EXAM I Flashcards
typical NMES settings and purpose
to strengthen muscles
35-50 pps
1:4 ratio
100-200ms for small mx and 300-400 for larger
typical TENS settings and purpose
for pain
low frequency endogenous - 10Hz
high frequency gate theory - 100 Hz
100-200ms for small mx and 300-400 for larger
typical ultrasound settings
size head 3 or 5cm
1Hz for deep, slow
3Hz for shallow, heat, fast
pulsed (non thermal) vs continuous (thermal)
0.8
heat superficial/deep condition and convection
superficial/conduction: hot packs, paraffin
convection: whirlpool, fluidotherapy
deep/conversion: ultrasound
cold conduction and convection
conduction: cold packs, ice massage
convection: cold water baths and whirlpools
uses for biofeedback
To assist in facilitation of weak or paralyzed muscles
To assist in the reduction of activity levels of spastic muscles
As a monitor to prevent overuse.
LLLT
Low-level laser therapy is used to increase local blood circulation, relief of minor muscle aches and joint aches, pain and stiffness, relaxation of muscles, muscle spasm and minor pain and stiffness associated with arthritis.
iontophoresis
A method of administering ionized drugs via electrical current
Like electrical charges repel, so a positively charged drug using the positive setting of the device will push the drug into the system
dose:
clinical hand presentations of UE nerve injuries
radial: wrist drop (radial nerve palsy)
median: ape hand, hand of benediction
ulnar: claw hand
acute phase
orthosis to protect nerve repair
maintain AROM in uninvolved joints
scar management
recovery phase
orthosis at night
digit/wrist motion
neuromuscular reeducation
desensitization
chronic phase
adaptive techniques for ADL
surgery
biofeedback
psychosocial therapy
phases of treatment for sensory return
1st: Pain/temp vibration 20 cps moving touch constant touch vibration 256 cps touch localization 2 pt discrimination last: stereognosis
process of desensitization, and sensory re-education
vibration thresholds, semmes weinstein, 2 point discrimination, ten test
OT process treatment: prevent rupture after surgical repair with orthosis fabrication and client education, control edema and scarring, maintain motion safely, promote healing.
work on sensory return and desensitization. work on strengthening avoiding fatigue when MMT is ⅗ or less
Phase I: sensory re-education and cortical remapping
silent phase (early)
mirror box, anesthesia
Early phase: return of vibration 30 cps and beginning to identify moving touch
then use textures/different stimuli
Late phase: transfer gains made into function
object recognition, prehension of objects, maintenance of force during transport off objects, object manipulation
Advanced late stage: proprioceptive activities, hypersensitivity (massage, textures, immersion to address this)
clinical tests, symptoms, etiology and treatment for Thoracic Outlet Syndrome
20-30 years old
women 3-4x more likely to develop neurogenic TOS
neurogenic is >90%, vascular 2-5%, arterial 1%
congenital anomaly related to extra 1st rib
post traumatic structure
post traumatic posture structures
clinical index for diagnosis of TOS (3 of 4 symptoms)
history of possible pain patterns
palpation: supra and infra clavicular fossa, distal nerve palpation to rule out peripheral nerve involvement, coracoid process
tests: elevated arm stress, supraclavicular pressure, costoclavicular maneuver, wright’s, cyriax release test (sleep), upper limb tension test (elvey test)
1. symptom control
2. specific postural control exercises
3. general maintenance exercises
causes, presentation and treatment for compartment syndrome
- Pain
- Paresthesis
- Passive stretch
- Pressure
- Pulselessness
Use a Stryker Device to measure the pressure (2-10 mm of mercury is normal)
fasciotomy - surgery that relieves swelling and pressure on a compartment in the body
kinesiology descriptions of normal forearm and wrist motion
Sagittal plane: 11 degree palmar tilt
Frontal plane: radial inclination 23 degrees
Radiocarpal joint: 80% → radioscaphoid 45% and radiolunate 35%
Ulnocarpal joint: 20% → ulnolunate 14% and ulnotriquetral 8%
Midcarpal joint: → STT 31%, SC 19%, lunocapitate 29%, triquetrohamate 21%
Analyse all aspects of the physical examination and treatment of the wrist
Stabilizers of the ulnar wrist: static stabilizers (sigmoid notch - TFCC) and dynamic stabilizers (pronator quadratus, FCU, ECU)
Triangular fibrocartilage complex (TFCC): connects ulnar side of the wrist
radial dorsal zone
- de quervains
- thumb CMC osteoarthritis
- thumb MP (gatekeeper’s thumb)
- scaphoid fracture (S-L and L-T)
- distal radius fracture
ulnar dorsal zone
- lunotriquetral instability
- TFCC
- ECU tenditnits
- distal radioulnar joint instability
radial volar zone
- carpal tunnel
- scaphoid fracture
- distal radius fracture
- ganglion cysts
ulnar volar zone
- guyons canal
- hamate fracture
- FCU tenditnits
- ganglion cysts
- distal radioulnar joint instability
central dorsal zone
- scaphoid lunate instability
- capitate fracture
- ganglion cysts
ulnar + and -
Ulnar +: distal ulnar longer than radius causing ulnar sided pain
Ulnar -: distal ulnar shorter than radius causing radial sided pain
amount of motion necessary for a functional elbow joint
functional elbow motion: -30 deg to 130 deg
functional forearm 50 deg pronation 50 deg supination
Analyze the position and significance of all elbow ligament
ulnar collateral ligament: connects medial elbow to distal proximal ulna
radial collateral ligament complex (annular, lateral ulnar collateral, radial collateral, and accessory lateral collateral ligaments)
functions of elbow capsule:
•Resists joint distraction, hyper-extension and valgus stress. (Safran & Baillargeon, 2005)
•Most lax at 80 degrees of flexion
•Position of comfort after injury
•Risk of flexion contracture
•Ligaments inter-digitate with the capsule and contribute to reinforcing the capsule.
•Wrist and hand muscles contribute to reinforcing the capsule.
medial collateral ligament injury
pain with resisted wrist flexion, tenderness with palpation to medial epicondyle
osteochondritis
edema and possible flexion contracture, pain and stiffness, arthritis
common fractures of the elbow
radial head, coronoid process of the ulna, epicondyle of humerus, lower humerus, upper ulna, upper radius
Identify the annual ligament, medial collateral ligament, and parts of the lateral collateral ligament complex.
ulnar collateral ligament, radial collateral ligament complex (annular, lateral ulnar collateral, radial collateral, and accessory lateral collateral ligaments)
Identify the functional motions of the limb girdle. Contributions of scapula, glenohumeral joint & scapula.
G-H: traps and serratus anterior
static stabilizers: ligaments, capsule, labrum
Rotator cuff: SITS and deltoid
- Functional motions of the shoulder girdle:
1. scapulothoracic joint not a true synovial joint, provides rotation of the scapula on the chest wall
2. sternoclavicular joint acts as a radius of limb-girdle motion
3. acromioclavicular joint: provides adaptive motion between the clavicle and scapula
sequential shoulder evaluation
history
- insidious (sleeping, sports, working)
- traumatic (mechanism, surgery)
- upper quarter screen –> AROM –> PROM –> palpation, mobilization, special tests –> treatment plan
pathology, underlying causes, clinical phases and principals of rehab for frozen shoulder
Underlying pathology of Frozen shoulder: adhesive capsulitis, impingement syndrome, peri arthritis
Clinical phases:
Freezing/inflammatory: 3-9 mo, pain worse at night, starts as dull ache and becomes more severe over time
Frozen: loss of motion, dull achy pain, capsular fibrosis
Thawing: regained motion, decreased pain, increased ADLs, capsular hypovascularity
structural and functional factors contributing to Impingement Syndrome
45-65% of all complaints of shoulder pain
correlate with bursal sided tendinopathy
increase incidence with age and more with dominant arm
Intrinsic: degeneration of rotator cuff, tears bursa inflammation mal union fractures anatomic variations of acromion from trauma (type II or III)
Extrinsic: poor posture glenohumeral muscle imbalance (weak RC) tightness in glenohumeral joint capsule encroachment of greater tuberosity on subacromial tissue periscapular muscular imbalance
post-operative rotator cuff surgery precautions to cases and general post-op treatment interventions.
Protection phase: 0-2 weeks post op
patient education
no exercise
Protection phase: 2-6 weeks post op
protected PROM (avoid passive or active extension and internal rotation)
Protection to Mobilization phase: 6-12 weeks
AAROM-AROM and protected PROM
Mobilization phase: 8-12 weeks and 12-120 weeks
exercises with increased EMG supraspinatus activity
Strengthening phase: 20 weeks
Recognize the characteristics of CRPS
Etiology: trauma, crush injuries, vascular damage, electrical injuries, edema, coagulopathies, abnormal sympathetic reflex
5 “Ps”: pain, paresthesia, passive stretch, pressure, pulselessness
classification:
Type I: Reflex Sympathetic (injury that did not directly involve the nerves)
Type II: Causalgia (over damage to peripheral nerve)
painful lesion from trauma or disease process, predisposition
female to male 3:31
Analyze Pain, stiffness, edema, skin temperature, color change, bone demineralization and the spreading of symptoms in CRPS. What is the most common characteristic?
burning pain in 97% of patients joint stiffness in 88% of patients edema in 69% skin color changes trophic (shiny, thin, sweaty) in 60% nail and hair growth patterns change hyperesthesia in 69%
Recognize the which CRPS symptoms occur in which of the 3 stages
Stage I acute (3 to 6 months): burning pain, sweating, tenderness. Possible patchy bone thinning on x-ray.
Stage II dystrophic (3 to 6 months): skin changes (shine and/or thickened), contractures and pain
Stage II atrophic: loss of motion and function, contractures and thinning of skin
Analyze all aspects of OT treatment for RSD/CRPS
prevention, elevation, dressings, cast
fasciotomy
pain and scar management, maintain/gain soft tissue mobility, progressive activity and strengthening
Pre-prosthetic evaluation and training
Patient education = psychosocial adjustment Pain, sensation Management of residual limb Strength and ROM ADL/IADL, balance, endurance
1) wash limb daily with mild soap and dry; 2) provide wound cleansing; 3) use appropriate creams to massage at the suture line to loosen crust
types of prosthetics
Passive prosthesis: systems that do not possess the ability to actively position/grasp/release; functions to protect limb, support/stabilize objects, social acceptance
Conventional body-powered prosthesis: uses motions from the proximal body to operate the device)
simple, low cost, reliable, may restrict some movement, patient exerts effort
voluntary opening: colitional force and excursion of the cable, prehension force is dictated by number of rubberbands
voluntary closing: allows for graded prehensile force, higher forces can be applied through cabling system
Externally powered prosthesis/myoelectric: uses power external to the body; muscle contractions to operate
wrist units: hook and hand, ball and socket
no harness, can get more types of motions, frequently prescribed for transradial amputations, electrode alignment
Hybrid prosthesis: combination of body powered and myoelectric
electrically powered elbow with a body powered terminal device; use proprioceptive feedback from the cable system and inputs from electromechanical stimulation
Activity specific prosthesis
levels/causes of amputation
primary cause of arm amputation: trauma
Transhumeral: above elbow
Transradial: below elbow
primary cause of leg amputations: vascular disease and diabetes
Know goals of residual limb shaping for prosthetic.
Goals: shrink and shape residual limb so that it is tapered at the distal end; want rounded end
Rigid dressings: protects limb from trauma, early prosthetic fit, effective in controlling edema, requires skill to put on and off
Shrinkers: easily applied, more consistent pressure, easier to maintain, loses elasticity when washed, more expensive
Elastic wraps: pressure can be customized and graded to reduce edema, adjustable compression, inexpensive, cannot self apply with UE, needs frequent reapplying
mechanical properties of wound healing
tissue regeneration: primary intention/closure; wound edges are close with little/no tissue loss (sutures)
tissue repair: secondary intention/closure; wound is beyond superficial later
When wounds won’t heal: grafts (skin/tendon/bone), flaps (share blood supply)
Factors that influence wound healing: humidity/temp, infection, edema, hematoma, depressed immune system, nutrition, smokers
Overlapping phases of wound healing
Hemostasis: immediate, lasts a few minutes, clotting cascade occurs and platelets adhere to collagen to seal and stop bleeding, produce thrombin and fibrinogen to clot
Inflammatory: 1-6 days, edema and pain, vasodilation, neutrophils and macrophages, prepares wound for closure
Proliferative: 3-20 days
filling the wound (granulation tissue replaces fibrin)
contraction of wound margins (pull together)
epithelialization (cover wound bed with epithelium)
Remodeling/maturation: 14 days-1 year, max strength is limited to ~80% of pre-injured strength
collagen cross linking is a key factor
