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NBCOT Study Guide > AOTA Hand and UE > Flashcards

AOTA Hand and UE Flashcards

1
Q

describe the evlauation of the hand and UE

A

establish rappot
observe posture, use of UE and hand
use gentle approahc to palpation to check for pain, adhesions, and edema
specific testing including ROM, strength, sensation, vascularity and coordination
interview about pain, splints, functional use
measure outcomes using DASH

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2
Q

what are the different types of fractures that can occur in the hand?

A

proximal fracture
carpal fracture - most common is scaphoid
avulsion injuries - when tendons separate from bone; include mallet finger, boutonniere deformity, and swan neck deformity

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3
Q

what are the three phases of fracture healing?

A

inflammation
repair
remodeling

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4
Q

how do you evaluate fractures of the hand or UE

A

visual exam/observation, client interview
sensory assessment
motion assessment
strength assessed using dynamomter and punch gauge
occupational performance
outcomes assessed using DASH

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5
Q

what are some interventions used for UE/hand fractures

A

orthotic fabrications
modalities
therapeutic exercises
home programs

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6
Q

what are the types of wrist fractures

A

colles fracture - distal radius fx with dorsal displacement, most common

smith fracture - distal radius fx with palmar displacement

benents fx - fracture of first metacarpal base

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7
Q

what nerve injuries are associated with wrist fractures

A

median nerve injury - carpal tunnel-esqe symptoms with generalized weakness and pain

ulnar nerve injury - results in julnar claw deformity and numbness of ulnar side of the hand

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8
Q

what interventions are used with wrist fractures

A 
ROM in early phases
orthotics
home programs
exercises
modalities
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9
Q

what are the three types of forearm fractures

A

type 1 - nondisplaced; tx with long arm sling

type 2 - displaced with single fragment; treated nonperatively with immobilization.

type 3 - comminuted; treated operatively with immobilization and early motion within first postoperative week

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10
Q

what interventions are used for forearm fractures

A

orthotics
ROM
sling

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11
Q

what interventions are used for arm fractures

A

orthotics
ROM as soon as 2 weeks for nonoperative
sling for immobilization

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12
Q

define CRPS

A

pain disproportionate to an injury that is either sympatheticall maintained or independent of sympathetic nervous system

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13
Q

what are the two types of CRPS

A

type 1 - devleoped after noxious event

type 2 - developed after nerve injury

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14
Q

what are the symptoms of CRPS

A 
allodynia
hyperalgia
hyperpathia
edema
contractures
bluish or red shiny skin
abnormal sweating and hair growth
muscle spasms
decreased strength
low tolerance for activity
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15
Q

how can you treat CRPS?

A 
stellate or sympathetic block
intrathecal analgesia
removal of neuroma
installation of spinal cord sitmulator
installation of peripoheral nerve stimulator
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16
Q

what are some OT interventions used for CRPS

A 
gentle, pain free AROM
stress loading
pain control tehcniques
edema control techniques
desensistzation
blocked exercuises, tendon gliding
joint protection
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17
Q

define cumulative trauma disorder

A

trauma to soft tissue caused by repeated force; overuse syndrome

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18
Q

what are the different diagnoses that can occur because of overuse?

A 
tendinitis
myofascial pain
cervical, thoraccic, and limbar oseteoarthrisits
TOS
rotator cuff tear
bursitis
epicondylitisis
cubital tunnel syndrome
carpla tunnel syndrome
de quervain syndrome
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19
Q

what are the work-related factors for overuse syndrome?

A

repetition, high force, direct pressure, vibration, cold environment, poor posture, female gender, prolonged static position

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20
Q

what are the symptoms of overuse syndrome

A

muscle fatigue, pain, chronic inflammation, sensory impairment, decreased abilty to work

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21
Q

what are the five grades of overuse syndrome?

A

1 - pain after activity, resolves quickly
2 - pain during activity, resolves when activity stopped
3 - pain persists after activity, affets work producitivyt, objective weakness and sensory loss
4 - use of extremity results in pain up to 75% of time, work is limited
5 - unrelenting pain, uinable to work

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22
Q

what are some interventions used for overuse syndrome in the acute phase?

A

reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, high-voltage electric and interferential stimulation

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23
Q

what are some interventions used for overuse syndrome in the subacute phase?

A

slow stretchiung, myofascial release, prgressive resistive exercise, proper body mechanics, education on identifying triggers and returning to acute phase treatment wiht flareups, static spolint during activiies that cause pain

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24
Q

what re some interventions used for overuse syndrome in the return to work phase

A

assessment of job site, tools used and body positionings

therapy using work simulator weight well, elastic bands, putty, functional activities and stregnthening activities

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25
Q

describe the extensor zones of the hand

A 
1 - falls over IP joint
2 - proximal phalanx
3 - falls over MCP joint
4 - falls over first metacarpal
5 -  falls over wrist
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26
Q

what are some interventions used after surgical repair of the extensor tendons

A

exercises promote tendon excursion and prevent adhesions
modalities - heat, NMES once cleared
clearly identified and planned home exercise program
tendon glides
ROM
strenghting not usd until 8-12 weeks

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27
Q

describe the flexor zones of the hand

A

1 - fingertip to center portion of middle phalanx
2 - center portion of middle phalanx to distal palmar crease; known as no mans land
3 - distal palmar crease to transverse carpal ligament
4 - overlies transverse carpal ligament
5 - goes beyond level of wrist

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28
Q

what are some complications that can occur in the flexer zones of the hanad

A

nerve involvement common
edema
pain

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29
Q

what are the different protocols used for flexion zone injuries?

A

duran - early passive ROM
lieinert - active extension with passive flexion via traction
early active motion - promotes tendon gliding
immobilization - mainly used wiht children
splinting - used to prevent rupture; tendons are weakest at 10-12 days post surgery

30
Q

what are some interventions used to help treat flexor tendon injury?

A 
exercises
modalities
home exercise program
tendon glides
ROM
strenghtening not used until week 8-12
31
Q

describe the symptoms for radial nerve injury

A

posture of hand is wrist drop with possible lack of finger and thumb extension

32
Q

describe the non-operative tx of radial nerve injuries

A

wrist cock up splint with or without dynbamic finger and humb extension assist, passive and actige ROM, with isotonic stregnthening exercises upon muscle reinnervation

33
Q

describe operative tx of radial nerve injuries

A

static wrist extension splint in 30 degrees, after 4 weeks, adjust splint to 10-20 degrees of extension

34
Q

describe radial tunnel syndrome with symptoms

A

entrpament of radial nerve in area extending from radial head to supinator muscle; symptoms - burning pain in lateral forearm

35
Q

describe non-operative tx of radial tunnel syndrome

A

long arm splint, elbow flexd, forearm supinated, wrist in neutral
massage or TENS for pain management, pain free ROM, nerve glides, activity mods, avoid foreful wrist extension and supination

36
Q

descrieb operative tx for radial tunnel syndrome

A

long arm splint, elbow flexed, forearm supinated, wrist in neutral for 2 weeks, then wrist cock up splint for 2 more weeks
passive anf active pronation anf supination, hand strengthening exercise at 3 weeks, resisteive exercise at 6 weeks.

37
Q

describe anteiror interosseous syndrome

A

compression to anterior interosseous nerve resulting in motor loss involving flexor digitiorm longus, flexor produnfus to index finger, and pronator quadratus.

38
Q

describe pronator syndrome wiht symptoms

A

entrapment of proximal median nerve between heads of pronator muscles; symptoms - deep pain proximal forearm with activity

39
Q

describe non-operative treatment for pronator syndrome

A

splint elbow 90-100 flexion, forearm neutral. TENS for pain, gentle prolonged stretching in supination and elbowm wrist and finger extension, activity modification, avoid repetitive forearm rotation with reksistance and prolonged elbow flexion

40
Q

describe operative tx for pronator syndrome

A

half cast, AROM all UE joints while wearing cast, muscle strengthening in 1 week, full AROM gained by 8 weeks.

41
Q

describe median nerve injury with symptoms

A

causes ape hand deformity; symptoms include ape hand deformity, sensory loss in index, middle and radial side of the ring finger, los of punch, thumb opopsition, index finger MCP and PIP flexion, decreased pronation

42
Q

describe nonoperative tx for median nerve injury

A

static thenar web space splint

43
Q

describe operative tx for median nerve injury

A

dorsal wrist blocking splint worn for 4-6 weeks, AROM and PROM in spolint for digits and thumb, tendon gliding exercises, scar massage. discontinue splint at 6 weeks and begin strengthening exercises.

44
Q

describe double crush syndrome wiht symptoms

A

occurs when a peripheral nerve is entrapped in more than one location; symptoms - intermittent diffuse arm pain and paresthesias with specific postures

45
Q

describe nonoperative tx for double crush syndrome

A

treat according to each nerve injury or symptom; avoid movments or postures thataggrevate the symptoms, nerve gliding execises, and exercises for scapular stability, posture adn core/trunk strengthening

46
Q

describe carpal tunnel syndrome with symptoms

A

caused by entrpament of the median nerve as it course through the carpal tunnel. most common nerve compression of UE
symptoms - tenosynovitis, cumulative trauma disorder, fluid renteion, ganglions, tumors, diabtetes, rheumatoid arthritis, and trauma such as wrist fracture or lunate dislocation
sensory impairment
motor impairments

47
Q

describe how to test for motor impairment for carpal tunnel syndrome

A

tinels sign
phalens test
moberg pick up test
semmes-weintein monofilament

48
Q

describe nonoperative tx for carpal tunnel syndrome

A

carpal tunel syndrome splint or wrist cock up splint at 0-10 degrees wrist extension is uised to relieve pressure on the median nerve in the carpal tunnel and control edema;
prefabricated wrist cock up splint used if wrist position is adjutable.
nerve and tendon gliding exercises
activity modifcation includes ergonomic handles, gel pads, padding on handles.
client education recommends avoidance of piostureds and activities taht aggravate the condition. training is provided in the use of an ergonomic keyboard moification, if applicable
postural retraining and proximal conditioning exercise are provided

49
Q

describe post-operative tx for carpal tunnel syndrome

A

surgical tx including traditional open carpal tunnel releae surgery or endoscopic release
wound care and scar mobilization
pain management
splinting only to clients who slep with wrist flxed or who will engage in too much activity too soon
AROM or wrist/thumb/fingers begins 1-2 days post-surgery
nerve and tendon gliding exercises are provided
strengthening activities begin in 3-6 weeks.

50
Q

describe cubital tunnel syndrome with symptoms

A

caused by proximal ulnar nerve compression at elbow between medial epicondyle and olecranon process.
symptoms - decreased senastion, decreaed girp and punch strength

51
Q

how do you evaluate for cubital tunnel syndrome?

A

tinels sign
froments sign
wartenburgs sign - fifth finger held abducted from fourth finger
elbow flexion test

52
Q

describe nonoperative tx for cubital tunnel syndrome

A

edema control, pain management, elbow splint or positioning at 30-60 degrees of flexion for 3 weeks
ulnar nerve gliding
proximal conditioning activities
posture and ergonomic training

53
Q

describe postoperative tx for cubital tunnel syndrome

A

during protection phase - splint elbow at 70-90 degrees of flexion, provide wound care, edema control, pain management and AROM of uninvolved joints; teach one handed ADL technique
during active phase - discontinue elbow splint and anticlaw splint if used before surgery, add elbow AROM(pronation first, then supination; add wrist motion with elbow flexed, then extended), ulnar nerve gliding, and desensitization tehcniques.

54
Q

describe de quervain syndrome with symtoms

A

caused by culumative trauama disorder resulting in tenosynovitis of tumb muscle tendon unit, abductor pollicuus longus and extensor pliicis brevis, and tendons in first dosal compartment of wrist.

55
Q

describe nonoperative tx for de quervain’s syndrome

A

corticosteroid injection
forearm based thumb spica splint with wrist in neutral and thumb radially abducted for 3 weeks
activity mods
after 3 weeks, progress to soft splint and isometric exercise
computer ergonomics
strenghtening

56
Q

describe operative tx for de quervains syndrome

A

surgical release of first dorsal compartment.
forearm based thumb pica splint with wrist at 20 degrees extension and thumb radially abducted for 3 weeks
gentle ROM and tendon gliding
grip and punch strenghtening at 2 weeks.
scar management and densensitization techniques are used.

57
Q

describe claw deformity with symptoms

A

distal ulnar nerve compression/lesion at wrist.
symptoms - sensory loss at little finger and ulnar side of ring finger, loss of intrinsic ulnar innervated muscles and motor loss

58
Q

describe the eval for claw deformity

A

froments sign
waretendergs sign
jeannes sign - hyperextension of thumb MCP
semmes-weinstein monofilament testing

59
Q

describe nonoperative tx for claw deformity

A

ulnar nerve palso of anticlaw splint is used; dynamic IP extension assist may be added if PIP flexion contracture are present
padded antivibration glove
activity mods
client education

60
Q

describe operative tx for claw deformity

A

bulky dressing applied for 3-10 days
dorsal blocking splint used to maintain wrist at 20-30 degrees of flexxion and MCP block to 45 degree extension to protet nerve repair.
wound car and scar mobilization
senosry desensation begins when wound has healed
AROM begins at 6 weeks
sensory reeducation begins at 10-12 weeks
tendon transfer done if nerve has not regenerated within 1 year

61
Q

describe digital stenosing tenosynovitis and treatment

A

occurs with sheath inflammation or nodules near A1 pulley

tx: splinting MCP at 0 degreeds for 3-6 weeks or surgically releasing A1 pulley

62
Q

describe the different types of sensory re-education

A

protective re-education: use of visual compensation for sensorynloss
discrimnative: uses motivation and repetition with vision-tatile matching process
sensory begins with pain perception
desensitization - process of applying different textures and tactile stimulation to reeducate nervous system to tolerate sensations

63
Q

describe cryotherapy

A

cools tissue 1-2 cm in depth
ex: ice masage, ice towels

used for pain relief, decreased edema, decreased muscle spasms, decreased inalmmation, decreased metabolicactivity, reduced nerve conduction

dont use if: avoid with clients with impaired ciruclation,k peripheral vascular disease, hpersensitivity to cold, impaired senastion, open wounds/infections

64
Q

describe thermotherapy

A

heats tissues to 1-2 cm in depth

increases blood flow, rate of cell metabolism, inflammation, muscle contraction velocity, capillary permeability, oxygen consumption; decreased fluid viscosityh, muscle spasms, and pain.

dont use with: acute inflmammation, edema, sensory impairment, cancer, blood clots, infection, cardiac problems, impaired cognition

65
Q

describe ultrasound

A

heats stissue to 1-5 cm in depth

has thermal and nonthermal effects including increasing bone healing and pritein synthesis

do not use with packmakers, carotid sinus, pregnant uterus, eyes, clients with epilepsy, cancer, infection, decreased sensation, cardiac disease and stroke.

66
Q

describe low levle laser and light therapy

A

decreases pain, edema, and inflammation; increaesd wound healing, decreased scar tissues

do not use with vagus nerve, carotid sinus, pregnant uterus, eyes, infection, endocrine glands, or cancer.

67
Q

how do you evaluate for use of splints

A

chart or medical report review, interview, and observation of client, aplpation, occupational assessment, and assessment of following components.

68
Q

describe the different types of splints

A 
static - no moving parts
resting hand splints - 
antideformity splint -
ball or cone antispasticity splints
wrist cock up splint
thumb spica spint
finger splints
elbow splints
knee extension splints
ankle splints
69
Q

what are dynamic splints used for

A

correcting contractures, increasing pasive motion, protecting recent surgery, or substituting for lost active motion.

70
Q

describe the different levels of wound closure

A

primary - wound is closed with sutures
secondary - wound is left open and allowed to close on its own
delayed primary - wound is cleaned, debrided, and observed 4-5 days before suturing it closed.

71
Q

what are the wound healing phases

A

inflammatory phases - 24-48 hbours to 7 days. subacute = 7-14 dys.
proliferative phase 5 days - 2-3 weeks. more perfect the squre, quicker it heals.
remodeling phase: 2 weeks - 1-2 years.

72
Q

how do you document wounds

A 
anatomical location and area of wound
length, width, depth and shape of wound
color and presence of necrotic tissue
description of wound exudate
granulation and epithetlial tissue at wound margins
description of surrounding intact skin.

NBCOT Study Guide (21 decks)

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