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Upper Extremity Orthotics > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is a dermatome?

A

An area of skin innervated by a single spinal nerve

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2
Q

What is cutaneus innervations?

A

Areas innervated by specific peripheral nerves which can contain fibers from multiple spinal nerve roots.

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3
Q

What is cutaneus innervation a result of?

A

Spinal nerve plexuses (brachial, lumbar, sacral) which in turn form terminal nerves

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4
Q

What are plexus injuries due to?

A

MVA

Trauma

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5
Q

What is the patient’s result after or during plexus injuries?

A

Generally active and able to carry out ADL’s with the use of one hand unless disabled by pain

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6
Q

What might plexus injured patients prefer?

A

To use sound limb and remain one-handed

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7
Q

What must be considered with plexus injured patients?

A

Due to sensory feedback loss from skin, muscles and joints, patients have to do skin checks, skin cleaning, and be aware during ADL’s

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8
Q

What are the biomechanical principles for plexus injuries?

A

Prevent deformity
Correct deformity
Position limb to obtain maximal function
5 degrees of supination

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9
Q

What should be considered with the device for plexus injured patients?

A

Most patients are independent with one hand and no device
Device shouldn’t interfer with remaining ability
Device should allow independent donning/doffing
Cost must be considered/length of use and benefit

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10
Q

What is an axillary nerve injury?

A

Loss of active shoulder abduction and flexion

Sensory loss of lateral side of proximal arm

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11
Q

How do patients compensate for axillary nerve injury?

A

By using rotator cuff musculature to abduct the arm

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12
Q

How does axillary nerve injury present?

A

Deltoid is atrophied

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13
Q

What is the orthotic considerations for axillary nerve injury?

A

Treatment is limited to functional arm support to decrease gravitational pull on the glenohumeral joint

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14
Q

What is musculocutaneous nerve lesion?

A

loss of biceps and brachialis, and all useful elbow flexor strength

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15
Q

How can the patient compensate for musculocutaneous nerve lesion?

A

Can compensate with pronator teres and brachiradialis if they are well conditioned

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16
Q

What are the orthotic considerations for musculocutaneous nerve lesion?

A

Use of an orthosis for elbow control and assistance is difficult due to soft tissue of the arm, which creates an unstable base

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17
Q

What are the three levels of involvement associated with radial nerve lesion?

A

Below elbow
Mid-humerus
Axillary level

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18
Q

Radial nerve lesion is often referred to as?

A

Wrist drop

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19
Q

What is the below elbow radial nerve lesion?

A

The finger and thumb extensors and long thumb abductor loses motor function

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20
Q

What is the presentation of below elbow radial nerve lesion?

A

MCPs, fingers and thumb will begin to contract

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21
Q

What is the orthotic treatment recommendations for below elbow radial nerve lesion?

A

HO or WHO with IP extension assist (MP extesnion stop if patient becomes hypermobile at MP joint)

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22
Q

What is mid-humerus radial nerve lesion?

A

Wrist extensor paralysis is added to the absence of finger and wrist-extensor control

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23
Q

What is affected due to mid-humerus radial nerve lesion?

A

grasp-and-pinch coordination because the finger flexors cannot contract sufficiently to maintain grasp

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24
Q

What is the orthotic treatment for mid-humerus radial nerve lesion?

A

Static control at the wrist to counteract the effects of gravity and pull of the finger flexors as they contract. (Static WHO or Thermoplastic WHO)

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25
What is axillary level radial nerve lesion?
Triceps motor function loss in addition to the wrist and hand extensors.
26
What should be considered with axillary level radial nerve lesion?
Deformity of the elbow is rarely a problem due to gravitational pull when the patient is upright.
27
What is the most common mechanism for radial nerve lesion at the axillary level?
Poorly fit crutches Falling asleep with arm over a chair Saturday night palsy
28
What are the levels of involvement for a ulnar nerve lesion?
Wrist | Elbow or above
29
What is wrist ulnar nerve lesion?
absent intrinsic muscle action in the ring and little finger
30
How does the patient present with wrist ulnar nerve lesion?
A claw position with incomplete IP extension and hyperextension of the MCP.
31
Where does sensory loss occur for an wrist ulnar nerve lesion?
On the palmar and dorsa aspect of 5th digit and 1/2 of 4th digit
32
What is the common mechanism of injury for the wrist ulnar nerve injury?
A cut horizontally at the wrist | Suicide attempt
33
What is claw hand also referred to as?
Intrinsic minus hand
34
What is Volkmann's ischemic contracture?
Trauma to the arm, including a crush injury or fracture, that can lead to swelling that presses on blood vessels and can decrease blood flow to the arm. Lack of blood to the arm
35
What can occur if there is a prolonged decrease in blood flow to the arm?
Injury to the nerves and muscles, causing them to become stiff (scarred) and shortened
36
What is also weakened due to Wrist ulnar nerve lesion?
Grasp because the loss of direct MP flexion and usual intrinsic tie between extensors and flexors. The IP joints hyperflex and the distal transverse arch flattens
37
What orthotic treatment can be given for the claw hand?
Orthotic MP extension stop | Allows long extensor muscles to complete IP extension
38
What are the four aspects of the ulnar nerve?
Formed from medial cord of brachial plexus Lies behind medial epicondyl Gives off dorsal branch Forms deep superficial branches
39
What is elbow and above ulnar nerve injury?
When the injury is at the elbow, the flexor digitorum profundus muscle (of the 4th and 5th fingers) loses motor function, in addition to the intrinsic hand muscles.
40
What is deprived of the patient with elbow and above ulnar nerve injury?
Ulnar grasp
41
What is the orthotic treatment for elbow and above ulnar nerve injury?
Same as below: HO with MP extension stop
42
Which way will the hand deviate for a patient with elbow and above ulnar nerve injury?
Radially because of flexor carpi ulnaris paralysis during radiocarpal flexion
43
What is the common mechanism of injury for elbow and above ulnar nerve injury?
fracture of the medial epicondyle of the humerus
44
What is the nerve lesion that causes the most critical loss of function?
Median Nerve lesion
45
What are the two sites of injury of involvement for median nerve lesion?
Wrist | Elbow and above
46
What is critical of Median nerve lesion?
Motor and sensory loss deficiency It is the absolute pathway for all sensory fibers from critical areas, which also includes the radial side of the index finger. The motor supply includes the thumb's intrinsic muscles and the extrinsic flexors of the thumb, index and middle finger
47
What is wrist median nerve injury?
Only the thumb intrinsics (Lumbricals to index and middle finger) are paralyzed
48
What is the orthotic treatment for wrist median nerve injury?
Prevent deformity, and encourage useful hand function due to the lack of sensation.
49
How can the patient present with elbow and above median nerve injury?
Ape hand | Hand of Benediction
50
How does ape hand occur?
When the thenar eminence is flattened
51
How does the hand of benediction occur?
When the patient attempts to make a fist and the index and middle fingers remain extended, while the 4th and 5th fingers flex
52
What does BPI stand for?
Brachioplexus injury
53
What are the four types of BPIs?
Neuroma Rupture Avulsion Neuropraxia
54
What is neuroma BPI?
Nerve root has attempted to heal on its own. | The neuroma is the scar tissue that grows around and decreases the signal strength sent to the muscles
55
What is Rupture BPI?
Where the nerve is torn, but not at the spinal attachement
56
What is Avulsion BPI?
When the nerve root is torn at the location where it exits the vertebral foramen
57
What is neuropraxia BPI?
When the nerve is damaged (stretched) but not torn
58
What is Erb's Palsy?
Upper portion of brachial plexus affected-C5,C6
59
How does Erb's Palsy present?
Adducted internally rotated shoulder, extended elbow and pronated wrist (Waiter's tip)
60
How often does Erb's Palsy occur?
0.7 in 1000 births
61
What is the mechanism of injury for Erb's Palsy?
Traction on the plexus during delivery
62
When should treatment occur for Erb's palsy?
7-10 days with physical therapy and splinting
63
What is Klumpke's Palsy?
Lower segment involvement (loss of hand intrinsic muscles-C7-T1
64
What is the cause of Klumpke's palsy?
A sudden shoulder abduction motion
65
What is the result of Klumpke's palsy?
Loss of ulnar nerve sensory areas with shoulder and elbow stability and function
66
What is the orthotic treatment for Klumpke's palsy?
WHO
67
How will the patient present with Klumpke's palsy?
Claw hand because of impingement of ulnar nerve. Wrist in extreme extension because of unopposed wrist extensors hyperextension of MCP and Flexion of IP because of loss of hand intrinsic muscles
68
What are the ADL's for C1-3 level impairment?
Total dependence on caregiver
69
What is the available movement of C1-3 impairment?
Neck control
70
What is the orthotic treatment for C1-3 impairment?
Positional WHO's
71
What are the ADL's for C4 impairment?
Total dependence (may incorporate external power systems)
72
What is the available muscles of C4 impairment?
Diaphragm and trapezius
73
What is the orthotic treatment for C4 impairment?
Mobile arm support, powered tenodesis WHO and/or static WHO
74
What are the ADL's for C5 impairment?
Can independently feed, groom and complete light home-keeping duties
75
What are the available muscles for C5 impairment?
Deltoid, Biceps, Supinator, Rotator cuff group
76
What is the orthotic treatment for C5 impairment?
Mobile arm support (initally) RATCHET WHO or powered tenodesis WHO (Ratchet WHO not bilaterally)
77
What are the ADL's for C6 impairment?
Can independently feed, groom, transfer and drive with hand controls
78
What are the available muscles for C6 impairment?
Extensor carpi radialis longus and brevis, prontator teres, pectoralis major.
79
What is the orthotic treatment for C6 impairment?
Wrist-driven WHO (Flexor hinge WHO)
80
What are the ADL's for C7 impairment?
Total independence and driving car with hand controls
81
What are the available muscles for C7 impairment?
Triceps, latissimus dorsi, extensor digitorum, flexor carpi radialis, flexor digitorum
82
What is the orthotic treatment for C7 impairment?
Wrist-driven WHO (initially) Static WHO
83
What are the ADL's for C8-T1 impairment?
Total independence and driving car with hand controls
84
What are the available muscles for C8-T1 impairment?
Interossei, lumbricals, thenar and hypothenar muscles
85
What is the orthotic treatment for C8-T1 impairment?
HO (initially) during recovery

Upper Extremity Orthotics (8 decks)

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