final review session Flashcards
annular pulleys are located where?
on bones
cruciate pulleys are located where?
over joints
what is the function of the pulley system?
keep tendon close to bone so when you flex, you don’t get bowstringing affect
why does ulnar drift occur?
MCP joints become swollen and cause fingers to bend ulnarly
what does a splint for swan neck deformity look like?
block PIP joint in slight flexion
what is the starting position for every flexor tendon injury protocol?
dorsal blocking splint
when it is time to start motion, how do you generally start for flexor tendon injuries?
passive flexion and active extension (within confines of protected environment - splint)
when it is time to start motion, how do you generally start for extensor tendon injuries?
passive extension and active flexion (within confines of protected environment - splint)
for PNIs, specifically median and ulnar nerve palsies, what is an important aspect of a splint?
maintaining the web space
which assessments have depth but not breadth?
diagnostic-related assessments
vincula are involved in which type of nutrition system to flexor tendons?
perfusion
the acute phase of PNI focuses on which type of sensory interventions?
desensitization
the intermediate phase of PNI focuses on what type of sensory intervention?
reeducation (only if pt. reaches protective sensibility)
sensory reeducation can only occur if pt. reaches what?
protective sensibility
what can only occur when pt. reaches protective sensibility?
sensory reeducation
which test is used to determine when a patient has reached protective sensibility?
semmes-weinstein test
what levels of PNI typically reach protective sensibility first?
lower levels (distal)
what do 2 pt. moving and static discrimination tests assess?
functional sensibility
how many mm apart is considered normal for static 2 pt. discrimination?
5 mm apart (can say that it’s 2 pts. not 1)
how many mm apart is considered normal for moving 2 pt. discrimination?
2 mm apart - able to sense if it’s 1 or 2 pts. moving proximal to distal on fingertip
what does semmes-weinstein measure?
how much sensory status you have - gives amount of sensation you have
describe an orthosis for boutonniere deformity. (position and length of time)
PIP extension, DIP is free (AROM is allowed for DIP with PIP in splint) - 6 weeks
which time of ROM is typically used first for burn patients?
AROM
when would you not use AROM for burn patients?
-if there is a skin graft that could be damaged doing active range, fracture, muscle cut
if there was a skin graft that must be protected, which type of motion would you use?
no motion
why is mobilization for zones 5 and 6 different?
differs bc there are no finger deformities that are more distal
why is mobilization for zones 5 and 6 different?
differs bc there are no finger deformities that are more distal - still generally, passive extension and active flexion
which type of splint is used for extensor tendon injuries?
volar blocking splint
why is PROM used for early mobilization for extensor tendons?
want the tendons to be able to move through tissue and avoid adhesions and scarring
why is PROM used for early mobilization of flexor tendons?
want the tendons to be able to move through the sheath to avoid adhesions and scarring
describe the relative motion orthosis.
use hand normally but splint directs forces to move the way you want.
boutonniere and swan neck deformities are mostly considered to be in which zone?
zone III
which type of splint/motion is used commonly in tendon transfers?
tenodesis
which type of splint/motion is commonly used for tendon transfers?
tenodesis
how many grades of muscle strength are typically lost after tendon transfers?
1 grade
if the tendon is cut beyond (more distal) the juncturae tendoni, how are splints focused?
you can focus on one finger
if the tendon is cut behind (more proximal) the juncturae tendoni, how should splints be focused?
keep all fingers splinted - connection is lost
describe the specific positioning of each joint in the dorsal blocking splint.
wrist: 20-30 degrees flexion
MCP: 50-70 degrees flexion
PIPs/DIPs - extension
name three main components of the indiana protocol.
- place/hold, then flex wrist (tenodesis)
- actively make a fist (composite and hook) followed by active extension
- blocking exercise
name the 3 common rehab approaches (protocols) of extensor tendon injuries.
- immobilization
- early but controlled mobilization
- early and active mobilization
how many degrees of DIP hyperextension is maintained in a mallet finger splint?
10-15 degrees
describe scoring on the DASH.
0 = best health or no disability 100 = worst health, most disability
DASH is the gold standard of what?
PROMs (patient-rated outcome measures)
what is the age range for the DASH?
18-64
- simple, slow, safe gait
- at any one time there are 3 points of support
- may be used with bilateral lower extremity involvement
four-point gait
describe the sequence of four pt. gait.
- right crutch forward
- left foot forward
- left crutch forward
- right foot forward
- requires more balance than 4-point
- only 2 points of support at any one time
two-point gait
describe the sequence of two-point gait.
- right crutch AND left foot forward simultaneously
2. left crutch AND right foot forward simultaneously
-used when only partial or no weight-bearing is allowed on one LE
three point gait
describe the sequence of three-point gait.
- two crutches AND involved LE forward simultaneously
2. un-involved (or stronger) LE forward
-requires strength, skill, and balance
swing-to gait and swing-through gait
describe the sequence of swing-to gait.
- two crutches forward simultaneously
2. two feet swing forward and are placed behind crutches
describe the sequence of swing-through gait.
- 2 crutches forward simultaneously
- both feet swing forward simultaneously and are placed in FRONT of the crutches
- very rapid means of locomotion
slow, safe, steady with 3 points of support at any one time
sideward four-point gait
describe the sequence of sideward four-point gait.
- right crutch sideways
- right foot sideways
- left foot sideways
- left crutch sideways
describe the sequence of walking with a cane.
- cane and involved LE forward simultaneously
2. the uninvolved LE forward
describe the ascending four/two-point sequence.
- right foot up
- left foot up
- right crutch up
- left crutch up
describe the descending four/two-point sequence.
- right crutch down
- left crutch down
- right foot down
- left foot down
describing the ascending three-point sequence.
- uninvolved LE up
2. involved LE and crutches up simultaneously
describe the descending three-point sequence.
- involved LE and crutches down simultaneously
2. uninvolved LE down
what is the pt. position when measuring hip flexion?
supine
what is the axis when measuring hip flexion?
greater trochanter
what are the stationary and movable arms when measuring hip flexion?
stationary: line from ASIS to PSIS (axis of trunk)
moveable: long axis of femur
what is the pt. position when measuring hip extension?
prone
what is the axis when measuring hip extension?
greater trochanter
what are the stationary and moveable arms when measuring hip extension?
stationary: line from ASIS to PSIS
moveable: long axis of femur
what is the pt. position when measuring hip abduction?
supine
what is the axis when measuring hip abduction?
greater trochanter
what are the stationary and movable arms when measuring hip abduction?
stationary: line from ASIS to PSIS
moveable: long axis of femur
what is the pt. position when measuring hip internal and external rotation?
seated or supine, knee flexed 90 degrees over end of mat
what is the axis when measuring hip internal and external rotation?
patella
what are the stationary and moveable arms when measuring hip internal and external rotation?
- both arms parallel to long axis of tibia
- follows tibia as pt. internally/externally rotates hip
when measuring hip internal rotation, which way does the foot move?
away - laterally
when measuring hip external rotation, which way does the foot move?
medially
what is the pt. position when measuring knee flexion/extension?
prone
what is the axis when measuring knee flexion/extension?
lateral side of knee joint
what are the stationary and moveable arms when measuring knee flexion/extension?
stationary: long axis of femur
moveable: long axis of tibia
what is the pt. positioning when measuring ankle dorsiflexion and plantarflexion?
seated with knee flexed to 90 degrees
what is the axis when measuring ankle dorsiflexion and plantarflexion?
1.5 inches below lateral malleolus
what are the stationary and moveable arms when measuring ankle dorsiflexion and plantarflexion?
stationary: long axis of fibula
moveable: long axis of 5th metatarsal
can you flex the knee when measuring hip flexion?
yes - we’re testing joint motion rather than muscle length
what % of the rule of 9s is the trunk in an adult?
18%
what % of the rule of 9s is the head in an adult?
4.5%
what % of the rule of 9s is each arm in an adult?
4.5% = 9% total
what % of the rule of 9s is each leg in an adult?
9% = 18% total
what % of the rule of 9s is the genitalia in an adult?
1%
what % of the rule of 9s is the trunk in a child?
13%
what % of the rule of 9s is the head in a child?
6.5%
what % of the rule of 9s is each upper leg in a child?
4% = 8% total
what % of the rule of 9s is each upper arm in a child?
4%
what % of the rule of 9s is each forearm in a child?
3%
what % of the rule of 9s is each hand arm in a child?
2.5%
what are the energy requirements for a unilateral BK amputee?
10-20%
what are the energy requirements for a unilateral BK amputee?
10-20%
what are the energy requirements for a bilateral BK amputee?
20-40%
what are the energy requirements for a unilateral AK amputee?
60-70%