Final exam - old stuff Flashcards
Carpal bones and hand/digit orientation with a flexed fist.
Flexed Wrist Proximal row goes dorsally Capitate glides dorsally on lunate Extended Wrist Proximal row goes volarly Capitate glides volarly
flexor tendon zones
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
extensor tendon zones
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
Orthosis for flexor zone injuries:
DORSAL BLOCKING ORTHOSIS (these prevent wrist extension)
Factors Related to Back Issues
- 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
OTs role with chronic pain includes….
- Patient education on posture/positioning
- Patient education on relaxation and pain management techniques
- Use of biofeedback
- Use of modalities
median nerve injuries
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
ulnar nerve injuries
claw of 4-5 digits (can’t extend)
radial nerve injuries
high lesion: wrist drop
low lesion: wartenberg syndrome
Biofeedback
Used to provide patient with some type of auditory and/or visual display to provide feedback to the patient regarding muscle activity.
Iontophoresis
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
TENS:
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
NMES
Used to re-educate muscles. strengthen, increase circulation, functional training
· Slower frequencies for slow reacting fibers
· Higher frequencies for fast reacting fibers
· Pulsed current
Ultrasound
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)
Know the difference between superficial and deep heat.
superficial heat: Hot packs Paraffin Fluidotherapy Contrast bath Infrared IR Lamp
Deep Heat (3cm or greater)
Continuous ultrasound
Diathermy
What are the different prehension patterns?
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
GG codes
1: dependent
2: substantial/max assist
3. partial/mod assist
4. supervision or touching assist
5: set up or clean up assist
6: independent
COPM: What is it measuring and how it is utilized clinically?
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.
3-color concept and the color effects managing wounds
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
What are the mechanical properties that can impact wound healing?
Chronic edema
Hematoma
Crust and foreign body
Others: humidity, temp, electrical gradient, infection, depressed immune system, nutrition (vitamins A&C, proteins), smokers
Know warning signs of infection.
Cardinal signs: Warmth (can also include pt fever), Redness (around wound, wound itself often yellow/crusty with green discharge), Swelling, Pain (continuous), Decrease function
What are appropriate occupational therapy goals and management of wounds? (3 phases)
- 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 - 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 - Maturation phase: continue with previous goals, scar management, stretch, friction massage
Work Assessment:
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).
MMT grades
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
UE & LE Amputation
Pre-prosthetic training
care of residual limb, relaxation and modalities, correction of body mechanics, ADL training, introduction to prosthetics, ROM and strengthening.
Prosthetic training
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.
Amputations can be classified based on level
Transhumeral=above the elbow (short above, very short above)
Transradial=below the elbow (short below, long below)
Prosthesis Options
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.
what is trigger finger
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
surgery trigger finger
A1 pulley is split longitudinally along the radial aspect of the pulley to allow full AROM without triggering
Dupuytren’s Contracture
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
dupuytren’s stages
mild <30 deg flexion
moderate 30 deg flexion
severe >30 deg flexion
tx for dupuytrens
surgery is the only option to correct; orthosis will not correct
Surgical Options:
1. Percutaneous Needle Aponeurotomy: needle makes multiple sweeps, until cord breaks.
- Enzyme Injection: cord is injected with xiafelx enzyme, the following day the cord is released.
- 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.
- Dermofascictomy: skin graft is used to close wound, would immobilize for 7-10 days, good for those that have poor skin quality.
burns layers of skin
Epithelium Non-vascular Capable of regeneration Dermis Vascular layer Collagen strands with nerve endings, hair follicles, and sweat glands Subcutaneous Fat and fibrous tissue
burn depth
1st degree epidermis
2nd degree dermis (partial thickness)
3rd degree subcutaneous tissue (full thickness)
4th degree mx and bone
types of burns
Thermal: flame, contact, scald**most common
Electrical: can lead to internal damage
Chemical: slow healing, can remain active and destroy skin over time
OT and Burns
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
assessment and tx for burns
emergency phase edema eschatomy positioning orthosis motion grafts rehab
General info about fractures and healing
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
Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD)
treatment
● 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
anterior interosseous compression
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
