Final exam - old stuff

Question 1

Carpal bones and hand/digit orientation with a flexed fist.

Answer 1

Flexed Wrist
Proximal row goes dorsally
Capitate glides dorsally on lunate
Extended Wrist  
Proximal row goes volarly 
Capitate glides volarly

Question 2

flexor tendon zones

Answer 2

zone 1: FDP only, jersey finger

zone 2: no mans land, most vulnerable

zone 3: lumbricals

zone 4: carpal tunnel

zone 5: proximal carpal tunnel to forearm, where flexor tendons are

Question 3

extensor tendon zones

Answer 3

zone 1: mallet finger

zone 2: mallet, swan neck

zone 3: boutonnière (PIP central slip_

zone 4: proximal phalanx

zone 5: sagittal band injury, boxers fracture

zone 6-8 see pic

Question 4

Orthosis for flexor zone injuries:

Answer 4

DORSAL BLOCKING ORTHOSIS (these prevent wrist extension)

Question 5

Factors Related to Back Issues

Answer 5

• Sprains/strains
• Bulging Disc-no symptoms, involves outer layer of cartilage
• Herniated Disc- more likely to cause pain, involves rubbery cushion
• Spinal Stenosis-narrowing of spinal column
• Facet Joint Syndrome-osteoarthritis
• Spondolyisis- stress fracture of vertebrae, more common in young people
• Spondyloisthesis-stress fracture has caused vertebrae to shift into abnormal position
  
  • both of these stress fractures can be (usually) treated with conservative management

Question 6

OTs role with chronic pain includes….

Answer 6

• Patient education on posture/positioning
  
  • Patient education on relaxation and pain management techniques
  • Use of biofeedback
  • Use of modalities

Question 7

median nerve injuries

Answer 7

hand of benediction: compression of high median nerve - unable to flex MCP of index due to profundus and superficialis loss of innervation

ape hand: prolonged low median nerve injury, loss of thumb opposition

Question 8

ulnar nerve injuries

Answer 8

claw of 4-5 digits (can’t extend)

Question 9

radial nerve injuries

Answer 9

high lesion: wrist drop

low lesion: wartenberg syndrome

Question 10

Biofeedback

Answer 10

Used to provide patient with some type of auditory and/or visual display to provide feedback to the patient regarding muscle activity.

Question 11

Iontophoresis

Answer 11

Uses electrical properties of skin to enhance uptake of medication
· Polarity of electrode (+ drugs connects to + electrode, - drug connects to - electrode)
· Current flow X dosage =total dosage

Question 12

TENS:

Answer 12

Used to reduce pain
· High Frequency (Gate Theory)
o Uses the larger, sensory fibers to close the gate to inhibit the pain signals
o Higher pulse frequency (90-250 pps/Hz)
o Short (low) duration: 50-100 ms
o Should feel like a tingle
20-60 mins for treatment

·   	Low Frequency (Endogenous Opiate) :
o   Brain is stimulated to release endorphins.
o   Low pulse frequency (2-10 pps)
o   Long pulse duration (160-400 msec.)
o   Intensity: motor level (‘twitching)
o   Treatment is 20-45 mins

Question 13

NMES

Answer 13

Used to re-educate muscles. strengthen, increase circulation, functional training
· Slower frequencies for slow reacting fibers
· Higher frequencies for fast reacting fibers
· Pulsed current

Question 14

Ultrasound

Answer 14

Thermal (continuous)
Increases tissue extensibility (increases mobility), decreases pain, decreases nerve spasms, increases oxygen and blood

Non-thermal (pulsed)
Metabolic, enhance healing, stimulates normal events of healing

Frequencies (depth of treatment)
3MHz= ‘hot, fast, and shallow’ ( I think you would use this on the wrist)
1 MHz= ‘deep, slower to warm’ (I think you would use this on a larger muscle, like the SITS)

Question 15

Know the difference between superficial and deep heat.

Answer 15

superficial heat:
Hot packs
Paraffin
Fluidotherapy
Contrast bath
Infrared
IR Lamp

Deep Heat (3cm or greater)
Continuous ultrasound
Diathermy

Question 16

What are the different prehension patterns?

Answer 16

Power: involves forceful grasp like on a hammer
Precision: can be described as tip to tip, pad to pad, or tip to pad
Cylindrical (gripping a cup or glass), spherical (gripping tennis ball), hook (holding a shopping or grocery bag

Question 17

GG codes

Answer 17

1: dependent
2: substantial/max assist
3. partial/mod assist
4. supervision or touching assist
5: set up or clean up assist
6: independent

Question 18

COPM: What is it measuring and how it is utilized clinically?

Answer 18

COPM is a patient interview that helps to identify goals to be worked on during therapy by identifying the importance, performance and satisfaction scores from 1-10 eventually ranking the pt’s top 5 areas.

Question 19

3-color concept and the color effects managing wounds

Answer 19

Red- healthy; protect wound, keep moist, use mild soap or saline
Yellow- continual cleaning, light whirlpool, remove necrotic tissue, absorb drainage/ Goal: evolve from yellow to red
Black- debride wound, possible mechanical scrub or debridement; wound dressing to protect and soften eschar

Question 20

What are the mechanical properties that can impact wound healing?

Answer 20

Chronic edema
Hematoma
Crust and foreign body
Others: humidity, temp, electrical gradient, infection, depressed immune system, nutrition (vitamins A&C, proteins), smokers

Question 21

Know warning signs of infection.

Answer 21

Cardinal signs: Warmth (can also include pt fever), Redness (around wound, wound itself often yellow/crusty with green discharge), Swelling, Pain (continuous), Decrease function

Question 22

What are appropriate occupational therapy goals and management of wounds? (3 phases)

Answer 22

1. Inflammatory phase: immobilize if needed in position of function, keep wound moist and reduce bacteria, RICE (rest, ice, compress, elevate) if indicated, modify activities as needed
   Goals: control edema, prevent dysfunction, wound care
2. Proliferative phase: monitor for infection, movement helpful if not contraindicated, keep moist, possible introduction of ultrasound or electro modalities
   Goals: increase PROM, gentle tension to increase tensile strength, begin scar remodeling with movement, help pt feel comfortable, prevent position of dysfunction, restore function, promote closure
3. Maturation phase: continue with previous goals, scar management, stretch, friction massage

Question 23

Work Assessment:

Answer 23

How to promote return to work:
Occupational therapy’s role with the injured worker:
Prognosis of return to work following a work related injury: after 6 months it is more unlikely pt will return to work.
Know the work capacity and the lifting requirements for each work category. The categories are: light medium, heavy and very heavy. Apply the duration scale terminology used to describe the physical demands of jobs (example: never, occasional, frequent, constant).

Question 24

MMT grades

Answer 24

5  completes ROM AG, MAX res
4+  nearly MAX res
4 MOD res
4- < MOD res
3+ MIN res
3 no res
3 - completes more than 1/2 ROM AG
2+ initiates ROM AG or completes ROM GM
2 completes ROM GM
2- does not complete ROM GM
1 palpable contraction
0 no palpable contraction

Question 25

UE & LE Amputation

Pre-prosthetic training

Answer 25

care of residual limb, relaxation and modalities, correction of body mechanics, ADL training, introduction to prosthetics, ROM and strengthening.

Question 26

Prosthetic training

Answer 26

don and doffing limb, bed mobility (especially in LE), transfer training, control training, ADL training, care of the prosthetic, vocational and avocational training, driving, psychological needs, and location of the patient.

Question 27

Amputations can be classified based on level

Answer 27

Transhumeral=above the elbow (short above, very short above)
Transradial=below the elbow (short below, long below)

Question 28

Prosthesis Options

Answer 28

No prosthesis: person learn to do things with other hand
Passive prosthesis: cannot actively grip/position objects. Used for aesthetic purposes and social acceptance
Body powered prosthesis: uses a person’s body and cords for motion. These require lots of effort to use and are not always precise.
Externally powered/ myoelectric: uses power outside of the body to control movements. Does not require a harness.
Hybrid prosthesis: mix between body powered and externally powered.

Question 29

what is trigger finger

Answer 29

Tenosynovitis of flexor sheath, nodule occurs at A1 and A2 pulley
Finger becomes locked in flexion, but sometimes extension
Usually occurs at ring, long finger, and dominate thumb
Common in women in 50s and 60s

Question 30

surgery trigger finger

Answer 30

A1 pulley is split longitudinally along the radial aspect of the pulley to allow full AROM without triggering

Question 31

Dupuytren’s Contracture

Answer 31

Disease of the palmar fascia in which progressive thickening and contracture of fibrous bands on the palmar surface of the hand and fingers results.

Occurs most often in the fourth and fifth digits.

Presents with small nodules in the hand that can thicken and contract, contributing to the formation of cords

Commonly affects PIP and MCP joints
MCP flexion >30 degrees and any amount of PIP flexion require surgery

Question 32

dupuytren’s stages

Answer 32

mild <30 deg flexion
moderate 30 deg flexion
severe >30 deg flexion

Question 33

tx for dupuytrens

Answer 33

surgery is the only option to correct; orthosis will not correct

Surgical Options:
1. Percutaneous Needle Aponeurotomy: needle makes multiple sweeps, until cord breaks.

2. Enzyme Injection: cord is injected with xiafelx enzyme, the following day the cord is released.
3. Fasciectomy: open procedure where diseased tissue is removed, patient is put under with anesthesia. Zig-zag (Z-plasty) inspection is used to limit scar tissue.
4. Dermofascictomy: skin graft is used to close wound, would immobilize for 7-10 days, good for those that have poor skin quality.

Question 34

burns layers of skin

Answer 34

Epithelium
Non-vascular
Capable of regeneration 
Dermis 
Vascular layer 
Collagen strands with nerve endings, hair follicles, and sweat glands 
Subcutaneous 
Fat and fibrous tissue

Question 35

burn depth

Answer 35

1st degree epidermis
2nd degree dermis (partial thickness)
3rd degree subcutaneous tissue (full thickness)
4th degree mx and bone

Question 36

types of burns

Answer 36

Thermal: flame, contact, scald**most common
Electrical: can lead to internal damage
Chemical: slow healing, can remain active and destroy skin over time

Question 37

OT and Burns

Answer 37

Determine TBSA
Rule of nines
Palmar Method: estimates % of burn by using patient’s palm to be estimated at 1%
Lund-Browder Chart: I think this is used for pediatric populations

Question 38

assessment and tx for burns

Answer 38

emergency phase
edema
eschatomy
positioning
orthosis
motion
grafts
rehab

Question 39

General info about fractures and healing

Answer 39

Primary Healing: without fracture callus, slow healing process.
Secondary Healing: occurs with a fixation device, where there is a strain. Most common type of healing. ‘Wolff’s Law’.

○ Phase I – prior to stability or clinical healing; joint motion may cause movement at the fracture site
○ Phase II – stable fracture, can withstand at least active joint ROM
○ Phase III – remodeling, fracture is healed or united. Can withstand PROM and normal resistive hand use

Question 40

Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD)

treatment

Answer 40

● There is no one answer
● New treatment has involved inducing a coma for 2 weeks (60% success) and a new medication called neridronate
● Evaluation: pain, skin temperature, edema, ROM
● Exercise: early is gentle and active, as pain decreases gentle PROM
● Massage: gentle massage before exercise and after
● Therapeutic modalities: heat (hot packs, whirlpool, paraffin, ultrasound, fluidotherapy)
● Electrical modalities: TENS (early stages), high voltage galvanic stimulation, NMES, biofeedback for relaxation
● Stress loading: exercise that requires stressful use of UE without forcing joint motion
● Constant passive motion devices: used with patients comfortable with ROM
● Splinting: night time (wrist 10 ext, MP 60 flex, IP ext); dynamic splinting later; serial splinting on PIP to increase extension
● Functional activities: progressive ADL tasks, crafts, work related tasks
● Strengthening: theraputty, theraband, BTE, work activity
○ Dystrophile - machine that provides structured exercise program

Question 41

anterior interosseous compression

Answer 41

proximal forearm pain volarly
sensory disturbances absent
thumb IP weakness and FDP weakness index
no symptoms with palpation of pronator
** unable to make an “O” due to paralysis of FPL and FDP to digit #2