Arm Interventions

Question 1

Patient education for work related factors:

Answer 1

• Tracker ball vs. mouse
• Workstation set-up
• Dictation application for entering electronic data

Question 2

Potential complications of corticosteroid injections?

Answer 2

• Local infection
• Post-injection steroid flare (temporary worsening of pain in the first 24 to 36 hours after injection)
• Atrophy of subcutaneous fat
• Local depigmentation of the skin
• Tendon rupture

Question 3

C level evidence for what assistive tech interventions for CTS?

Answer 3

• Effects of mouse use on carpal tunnel pressure

- Develop alt strategies (touch screen/alt mouse hand)

Question 4

B level evidence for orthoses (nonsurgical) interventions for CTS?

Answer 4

Neutral position wrist orthosis worn at night for short-term symptom relief

Question 5

C level evidence for orthoses interventions for CTS?

Answer 5

• Adjust wear time to daytime, symptomatic, full time use

- Add MCP joint immobilization

Question 6

C level evidence for orthoses interventions for CTS in pregnant women?

Answer 6

Orthosis for women experiencing CTS during pregnancy and provide postpartum follow up

Question 7

C level evidence for biophysical agents as interventions for CTS?

Answer 7

• Superficial heat for short-term symptom relief

- Interferential current

Question 8

B level evidence for what not to do for biophysical agents as interventions for CTS?

Answer 8

• Not use low-level laser therapy
• Iontophoresis
• magnets

Question 9

C level evidence for what not to do for biophysical agents as interventions for CTS?

Answer 9

Not use thermal US

Question 10

T/F Clinicians may perform phonopheris with nonsurgical management of patients with mild to moderate CTS for treatment of clinical signs and symptoms.

Answer 10

True

Question 11

C level evidence for manual therapy techniques as intervention for CTS?

Answer 11

Manual therapy at cervical spine and UE

Question 12

C level evidence for therapeutic exercise as intervention for CTS?

Answer 12

Combined orthotic/stretching program who do not have thenar atrophy and have normal 2 point discrimination

Question 13

When are nerve mobilizations appropriate?

Answer 13

May be appropriate for various peripheral nerve entrapments

Question 14

Mechanism of nerve mobilizations:

Answer 14

• Thought to decrease adhesions and allow improved movement of peripheral nerves
• May increase neural vascularity, allowing increased oxygenation of the nerve and a resultant decrease in ischemic pain
• Dispersion of noxious fluids
• Improvement of axoplasmic flow

Question 15

Glider nerve mob -

Answer 15

2 simultaneous movements: one movement loads the nerve, one movement unloads the nerve

Question 16

Tensioner nerve mob -

Answer 16

2 simultaneous movements: both movements load the nerve

Question 17

Case studies/expert opinion supports which nerve glides for cubital tunnel syndrome?

Answer 17

Ulnar nerve glides

Question 18

T/F Median nerve glides for CTS is conflicting in regard to efficacy.

Answer 18

TRUE

Question 19

Inflammatory OA management -

Answer 19

Thermal/ cryotherapy

Question 20

Exercises for OA management -

Answer 20

Gripping/ resistive exercises

ROM exercises

Question 21

Manual therapy for OA management -

Answer 21

Joint mobs (pain vs extensibility)

Question 22

Joint protection for OA management -

Answer 22

• Splinting (keeps patient more functional)

- Activity modification

Question 23

Medical approach to tendinopathy -

Answer 23

NSAIDs, local steroid injection, Sx

Question 24

Education for tendinopathy -

Answer 24

• Resting position

- Activity modification

Question 25

Protection for tendinopathy -

Answer 25

- Splinting | - Activity Modification

Question 26

Exercise for tendinopathy -

Answer 26

- Stretching ??? - AROM/ tendon gliding - Eccentrics (facilitates more organized CT and increased fibroblast activity)

Question 27

Indications for tendon glides of hand:

Answer 27

- Prevent adhesion postoperatively - Address adhesion with tenosynovitis - Maintain/ Improve ROM - Pain relief

Question 28

Interventions for lateral epicondylopathy:

Answer 28

1. Patient education/ activity modification 2. Inflammatory/ pain management interventions 3. Eccentrics (Hand weights, Elastic bands, Elastic band (rubber band) around fingers with finger extension) 4. Joint Manipulation (C-Spine, T-Spine, Elbow/ Forearm/ Wrist) 5. Joint Mobs (including MWM – stronger evidence with lat epi) 6. Soft tissue mobilization 7. ROM/ stretching exercises

Question 29

T/F Cspine manipulations (c5/6) more effective for short-term lateral epicondylopathy pain improvement than t-spine manipulation

Answer 29

True

Question 30

What is mill's manipulation? Indicatio?

Answer 30

- high-velocity thrust administered at the elbow | - Short & Long Term improvements with pain, pain-free grip, function for individuals with lateral epicondylopathy

Question 31

Watson's manipulation? Indication?

Answer 31

- "scaphoid whip" PT provides ventral force on scaphoid during quick extension of wrist - Lateral Epicondylopathy

Question 32

``` MWM: LATERAL GLIDE of HUMERO-ULNAR JOINT Patient position - Direction of force - Mobilize - Stabilize - ```

Answer 32

Patient position - supine, neutral pronation/ supination -> Pt grasps towel or ball with targeted UE’s hand Direction of force - lateral Mobilize - proximal forearm (ulna) with belt (belt secured just below the clinician’s waist, waist moves away from the patient) Stabilize - More cranial hand: distal upper arm against table (wrist & elbow strait to w/b through the dorsum of the fingers)

Question 33

MWM: ANTERIOR GLIDE of HUMERO-RADIAL JOINT Patient position - Force -

Answer 33

- The patient assumes the position for the proximal radio-ulnar joint anterior glide mobilization - An anterior force is applied to the radial head with the hypothenar eminence of the mobilizing hand - Active supination is performed with anterior glide on radius

Question 34

MWM: POSTERIOR GLIDE of HUMERO-RADIAL JOINT Patient position - Force -

Answer 34

- The patient assumes the position for the proximal radio-ulnar joint posterior glide mobilization - The fingers are hooked around the anterior aspect of the lateral forearm and a posterior force is applied to the radial head with the fingers of the mobilizing hand - Active pronation is performed with posterior glide on radius

Question 35

Humero-ulnar distraction

Answer 35

place the dorsal wrist on the clinician’s shoulder with the table elevated, grasping the proximal forearm from dorsal to ventral with both hands

Question 36

HUMERO-RADIAL ANTERIOR GLIDE

Answer 36

- The elbow is flexed 90° & the clinician’s thenar eminences contact the proximal dorsal surfaces of the forearm - An anterior force is provided on the posterior lateral forearm (radius) while the other hand stabilizes the ulna

Question 37

HUMERO-RADIAL POSTERIOR GLIDE

Answer 37

- force is applied to the radius with the mobilizing hand - The dorsum of the stabilizing fingers contacts the table for stability (neural wrist & extended elbow with body weight through the UE)

Question 38

PROXIMAL RADIO-ULNAR ANTERIOR GLIDE

Answer 38

The proximal radius is anteriorly mobilized