, pain-free ______ for short periods; no passive range of motion (PROM) or painful treatment 2. Stress loading: for example, scrubbing the floor, carrying a weighted handbag 3. Pain control techniques: Transcutaneous electrical nerve stimulation, splinting (static, then dynamic as tolerated), continuous passive motion 4. Edema control techniques: Elevation, massage, AROM, contrast baths, compression 5. Desensitization techniques, fluidotherapy 6. Blocked exercises, tendon gliding 7. Joint protection, energy conservation

Answer 47

AROM

Question 48

``` _________ trauma disorder Five grades (I–V) according to severity ``` 1. Grade I: Pain after activity, resolves quickly 2. Grade II: Pain during activity, resolves when activity stopped 3. Grade III: Pain persists after activity and affects work productivity; objective weakness and sensory loss 4. Grade IV: Use of extremity results in pain up to 75% of time, work is limited 5. Grade V: Unrelenting pain, unable to work

Answer 48

Cumulative

Question 49

Intervention for Cumulative Trauma Disorder 1. Acute phase: Reduction of inflammation and pain through ______ splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, and high-voltage electric and interferential stimulation 2. Subacute phase: Slow stretching, myofascial release, progressive resistive exercise as tolerated, proper body mechanics, education on identifying triggers and returning to acute phase treatment with flareups; static splint during activities that cause pain 3. Return to work a. Assessment of job site, tools used, and body positioning b. Therapy using a work simulator, weight well, elastic bands, putty, functional activities, and strengthening activities 4. Functional capacity evaluation 5. Work hardening

Answer 49

static

Question 50

Extensor tendons post surgery Strengthening usually is not initiated until the late phase of the repair, around 8–12 weeks after surgery. True or false?

Answer 50

True

Question 51

An individual with a short below-elbow amputation will require a _____ elbow socket to provide stability because natural forearm rotation is not possible.

Answer 51

fixed