Chapter 6: UE Disorders and Injuries

Question 1

Dupuytren’s Disease

Answer 1

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.

Question 2

Skier’s Thumb (gamekeeper’s thumb)

Answer 2

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.

Question 3

Complex Regional Pain Syndrome (CRPS)

Answer 3

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.

Question 4

Colles’ Fracture

Answer 4

Fx of distal radius with dorsal displacement, most common type of wrist fracture

Question 5

Smith’s Fx

Answer 5

Fx of distal radius with volar displacement.

Question 6

De Quervain’s

Answer 6

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)

Question 7

Lateral Epicondylitis (tennis elbow)

Answer 7

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

Question 8

Medial Epicondylitis

Answer 8

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

Question 9

Trigger Finger

Answer 9

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

Question 10

Froment’s sign

Answer 10

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.

Question 11

Wartenberg’s sign

Answer 11

Fifth finger head abducted from the fourth finger, sign of cubital tunnel syndrome.

Question 12

Club Hand

Answer 12

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.

Question 13

Boutonniere Deformity

Answer 13

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.

Question 14

Tinel’s Sign

Answer 14

detect irritated nerve by lightly tapping on them and seeing if it causes pins and needles in the distribution of nerve.

Question 15

Phalen’s Sign

Answer 15

Question 16

Pronator Teres Syndrome

Answer 16

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.

Question 17

Guyon’s Canal

Answer 17

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.

Question 18

Cubital Tunnel Syndrome

Question 19

Median Nerve Injury & Treatment

Answer 19

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

Question 20

Rotator Cuff Tendonitis (etiology, conservative interventions, surgical interventions, post-op interventions)

Answer 20

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)

Question 21

Shoulder Dislocations (most common type, etiology, interventions)

Answer 21

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

Question 22

Mallet Finger

Answer 22

Avulsion of terminal tendon in phalange, splinted in full extension for 6 weeks.

Question 23

finkelstein’s test

Answer 23

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.

Question 24

Carpal bones of hand

Answer 24

Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capatate, hamate

Question 25

Pacinian corpuscles

Answer 25

Sensory receptor responsible for vibration

Question 26

Ruffini end organs

Answer 26

Sensory receptors responsible for tension

Question 27

Boxer’s Fracture

Answer 27

A type of proximal fx, fx of 4th and 5th metacarpals.

Question 28

Keinbock Disease

Answer 28

Avascular necrosis of lunate bone, can cause lunate fx and pain and stiffness with wrist movement

Question 29

Swan Neck Deformity

Answer 29

PIP hyperexention & DIP flexion. PIP is splinted in slight flexion.

Question 30

Define avulsion injuries

Answer 30

When the tendon separates from the bone and its insertion and removes bone material with the tendon. (e.g. mallet finger)

Question 31

Bennet’s Fracture

Answer 31

Fx of the first metacarpal base (Remember: Bennet always gives thumbs up)

Question 32

Treatment for CRPS

Answer 32

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.

Question 33

Grading of cumulative trauma: Grade I

Answer 33

Pain after activity, resolves quickly

Question 34

Grading of cumulative trauma: Grade II

Answer 34

Pain during activity, resolves when activity stopped

Question 35

Grading of cumulative trauma: Grade III

Answer 35

Pain persists after activity, affects work productivity, objective weakness and sensory loss

Question 36

Grading of cumulative trauma: Grade IV

Answer 36

Use of extremity results in pain up to 75% of the time, work is limited

Question 37

Grading of cumulative trauma: Grade V

Answer 37

Urelenting pain, unable to work

Question 38

Kleinert Protocol

Answer 38

Protocol for flexor tendon injury, active extension of digits and passive flexion via traction, ususally with rubber band.

Question 39

Druan Protocol

Answer 39

Protocol for flexor tendon injuries. Early PROM 3-5mm of tendon mvmt to avoid adhesions.

Question 40

Symptoms and nonoperative treatment of a radial nerve injury

Answer 40

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.

Question 41

Nonoperative and operative tx and symptoms of radial tunnel syndrome

Answer 41

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.

Question 42

Anterior Interosseous Syndrome

Answer 42

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

Question 43

desensitization techniques for hypersensitivity after a peripheral nerve injury

Answer 43

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.

Question 44

Eval & Intervention for Fractures

Answer 44

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.*

Question 45

Roos’ Test

Answer 45

Tests for thoracic outlet syndrome. Shoulder abducted with external rotation for 3 minutes.

Question 46

Allen’s Test

Answer 46

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.