Chapter 6: UE Disorders and Injuries Flashcards
Dupuytren’s Disease
Disease of fascia of palm and digits. Fascia becomes thick and contracted, cords and bands into digits. Tx: Sugical release is required. Wound care, edema control, extension splint, A/PROM when wounds are healed, scar managment, tasks that emphasize flexion and extension.
Skier’s Thumb (gamekeeper’s thumb)
Rupture of ulnar collateral ligament of the MCP joint of the thumb. Conservative tx: thumb splint for 4-6 weeks then AROM at 6 weeks. Post-op tx: thumb splint for 6 weeks, then AROM, PROM at 8 weeks and strengthening at 10 weeks.
Complex Regional Pain Syndrome (CRPS)
unknown cause, may follow trauma. symptoms: severe pain, edema, discoloration, osteoporosis, sudomotor changes (sweat), temperature changes, trophic changes, vasomotor instability. Tx: edema mgmt, AROM, stress loading, splinting to prevent contractors. Avoid: PROM, dynamic splinting.
Colles’ Fracture
Fx of distal radius with dorsal displacement, most common type of wrist fracture
Smith’s Fx
Fx of distal radius with volar displacement.
De Quervain’s
description: stenosing tenosynovitis of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) symptoms: pain, swelling over radial styloid diagnosis: positive Finkelstein’s test conservative treatment: thumb spica splint (IP joint free), activity/work mod, ice massage over radial wrist, gentle AROM of wrist and thumb to prevent stiffness post-op treatment: thumb spica splint and gentle AROM (0 to 2 weeks), strengthening, ADLs, and role activities (2 to 6 weeks), unrestricted activity (6 weeks)
Lateral Epicondylitis (tennis elbow)
Tennis elbow description: degeneration of the tendon origin as a result of repetitive microtrauma etiology: overuse of wrist extensors, especially the extensor carpi radialis brevis (CRB) conservative treatment: elbow strap, wrist splint, ice and deep friction massage, stretching, activity/work mod, as pain decreases, begin strengthening
Medial Epicondylitis
Golfer’s elbow description: degeneration of the tendon origin as a result of repetitive microtrauma etiology: overuse of wrist flexors conservative treatment: elbow strap, wrist splint, ice and deep friction massage, stretching, activity/work mod, as pain decreases, begin strengthening
Trigger Finger
tenosynovitis of the finger flexors: commonly the MCP jt. etiology: repetition and the use of tools that are placed too far apart conservative treatment: splint, scar massage, edema control, tendon gliding, activity/work modification
Froment’s sign
Present in ulnar nerve injury. increased flexion of the thumb interphalangeal joint , occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis.
Wartenberg’s sign
Fifth finger head abducted from the fourth finger, sign of cubital tunnel syndrome.
Club Hand
partial or full absence of the radius and bowing of the ulnar shaft. In addition, the upper extremity nerve and musculature are either absent or underdeveloped.
Boutonniere Deformity
Disruption of central slip of the extensor tendon. 0-4 weeks: PIP extension splint, AROM of DIP while in splint. 4-6 weeks: AROM of DIP and flexion of digits to the distal palmar creas.
Tinel’s Sign
detect irritated nerve by lightly tapping on them and seeing if it causes pins and needles in the distribution of nerve.
Phalen’s Sign
Pronator Teres Syndrome
Median nerve compression between two heads of pronator teres. Symptoms: same as carpal tunnel but also aching pain in proximal forearm, positive tinel in forearm, no night symptoms. Tx: elbow splint at 90 degrees forearm neutral. TENS post-op: AROM, n. gliding, strengthening (1-2 weeks post), sensory reed, activity modification.
Guyon’s Canal
Ulnar nerve compression at wrist. numbness and weakness in ulnar disribution of hand. TX: wrist splint in neutral. post op: AROM, edema control, nerve gliding, strengthening.
Cubital Tunnel Syndrome
Median Nerve Injury & Treatment
Sensory loss to median n distribution. Motor loss low lesion: 1/2 LOAF i.e. loss of pinch, thumb opposition, and index finger flexion. Lack of ability to abduct and oppose the thumb due to paralysis of the thenar muscles”ape-hand deformity” , “hand of benediction” Non-op tx: static thenar webspace splint. Post-op tx: dorsal wrist block splint
Rotator Cuff Tendonitis (etiology, conservative interventions, surgical interventions, post-op interventions)
etiology: repetitive overuse, curved or hook acromion, weakness of rotator cuff,weakness of scapula musculature, ligament and capsule tightness, trauma conservative interventions: activity mod (avoid above shoulder level activities until pain subsides), educate in sleeping posture (avoid sleeping with arm overhead or combined ADductiona nd internal rotation), decrease pain (positioning, modalities, and rest), restore pain free ROM, strengthening (below shoulder level), occupation and role specific training surgical interventions: athroscopic surgery, open repair (small, medium, large, and massive tears) post-op interventions: PROM (0 to 6 weeks – progressing to AA/AROM), decrease pain (begin with ice, progress to heat), strengthening (6 weeks post-op – begin isometrics, progress to isotonic below shoulder level), activity mod, leisure and work activities (8 to 12 weeks post-op)
Shoulder Dislocations (most common type, etiology, interventions)
most common type: anterior dislocation etiology: trauma, repetitive overuse interventions: regain ROM (avoid combined ABduction and external rotation with anterior dislocation), pain free ADLs and role activities, strengthen rotator cuff
Mallet Finger
Avulsion of terminal tendon in phalange, splinted in full extension for 6 weeks.
finkelstein’s test
Finkelstein’s test is used to diagnose De Quervain’s tenosynovitis in people who have wrist pain. To perform the test, the therapist grasps the thumb and ulnar deviates the hand sharply, If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain’s tenosynovitis is likely.
Carpal bones of hand
Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capatate, hamate
Pacinian corpuscles
Sensory receptor responsible for vibration
Ruffini end organs
Sensory receptors responsible for tension
Boxer’s Fracture
A type of proximal fx, fx of 4th and 5th metacarpals.
Keinbock Disease
Avascular necrosis of lunate bone, can cause lunate fx and pain and stiffness with wrist movement
Swan Neck Deformity
PIP hyperexention & DIP flexion. PIP is splinted in slight flexion.
Define avulsion injuries
When the tendon separates from the bone and its insertion and removes bone material with the tendon. (e.g. mallet finger)
Bennet’s Fracture
Fx of the first metacarpal base (Remember: Bennet always gives thumbs up)
Treatment for CRPS
gentle, pain-free AROM for short periods, NO PROM OR PAINFUL TX, stress loading, pain control (TENS, splinting, continuous passive motion), edema control, desensitization (fluidotherapy), blocked exercises, tendon gliding, joint protection, energy cons.
Grading of cumulative trauma: Grade I
Pain after activity, resolves quickly
Grading of cumulative trauma: Grade II
Pain during activity, resolves when activity stopped
Grading of cumulative trauma: Grade III
Pain persists after activity, affects work productivity, objective weakness and sensory loss
Grading of cumulative trauma: Grade IV
Use of extremity results in pain up to 75% of the time, work is limited
Grading of cumulative trauma: Grade V
Urelenting pain, unable to work
Kleinert Protocol
Protocol for flexor tendon injury, active extension of digits and passive flexion via traction, ususally with rubber band.
Druan Protocol
Protocol for flexor tendon injuries. Early PROM 3-5mm of tendon mvmt to avoid adhesions.
Symptoms and nonoperative treatment of a radial nerve injury
Symptoms: wrist drop, possible lack of finger and thumb extension. Non-op Tx: wrist cock-up splint with or without dynamic finger extension assist, PROM & AROM, isotonic strengthening upon reinnervation.
Nonoperative and operative tx and symptoms of radial tunnel syndrome
Symptoms: burning in lateral forearm. Non-op Tx: long arm splint, elbow flexed forearm supinated wrist neutral. TENS, pain free ROM, nerve glides, avoid forceful wrist extension and supination. Post-op Tx: Same long arm splint as mentioned above, but cock-up wrist after 2 weeks, PROM & AROM pronation and supination, hand stengthen at 3 weeks.
Anterior Interosseous Syndrome
Compression of the anterior interosseous nerve (branch of median n.) Results in motor loss involving flexor digitorum longus, flexor profundus to index finger, and pronator quadratus. Splint forearm in neurtral, elbow in 90 flexion
desensitization techniques for hypersensitivity after a peripheral nerve injury
Desensitization begins with the least irritating texture in the least sensitive area to be treated. Desensitization is best used for short periods (3 to 5 minutes five or six times per day). If desensitization is poorly tolerated, the activity can be combined with use of a TENS unit initially to decrease the client’s perception of pain.
Eval & Intervention for Fractures
Eval: hx, xrays, edema, pain, AROM (do not test PROM or strength until ordered by physician), sensation. Intervention: immobilization phase: AROM of joints above and below fx, edema, ADLs with no resistnace. Mobilization phase: edema, AROM and PROM when approved (4-8wks), stengthening begin with isometrics. *Exception: Humeral fractures often begin with PROM.*
Roos’ Test
Tests for thoracic outlet syndrome. Shoulder abducted with external rotation for 3 minutes.
Allen’s Test
cut off the circulation to the hand and then see if it comes back within 7 seconds. If it doesn’t then you know there is vascular problems.
