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2) Patho 2 > 8) Elbow & Hands > Flashcards

8) Elbow & Hands Flashcards

1
Q

What is critical to healing & what is not?

A

Inflammation is critical; Edema is not

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2
Q

Inflammation causes the release of what, and what does this cause?

A

Chemotactic factors (histamine, prostoglandins, bradykinin, substance P, complements, etc)

*Causes vasodilation

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3
Q

Vasodilation does what?

A

*Incr interstitial fluid & macrophages & activates fibroblasts–> blocks venous & lymphatic drainage

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4
Q

What is chronic inflammation characterized by?

A

Exuberant fibrous tissue, loss of tissue elasticity, & scaring

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5
Q

What are the physical therapy gremlins?

A

Edema & pain

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6
Q

Why does edema cause pain?

A

It compresses nerves

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7
Q

Does pain always occur at the location the pt feels it?

A

No, it occurs in the cortex

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8
Q

What is common for a pt to have after surgery?

A

Adhesions

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9
Q

How many days post-op does scar tissue start to form?

A

11 days

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10
Q

What is good about a splint?

A

It allows for PROM, but no AROM, so pt can move w/out putting stress on their tendons

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11
Q

Does a pt need to be in a splint during the fibroplastic stage?

A

No

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12
Q

What should be avoided in the fibroplastic stage?

A

Forceful grip

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13
Q

Why does the Tinel’s sign work?

A

*

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14
Q

Tinel’s Sign

A

Test for carpal tunnel syndrome where percussion over the irritated area of a damaged peripheral nerve elicits distal electrical sensation to tell you the location of nerve damage

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15
Q

Phalen’s Test

A

Tests for median nerve compression by reproducing tingling at fingers

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16
Q

Tx for carpal tunnel syndrome

A
  • Modify activities & the workplace
  • Avoid wrist flexion
  • Brace/splint for protection
  • Rest from repetitive activity
  • Pt ed
  • US
  • Tendon gliding exercises
  • Steroid injections
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17
Q

What are the indications for surgical management of carpal tunnel syndrome?

A
  • Sensory/motor deficits
  • Persistant pain
  • Sx’s despite supportive care
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18
Q

What are the post-op complications of carpal tunnel surgery?

A

Hypersensitivity/Hypertrophy

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19
Q

DeQuervain’s Tenosynovitis

A

Entrapped & inflamed tenosynovium of the thumb’s extensor tendons at the wrist

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20
Q

Sx’s of DeQuervain’s tenosynovitis

A
  • Tenderness at the 1st dorsal compartment of the wrist

* (+) Finkelstein’s Test

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21
Q

What is a requirement for a pt to have DeQuervain’s tenosynovitis?

A

Pt should not have jt pathology or nerve dysfxn

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22
Q

Fx for DeQuervain’s tenosynovitis

A
  • Rest w/temporary exercise modification
  • Heat & anti-inflammatory modalities
  • Protective splint to relax tendons
  • Steroid iontophoresis or injection
  • Surgical release of extensor compartment for chronic/unresponsive cases
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23
Q

What PA is great for DeQuervain’s tenosynovitis?

A

Phonophoresis

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24
Q

How many days does Ca2+ deposition begin post-fx?

A

21

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25
Q

What is the surgical tx for wrist & hand fx’s?

A

Pinning & InFix

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26
Q

What is the benefit to pinning & InFix of of hand & wrist fx’s?

A
  • Allows for early, controlled mobilization of uninvolved jt’s
  • Maintains fx position
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27
Q

Does pinning & fixation of wrist & hand fx always completely stabilize the bone fragments?

A

No

28
Q

What does ExFix of wrist & hand fx allow for?

A

Immediate skin care, edema care, & jt mobilization bc the pt won’t need a cast

29
Q

What does InFix of the distal radius allow for?

A

Early jt motion

30
Q

Will a pt need a cast w/an InFix?

A

No, but they should still have a splint for protection

31
Q

When can you start AROM after an InFix?

A

Immediately

32
Q

What structure actually causes the pain of a fx?

A

Periosteum

33
Q

What carpal bone is the most commonly fx’ed?

A

Scaphoid

34
Q

Why do pt’s w/pain for >2yrs have a very hard time getting rid of their pain?

A

Bc the brain has gotten used to the pain stimulus

35
Q

Colle’s Fx

A

Fx of the distal radius, usually dorsally displaced

36
Q

What is the most common fx in adults?

A

Colle’s Fx

37
Q

What does a colle’s fx require PT for?

A
  • Wrist stiffness
  • pain
  • persistent swelling
  • weakness
  • post-traumatic OA
38
Q

Do most wrist ligament tears respond well to rest & rehab?

A

Yes

39
Q

Where do 90% of wrist sprains occur & why is this so bad?

A

*Occur at the scaphoid-lunate ligament–>Bade bc it doesn’t heal which causes instability & makes pt prone to subluxation

40
Q

Sx’s of wrist sprain

A
  • Persistant pain
  • clicking
  • shifting sensation
  • tenderness w/palpation
41
Q

What is basilar jt OA?

A

OA of the CMC jt of the thumb

42
Q

What pt pop is basilar jt OA most common in?

A

Middle-aged women

43
Q

Describe the surgery done for basilar jt OA

A

Trapezium is removed, clean out osteophytes, & then sometimes a piece of tendon is coiled up to use as a spacer & shock absorber

44
Q

What is the fxnl purpose of the elbow?

A

To position & propel the hand in space

45
Q

Full ROM of elbow

A

0-145

46
Q

Fxnl ROM of elbow

A

30-130

47
Q

Where does 50% of hand strength come from?

A

Forearm muscles

48
Q

Forearm muscles provide what percent of hand strength?

A

50%

49
Q

What do forearm fx’s in adults require & why?

A

Surgical fixation & early controlled mobilization bc they won’t regain their ROM like kids do

50
Q

What is the most common injury as the result of falling on an outstretched hand?

A

Radial head fx

51
Q

What will be limited if an articular jt fx heals displaced?

A

Elbow flexion, extension, pronation, & supination

*Can also cause OA

52
Q

When can you allow controlled AROM in GA after radial head fx?

A

As soon as pain & fx stability allow

53
Q

What does controlled motion after radial head fx help to prevent?

A

Capsular adhesions & contractures

54
Q

Sx’s of lateral epicondylitis

A

Pain & tenderness at lateral epicondyle & elbow ache w/activity

55
Q

In a pt w/lateral epicondylitis, what reproduces pain?

A

Resisted elbow & wrist extension

56
Q

Will a pt w/lateral epicondylitis have normal ROM?

A

Yes

57
Q

Tx for lateral epicondylitis

A
  • Modify/stop aggravating activity
  • No splint for elbow, although can splint wrist
  • Modalities for pain & inflammation
58
Q

What is RA?

A

Autoimmune disease that causes jt ankylosis, which affects ADL’s

59
Q

What is key for RA tx?

A

Early recognition of jt swelling & decr ROM

60
Q

What can prevent further destruction w/RA?

A

Aggressive care of jt inflammation flare-ups

61
Q

What is the first stage of tissue response to injury & how long does this last?

A

Inflammation & edema; Lasts 3 wks

62
Q

True or False: When scar tissue starts to form, its very thin & has little tensile strength.

A

True

63
Q

Why do you need to be careful w/muscle contractions after surgery?

A

It can rip the stitches.

64
Q

Can PRE’s be done during the fibroplastic stage?

A

Yes but w/caution

65
Q

What does Tinel’s sign tell you?

A

Where the nerve has been damaged

2) Patho 2 (20 decks)

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