Hand Flashcards
Resting hand splint degrees
Wrist 20-30 extension
MCP 45 to 60 flexion
PIP and DIP 15 to 30 flexion
Thumb in opposition
Anti deformity or intrinsic plus position degrees
MCP flexion 70-90
PIP and DIP full extension
Thumb in abduction and opposition
Wrist extension 20-30
What is anti deformity or intrinsic plus position used for
Burns, trauma and invasive suegery
For sensation how is SCI tested
Proximal to distal following dermatome patterns
For sensation, how is peripheral nerve injuries tested
Distal to proximal
What is the order of return for sensation for peripheral nerve injuries
Pain
Moving touch
Static light touch
Touch localization
Nerve healing and testing order if recover for sensation
1 Point moving
1 Point discrimination
2 Point moving
2 Point discrimination
What is steregnosis
Recognition by touch of objects
What is moving 2 point discrimination
Tests begins with points 5-8mm apart
Proximal to distal on fingertips in longitudinal orientation
What is static 2 point discrimination
Begins at 5mm
Applied to fingertips in longitudinal orientation
What is the Purdue pegboard
Test of fingertip dexterity and assembly job stimulation
Perferred
What is the Minnesota manual dexterity test
Test of gross hand and arm movements
What is the o’Connor tweezer test
Test of hand eye coordination using tweezers
What is the Crawford small parts dexterity test
Test of fine motor dexterity using small tools (tweezers and screwdrivers)
What is 9 hole peg test
Measures finger dexterity
What is codmans exercise
Common form of PROM
Lean on table and let arm dangle
What is isometric contraction
Contraction without movement
Can produce forceful contraction
What type of individuals is isometric contraction contraindicated for
Hypertension and cardiovascular problems
What is isotonic contraction
Concentric- shortening
Eccentric- lengthening
What population uses isotonic exercises
For people with hypertension and heart disease
What splint would a child under 12 use
Immobilization splint
What splint is used for brachial plexus injury
Flail arm splint for positioning
Greatest degree of abduction OTR should allow is 90
Splint for radial nerve injury
Colditz splint or radial nerve splint to assist with partial wrist motion and finger extension
Wrist cock up
Splint for median nerve injury
Opponens splint, C bar and thumb post splint used to hold thumb in opposition
Splint for ulnar nerve injury
Anticlaw splint or lumbrical bar splint to position MCPs in flexion of 4 and 5 digit
Splint for combo median and ulnar nerve
Figure 8 or lumbricald bar splint to position MCPs in flexion for digits 2-5
Splint for carpal tunnel
Wrist cock up
Wrist slight extension (10 degrees), fingers and thumb free
Splint for cubital tunnel syndrome
Elbow splint position at 30 flexion
Splint for de quervains and skiers thumb
Thumb spica splint
Splint for cmc arthritis
Hand based thumb splint
Splint for ulnar drift
Ulnar drift/ deviation splint
Splint for flexor tendon injury and degrees
Dorsal protection splint
20-30 wrist flexion
50-70 IP flexion
IP extension
Splint for boutonnière and Swan neck
Silver ring
Splint for flaccidity
Resting/ functional hand splint
Splint for spasticity
Cone splint
What PAMs used for CRPS
Contrast bath- type 1
Biofeedback- Type 2
What is dupuytrens disease
Disease of fascia of palm and digits
Results in flexion deformities of involved digits
What is skiers thumb
Rupture of ulnar collateral ligament of MCP joint of thumb
OT interventions for skiers thumb
Thumb spica splint- 4-6 weeks
AROM and pinch strength- 6 weeks
ADL that focus on opposition and pinch strength
Complex regional pain syndrome
Follows trauma
Pain, edema, discoloration, osteoporosis, sudomotor changes, temp changes, tropic changes, vasomotor instability
OT intervention for CRPS
STRESSLOADING
Colles fracture
Distal radius fracture with dorsal displacement
Fall with outstretched hand
Smiths fracture
Distal radius with volar displacement
Fall with wrist in flexion
Boxer fracture and splint
4 and 5 MCP
Ulnar gutter fracture
Mallet finger and splint
Avulsion injury to terminal extensor tendon
Splint in full extension for 6 weeks
Elbow fractures
Humerus ROM as early as 2 weeks
Aggressive strengthening 4-6 weeks
Immobilization phase of fractures
Stabilization and healing is goal
AROM of joints above and below stabilized parts
Edema control
Light ADL with no resistance
Mobilization phase of fractures
Consolidation is goal
Edema control
Splint for protection
AROM
Light purposeful occupation based activities
Pain management
Strengthening when approved
De quervains
Abductor pollicis longus and extensor Pollicis brevis
Pain and sweeping over radial styloid
Positive finklesteins test
Thumb spica
Lateral epicondylitis
Overuse of wrist extensors
Tennis elbow
Medial epicondylitis
Overuse of wrist flexors
Golfers elbow
Treatment for lateral and medial epicondylitis
Elbow strap/ wrist splint
Ice and deep friction massage
Stretching
Activity and work mods
Trigger finger
Tensynovitis of finger flexors A1 pully
Treatment for trigger finger
Hand or finger splint- MCP extended and IP joints free
Scar massage
Edema control
Tendon gliding
Activity and work mods
When is a repaired tendon at its weakest
10-12 days post op
Early mobilization program for flexor tendons kleinert approach
Passive flexion and active extension
Kleinert protocol early phase
0-4 weeks
Dorsal block splint
Passive and active extension
Kleinert protocol immediate phase
4-7 weeks
Continue dorsal splint but wrist in neutral
Place/ hold exercises and differential flexor tendon gliding exercises
Kleinert protocol 6-8 weeks
AROM
Differential tendon gliding
Light purposeful and occupation based activities
Discharge splint
Duran protocol
Passive flexion and extension of digits
Duran protocol 0-4 1/2 weeks
Dorsal blocking splint
Exercises in splint
Duran protocol 4 1/2- 6 weeks
Tendon gliding
Place and hold
Active flexion and extension
Duran protocol 6-8 weeks
Tendon gliding and differential tendon gliding
Scar management
Light purposeful and occupation based
Duran protocol 8-12 weeks
Strengthening and work activities
Carpal tunnel syndrome
Median nerve compression
Positive tinel and phalen test
Treatment for carpal tunnel
Wrist splint in neutral
Median nerve gliding
Activity mod
Surgical release
Edema control
AROM
Pronator teres syndrome
Median nerve compression between pronator heads
Aching pain in proximal forearm
Positive Tinels sign at forearm
Treatment for pronator teres syndrome
Elbow splint at 90 with forearm neutral
Avoid pronation and supination
AROM (8 weeks)
Nerve gliding
Strengthening
Sensory re-education
Guyons canal
Ulnar nerve compression at wrist
Positive tinels syndrome at guyons canal
Treatment for Guyons canal
Wrist splint in neutral
Work/ activity mod
Edema control
AROM
Nerve gliding
Strengthening (2-4) weeks- power grip
Cubital tunnel syndrome
Ulnar nerve compression at elbow
Avoid elbow flexion
Positive tinels sign at elbow
Weakness of power grip
Treatment for cubital tunnel syndrome
Elbow splint 30 flexion
Work/ activity mod
Edema control
Scar management
AROM and nerve gliding (post 2 weeks)
Strengthening (4 weeks)
Radial nerve palsy
Radial nerve compression
Wrist droop
Radial nerve palsy treatment
Wrist cock up splint
Dynamic wrist and MCP extension splint
Work/ activity mod
Strengthening wrist and finger extensors
AROM
strengthening (6-8 weeks post)
Avoid combo forearm pronation, elbow extension and wrist flecion
Low lesion deformity to median nerve
Ape hand
High lesion deformity to median nerve
Benediction
Ape hand
Low lesion
Flattening of thenar eminence
Fixed position
Benediction
When asked to make fist- can flex digits 4 and 5 but not digits 2 and 3
High lesion median nerve
Splint for ape hand
30 flexion dorsal blocking splint
Splint for benediction
30 flexion dorsal blocking splint with elbow 90 flexion
Treatment for ape hand and benediction
Dorsal splint
AROM/ PROM of digits with wrist flexed position (2 weeks post op)
Scar management
Strengthening 9 weeks
Claw hand
Fixed position
Ulnar nerve laceration
Positive froments sign
Loss of power grip and decrease pinch strength
Digits 4 and 5
OT intervention for claw hand
MCP flexion block splint
Sensory re education at 10-12 weeks
Same as median nerve repair
OT intervention for radial nerve injury
Dynamic extension splint
ROM
Sensory re-education
Home program
Activity mod
NMES
Isotonic stretching
Rotator cuff tendinitis OT conservative treatment
Activity mod
Educate in sleep position
Decrease pain
Restore pain free ROM
strengthening below shoulder level
Occupation and role specific training
Rotator cuff tendinitis OT postoperative intervention
PROM 0-6 weeks
AAROM/ AROM 6-8 weeks
Sling or abduction orthosis between extremities
Decrease pain ice to heat
Strengthening with isometric to isotonic 8-10 weeks
Leisure and work activities 8-12 weeks
Adhesive capsulitis
Restricted ROM
So encourage ROM through ADL and role
PROM
Modalities
Rheumatoid arthritis
Remission and exacerbation
Systemic, symmetrical and affects many joints
Osteoarthritis
Degenerative joint disease
Wear and tear
Affects large joints
Attacks hyaline cartilage
Bone spurs at DIP joints
Heberden
Bone spurs at PIP joints
Bouchards
OT interventions for OA and RA
Resting hand splint in acute phase
Joint protection techniques
Energy conservation
ROM- focus on PROM
Heat modalities- hot pack before exercises, parafinn
Radial tunnel syndrome
Entrapment of radial nerve in area extending from radial head to supinate muscles
Burning pain in lateral forearm
anterior interosseous syndrome
Compression to anterior interosseous nerve
Motor loss involving flexor Pollicis longus to thumb and FDP to index finger and pronator quadratus
Double crush injury
Occurs when peripheral nerve is entrapped in more than 1 location
Protective re-education after nerve injury
Educates client to visually compensate for sensory loss and avoid working with machinery below temp of 60
Discriminative reeducation after nerve injury
Uses motivation and repetition in a vision tactile matching process in which clients identify objects with or without vision
Inflammatory wound healing phase
Acute phase lasts 24-48 hrs to 7 days
Subacute phase 7-14 days
Redness, swelling, heat and pain
Proliferators phase of wound healing
Wound contraction lasts 5 days to 2-3 weeks
Remodeling phase of wound healing
Lasts 2 weeks to 1-2years
Dynamic splinting, serial casting, continuous passive motion, positional stretching, NMES, and gel pads to decrease hypertrophic scarring
Splint for dupuytrens
Extension splint at all times except bathing
