Hand and Upper Extremity Flashcards
Monofilament sensory testing is used for…
nerve compression injury
2-point discrimination sensory testing is used for…
nerve laceration injuries
Boxer’s fracture
Metacarpal fracture
Bennet’s fracture
thumb fracture
Boutonniere Deformity
PIP flexion
DIP hyper extension
Mallet Finger
DIP flexion
Swan Neck Deformity
PIP hyper extension
DIP flexion
What are the 3 phases of fracture healing?
inflammation, repair, and remodeling
TENS is used primarily for…
pain relief
AROM usually begins __-__ weeks following fracture
3-6 weeks
What is the most common complication of hand and wrist fractures?
CRPS
Sensory deficits following median nerve injury includes
numbness in the palm, & pointer finger through radial 1/2 of the ring finger
Sensory deficits following ulnar nerve injury includes
pinky and ulnar half of ring finger
Radial nerve injury results in what presentation
wrist drop
Ulnar nerve injury results in what presentation
Ulnar claw hand deformity
Median nerve injury results in what presentation
Ape hand deformity
What is CTS (carpal tunnel syndrome)?
compression of median nerve
What is the most common type of elbow fracture?
Radial head fracture
Radial head fractures are mostly caused by…
fall on an outstretched hand
What are the 3 types of Radial head fractures?
Type I (nondisplaced)
Type II (displaced)
Type III (communuted)
Someone with a type I radial head fracture (nondisplaced) will most likely be treated with…
A long arm sling
Someone with a type II radial head fracture (displaced) will most likely be treated with…
2-3 weeks of immobilization
T/F: Someone with a type III radial head fracture (comminuted) will be engaged in an early motion protocol within the 1st week post-op
True
What is CRPS (complex regional pain syndrome)?
pain that is disproportionate to an injury
What is type I CRPS?
CRPS that develops after a noxious event
What is type II CRPS?
CRPS that develops after a nerve injury
Allodynia
sensation misinterpreted as pain
Hyperalgia
increased response to painful stimuli
Hyperpathia
pain that continues after stimuli is removed
For a patient with CRPS, should you utilize AROM or PROM?
AROM (gentle, pain free)
T/F: stress loading/WBing is not a treatment for CRPS
false
What is a CTS (cumulative trauma disorder)?
damage caused by repetitive use (repetitive strain/overuse syndrome)
Examples of CTS (cumulative trauma disorders) include…
rotator cuff tears, epicondylitis, cubital tunnel, carpal tunnel syndrom
How many extensor tendon zones are there for digits II-V?
7
Extensor tendon zone 1
DIP joints
Extensor tendon zone 2
middle phalanx
Extensor tendon zone 3
PIP joints
Extensor tendon zone 4
proximal phalanx
Extensor tendon zone 5
MCP joints
Extensor tendon zone 6
MCP bones
Extensor tendon zone 7
carpal bones/wrist
HEAT would be used as a PAM (physical agent modality) in what case?
increase blood flow, prepare tissue for motion
How many flexor tendon zones are there?
5
What flexor tendon zone is knowns as “no man’s land)
Zone 2, aka middle phalanx to distal palmar crease
Duran protocol
early PROM program “do it yourself”, pt does PROM flex/extension
Kleinert Protocol
PASSIVE flexion with active extension via rubber band
Extensor tendon injury at the DIP joint (zone 1) indicates what type of deformity
mallet finger
Extensor tendon injury at the PIP joint and proximal phalanx (zone 3-4) indicates what type of deformity
Boutonniere deformity (PIP flexion, DIP hyperextension)
“Mallet finger” splint
DIP extension splint
“Boutonniere” splint
PIP extension splint
Flexor tendon injury splint
Dorsal block splint
- wrist 20-30 degrees flexion
-MCP’s 50-70 degrees flexion
-IP’s extended
For a flexor tendon injury, at what point would you discontinue a dorsal block splint?
6-8 weeks
T/F: early mobilization is key in a flexor tendon injury
TRUE
What is radial tunnel syndrome?
entrapment of the radial nerve
Avoid what movement for radial tunnel syndrome?
wrist extension and supination
What is pronator syndrome?
proximal median nerve entrapment
Avoid what movement for pronator syndrome?
repetitive forearm rotation and elbow flexion
Tinel’s sign for CTS (carpal tunnel)
tapping over median nerve to elicit symptoms
Phalen’s test (carpal tunnel)
hold wrist flexion for 1 minute to elicit symptoms
Moberg Pickup Test (carpal tunnel)
timed test involving picking up, manipulating, and holding items. usually for PEDS population or for adults with cog impairments
What is cubital tunnel syndrome?
proximal ulnar nerve compression at the elbow joint
Froment’s sign (cubital tunnel)
thumb IP flexion when performing lateral pinch
Wartenberg’s sign (cubital tunnel)
pinky held in abduction
Elbow flexion test (cubital tunnel)
Hold elbow flexion x 5 mins to elicit symptoms
What is de Quervain’s syndrome?
tenosynovitis (tendon sheath inflammation) of the thumb
What is trigger finger?
A1 pulley inflammation
What is protective re-reducation?
Visual compensation for sensory loss
What is discriminative re-education?
vision-tactile matching, identifying objects with and without vision
When should you avoid HEAT PAM’s
in pt’s with edema, blood clots, sensory impairments, cancer, impaired cognition
Desensitization
applying different textures and tactile input to re-educate the nervous system