1
Q
Flexor carpi radialis action
A
Flex wrist, radial deviation
2
Q
Palmaris longus action
A
Wrist flexion
3
Q
Lumbricals action
A
IP extension, MP flexion (intrinsic +)
4
Q
Interossei action
A
Digit AB/ADduction
5
Q
GH rhythm
A
In ABduction, humerus is most of the movement up to 90 deg, the scapular rotation is most of the movement after 90 def
6
Q
Flexor tendon zones
A
1: DIP & distal, only contains FDP tendon
2: from insertion of FDS (PIP) to A1 pullet (MCP), contains FDS & FDP tendons
3: below MCP to edge to carpal tunnel (bottom of palm), contains lumbricals
4: within carpal tunnel, has ALL 4 flexor tendons & median nerve
5: proximal to carpal tunnel, has flexor tendons withinin the forearm muscles
*thumbs zones go T1-T3 from distal to proximal
7
Q
Functional position of hand
A
Wrist slight extension (~30 deg), MCPs & IPs slightly flexed, thumb in opposition
8
Q
Zero position
A
Resting position of hand as opposed to anatomical position: wrist more or less neutral, fingers in more flexion
9
Q
Mnemonic for UE nerves
A
DR. CUMA
drop wrist - radial
(ulnar) claw - ulnar
ape hand - median
10
Q
Static progressive splint
A
Does NOT allow movement, but is adjustable
- non elasitc
- strap pulls at body part at 90 deg
- good for: stiff joints, wear should be followed w/ ACTIVE use of joint
11
Q
Dynamic splint
A
Dynamic w/ elastic component
- strap/lever pulls at body part at 90 deg angle
- assists w/ movement (ex: radial nerve palsy)
12
Q
Resting hand splint use
A
General comfort/prevents contractures
- ex: stroke
13
Q
Anti-deformity splint (intrinsic + splint) use
A
Positioning after trauma/edema
- ex: burns
14
Q
Short thumb spica (short opponens) splint use
A
Looks like a hand puppet unicorn; unicorn horn = spike = spica
- leaves wrist free
- used for: CMC & MP arthritis
15
Q
Lumbrical bar/Anti-claw splint use
A
A hand based orthotic that positions the 4th & 5th digits in 30°-40° of MCP joint flexion while allowing IP joint motions
- Reduce MCP hyperextension & IP flexion contractures
- Mostly used for: Ulnar nerve injury (claw hand)
16
Q
Wrist cock-up (volar wrist) splint use
A
Static splint, immobilizes wrist but keeps fingers free
- looks like a finger puppet squid (fingers are tentacles)
- Used for: Radial nerve injury, radial tunnel syndrome (wrist is neutral for CTS) & for wrist arthritis & sprains
17
Q
Wrist extension splint use
A
Functional splint w/ 45° wrist extension, worn during day to prevent wrist drop
18
Q
Long thumb spice (long opponens) splint use
A
Similar to short opponens but goes down 2/3 of the forearm to immobilize wrist & used for De Quervain’s
- wrist is NOT free
- *Kevin the unicorn used for de quervain’s
19
Q
Dorsal block splint
A
Prevents from going into too much extension of MPs
- Used for: post-flexor tendon repair (Dorothy has a FLEXible trunk)
- *Dorothy the elephant so big she “blocks the door”
20
Q
Posterior elbow splint
A
Positions elbow 90° of flexion
- Trough of splint is placed along posterior surface of upper arm & ulnar surface of forearm
- Used for: MCL/LCL injury or elbow fx
21
Q
Anterior elbow splint use
A
Used in case of a burn to dorsal aspect of forearm
22
Q
Mallet/DIP extension splint
A
Corrects mallet deformity, used for injury of extension tendon to DIP
- immobilize in full extension 6-8 weeks
23
Q
Oval 8 splint
A
Used for: Boutonniere deformity (finger looks like this when u press a button too hard) OR Swan neck deformity (inverse of Boutonniere), depending on position of splint
- can be used for arthritis
24
Q
What orthosis is best for inhibiting/normalizing tone?
A
Saebostretch dynamic resting hand orthosis (for minimal to moderate tone)
25
Mnemonic for when to AVOID using PAMs
CVS: Communication/cognition
Vasular Function (inc. Cardiac conditions)
Sensation
26
When to use heat w/ injury
NON-ACUTE swelling (after 24-48 hrs)
- OK for generalized swelling but NOT edema
27
ROM after heat precautions
Be extra gentle w/ PROM
28
Benefits of fluidotherapy vs paraffin/hot pack
Allows for motor tasks during heating & provides sensory component
*Higher heat tolerated d/t. barrier & material
29
Continuous wave US
Improves blood flow, stretch, pain, muscle spasms
30
Pulsed wave US
Improved healing of tendons/ligaments & bone, decreased inflammation
31
3 stages of healing
Inflammation - avoid infection (a few days)
Proliferation - forming scar tissue (a few weeks 2-8, 6 common)
Maturation - scar formation (a few months to years)
32
What types of conditions is cold contraindicated?
Vascular conditions
- ex: Raynaud's
33
When to use cold w/ injury?
ACUTE injury (first 24-48 hours)
34
NMES & FES e-stim
For exercise & functional use; used for muscle injury
35
High Volt Pulsed Current (HVPC) e-stim
Edema, pain, healing, small muscle re-ed
36
TENs
STRICTLY for pain management, best for acute pain, used for nerve stimulation
37
Best PAM for arthritis
Paraffin
38
Best PAM for trigger points
TENs
39
Best PAM for edema
Cold, contrast bath
40
Best PAM for CRPS
Fluidotherapy
41
Edema deformity
Intrinsic Minus + Loss of metacarpal arch
42
Edema interventions
*You can get edema after a MASTECCTomy
M: Manual edema mobilization (requires special training)
A: AROM
S: Splint (anti-deformity)
T: Taping
E: Elevation
C: Compression
C: Cryotherapy
T: Think! Consider cancer, open wound, DVT, etc.
43
Standard ROM Progression
Immobilization --> AROM --> PROM --> resistance
44
Where to start w/ exercise post-injury?
Isometrics, low weight high reps
45
Muscle contraction grading
Isometric --> Eccentric --> Concentric
46
Eval Mnemonic
Eval physical & Functional your NEW SPORC
47
Common UE function assessment
DASH/Quick DASH
48
If digit AROM is less than PROM
Weakness or Adhesion
49
If digit AROM = PROM, and wrist positions does NOT affect it
Joint stiffness/contracture
50
If digit AROM = PROM and wrist position DOES affect it
Extrinsic issues (tightness, adhesions, etc.)
51
If digit AROM = PROM and MP positions DOES affect it
Intrinsic issues
52
5 steps of Contracture tx
1: Superficial & deep heat
2: Slow stretch
3: Static splinting
4: Serial/progressive static splinting
5: Dynamic splinting
53
What structures surround the thoracic outlet & what vasculature/nerves run through it?
Structure: between clavicle & 1st rib
Vasculature: Subclavian artery & vein; brachial plexus
54
What body positioning worsens TOS & brachial plexopathy symptoms & why?
Overhead movements & poor posture as it compresses the thoracic outlet
55
Brachial plexopathy/TOS interventions
Key: Give it space & keep it mobile
- Strengthen scapular elevators to improve posture, avoid most other exercises
- Nerve glides & stretching (AVOID SCAPULAR DEPRESSION STRETCH)
- Sleep on back to avoid compression
- Diaphragmatic breathing (less chest compression)
- Visual feedback exercises to facilitate scapular prop
56
Blanching on splint
BAD can cause more damage
57
Erb's palsy (Erb Duchenne)
Upper brachial plexus injury affecting arm from shoulder down
- think Waiter's tip
- "The nerd Erb always raises his hand in class"
58
Klumpke's palsy
Lower brachial plexus injury, claw hand appearance; can affect more of arm but most pronounced in hand
- "Can't hold your keys w/ Klumpke's"
59
What movement is common to see w/ a proximal humerus fx?
Compensation via shoulder hiking w/ early scapular rotation/elevation
60
Proximal humerus fx protocol
Immobilize w/ sling --> PROM when cleared (pendulum swings, towel glides, etc. ) --> AROM (focus on scapulohumeral rhythm)
61
Adhesive Capsulitis intervention
Avoid OVER stretching (don't wait bc causes inflammation), encourage pain free ROM until it thaws on its own
- Educate pt on compensatory strategies & environmental mods
62
2 types of GH Instability
TUBS & AMBRI
TUBS: Traumatic, uni-directional instability, bankart lesion, SLAP lesion, surgery required (Torn loose)
AMBRI: atraumatic, multi-directional instability, bilateral, rehab, inferior shift (Already loose)
63
Bankart Lesion
Damage to GH capsule associated w/ GHJ TUBS instability (requires surgery after non-surgical attempts)
64
SLAP Lesion
Superior Labrum anterior to posterior associated w/ GHJ TUBS instability (requires surgery after non-surgical attempt)
65
GHJ instability intervention
Start w/ isometrics in neutral positions
- Anterior instability: internal rotators & adductors (subscap, pec major, lats, teres major, anterior delt) ti pull it back into place
- Global instability: all muscles of RTC
66
RTC testing
- Empty can: pouring out an empty can --> tear
- Hawkins Kennedy: flapping wings like a hawk --> impingement
- Neers Impingement: shoulder is NEERest (nearest) joint of arm --> impingement
- Drop arm: tear
67
RTC Disease intervention
Early rom (pendulums, A/AROM, isometrics)
- strengthen healthy partsB
68
Biceps speed test
Tests biceps tendon for weakness/tendinopathy
- Not part of RTC but may be grouped together as answer choice
69
Joints commonly affected by OA
DIPs, PIPs, CMC
70
Joints commonly affected by RA
Carpals, MPs, CMC
71
Joint that can be affected by either RA or OA
CMC
72
CMC/Basal joint OA deformity
Dorsal sublux of CMC, leads to mallet finger or boutinniere deformity
73
Common RA deformities of the hand
- Boutonniere (thumb) & Swan neck (digits 2-5)
- Ulnar drift (at level of MPs)
- Radial wrist sublux
- Mutilans deformity
*Always address MOST proximal deformity first
74
RA Pams
Think RA "Really Anything"
- responds to a variety of PAMs including heat, cold, and TENs depending on disease state
- *HEAT contraindicated during a FLARE UP (acute phase), COLD contraindicated in subacute phase
75
OA PAMs
Responds best to HEAT, for both pain & ROM
- avoid COLD
76
OA assessment
Bunnell-littler (measures PIP joint flexion while MCP joints moves from flex/extend)
77
Consider this PAM for arthritis, stiffness & HEALED burns
PARAFFIN
78
Arthritis intervention
Main approach --> Joint Protection (activity mod/avoidance to reduce inflammation)
- Can return to modified version of prior occupations once joints are healthier & less inflamed
- Aerobic activity & isometric/isotonic exercise within pain free range/aquatic exercise, yoga/tai chi (but not during an RA flare up)
79
Juvenile RA recommendations during a flare up
Recommended: AROM
NOT recommended: resistive exercise, taping program (unless there's a comorbid condition), pacing program (also unless comorbid)
80
RA contraindicated interventions
- progressive resistance
- isotonic exercise is controversial --> must be established that joints are stable & would benefit from isotonic exercise w/o compromising other joints
81
Bouchards & Herberderns Nodes
OA Nodes
- Bouchard: PIP
- Herberderns: DIP
82
RA joint protection (compensatory & AE)
Compensatory: Utilize larger (more proximal) joints, use both hands to spread force
AE: Built-up handles, dycem to open jars or other jar openers
83
Contraindicated exercises for osteoporosis
Vigorous aerobics
Twisting/bendin
AB machines
Bicep curl machines
Rowing machine (erg)
Tennis
Golf
Bowling
84
Flexor Carpi Ulnaris Actions
Flex wrist, ulnar deviation
85
Flexor digitorum Superficialis (FDS)
Flexes up to PIP & FDS splits & stops at PIP
86
Flexor Digitorum Profundus (FDP)
Flexes to DIP
- Profundus: profound --> deep --> FDP --> P passes through PIP to DIP
87
Extensor Carpi Radialis Brevis action
Extend wrist, radial deviation
88
Extensor digitorum
extends digits
89
Extensor digiti minimi
extends little finger
90
Extensor Carpi Ulnaris Action
extend wrist, ulnar deviation
91
extensor indicies action
extends index finger
92
flexor policis longus/brevis action
flex thumb
93
extensor policis longus/brevis
extends thumb
94
ABductor policis longus
ABduct thumb
95
Adductor policis
ADduct thumb
96
Opponens policis
Opposition of thumb
97
Supinator
supinates forearm
98
Pronator teres
Pronates forearm & flexes elbow
99
Pronator Quadratus
Pronate forearm
100
Anconeous
elbow extension
101
Brachiradialis action
Elbow flex
102
Extensor tendon zones
I: distal to IP
II: middle phalanx
III: PIP joint
IV: proximal phalanx
V: MP joint
VI: dorsum of hand, MCPs, carpals
VII: extensor retinaculu,,
VIII: forearm
*Thumbs zones names T1-T5 going distal --> proximal
103
What spine levesl are associated w/ Brachial Plexus>
C5, C6, C7, C8, T1
104
Serial static splinting
Static splint applies constant pressure, once more ROM is required, upgrade to a new splint until full ROM achieved
105
Volumetry
Method of edema measurement, best option but occasionally contraindicated (open wound, burn)
- involves dunking hand in water & measuring change & often done before & after intervention
106
Figure 8 & circumferential measurement
Alt method of edema measurement that has issues w/ consistency
107
Most if not all PAMs should NOT be applied to somewhere ...
Something abnormal is happening like wounds, cancer, or pregnancy
108
Go to CVA to get PAMs
Cognition
Vascular
Sensation
*When to avoid PAMs
109
Distal radius FX cause
Most commonly from FOOSH (aka Colles' fx), can also be from a fall on flexed wrist (Smith fx)
110
Non-displaced forearm fx protocol
Long arm sling for 1st week, emphasis on elbow extension
111
Closely associated PAM for Arthritis, especially OA
Paraffin
112
Closely associated PAM for Trigger points
TENs
113
Closely associated PAM for Edema & Acute injury
Cold
114
Closely associated PAM for CRPS
Fluidotherapy
115
Elbow fx protocol
Immobilzie for 1 wk
Early A/AROM
Edema/pain management
Strengthening after 8-12 weeks
116
Proximal humerus fx protocol
1 part fx: immobilize for 1-3 wks
2-4 parts fx: immobilize for 4-6 wks
Non-op: immobilize 2 wks
Immobilize --> PROM --> AROM --> Resistive exercise (after 8-12 weeks)
117
Standard mobility progression
Post immobilization!
AROM --> PROM --> Resistance
118
Wrist fx protocol + splint
"Wrists are routine": move what you can while casted (tendon glides!) then follow standard ROM
- rarely referred to OT during acute stage but would splint in wrist cock-up in 30° extension
119
Proliferation stage of healing for BONE
4 to 6 weeks
120
Elbow collateral ligaments positions of stretch/relaxation
Stretched in extension & Relaxed in flexion
121
Hand fx splint position
Intrinsic plus/Anti-deformity position
122
MCP fx immobilization position & splint
For a proximal phalange, MCP, or metacarpal fx --> immobilize MCP in 70°-90° flexion
- Radial or ulnar gutter splint (can be either hand or forearm-based depending on placement of fx)
123
Boxer's fx splint
Fx of 5th digit metacarpal & uses a ulnar gutter splint
124
PIP fx immobilization splint
Full finger extension splint (MCP free) w/ a buddy finger
125
DIP immobilization splint
Clamshell or DIP extension splint
126
Thumb MP fx splint
Can just include MP but if pt is more active should include CMC
- thumb spica splint
127
Valgus deformity
ValGUNs --> Guy holding a gun in flexion/ER (valgus deformity plane)
Michael (MCL) & GUS loves guns --> MCL tear leads to valgus
128
Varus deformity
Lucille (LCL) has her hands in her lap next to RUSs like a real lady --> LCL tear leads to varus
129
What type of splint for an elbow fx or elbow collateral ligament tear?
Posterior elbow splint or a sling to hold in 90° flex
130
Elbow collateral ligament ROM progression: AROM
Begin w/ AROM, position pt lying supine w/ shoulder flexed to 90° & forearm pronated for LCL (most common)/ Supinated for MCL
* think Egyptian elbow
131
Elbow intervention if progress plateaus
Static progressive or serial static splint
132
Mallet finger
DIP flexion deformity
133
Boutonniere deformity
Flexion of PIP & hyperextension of DIP --> position of finger when u press down too hard on a button d/t lengthening or rupture of central slip of EDC tendons
134
Pitting edema
pressing a finger leaves an indentation that takes time to refill
135
Non-pitting edema
Hard to touch, skin often thicker & discolored from proteins
136
Lymphedema
Edema d/t poor lymphatic function & typically incurable but manageable
137
Swan neck deformity
Hyperextension of PIP & flexion of DIP --> looks like a swan neck d/t rupture of lateral slip EDC & FDS tendons
138
Proliferation stage of healing for TENDONS
6-8 weeks
139
Finger deformity splinting
Splint in anti-deformity position DAY & NIGHT for 6-8 weeks
140
Mallet finger splint
DIP extension splint, cap, or clamshell
141
Tinel's sign
Tapping along ulnar nerve to elicit response, + could indicate nerve compression, i.e. carpal tunnel
142
O'riain Winkle test
Keep hand submerged in water to test if wrinkle response is in tact, if not indicates nerve damage
143
Radial nerve motor function
Elbow, wrist, and MP extension, forearm supination
144
Names for radial nerve injuries at different levels
Crutch palsy: Axilla
Saturday night/Radial palsy: mid humerus
Radial tunnel syndrome: elbow, felt along lateral forearm
PINS: posterior interossesous nerve syndrome (forearm)
145
Radial nerve sensory function
Sensation to posterior/lateral arm & posterior forearm, hand, and most digits 1-3 & 1/2 of digit 4
146
Common functional issues associated w/ radial nerve injury
Wrist drop, loss of FMC/grip strength, posterior arm parasthesia/aching pain
147
Radial nerve injury splinting
Most commonly wrist cock-up splint w/ wrist in SLIGHT EXTENSION or elbow flexion/supination orthosis
- common to use dynamic extension later on
148
Radial tunnel syndrome splint
Long arm splint w/ elbow flexed, forearm supinated, wrist in neutral ~30° extension
149
PINS splint
PINS: weakness/paralysis of ulnar wrist extension, digit extension, and thumb extension/radial abduction
- splint in elbow flexion, forearm supination, and wrist extension
150
Ulnar nerve functions
Ulnar wrist/digits 4*-5 flexions & lumbricals & FMC
- sensation to medial half of palm, digit 5 and 1/2 of digit 4
151
Names for Ulnar nerve injuries
Cubital tunnel: medial elbow
Guyon's/ulnar canal: ulnar anterior wrist (next to carpal tunnel)
CUbital + GUyon = U for Ulnar
152
Common functional issues associated w/ ulnar nerve injury
Diminished grip strength, key pinch, loss of ability to hold objects in hand (frequent dropping of objects)
"Claw is key"
153
Edema compression contradindications
DVT, severe cardiovascular concerns, peripheral neuropathy & active TB
154
Froment's sign
Hold paper in lateral pinch & pull, have pt try to hold paper in place
If paper slips out = + sign of ulnar nerve injury (typically cubital tunnel)
ulNAUR this paper is froMEANT for me (give it back!)
155
Cubital tunnel syndrome & splint
Ulnar nerve compression at elbow, symptoms worsen w/ elbow flexion
- paresthesia/weakness down forearm/hand
- may also experience discomfort w/ extension
Splint: elbow extension (or near extension in 30°-70° flexion) w/ forearm & wrist in neutral
156
Double crush syndrome
Occurs when a peripheral nerve is entrapped in more than 1 location
- treat each nerve injury individually, avoid painful movements, nerve glides!
157
PAM for edema
COLD!
158
Guyon canal compression/ulnar canal syndrome & splint
Sensory loss to palmar ulnar hand, weakness of intrinsic ulnar innervated muscles
- anti-claw splint
159
Wartenberg's sign
Involuntary ABduction of 5th digit indicates ulnar nerve injury
- kind of makes a "W", other digits wanna know WHY its further away
160
Ulnar nerve injury splinting
Common tx is using a NIGHTtime splint to limit elbow flexion for cubital tunnel & excessive wrist flexion for Guyon's canal
- elbow/slight wrist extension splints
161
Median nerve motor & sensory functions
Radial wrist/digits 1-3* & Lumbcricals & Thenar (thumb opposition) & forearm PRONATION
- sensation to digits 1-3 & 1/2 of digit 4
162
Names for median nerve injuries
Pronator syndrome: anterior forearm
AIN (anterior interosseous) syndrome: anterior forearm
Carpal tunnel: wrist
163
isometric
No motion, hold in place
164
Eccentric contraction
Holding resistance then lowering
- lengthening of muscle/lowering to ground
- going down from a bicep curl
Opposite of what weight lifters do
165
Concentric contraction
Lift against gravity & muscle shortens
- think going up for bicep curl
"Cool"; what weight lifters do
166
Pronator syndrome & splint
Deep pain in forearm w/ activity, sometimes sensory involvement but negative tinels
- splint in 90° elbow flexion forearm & WRIST NEUTRAL
167
AIN syndrome & spint
Anterior interosseous syndrome: deep ache in proximal, weakness of digits 1-3 flexion, no sensory symptoms (negative tinels)
- splint in 90° elbow flexion, forearm & wrist neutral
-sometimes splint thumb & index IP in flexion
168
AROM is
Internal inesnion/force onlyP
169
PROM is
external tension/force
170
Resistance is
increased external tension/force
171
Carpal tunnel syndrome & splint
CTS: compression of median nerve at wrist
- causes paresthesia of palm & digits 1-3 & 1/2 digit 4 that can radiate up arm, weak grip, and impaired FMC/opposition, edema, sensitivity to cold/touch
- Splint w/ WRIST IN NEUTRAL
172
Common functional issues associated w/ median nerve injury
Loss of 3 pt pinch (3 jaw chuck), diminished grasp, diminished thumb opposition, thenar muscle wasting
173
APE hand deformity splint
Non-op: Static thenar web spacer splint
Post-OP: dorsal wrist block splint 4-6 weeks
174
Moberg pick up test
Recall: need to pick up coins to pay for Mo burgers
Moberg --> Median
175
Carpal compression test
Applying direct pressure over carpal tunnels for 30 secs
176
Grading resistance: Good places to start w/ exercises
Isometric contractions
Low weight high reps
Slow, controlled movements
177
Grading resistance: Goals to work towards w/ exercise
Eccentric & then concentric contractions
Higher weight
178
Phalen's sign
Put hands into upside down prayer position & if there's tingling = carpal tunnel (median nerve compression)
*Phalen's = failing to pray
179
Median nerve injury splinting
Most commonly wrist cock-up w/ wrist in NEUTRAL
180
Sign of Benediction
Median nerve injury sign
- may look similar to ulnar claw, however occurs when trying to FLEX digits
- occurs more in proximal median nerve injuries like forearm & above
181
APE hand
sign of a median nerve injury
182
Nerve glides for nerve injuries
Do NOT want to put in position of maximal stretch like normally b/c nerve glides can delay healing, keep it proximal position wise w/ more slack
183
FIRST thing to consider w/ nerve injuries
EMPHASIZE PROTECTIVE SENSATION, then discriminatory sensation
184
Typical grip test
Using the second handle setting w/ 3 trials per side, alternating sides each test
185
5 level grip test
Used to determine max/consistent effort v. submax/faked effort, should expect strongest grip on 2nd or 3rd handle settings
- have pt complete 1 trial on each of the 5 handle settings
186
Rapid exchange grip testing
Used to determine max/consistent vs submax/faked effort
- have pt perform rapid exchange btw Left & right hands for a total of 10 trials per hand
- static grip strength should be 15% higher
187
High risk for CRPS
Post UE injury or stroke
188
CRPS intervention mnemonic
C: Calm (CBT/relaxation)
R: Reflection (mirror therapy)
PS: Progressive stimulation (desensitization, should NOT be painful)
189
Other CRPS interventions
*CRPS IS FLUID & STRESS
Fluidotherapy (primary PAM used)
Stress loading: push & pull forces on UE w/ minimal joint movement, think scrubbing & carrying tasks
type 1 CRPS: includes AROM & functional activities that promote weight bearing
190
Lateral epicondylitis/epicondylosis
aka Tennis elbow
- painful EXTENSOR tendons at lateral elbow, painful to touch & w/ use, results in decreased grip strength
191
Lateral epicondylitis tests
Mills' test
Maudsley's test
Cozen's test
"Showed up LATE to Maudsley's Cozy Mill"
192
Medial epicondylitis
aka Golfer's elbow
- painful FLEXOR tendons (also involved w/ pronation) at medial elbow, painful to touch & w/ use, decreased grip strength
193
De quervain Tenosynovitis & assessments used & splint
D/t inflammation of APL & EPB
Assessment: Finkelstein's test "I FINK you did a great job deKevin"
Splint: forearm based thumb spica w/ wrist in NEUTRAL & thumb in opposition
194
Trigger finger (aka digital stenosing tenosynovitis)
Inflamed tendon or tendon sheath gets caught in A1 pulley
195
Tendinopathy intervention mnemonic
Tendinosis OASIS
Orthotic
Activity mod
Stretch
Ice
Strengthening
196
Lateral epicondylosis OASIS
O: wrist cock-up in 35° extension or forearm band
A: avoid painful movements & mod activities
S: focus on Total End Range Time (TERT), pain free ROM
I: ice as needed for pain relief b/c ice = good for tendons
S: implement later & start w/ eccentric
(similar for medial epicondylosis except for splint)
197
Eval: the most functional utensil - the SPORC
Think about how the pt functions
S: strength
P: pain
O: occupations/tasks
R: ROM
C: coordination
198
Medial epicondylosis OASIS
O: wrist cock-up in NEUTRAL or forearm band
A: avoid painful moves & modify activities
S: focus on TERT & pain free ROM
I: ice as needed
S: implement later & start w/ eccentric
(similar to lateral epi except for splint is in slight extension NOT neutral)
199
De Quervains OASIS
O: forearm based thumb spica
A: avoid prolonged pressure/repetitive movements
S: AROM & PROM, tendon glides
I: ice as needed
S: implement later & start w/ isometric
200
Trigger finger OASIS
O: MP extension/volar blocking splint for 6-10 weeks DAY & NIGHT
A: avoid pain/nodule getting stuck
S: AROM/PROM a few times daily & can remove splint
I: as needed
S: less relevant
201
Extensor tendon zones grouped
1 & 2: DIP, distal finger
3 & 4: PIP, proximal finger
5, 6, & 7: MP, dorsal hand, wrist
8: forearm
202
Tendon repair ROM: standard v. tension limiting mobility progression
Immobilize --> PROM --> AROM
*d/t PROM puts less tension on tendon than AROM does
- physician will choose whether to follow standard or tension limiting & may even go straight ROM
203
Extensor zones 1 & 2 injury & protocol
Mallet finger --> immobilize from MP to DIP until cleared for ROM
204
Extensor zones besides 1 & 2 phases & timeline
Early phase: immediately post-op for 4 weeks
Intermediate phase: 4-8 weeks
Late phase: 8-12 weeks
205
Extensor zones 3 & 4 injury & protocol
Involves PIP --> physician chooses protocol (immobilize, early PROM or AROM)
Immobilize: finger length PIP & DIP extension splints full time for 3-4 weeks post-op
Early PROM: dynamic extension outrigger w/ volar block, active flexion up to 30°, passive extension only
Early AROM = set of 3 static splints, (1) for immobilize, (2) for partial PIP flexion worn during extension exercise, and (3) for in PIP flexion worn during DIP flexion exercise
206
Intervention in intermediate phase of extensor tendon zones 3-4 repair?
Discontinue use of static splint, begin ROM of individual joints, advance to composite flexion week 5 & can begin to use heat only if there's no edema
207
Extensor zones 5, 6, & 7 injury & protocol
Involves area between MCPs & wrist --> physician chooses protocol (immobilize, early PROM or AROM)
Immobilize: full length hand extension like a pan splint for around ~4 weeks
Early PROM: dynamic splint for active flexion, passive extension (similar to zones 3 & 4 but more focus on movment)
Early AROM = same as PROM but some AROM done during therapy
208
Interventions in intermediate phase of extensor tendon zones 5-7 repair?
Orthosis used only during work/heavy activity, start use of PAMs, individual joint ROM at 4 weeks composite flexion at 5-6 weeks
209
Interventions for weeks 8-12 (late phase) for extensor tendon repair for zones 5, 6, 7?
Stretch, PROM & AROM of individual joints, blocking exercises, composite flexion, grip stretching, use of progressive/dynamic orthoses
210
Flexor tendon zones
5 zones, use hand to remember
5 flexor
211
Flexor tendon repair approaches
Differs by "strand/thread" (sutures) counted
More sutures = more stable - earlier ROM
212
Flexor tendon damage complications
Typically nerve involvement, wrist flexion & deviation impacted, edema, PIP flexion contracture
213
Flexor tendon repair immobilization
- Dorsal block splint in anti-deformity position
- immobilization only approach
- typically only for dementia or pediatric pt's
214
Flexor tendon repair early PROM approach
For dorsal block splint holding wrist & MP in flexion & IP in extension
- actively extend (to blocking point) & therapist helps to passively flex, initiated 3-4 days post-2 strand repair
- tendon glides after 2 weeks
- early AROM after 3-4 weeks (including composite flexion & blocking)
215
Flexor tendon repair early PROM approach
Uses dorsal block splint most of the time & separate splint w/ wrist extension for gentle active flexion
- start w/ active IP extension & place & hold active finger flexion
216
Flexor tendon early AROM apporaach
- Uses dorsal block splint most of time
- Separate splint w/ wrist extension for gentle active flexion
- start w/ active IP extension & place & hold active finger flexion
217
Flexor tendon early AROM exercised from LEAST to most force
Passive flexion & protected extension
- Place & hold in flexion
- active composite flexion
- hook & straight fist
- isolated joint blocking
- resisted composite fist
- resisted joint blocking
218
Flexor tendon PAMs
Heat & NMEs
219
Dupuytren's contracture
Progressive contracture of palmar fascia into MP & sometimes PIP flexion, typically 4th & 5th digits
220
Dupuytren's contracture post-op ROM progression
Immediate AROM & PROM that can be relatively aggressive w/ mobilizing
*Avoid strenuous activity until healed (6 wks post-op)
221
Post-op Dupuytren's contracture splint
MP extension slightly at night & if necessary during day splint would include PIP if involved
222
Dupuytren's contracture intervention
- scar massage
- ROM
- soft tissue mobilization
- ultrasound
- stretch w/ heat
223
Specific thumb injuries
Bennett's fx: base of thumb (1st metacarpal) near CMC
Skier's thumb: torn thumb ligament
224
Progression of sensory recovery (Note: NOT same as desensitization)
Pain perception --> Vibration --> Moving touch --> Constant touch
225
Cumulative trauma disorder grades
I: pain after activity resolves quick
II: pain during activity resolves after
III: pain persists after activity & limits work productivity
IV: activity limited 50%-75%
V: unrelenting pain, unable to work
226
Acute cumulative trauma disorder interventions
- static splinting
- ice
- constrast baths
- ultrasound
- iontophoresis
- HVES
- interferential stimulation
227
Subacute cumulative trauma disorder interventions
- slow stretch
- myofascial release
- progressive resistive exercises
- body mechanics
- identifying triggers
- return to work
- functional capacity eval
- work hardening
NBCOT
flashcards
Decks in class (14)
# Cards
-
NBCOT109
-
UE227
-
Wheelchairs, Community Mobility, Driving, and Work Rehab52
-
Mental Healthcare & Acute Care52
-
Pediatrics0
-
Neuro0
-
NBCOT Formula 450237
-
Grasp patterns & In-hand manipulation17
-
Cardiopulmonary14
-
Practice Q's58
-
Miscellaneous0
-
COTA, ADA, Supervision, Core concepts, Assessments & FOR0
-
Research, Pain, Wounds, Vision72
-
Ortho, Amputations & Burns50
