Exam 2 Flashcards
intra-articular fracture
within the joint K wire (Kirshner wire for temporary repairs)
green stick fracture
incomplete fracture often seen in children
avulsion fracture
tendon pulled bone away, common in fingers
compression fracture
bones press together (Elderly) typically in the vertebrae
monteggia fracture dislocation
dislocated radial head
glaeazzi fracture dislocation
dislocated distal radioulnar joint
colle’s fracture
FOOSH, distal radius fracture, dorsal displacement
smith’s fracture
FOOSH, distal radius fracture, volar displacement
barton’s fracture
can be FOOSH, distal radius fracture, dorsal or volar displacement, also has dislocation so more severe
carpal fractures
less common than distal radius fractures
scaphoid fracture is most common, 90% occur due to FOOSH
then lunate and triquetrum
metacarpal fractures
neck of 4th and 5th (boxer’s) metacarpal is most common
elbow fracture
most common: radial head fracture- caused by a valgus force on the forearm
olecranon- can be caused by passive flexion of the arm and forceful contraction of the triceps causing an avulsion fracture
humeral fracture
radial nerve injury often
humeral neck fracture- impacted: common in elderly women with osteoporosis after a fall on hand transmits force up the extended arm
non-impacted: more common after trauma in younger adults
clavicle fracture
caused by FOOSH that transmits force up the arm to the clavicle
more common in children because smaller clavicle
carpal fractures tx phases
(thumb spica cast for carpal)
phase I: edema control, immobilization
phase II: AROM with some splinting
phase III: increase strength
principles of fracture management: 3 R’s
Recognition: identifying fractures, using imaging and palpation
Reduction: installing plates, casts, fixation
Retention: healing rates (young vs old), edema and pain control, immobilization, restoring ROM
goniometer placements
Axis— close to joint
Stationary arm— does not move
Moving arm— moves
rotary force
Occurs around a center axis, Rotating objects change orientation during motion, Two points moving in a circle move at different speeds, the
point further away from the center moves faster than the point closer to the center
linear force
Occurs along a straight line, Linear motion keeps its original orientation through the movement, Two points in a segment moving a line from one place to another move at the same speed.
active rom (AROM)
active muscle contraction moving joint
active assist rom (AAROM)
muscle actively move the joint, but external assistance is required (therapist or strap)
passive rom (PROM)
no muscle contraction while the joint is passively moved by either a therapist or external equipment
OT doing all the work
passive stretch
passive over-pressure to a joint to reach end range
Moving the joint past its end range
OT helping stretch further
scaption
30-45 deg in front of coronal plane; Congruency of humeral head and glenoid fossa; where people are successful
- about halfway between shoulder flexion and shoulder abduction
arches of the hand
transverse arch curves from radial to the ulnar side of the hand
longitudinal arch from wrist to fingers
wrist and hand mobility
prolonged hold/joint mobilization increase ROM promoting capsular mobility
distal carpal row is immobile while mobility occurs at proximal carpal row
intrinsic hand muscles
(18) muscles that begin and end within the hand
Intrinsics are stabilizers and balance motions
Lumbricals flex MCP joints and extend IP joints
intrinsic plus and minus
Intrinsic plus: immobilize the hand into a safe position for healing
Approximately 60-90 degrees flexion
Intrinsic minus: making a claw
Extensor digitorum hyperextends the MCP joints and simultaneously flexes the IPs with profundus
Happens when interossei and lumbricals are not working
extrinsic hand muscles
(18 tendons) muscles that terminate in the hand but have muscle bellies in the forearm
they cross the wrist and flex and extend the digits
mobile rays of hand
thumb, ring, and small digit metacarpals
fixed rays of hand
index and long fingers metacarpals
flexor tendon pulley system
annual pulleys and cruciate ligaments prevent the extrinsic digit flexor tendons from bowstringing
annular pulleys (5) in each finger
A1-A5 → prevent bowstringing
3 cruciate ligaments (C1-C3)
prevents outer sheath from collapsing
positioned around the flexor digitorum profundus and superficialis
extensor mechanism (mx and function)
lumbricals, interossei, and extensor communis
function: to safely extend digits, provide shortcuts for extensor tendons across joints, permits full flexion
3 bands: 2 lateral and 1 central
primary wrist flexors
flexor carpi ulnaris and radialis
primary wrist extensors
extensor carpi ulnaris, extensor carpi radialis longus and brevis
measures for intrinsic tightness
Bunnell test: if the mcp is extended and you do passive pip flexion and it’s limited, but if you switch to flexion for both and it’s better that tells you there is intrinsic tightness (table top)
positive test finding for PIP restriction: increased PIP flexion with MCP flexion (implies intrinsic restriction)
full PIP flexion with MCP extension is a normal test finding
measures for extrinsic tightness
digit extension increases as wrist moves towards flexion, or digit flexion increases as the wrist moves towards extension due to tightness at extrinsic wrist flexors
hold a fist, extend their wrist and then have them drop out of their fist and if they have trouble with it, they have issues with extrinsic extensor tightness
grip strength
Measure on dynamometer
3 times and take average
pinch strength
Chuck pinch – two fingers on top, thumb on bottom
Lateral pinch – a scissor grasp with the thumb on top and lateral border of the index finger on the bottom
Tip to tip – tip of index on top, tip of thumb on bottom
edema measures
Skin creases
Volumetric
Putting hand in water to measure difference in water volume
Girth/circumference
peripheral v nerve root injuries
Peripheral nerve injury: decreased sensation in the peripheral pattern; decreased strength in specific peripheral nerve muscle innervations
Nerve root injury: dermatomal patterns of decreased sensation; myotome patterns of decreased strength
sunderland 1st degree
disruption: intact axon and preserved structures
prognosis: full recovery in days to week
therapy: short term, focused
tx: observe, conservative
Sunderland 2nd degree
disruption: disrupted axon with intact endoneurium
prognosis: variable recovery, worse with proximal injuries
therapy: short term/moderate
tx: surgical or conservative intervention
sunderland 3rd degree
disruption: endometrium disrupted with perineum intact
prognosis: 60-80 recovery, incomplete
therapy: moderate
tx: surgical may be required
sunderland 4th degree
disruption: endometrium and perineurium disrupted and epineuruem intact
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention
sunderland 5th degree
disruption: loss of nerve trunk continuity, complete disorganization/transection
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention
capsular patterns and related conditions
predicted loss of motion;
limited movement in a joint specific ratio
Arthritis: inflammation when the entire capsule is involved
glenohumeral: more limited ER, abduction, IR (In order)
elbow: more limited flexion
distal radioulnar: full ROM with pain at extreme ends
wrist: flex/ext limited
non capsular patterns
Limitation of ROM that do not involve the entire capsule/joint
ex) ligament adhesions
gleno: acute deltoid bursitis
elbow: internal derangement
wrist: subluxated capitate bone
clinical reasoning process
initial referral → additional information → check: occupational profile performance, occupational tasks, activities, component performance → problem definition → patient and OT understanding roles → treatment selection → treatment → reevaluating → treatment modification → discharge planning → treatment termination
ADL
bathing, showering, toileting, dressing, eating, feeding, functional mobility, personal hygiene and grooming, sexual activity
IADL
care of others, pets, children, communication management, driving and community mobility, financial management, home establishment and management, meal prep and cleanup, religious and spiritual activities and expression, safety and emergency maintenance, shopping
spinal curves
2 Primary Curves: Thoracic & Sacral / Posterior convexity / Kyphosis
2 Secondary Curves: Cervical & Lumbar / Anterior convexity / Lordosis
common causes of lumbar pain
spinal stenosis and fractures !!!
others:
spondylosis: nerve root compression
spondylolysis: fracture of lumbar vertebrae
spondylolisthesis: vertebrae slippage
stenosis: narrowing of spinal canal
herniation: protrusion
nucleus protrudes into ruptured inner fibers of annulus; peripheral fibers intact but a general bulging of the disc occurs
herniation: extrusion
nucleus penetrates outer walls of the annulus, but the protruding tissue is still connected to the central portion of the disc
herniation: sequestration
posterior longitudinal ligament is ruptured, and one or more fragments of the herniated material protrude in the spinal cord
herniation: schmorl’s node
rupture of the disc through the cartilaginous end plate due to a congenital weakness
pelvic-spinal movement
anterior pelvic tilt = spinal extension
posterior pelvic tilt = spinal flexion
lateral pelvic tilt = scapular elevation in rhythm with the lower side of the pelvis
= scapular depression in rhythm with the higher side of the pelvis
spinal-scapular movement
extension of spine = adduction of scapula
flexion of spine = abduction of scapula
scapulo-humeral movement
adduction of scapula = external rotation of humerus
abduction of scapula = internal rotation of humerus
upward rotation of scapula = humeral flexion/abduction
downward rotation of scapula = humeral extension/adduction
Identify the order of muscle return following a median nerve surgical repair (proximal to distal innervated muscles)
median nerve is medial side of the biceps tendon, proximal to carpal tunnel
the muscles most proximal to the lesion will return first and that muscle’s motion will be first as well
motor return continues proximal to distal
- superficial volar forearm (pronator teres, FCR, palmares longus), intermediate group (FDS), deep group
contraindications for performing AROM
- many types of tissue injury and/or treatment
- cardiac status
precautions: pain, cognition, movement into end range
benefits of AROM
- maintain tissue length, increase circulation, proprioception
- decrease rate of atrophy
benefits of PROM
- preserves soft tissue length
- prevents contractures
- allows tissue gliding
median nerve injury
will not be able to oppose thumb or flex radial 3 fingers, pinky and ring finger will be flexed
(ape hand)
ulnar nerve injury
will not be able to extend 4th & 5th digits, index & middle will be extended (“claw hand”)
- crossed finger sign, froment’s, duchenne, claw
radial nerve injury
wrist drop
tenodesis
starts with relaxed digits and wrist flexion, active wrist extension results in the digits flexing due to passive insufficiency
hutchinson’s fracture
(chauffeur’s)
radial styloid fracture
distal radius fracture phases
phase I: edema and pain control, not moving, some passive movement
phase II: edema control, restore ROM to AROM in wrist, light ADL
phase II: passive stretching, some resistance, strengthening wrist
most common UE fracture
distal radius
slipped disk
doesn’t actually slip, vertebra can slide forward due to excessive shear forces
Tangential strain (disc)
posterior fibers of annulus are stretched to a point of damage (deformation); strain is without tearing
strains vs sprains
Strains: pulling of ligamentous, capsular, or tendinosis structure without tearing
Sprains: tearing or excessive stretching with microscopic contusion (bruising) or hemorrhage or both
types of bone in the vertebral column and their function
Trabeculae (spongy) bone supports weight
Covered with cortical bone thickened around the rim where the epiphyseal plates located in the center by the cartilaginous end plate
proximal phalanx fracture tx phases
Phase I: edema control, immobilize
Phase II: AROM, scar message, gliding exercises
Phase III: PROM and progressive resistance
middle phalanx fracture tx phases
same as proximal phalanx EXCEPT:
- special attention to DIP joint function
- phase II emphasis on FDP blocking and gliding
phase III flexing into therapy putty, dynamic splinting
greatest risk for rupture of disk
torque (twisting) with axial compression and bending
