Exam 5: Hand Stuff

Question 1

purpose of an orthosis

Answer 1

Protection
* Fractures, tendon repair, trauma
Positioning to relieve symptoms and promote
healing
* Nerve compression, arthritis
Awaiting functional return
* CVA, SCI, TBI
Increase motion/compensate for lost motion
* Stiffness, nerve compression injuries, SCI

Question 2

static orthosis

Answer 2

• no moveable parts
• designed to protect, restrict motion, and provide proper positioning

Question 3

static progressive orthosis

Answer 3

• uses inelastic parts to position a joint at the available end of ROM
• intent is to improve PROM

Question 4

dynamic splint

Answer 4

• has moveable or elastic parts
• used to improve motion, provide controlled motion or compensate for loss of motion

Question 5

static and static progressive orthosis principles

Answer 5

• 3/4 length of forearm
• 1/2 up sides of hand/ forearm
• fractures - one joint above/ below injury stabilized
• avoid pad/ bony prominences
• edges smooth
• strapping wide enough to distribute pressure (also at angle)

Question 6

dynamic orthosis principles

Answer 6

• same as static/ static progressive +
• high/ low profile outriggers
• force should be enough to achieve goals while being tolerable

Question 7

orthosis precautions and contraindications (5)

Answer 7

• poor skin integrity
• decreased cognitive status
• undiagnosed joint instability
• pain
• client unwillingness to accept responsibility

Question 8

orthosis education and training (5)

Answer 8

• wearing schedule
• caring for the orthosis
• monitoring for skin irritation
• not stored near heat source
• picture of client wearing orthosis

Question 9

thermoplastic properties (5)

Answer 9

• thickness
• drapability
• memory
• rigidity
• adherence

Question 10

purpose of serial casting

Answer 10

to decrease tone
- botox often injected in muscle
to decrease joint stiffness
- casting motion to mobilize stiffness (CMMS)

Question 11

precautions and contraindications to serial casting

Answer 11

• poor skin integrity
• decreased cognitive status
• bony restrictions

Question 12

different types/ names of orthoses (7)

Answer 12

• resting hand
• volar wrist
• thumb spica
• ulnar gutter
• dorsal blocking
• metaphalangeal blocking
• finger gutter

Question 13

different types of assessment of the hand (8)

Answer 13

• ROM
• Strength
• Sensation
• Inflammation/ Edema
• Integument
• Observation
• Functional Performance
• Provocative Testing

Question 14

ganglion cysts

Answer 14

soft tissue mass

Question 15

Dupuytren’s Contracture (disease)

Answer 15

• progressive contraction of fascia in palm
• can occur in any finger

Question 16

de Quervain’s tendinopathy

Answer 16

tenosynovitis of first dorsal compartment

Question 17

trigger finger

Answer 17

tenosynovitis at the A1 pulley

Question 18

complex regional pain syndrome (CRPS)

Answer 18

• pain
• skin and temperature changes
• inflammation and waxy
  swelling, stiffness, burning pain, hypersensitivity to cold, changes in skin color, hair/nail growth, loss of functional use
  Type I vs Type II
• diagnosed exam, x-ray, bone scan or diagnostic sympathetic block
  THERAPEUTIC GOALS
• minimize pain, decrease edema while improving functional ROM
• need encouragement to use extremity
  ‒ bilateral activities, ADLs, weight bearing
  ‒ graded motor imagery, sensory re-education, orthotic intervention, modalities

Question 19

goals of traumatic hand injuries (5)

Answer 19

• wound, inflammation, scar and pain management
• client education
• fabrication of a custom positional orthosis
• ADL training
• discussion of the psychological effect of trauma

Question 20

OT interventions for ROM vs. strengthening (6)

Answer 20

• arom vs. prom
• tendon glides
• blocking
• controlled motion
• early protected motion
• goal of early mobilization

Question 21

OT interventions for rom vs. STRENGTHENING (4)

Answer 21

• isometric, isotonic, isokinetic
• ways to provide resistance
• contraindications
• use of functional movements

Question 22

stage 1 orthosis fabrication and fitting

Answer 22

positioning and support

Question 23

stages 2 & 3 orthosis fabrication and fitting

Answer 23

decrease joint stiffness and increase functional ROM

Question 24

sensory re-education

Answer 24

• treatment similar for both hypo- and hypersensitivity
• sensory re-education
• mirror visual feedback
• protection/ injury prevention
• desensitization - immersion, textures, and vibration
• PAMs
  
  • always use as an adjunt
  • superficial heat/cold, fluidotherapy, ultrasound, NMES, TENS

Question 25

general areas for education (5)

Answer 25

• ergonomics
• jp
• use of AE
• activity and lifestyle modification
• care and use of orthoses