Arm Interventions Flashcards
Patient education for work related factors:
- Tracker ball vs. mouse
- Workstation set-up
- Dictation application for entering electronic data
Potential complications of corticosteroid injections?
- 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
C level evidence for what assistive tech interventions for CTS?
- Effects of mouse use on carpal tunnel pressure
- Develop alt strategies (touch screen/alt mouse hand)
B level evidence for orthoses (nonsurgical) interventions for CTS?
Neutral position wrist orthosis worn at night for short-term symptom relief
C level evidence for orthoses interventions for CTS?
- Adjust wear time to daytime, symptomatic, full time use
- Add MCP joint immobilization
C level evidence for orthoses interventions for CTS in pregnant women?
Orthosis for women experiencing CTS during pregnancy and provide postpartum follow up
C level evidence for biophysical agents as interventions for CTS?
- Superficial heat for short-term symptom relief
- Interferential current
B level evidence for what not to do for biophysical agents as interventions for CTS?
- Not use low-level laser therapy
- Iontophoresis
- magnets
C level evidence for what not to do for biophysical agents as interventions for CTS?
Not use thermal US
T/F Clinicians may perform phonopheris with nonsurgical management of patients with mild to moderate CTS for treatment of clinical signs and symptoms.
True
C level evidence for manual therapy techniques as intervention for CTS?
Manual therapy at cervical spine and UE
C level evidence for therapeutic exercise as intervention for CTS?
Combined orthotic/stretching program who do not have thenar atrophy and have normal 2 point discrimination
When are nerve mobilizations appropriate?
May be appropriate for various peripheral nerve entrapments
Mechanism of nerve mobilizations:
- 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
Glider nerve mob -
2 simultaneous movements: one movement loads the nerve, one movement unloads the nerve
Tensioner nerve mob -
2 simultaneous movements: both movements load the nerve
Case studies/expert opinion supports which nerve glides for cubital tunnel syndrome?
Ulnar nerve glides
T/F Median nerve glides for CTS is conflicting in regard to efficacy.
TRUE
Inflammatory OA management -
Thermal/ cryotherapy
Exercises for OA management -
Gripping/ resistive exercises
ROM exercises
Manual therapy for OA management -
Joint mobs (pain vs extensibility)
Joint protection for OA management -
- Splinting (keeps patient more functional)
- Activity modification
Medical approach to tendinopathy -
NSAIDs, local steroid injection, Sx
Education for tendinopathy -
- Resting position
- Activity modification
Protection for tendinopathy -
- Splinting
- Activity Modification
Exercise for tendinopathy -
- Stretching ???
- AROM/ tendon gliding
- Eccentrics (facilitates more organized CT and increased fibroblast activity)
Indications for tendon glides of hand:
- Prevent adhesion postoperatively
- Address adhesion with tenosynovitis
- Maintain/ Improve ROM
- Pain relief
Interventions for lateral epicondylopathy:
- Patient education/ activity modification
- Inflammatory/ pain management interventions
- Eccentrics (Hand weights, Elastic bands, Elastic band (rubber band) around fingers with finger extension)
- Joint Manipulation (C-Spine, T-Spine, Elbow/ Forearm/ Wrist)
- Joint Mobs (including MWM – stronger evidence with lat epi)
- Soft tissue mobilization
- ROM/ stretching exercises
T/F Cspine manipulations (c5/6) more effective for short-term lateral epicondylopathy pain improvement than t-spine manipulation
True
What is mill’s manipulation? Indicatio?
- high-velocity thrust administered at the elbow
- Short & Long Term improvements with pain, pain-free grip, function for individuals with lateral epicondylopathy
Watson’s manipulation? Indication?
- “scaphoid whip” PT provides ventral force on scaphoid during quick extension of wrist
- Lateral Epicondylopathy
MWM: LATERAL GLIDE of HUMERO-ULNAR JOINT Patient position - Direction of force - Mobilize - Stabilize -
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)
MWM: ANTERIOR GLIDE of HUMERO-RADIAL JOINT
Patient position -
Force -
- 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
MWM: POSTERIOR GLIDE of HUMERO-RADIAL JOINT
Patient position -
Force -
- 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
Humero-ulnar distraction
place the dorsal wrist on the clinician’s shoulder with the table elevated, grasping the proximal forearm from dorsal to ventral with both hands
HUMERO-RADIAL ANTERIOR GLIDE
- 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
HUMERO-RADIAL POSTERIOR GLIDE
- 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)
PROXIMAL RADIO-ULNAR ANTERIOR GLIDE
The proximal radius is anteriorly mobilized
