Chapter 6 - Musculoskeletal Systems Disorders

Question 1

Dupuytren’s Disease

Answer 1

Results in flexion deformities of involved digits
Surgical release required
OT role: wound care, edema control, extension splint, A/PROM and Strengthening when wound heals, activities that emphasize gripping/flexion and releasing/extension

Question 2

Skier’s Thumb (gamekeeper’s thumb)

Answer 2

Rupture of the ulnar collateral ligament of the MCP joint
Conservative tx: thumb splint, AROM and pinch strengthening, and opposition strength
Post-op tx: thumb splint, followed by AROM, PROM can begin at 8 weeks and strengthening at 10 weeks

Question 3

Complex Regional Pain Syndrome

Answer 3

Type I and II - severe pain, edema, discoloration, osteoporosis, sudomotor changes, temp. changes, trophic changes, and vasomotor instability
Splinting to prevent contractures and stress loading
AVOID: PROM, passive stretching, joint mobilization, dynamic splinting and casting

Question 4

Colle’s Fracture

Answer 4

distal radius fx with dorsal displacement

Question 5

Smith’s Fracture

Answer 5

Distal radius fx with volar displacement

Question 6

de Quervain’s

Answer 6

pain and swelling over radial styloid, positive Finkelstein’s Test
Conservative tx: thumb spica splint (IP joint free), modification, ice massage over wrist, gentle AROM of wrist and thumb to prevent stiffness
Post-op tx: thumb spica splint and gentle AROM, strengthening, unrestricted activity @ 6 weeks

Question 7

Lateral epicondylitis

Answer 7

Tennis elbow - overuse of wrist extensors
Elbow strap, wrist splint, ice and deep friction massage, stretching and modification
Isometric, then isotonic and eccentric

Question 8

Medial epiocondylitis

Answer 8

Golfer’s elbow - Overuse of wrist flexors
Elbow strap, wrist splint, ice and deep friction massage, stretching and modification
Isometric, then isotonic and eccentric

Question 9

Trigger finger

Answer 9

too much repetition and use of tools that are placed too far apart
Tx: hand based trigger finger splint (MCP extended, IP free), scar massage, edema control, tendon gliding, avoiding repetitive gripping

Question 10

Carpal tunnel syndrome

Answer 10

Median nerve compression, numbness and tingling of thumb, index, middle, and radial half of ring and pinky finger, positive tinel sign at wrist and positive phalen’s sign
Wrist splint in neutral
AVOID extreme wrist flexion and wrist flexion with repetitive finger flexion and wrist flexion with a static grip

Question 11

Pronator teres syndrome

Answer 11

Proximal volar forearm, median nerve compression, from repetitive pronation/supination and excessive pressure on volar forearm
Positive tinel sign at forearm
Elbow splint at 90 degrees, forearm in neutral and AVOID repetitive pron/sup.

Question 12

Guyon’s Canal

Answer 12

Ulnar nerve compression at wrist, positive tinel sign at Guyon’s canal
Wrist splint in neutral

Question 13

Cubital Tunnel Syndrome

Answer 13

Ulnar nerve compression at the elbow, 2nd most common compression, hurts with pressure on elbow or extreme elbow flexion
Weak power grip and positive tinel sign at elbow

Question 14

Radial Nerve Palsy

Answer 14

Radial nerve compression - weakness/paralysis of extensors to the wrist, MCPs, thumb - wrist drop

Question 15

Median Nerve Laceration

Answer 15

sensory and motor loss, ape hand, clawing of index and middle finger, or benediction sign
lose thumb opposition and pinch
Dorsal protection splint

Question 16

Ulnar Nerve Laceration

Answer 16

Sensory and motor loss, claw hand, positive froment’s sign

Lose power grip and pinch

Question 17

Radial Nerve Laceration

Answer 17

Sensory and motor loss, lose ability to extendt digits to release objects/difficulty manipulating
Wrist drop

Question 18

Rheumatoid Arthritis

Answer 18

Systemic and symmetrical, affects many small joints.

known for remissions and exacerbations

Question 19

Osteoarthritis

Answer 19

Degenerative joint disease, wear & tear of large weight bearing joints

Question 20

Superficial partial thickness burn

Answer 20

2nd degree burn, epidermis and upper portion of dermis.

ROM 72 hours post-op, sensation and strengthening when wounds heal, ADL asap

Question 21

Deep partial thickness burn

Answer 21

deep 2nd degree burn, epidermis and deep dermis, hair follicles and sweat glands
ROM 72 hours post-op, sensation and strengthening when wounds heal, ADL asap

Question 22

Full thickness

Answer 22

3rd degree burn, requires skin graft
epidermis, dermis, hair follicles, sweat glands, and nerve endings - hypertrophic scar
ROM 5-7 days post-op

Question 23

Terminal Device

Answer 23

Movement - humeral flexion with scapular abduction on side of amputation; bilateral scapular abduction for midline use of TD or when strength is limited
Intervention - manually guide pt through motions

Question 24

Wrist Unit

Answer 24

Movement - rotate TD to supination, midposition, or pronation. For unilateral amputation, patient uses sound hand to rotate TD. For bilateral amb - pt rotate TD against stationary object, between knees or with contralateral TD
Intervention - Have pt analyze task and determine the most efficient approach for grasp, avoiding excessive or awkward movements

Question 25

Elbow Unit

Answer 25

Movement - depress arm while extending and abducting humerus to lock or unlock elbow mechanism. Practice flexing and locking elbow in several planes.
intervention - Manually guide pt through motions. Begin with elbow unlocked, have pt exaggerate motions initially, use mirror. Use humeral flexion to flex elbow, go beyond desired height since arm will drop with gravity

Question 26

Turntable

Answer 26

Movement - rotate elbow turntable forward or away from body using sound hand. With bilateral amp, push or pull against stationary object to rotate
Intervention - teach pt to analyze task to determine need to use this component for more efficiency