Cumulative Trauma Disorders Flashcards
What is CTD?
- Also called
- Repetitive trauma disorder
- Overuse syndrome
- Repetitive strain injuries
- Inflammatory response to overuse of anatomical structure
- Tendonitis
- Tenosynovitis
- Nerve entrapment
- Risk factors
- Force
- Repetition/Speed
- Mechanical stress
- Abnormal Joint Posture
- Temperature
- Vibration
- Working in static positions
What are the most common UE CTDs?
- Carpal tunnel syndrome
- Lateral epicondylitis
- Medial epicondylitis
- de Quervains
- Trigger finger
What is a common tendon injury? What are the symptoms?
•Tendonitis–inflammation of tendon & tendon-muscle attachment
–Injury
–overuse
•Trauma causing rupture
Symptoms:
- Pain
- Swelling
- Tenderness
- Localized
- Weakness due to pain and/or nerve compression
Evaluation
- Check for swelling, redness, heat
- Compare extremities
- Must identify activity causing the problem
- Provocative tests with care
–Tinel’s
–Phalen’s
Treatment:
- Rest
- Ice
- Compression
- Elevation
- Anti-inflammatory meds
- Splinting
- Ergonomic adjustments
- Tendon gliding & gradual mobilization
What is Carpal Tunnel Syndrome? What are the 3 stages?
- Parathesia over thumb and 2 1/2 fingers
- Burning pain
- Decreased thumb opposition or abduction
- Awakened at night
Stage 1 Mild
- Sporadic symptoms and clumsiness
- Response to activity
- May have no abnormal signs at examination
Stage II
- Pain, often burning
- Some thenar weakness or atrophy
- Sensory loss
- Clumsiness
- Positive Phalens (back of hands together) or Tinels (tapping on median nerve)
Stage III
- Pronounced thenar wasting/atrophy
- Sensory loss
- Loss of 2-point discrimination
- Significant loss of dexterity
- Functional difficulties
- Poor prognosis due to nerve destruction
What is the acute treatment for carpal tunnel?
Rest
Modify activity for wrist posture, vibration, decrease repetition
Wrist splint—wear night and day for 4-6 weeks then decrease
Nonsteroidal anti-inflammatory drugs or oral steroids
Diuretics
100-200 mg of vitamin B6
Local steroid injection
Tendon-gliding exercises
Surgery Indications:
- If not responsive to above
- Long-standing sx
- Thenar atrophy
What happens post-sugrey for carpal tunnel?
- Bulky dressing and wrist splint (wrist neutral) for 1 week
- 1 week volar wrist splint at night and during strenuous exercise
Post-op Rehab:
Therapy for 1-3 weeks
Edema control
Maintain ROM
Prevent adhesions
Protected hand use
Retrograde massage
Tendon gliding Exercises
Elbow and shoulder ex.
•3 weeks post
–Scar remodeling
–Tx for hypersensitivity
–Increase strength and functional use
• 8 weeks post
–Work hardening
What is cubital tunnel?
- Ulnar nerve compression
- Cubital Tunnel
–Ulnar collateral ligament
–Medial epicondylar groove
•Causative factors
–Recurrent subluxation, dislocation, RA, Excessive elbow valgus, bony spurs, cysts, trauma
Symptoms:
•Mild:
–Intermittent paresthesia, c/o cluminess or decreased coordination,, difficulty crossing fingers
•Moderate:
–Above symptoms
– Grip/pinch weakness
•Severe
–Above Symptoms
–Persistent paresthesias, Decreased 2-pt, muscle atrophy, claw deformity
What is the diagnosis for cubital tunnel?
•Diagnosis:
–Patient/Medical History
–Provocative Tests
- Positive Tinel’s at medial elbow
- Positive elbow flexion test
What is the treatment for cubital tunnel?
•Mild/ Conservative
–Pain and Inflammation reduction
–Postural/ Positional education
–Splinting
- Elbow Flexed 30-45 degrees
- Wrist neutral
- 3months – night and prn during the day
- Elbow pad during the day
- Moderate to Severe
–Surgery
- Decompression
- Anterior submuscular transposition
–Pronator teres
•Medial Epicondylectomy
What is post-op rehab for cubital tunnel?
–Elbow splint: elbow 80-90degrees, wrist 20 flexion
–10days to 2 weeks – gentle ROM (elbow with wrist supported)
–Week 2 – elbow extension allowed
–Week 5 – strengthening
–***Follow MD orders post-op
Rehab:
- Pain / edema/ scar management
- Sensory re-education
- ROM and Strengthening
- ADL/Work/ assessment
What is Lateral Epicondylitis?
- Tennis elbow
- Most common due to tears in common extensor tendon
- Extensor carpi radialis brevis
- Minor tear to complete rupture
- Pain with lifting, gripping, and/or grasping.
•Static wrist extension position
Symptoms:
•Pain & tenderness over lateral epicondyle
–Constant ache
–Episodes of sharp pain
–Increases with stretching & lifting
•Forearm pain
–Resisted wrist extension
–Passive wrist flexion
- Pain radiating into ring & little fingers
- Inflammation
- Redness & heat
What is the diagnosis for Lateral Epicondylitis?
•Resistive muscle testing
–Elbow negative
–Wrist extension positive
–Wrist flexion negative
- Palpation of extensor muscles
- ROM
- Inflammatory changes
What is the treatment for lateral epicondylitis?
•Pain/Edema Control
–Icing
–Anti-inflammatory modalities/meds
- Rest 1-3 days
- Splinting – Wrist cock up
- Tennis elbow cuff/Taping
- Gentle transverse friction massage
- Ergonomic adjustments
- Tendon gliding & gradual mobilization
–Progression: Gentle ROM/stretching/strengthening
•Ergonomic changes
–Built-up handles
–Modify work/leisure activities
–Patient education
•Return to work
What is medial epicondylitis?
•Golfer’s elbow
–Pain with resisted wrist flexion and/or passive wrist extension
–Pain over medial epicondyle
- Same treatment
- Neutral wrist splint
What is De Quervain’s Disease?
- Tenosynovitis
- Abductor pollicis longus & extensor pollicis brevis at the the first dorsal compartment (radial styloid and dorsal carpal ligament)
- Due to excessive friction
–Overuse
–Arthritis
–Inflammation
Symptoms:
•Pain over radial styloid
–May radiate distal or proximal
–Thumb flexion and ulnar deviation
–Pain with gripping
- Swelling
- Tenderness
