Exam 2 Flashcards

1
Q

What type of heat transfer is US

A

Conversion

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2
Q

3 types of US

A

Diagnostic
Therapeutic
Surgical

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3
Q

How deep does therapeutic US go

A

2-5 cm

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4
Q

What is US most commonly used for?

A

deep heating and biophysical effects

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5
Q

what type of tissue does US travel best through

A

Dense material
Ligaments, tendons, joint capsule, scar tissue etc.

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6
Q

What does frequency of US determine

A

depth, wavelength and temperature

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7
Q

1 MHz

A

goes deeper 2-5 cm
slower absorption
long wave length

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8
Q

3.3 MHz

A

shower wavelength
quick absorption
reaches only 2 cm

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9
Q

What is the effective radiating area

A

The inner portion that propagates sound

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10
Q

What is the beam non-uniformity ratio with US

A

the middle of transducer has the highest peak and the outside has less

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11
Q

Continuous mode for US

A

100% duty cycle
sound energy is constant
thermal effects

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12
Q

Pulsed Mode for US

A

10, 20, or 50% duty cycle
minimizes thermal effects

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13
Q

Thermal effects of US

A

increase metabolic rate for tissue healing
elevate motor and sensory nerve conduction (pain reduction)
Reduces spasm
Vasodilation
increased ROM

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14
Q

what is ultrasound not ideal for heating?

A

Muscles

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15
Q

how to increase thermal effects of ultrasound

A

Increase duration and/or increase intensity 1.5 watts/cm

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16
Q

non-thermal effects of US

A

increased skin and cell permeability
increased cell degranulation
increase phagocytic activity
increased rate of protein synthesis by fibroblast
Enhances wound healing

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17
Q

Clinical applications of non-thermal US

A

Edema
pain control
wound healing
Trigger points

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18
Q

Documentation of US

A

Frequency
Intensity
Duty cycle
time
location
transmission medium
Pt tolerance
results

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19
Q

phonophoresis

A

delivery of medicated lotion via ultrasound
“upgraded ultrasound and downgraded iontophoresis”

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20
Q

What level does TENS and Iontophoresis reach

A

sensory level

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21
Q

Contraindications for electrical modalities

A

cardiac pacemakers/ electronic implants
over carotid sinus
near venous or arterial thrombosis
over areas of indwelling phrenic nerve or urinary bladder stimulators

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22
Q

Direct current

A

continuous unidirectional flow of electrons

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23
Q

alternating current

A

uninterrupted bilateral flow of electrons

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24
Q

pulsed current

A

when electron flow is interrupted for milliseconds or microseconds
can be either AC or DC

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25
Types of pulsed waveform
mono-phasic biphasic- 2 phases with current flow in both direction polyphasic
26
amplitude/intensity of wave form
distance the impulse rises above or below a baseline
27
duration of waveform
length of time to complete one wave
28
modulation of waveform
changes made in one or more aspect of the current (duration or amplitude)
29
Subsensory level of stimulation
no nerve fiber activation no sensory awareness
30
sensory level of stimulation
non-noxious paresthesias tingling cutaneous A-beta nerve fiber activation
31
What level of stimulation do we typically stay in during TENS
Subsensory and sensory
32
Motor level of stimulation
strong tingling and pins and needles muscle contraction A-alpha nerve fiber activation
33
Noxious level of stimulation
strong uncomfortable paresthesia strong contraction A delta and C fiber activation
34
Pulse duration/ width
length of time between beginning and end of all phases in a single pulse commonly set to 50-150 usec for TENS
35
what does pulse duration determine?
Which types of fibers are stimulated Short-sensory (less than 100) longer- motor (more than 100) longest-pain (more than 200)
36
What does frequency determine
type of muscle contraction that occurs 1-20 pps (subsensory and sensory) 20-40 (necessary for muscle contraction) 50-80 (creates tetany with significant fatigue
37
what is the average intensity that is tolerated?
35-80 mA
38
What is intensity responsible for
level of sensory and motor response number of fibers being stimulated
39
What is TENS utilized for?
acute and chronic pain management
40
How is TENS beloved to decrease pain
by counter-irritant theory creates a signal to counter pain that a person is feeling
41
Elements of TENS
Pulse duration - less than 150 is short Frequency- Greater than 8- is high amplitude is determined by patient
42
precautions of TENS
narcotic pain med usage unclear diagnosis general E-stim precautions
43
Contraindications for TENS
Driving MG or MS (rapid fatigue) Contralaterally- transthoracically Children
44
Documentation for TENS
treatment parameters electrode placement Pain description Change in occupational performance or biomechanics components
45
Conventional TENS
High rate sensory most commonly used for acute pain effect doesn't last ling patient feels pins and needles
46
Motor TENS
low rate sub-acute or chronic pain Effects last longer patient feels thump
47
Iontophoresis
Delivery of ions into body for therapeutic purposes E-stim for medication delivery Need referral and prescription
48
Causes of soft tissue injuries
minor and persistent repetitive trauma Direct blunt trauma Sudden uncontrolled and excessive overuse
49
What is a contusion
a region of inured tissue or skin in which blood capillaries have been ruptured
50
Early and later stage of contusion
Early- erythema Later- swelling and loss of function
51
tx for contusion
prevent tissue form further injury compression wrapping MICE
52
Definition of a strain
damage of some part of contractile unit of muscle caused by overuse or over stress
53
Where does a strain occur
the weakest link of the muscle tendon unit
54
3 degrees of strain from lowest to highest
mild pulling without tearing damage to a portion of the junction complete rupture of the junction
55
Tx for acute strain
RICE for at least 1 week muscle is vulnerable to re-injury Later warm-up, stretch and resume activity as long as there's no pain
56
Tx for chronic strain
High risk for re-injury so prevention is key Gradually build ip activities including closed chain
57
Strain
involves ligamentous attachment usually sudden minor tears and hemorrhage without loss of joint stability
58
Grading for strain
similar to sprain mild damage to complete ligament rupture (ACL tear)
59
tx for strain
protect ligament from stretch gentle movements that maintain joint motion but do not reach full stretch increase strength of surrounding musculature in case ligament is not back to full strength
60
Occult
occurs only when the joint is stretched or stressed, otherwise stable no Pain or symptoms
61
Subluxation
joint loses some stability but maintains joint contact
62
3 degrees of joint instability
occult subluxation dislocation
63
Dislocation
joint stability is in jeopardy and the joint surfaces are not in contact
64
Late effects of dislocation
after 4 weeks joint stiffness recurrent dislocation post-traumatic arthritis epically if further damage to capsule
65
When is immobilization always necessary
dislocation and sometimes subluxation
66
Effects of immobilization on soft tissue
stiffness and weakness of CT loss of extensibility atrophy and adaptive length changes in muscles loss of fibers/shortening of fibers lead to contracture
67
How much stretch should you bring a client in for immobilization
some stretch but not into new pain submaximal
68
olecranon bursitis
inflammation of olecranon bursa caused by trauma or prolonged pressure on elbow
69
tx for olecranon bursitis
rest, avoid pressure on elbows, custom padding
70
Lateral epicondylitis
tennis elbow insidious onset of pain over extensors felt at lateral epicondyle aggravated by wrist flexion/extension with pronation or supination and gripping
71
Tests for lateral epicondylitis
Cozens test and Mill's Test
72
Cozens test
provocative test elbow stabilized by thumb patient makes a fist and prints, radially deviates and extends wrist Clinician resists wrist extension
73
Mill's Test
passive elbow extension and wrist flexion
74
What tendons/muscles are most commonly effected during lateral epicondylitis
extensor digitorium Extensor carpi ulnaris
75
tx for Lateral epicondylitis
stop doing what makes it hurt NSAIDS US compression brace activity modification
76
What muscles are involved for medial epicondylitis
pronator tires and flexor capri radialis sometimes FCU and PL
77
Medial epicondylitis cause
throwing athletes repetitive trauma
78
Testing for Medial Epicondylitis
resistive wrist flexion with pronation elbow extension with passive wrist extension decreased grip strength
79
What should be ruled out when testing for medial epicondylitis
UCL rupture Cubital tunnel syndorme
80
Tx for medial epicondylitis
similar to lateral epicondylitis
81
Tinels sign
tingling or prickling sensation elicited by tapping injured nerve trunk if positive nerve, if negative tendon
82
symptoms of overuse syndromes of muscles
vague diffuse pain cramping fatigue loss of strength and control for an extended period of time
83
tx for overuse syndromes of muscles
rest until symptoms subside modalities to decrease pain progressive exercise and strengthening programs
84
Where is compartment syndrome most common
volar compartment
85
When does compartment syndrome occur
sustained excessive pressure develops in one of the 3 forearm compartments following acute trauma
86
Signs and symptoms of compartment syndrome
Significant swelling severe pain not relived with immobilization tense to palpation
87
Tx for compartment syndrome
rest modalities progress to exercise faciotomy if blood is not getting to hand
88
Tendonitis and stenosing tensosynovitis
inflammation of tendons leads to fibrosis structures become thick, unyielding and restrictive to tendon excursion tendon will not be able to slide through sheath/retinaculum
89
tx for tendonitis
initially conservative edema management gentle exercise
90
Dequervains tensosynovitis
most common stenosing tensosynovitis inflammation of APL and EPB at the level of the radial stolid in 1st compartment
91
When does DeQuervains Tensosynovitis occur
with repetitive ulnar deviation and grasping or repetitive use of the thumb
92
Symptoms of DeQuervains Tensosynovitis
pain, stiffness, and weakness of pinch
93
What test shows DeQuervains Tensosynovitis
finkelsteins test positive
94
Finkelsteins test
passive stretching of extensor thumb tendons Clinical brases wrist in ulnar deviation and then passively flexes thumb across palm Dorsal thumb pain will be present
95
tx for DeQuervains Tensosynovitis
stop doing what motion causes pain thumb spica splint rest from activities modalities gentle stretching and thumb
96
Intersection Syndrome
involves 1st and 2nd dorsal compartments
97
signs and symptoms of intersection syndrome
point tenderness 3 fingers proximal to the wrist joint squeaking on A&PROM pain during flexion or extension
98
Where is intersection syndrome compared to DeQuervains
proximal
99
What tests for intersection syndrome
negative Finkelsteins test
100
Tx for intersection syndrome
similar to DeQuervains but no dumb splint
101
Trigger Finger
painful snapping as FI tendons suddenly pull through a tight A1 pulley can occur during fl or ext
102
What comes first A1 stenosis or tendon thickening in trigger finger
either one
103
Most common occurrences of trigger finger
thumb, mid, ring women DM or RA and other tendonitis
104
tx for trigger finger
limit snapping/ tendon excursion for a bit of time modalities ot help decrease swelling
105
TFFC injury causes
traumatic or degenerative falls rotational injuries repetitive axial loading
106
Symptoms of TFCC causes
ulnar wrist pain clicking credits with forearm rotation, gripping or UD
107
Tx for TFCC injury
brace injection Gentle AROM, don't want to stretch too far surgery
108
UCL of Thumb sprain
gamekeepers/skiers occurs with values stretch stability of MP by adductor aponeurosis, AP, UCL and the solar plate
109
Eval for UCL of thumb sprain
valgus stretching testing with MP 30 degrees of flexion 30-35 degrees of RD indicates complete rupture requiring surgery
110
Tx for UCL of thumb sprain
partial tear: 3-4 weeks of immobilization then some AROM but no stretch
111
Dupuytrens Disease
gradual thickening and tightening of fascia under the skin in he hand
112
Genetic origin of Dupuytren's Disease
Northern European s more men than women 5th decade
113
1signs of Dupuytrens Disease
nodule in palm near DPC and in line with ring finger continues to get tighter and tighter
114
Indications of Dupuytrens Disease that do not require tx
nodule, MCP joint contracture less than 30 degrees
115
Indications for tx for Dupuytrens Disease
finger joint contracture MCP flexion more than 30 PIP flexion contracture of 15 DIP hyper extension Contracture or tightness in the thumb
116
Most common Radial collateral ligament sprain of fingers
PIPJ
117
What are radial collateral ligament sprains vulnerable to
flexion contracture
118
What does untreated PIP collateral ligament injury lead to
stiff and painful lack of PIP ROM
119
Tx for "itis" vs sprain/injury
"itis"= RICE Injury/sprain= immobilization then MICE
120
Ganglion cyst
soft-fluid-filled cyst attached to or near joint capsule, tendon, or tendon sheath palpable mobile mass
121
Who is more likely to get ganglion cysts
women
122
Symptoms and signs of ganglion cyst
cosmetic pain weakness if it gets too big
123
tx for ganglion cyst
Temporary immobilization and strengthen
124
3 parts of cardiac rehab
exercise counseling and training education for heart-healthy living counseling to reduce stress
125
post pacemaker precautions
Standard sling for L UE for 24 hrs No exercise to involved shoulder for 4-6 weeks No shoulder flexion/abduction greater than 90 degrees for 4-6 weeks no lifting more than 5 lbs use minimal weight bearing
126
Sternal Precautions
avoid unilateral shoulder flexion greater than 90 degrees avoid bilateral and unilateral shoulder abduction greater than 90 degrees No lifting/pushing greater than 10 pounds don't want traction of sternum
127
1st area of consideration of cardiac recovery
monitoring progression of early mobilization and activity
128
OT role in 1st steps of cardiac recovery
want early mobilization but in structured and monitored way need to find a balance of too much or too little movement
129
method of monitoring exertion/energy expenditure
MET- monitors energy, metabolism RPE or BORG- how much is being exerted Vital signs
130
MET
measures the oxygen or calorie consumption is during specific activities 1 MET generally is equal to the resting metabolic rate Can be used in conjunction to where they are in rehab Want to help individuals understand their energy expenditures
131
Using MET to determine activities
each activity has a MET value that correlates individuals only have so much energy in the day so MET values can be used to determine what can be done during the day
132
BORG
Has to do with what person perceives/ how they feel Rating scale of 6-20 to correlate with heart rate range 60-200 In phase 1 of rehab RPE should not exceed 11-13
133
When should the BORG scale be used
when used in conjunction with vital sign monitoring helps patients be more in tune with their body and when they feel overexterion
134
recommendations for Phase 1 of cardiac rehab
Intensity: RPE below 13 or HR below 120 Duration: intermittent sessions lasting 3-5 minutes, 20 minutes total Resting periods: as patient wants, lasting 1-2 minutes, shorter than time of activity Frequency: 3-4 times per day for 1st to 3rd days
135
Methods for monitoring progession of early mobilization
MET levels as an index for profession BORG scale in conjunction with vital signs to help patient become more intone with body and know when they need to stop activities Pre/post vital sign ,monitoring
136
2nd area of consideration for cardiac rehab
cognitive factors
137
Cognitive factors of rehab patients
Non surgical: premorbid changes, ischemic hypoxia after MI, decreased perfusion Complications of cardiac surgery: Type 1- stroke, TIA, Type 2- delirium and post op cognitive dysfunction due to decrease in O2
138
3rd area of consideration for cardiac rehab
Psychosocial factors
139
Psychosocial factors during cardiac rehab
Depression anxiety perceived decreased quality of life
140
Heart-focused anxiety
a specific fear of cardiac-related stimuli and sensations because of their expected negative consequence
141
Instrument for screwing depression/anxiety in cardiac population
Beck depression inventory
142
Areas of focus for education during cardiac rehab
energy conservation tips for coping with stress or anxiety tips for managing cognitive impairments
143
Phase 1 of cardiac rehab
Acute inpatient hospitalization Vital signs patient and family education improve ADLs Discharge to phase 2 at MET 3.5
144
Phases of cardiac rehab
Acute inpatient hospitalization outpatient rehabilitation community exercise and support programs
145
Phase 2 of cardiac rehab
outpatient activity tolerance improve ADLs Graded exercise program improve ability for occupational roles and work
146
phase 3 of cardiac rehab
No more therapy less intensive monitored exercise programs nutrition programs senior community programs
147
Purpose of workplace assessments
prevent injuries promote comfort safety and productivity
148
Workplace assessment inputs
Workers Supervisors Employers not just looking at what they are doing but also looking at policies and standards
149
2 components of workplace assessments
Clearance Reach
150
Clearance of workplace
sufficient headroom, legroom and elbowroom in the work area posture Designed for largest user
151
Reach in workplace
location of controls and materials accessed to perform job tasks looks at posture and repetitive motions designed for the smallest user
152
Reach envelope
Want most used objects within 10 inches want least used things within 20 inches past 20 inches is high risk for injuries
153
Visual requirements in workplace
Head position locations of visual cues, object placement, information placement visual input should be directly in the line of sight
154
Placement of equipment in workplace
postures and motions are objects too high or too low is equipment too far away leading to extensive extension
155
Seated workstations
Ergonomic chair- height adjustable, lumbar and thoracic support, seat pan length Desk/surface height- low height at 90 degrees
156
Standing workstations
surface height, clearance and posture should be assessed Flooring and mats can be really hard on back to stand all day on hard floor
157
Workplace intervention
start with problem list include recommendations and education then follow up promote neutral posture and change layout of work surfaces
158
Work place intervention for group
OT as a consultant at community level or company levels
159
Seddon Classification
Neuropraxia Axonotmesis Neurotmesis
160
Neuropraxia
damage to myelin but axon is still intact impacts conduction
161
Axontmesis
Axon and myelin is damaged
162
Neurotmesis
Full nerve is damaged
163
Problem of nerve with PNI
divided into proximal and distal segment distal segment undergoes degeneration
164
What is required for recovery after full severance
Extension of proximal segment back to distal orientation of proximal segment to distal, needs ot find its way back
165
Anatomy fo nerve fiber
axon encased by endoneurium nerve fibers bundled into fascicule encased in perineurium many fascicule are embedded in epineurium
166
Sunderland classification
1- myelin damage 2- axon damage 3- endoneurium damage 4- entire fascicle/perineurium damage 5- entire nerve including epineurium is damaged
167
Seddons vs Sunderland
Neurapraxia=Grade 1 Axonotmesis- Grade 2 Neurotmesis= grade 3, 4, and 5
168
Metabolic conduction block
caused by compression Temporary 6-12 week recovery severe falling asleep with sensory and motor impairment Recovery signs start with itching, shooting pain, and then parenthesis
169
Neurapraxia/Sunderland Type 1
complete motor paralysis minimal sensory loss complete recovery short term focused intervention
170
Axonotmesis/ Sunderland Type 2
Transection of axon complete motor paralysis and sensory loss usually complete recovery moderate intervention
171
Neurotmesis/ Sunderland type 3
often a traction injury complete motor and sensory loss surgery may be required incomplete recovery moderate intervention
172
Neurotmesis/ Sunderland type 4
Complete motor and sensory loss Surgery recommended nerve may not be able to locate distal end on its own incomplete recovery long-term intervention
173
Neurometsis/ sunderland type 5
complete motor and sensory loss surgery mandatory never complete recovery long-term intervention
174
2 phases of nerve response
Disintegration of the axon and breakdown of myelin sheath (wallerians) neuronal regeneration (extension and orientation)
175
Wallerian degeneration
occurs distal to level of injury distal end shrinks and collapses fascicle gets smaller
176
When can nerve response begin
at grade II
177
Rate of recovery of nerve
1-3 mm per day after initial latency period of 3-4 weeks
178
Techniques of nerve repair
Epinerual repair- stitching segments together group fascicular repair nerve grafting Nerve conduit
179
What is classic posture when referring to a PNI
resting/active hand posture all 3 nerves have this, if individual has it you can rule in nerve injury
180
Radial nerve injury
high injury often caused by humeral fracture- will effect upper arm all the way to hand Classic hand posture- wrist drop Radial nerve innervates extensors
181
Median nerve injury
cannot flex digits on medial side and no wrist flexion depending on location of injury Classic posture- benediction during active fist (only ulnar side flexes)
182
Ulnar nerve injury
intrinsics in digits and wrist flexion is effected classic posture: ulnar claw deformity at rest of lesion is at wrist
183
Tx for PNI
Immobilization based on what nerve is injured preserve unaffected joints and muscles slow lengthening of repaired nerve segment
184
entrapment vs injury
there is not typically a full loss of sheath with an entrapment getting compressed for some reason
185
Radial Nerve Palsy
injury to radial nerve at level of humerus often follows humerus fracture
186
What are symptoms of radial nerve palsy
absence of all wrist and finger extensors and supination loss of sensation at the dorsoradial aspect of the hand
187
Tx for radial nerve palsy
wrist extension splint while healing strengthening as motor function returns
188
Radial Tunnel syndrome
compression as the nerve lies against the capitulum by the ECRB
189
Symptoms of radial tunnel syndrome
sensory only!!! aching in the prox/distal forearm with wrist flexion and forearm rotation night pain point tenderness 4-5 cms distal to lateral epicondyle pain with resisted supination and MF extension
190
Radial tunnel syndrome treatment
activity modification nerve glides
191
PIN syndrome
compression of the nerve between the two heads of the supinator
192
PIN syndrome symptoms
paralysis of ECU, EDC, EDM, and EI Loss of MP extension of digits and full thumb extension
193
median nerve entrapment syndromes
Pronator syndrome AIN syndrome Carpal Tunnel Syndorme
194
Pronator Syndrome
compression between two heads of pronator teres
195
Symptoms of pronator syndrome
pain in volar forearm no night pain or paresthesias parenthesis in digits and thenar eminence positive tingles over pronator tunnel
196
2 special tests for pronator syndrome
pronator teres test- resisted pronation with the gradual extension of the elbow, if there's pain then + Resisted middle finger flexion- compression at FDS fibrous arch
197
Pronator syndrome treatment
Elbow splint activity modification modalities nerve glides
198
AIN Syndrome
Compression as it branches off the median nerve
199
Symptoms of AIN
Motor symptoms only Paralysis of FDP of digits 2 and 3 and the FPL Pain with resisted pronation paralysis of PQ
200
AIN treatment
PROM Elbow splint or thumb IP flexion splint
201
Carpal tunnel syndrome symtpoms
numbness nocturnal pain and paresthesias positive tinels and phalens at wrist Sensitivity to cold positive berger test
202
Carpal tunnel treatment
splint activity modifications nerve and tendon gliding modalities
203
Ulnar nerve compressions
Thoracic outlet cubital tunnel Guyon tunnel
204
Thoracic outlet syndrome
compression of the brachial plexus and subclavian vessels
205
Tx for TOS
rest pain modalities nerve glides gentle massage
206
Cubital tunnel syndrome
Compression at elbow from leaning on it
207
Sx of cubital tunnel
numbness and tingling along ulnar forearm and hand pain at medial aspect of elbow esp. with extreme elbow flexion
208
Tests for cubital tunnel
Positive elbow flexion test positive tinels at elbow Positive froments sign Positive Wartenbergs
209
Cubital tunnel treatment
Elbow pad, activity modification modatilies edema control nerve glides
210
Guyon Tunnel syndrome
Ulnar nerve at wrist repetition ganglion pressure fascia thickening
211
Symptoms of guyon tunnel syndrome
pure sensory, pure motor or both depending on level decreased pinch and power grip pain over volar waist and 5th digit
212
GTS tests
+ froments + wartenbergs
213
GTS treatment
work/activity modification modify hand position, wear padded gloves nerve glides
214
What is the first goal for the healing process of the wound
infection control if present
215
3 phases of wound healing
Inflammation Proliferation Remodeling/Maturation
216
Inflammatory phase of wound healing
Contain exudate, reduce edema, remove dead tissue, promote granulation Length= 1-10 days Goal is to be able to manage wound care on own or with caregiver
217
Proliferation phase
stimulate angiogenesis, promote epithelialization, protect wound, maintain a moist environment Length: 3-21 days
218
Remodeling phase
Educate on pressure relief, skin inspection, mobilize soft tissue Length= 3 weeks-2 years
219
Red wound
what we want to see cellular activity- oxygen and nutrients Therapeutic goals protect/ keep moist
220
Yellow wound
Slough, biofilm cellular activity- fibrin Therapeutic goals- remove yellow may or may not heal with further intervention besides cleaning
221
Black wound
Necrotic tissue must be removed or healing wont occur no cellular activity
222
Types of wound closure
Primary closure- staples, stitches, glue Secondary closure- no intervention, healing on its own Delayed primary closure- primary closure after surgery
223
Types of scar
Soft- how we want scars to heal Hypertrophic- raised red rigid Keloid- spread beyond wound boundaries Contracture- very tight that restricts motion
224
Scar management
compression garments, wear 23-24 hours for a year massage silicone/gel inserts ROM Thermal agents