Hand and Upper Extremity Flashcards
1
Q
Pacinian corpuscles
A
sense vibration
2
Q
Ruffini end organs
A
sense tension
3
Q
merkel cells
A
sense pressure
4
Q
why is it important to assess cognition with UE evaluations
A
to learn more about adherence to HEP
5
Q
Important observations for UE evaluations
A
- nonverbals
- positioning
- guarding
- posture
- spontaneous use of UE
- skin, wounds, scarring
6
Q
Pain assessment
A
when is it occurring and how much
7
Q
vascular assessment
A
color and trophic changes, temperature
8
Q
4 regions where TOS can occur
A
- sternocostovertebral space
- scalene triangle
- costoclavicular space
- pectoralis minor space
9
Q
TOS level of restriction is based on what
A
severity, neural sensitization, intra/perineural scarring
10
Q
nonoperative treatments of TOS
A
- minimize irritation with safe motions
- diaphragmatic breathing
-safe sleeping positions - posture and scapular proprioception
- strengthen scapular stabilizers
11
Q
signs of frozen shoulder
A
loss in ROM at glenohumeral joint
- ER, abduction, IR
12
Q
freezing phase of frozen shoulder
A
shoulder pain with ADLs and rest, close to full ROM
13
Q
Frozen phase of frozen shoulder
A
pain with stretching movements, compensation for decreased ROM
14
Q
Thawing phase of frozen shoulder
A
gradual return of motion for up to 26 months
15
Q
operative treatment of frozen shoulder
A
manipulation and release of glenohumeral capsule ligaments
16
Q
nonoperative treatment of frozen shoulder
A
ADL modifications
- avoid overstretching and pushing joint to point of restarting inflammation
17
Q
What makes of a majority of shoulder disorders
A
rotator cuff disorders
18
Q
operative treatment for rotator cuff disorders
A
- 2-4 weeks immobilization
- week 6-7 ROM passive working to active
- weeks 8-10 begin strengthening
19
Q
nonoperative treatment of rotator cuff
A
- rest and anti-inflammatory modalities
- ROM with pendulums and wand based elevation
-strengthening healthy parts of RC and scapular stabilizers
20
Q
where do half of all hand fractures occur
A
metacarpals
21
Q
boxers fracture
A
head of MC 4 and 5
22
Q
bennett’s fracture
A
thumb base fracture
23
Q
skier’s thumb
A
torn ligament in thumb
24
Q
avulsion injuries
A
when the tendon separates from bone and insertion
25
mallet finger
avulsion of terminal finger tendon
26
treatment for mallet finger
splint in extension for 6 weeks
27
boutonniere deformity
- disruption of central slip of extensor tendon
- PIP flexion and DIP hyperextension
28
treatment for boutonniere deformity
splint PIP in extension and perform isolated DIP flexion exercises
29
swan neck deformity
injury to MCP, PIP or DIP characterized by PIP hypertension and DIP flexion
30
treatment of swan neck deformity
splint PIP in slight flexion
31
3 phases of bone fracture healing
inflammation, repair, remodeling
32
inflammation phase of fracture healing
provides cellular activity
33
repair phase of fracture healing
forms callus for stabilization
34
remodeling phase of fracture healing
deposits bone
35
complications of fracture healing
misaligned fracture, wounds and pain, decreased nutrition, age, bone disesase
36
rehab for bone fractures
- orthotic fabrications
- pain relief
- ther ex
- monitor CPRS
37
colles fracture
dorsal placement
- fall on extended hand
38
smith's fracture
palmar displacement
- fall on flexed hand
39
what is the most common carpal fracture
scaphoid- 90%
40
kienbocks disease
associated with lunate fracture because of decreased blood flow
41
medical management of fractures
surgical intervention or casting
42
nondisplaced fracture
fractured bone with no misalignment
43
displaced fracture
fractured bone and no longer aligned
44
extraarticular fracture
occurs outside of joint and does not interrupt articular cartilage
45
intraarticular fracture
extends into the joint
46
which type of fracture can lead to OA
intraarticular fracture
47
acute phase of wrist fractures
- 0-6 weeks
- immobilization is common
- edema and pain management
- functional use with NWB status
48
subacute phase of wrist fractures
- 6+ weeks
- casting and orthotics to support soft
- edema and pain management
- ROM and functional use graded up
- strengthening at 8-10 weeks
49
what is the most common elbow fracture
radial head fracture
50
common complications of radial head fractures
elbow flexion contracture
51
what is susceptible to injury after a olecranon fracture
ulnar nerve
52
medical management of nondisplaced elbow fractures
long arm sling with emphasis on elbow extension
53
medical management of displaced elbow fractures
surgical fixation
54
rehab for elbow fractures
- stabilization before motion
- ROM once cleared (~1 week)
- strengthening at 8-12 weeks
- pain and edema management
55
medical management of 1 part humerus fracture
immobilization with sling 1-3 weeks and passive movements
56
medical management of 2-4 part humerus fractures
- 4-6 weeks of immobilization
- PROM day 1
- commonly ORIF
57
rehab for humerus fractures
- grip and AROM exercises
- ROM at 2 weeks
- aggressive stretching 4-6 weeks
- strengthening at 8-12 weeks
58
what do saggital bands do
center the extensor tendons over MCP joint
59
common extensor tendon injuries to zone 1
-cut, laceration or jamming finger
-mallet finger
60
common extensor tendon injuries to zone 2
- laceration, evulsion, RA
- Boutonniere deformity
61
thumb extensor tendon zones
1- IP joint
2- Over prox. phalanx
3- over MCP joint
4- over MC1
5- over wrist
62
thumb extensor tendon zones over fingers
1- over DIP joint
2-middle phalanx
3- PIP joint
4- proximal phalanx
5- MCP joint
6- metacarpals
7- carpal bones and wrist
63
goals of extensor tendon rehabd
- achieve tendon gliding and decrease tension on repaid
- decrease edema and stiffness
64
rehab of zones 1 and 2 extensor tendons
immobilize then gradually increase DIP flexion
65
early phase of rehab of zones 3 and 4 extensor tendons
- 0-3,4 weeks
- orthosis worn full time with PIP in full extension
66
Intermediate phase of rehab of zones 3 and 4 extensor tendons
- 4-8 weeks
- d/c orthosis and begin AROM individual joint flexion
- at 5 weeks begin gentle composite flexion
67
late phase of rehab of zones 3 and 4 extensor tendons
- 8-12 weeks
- full normal use of hand
- stretching
- static progressive or dynamic flexion orthosis
68
early phase of rehab of zones 5-7 extensor tendons
- 0-3,4 weeks
- full-length resting cast
69
intermediate phase of rehab of zones 5-7 extensor tendons
- 4-8 weeks
- orthosis used during work and heavy activities
- gradual increase in active flexion
- begin composite flexion
70
late phase of rehab of zones 5-7 extensor tendons
- 8-12 weeks
- strengthening and functional UE exercise
- static progressive or dynamic orthoses
71
Anatomy of flexor tendons
glide and run under tight pulley system
72
where is "no man's land" and why is it called that
- Zone 2 of flexor tendons
- hard to treat and diagnose
73
Zones of flexor tendons
1- finger tip to center of middle phalanx
2- center of middle phalanx to distal palmar crease
3- distal palmar crease to transverse carpal ligament
4- overlies transverse carpal ligament
5- extends beyond wrist
74
complications of flexor tendon injuries
- often nerve involvement
-edema and pain
- PIP flexion contractures
75
when is immobilization approach to flexor tendon rehab used
- rare
- children under 12
- significant loss in skin requing graft
- cognitive limitations
76
describe the immediate passive flexion approach to flexor tendon rehab
- initiated 3-4 days following repair
- dorsal blocking splint with wrist and MP joints in flexion and IP joints in extension
- Duran protocol
77
duran protocol
- passively flex fingers while wearing dorsal blocking splint
- used for flexor tendon rehab
78
immediate active flexion approach to flexor tendon rehab
- achieve flexor tendon gliding before adhesions form
- dorsal blocking orthosis at rest
79
when can strengthening begin for flexor tendon rehab
8 weeks
80
what is the most common nerve injury after a humeral fracture
radial nerve
81
symptoms of radial nerve injury
wrist drop, decreased finger and thumb extension
82
nonoperative treatment of radial nerve
- wrist cock up splint
- PROM and AROM
- isotonic strengthening upon reinnervation
83
operative treatment of radial nerve injury
static wrist extension splint at 30 degrees adjusted to 10 to 20 degrees at 4 weeks
84
describe radial tunnel syndrome
- entrapment in area extending radial head to supinator
- causes burning pain in lateral forearm
85
nonoperative treatment of radial tunnel syndrome
- long arm splint with elbow flexion, supination and wrist in neutral
- massage, TENS
- pain-free ROM
-nerve glides
86
operative treatment of radial tunnel syndrome
- 2 weeks of long arm splint with elbow flexion, supination and wrist in neutral
- wrist cock up 2 weeks
- PROM and AROM supination and pronation
- strengthening 3 weeks
-resistive ex at 6 weeks
87
posterior interosseus nerve syndrome
- rare nerve palsy of extensors
-weak or paralyzed wrist and digit extension and thumb radial abduction
- deep ache pain with palpation of lateral forearm
- worse at night
-nerve compression at radial tunnel
88
nonoperative treatment of PINS
splint with elbow flexion, supination, wrist extension
89
ape hand deformity
fingers are close together
90
hand of benediction
- occurs with high median nerve lesion
- D4+5 flexed, D1-3 extended
91
describe median nerve injuries
- ape hand or hand of benediciton
- sensory loss in radial fingers
- decreased pinch, thumb opposition and radial flexion
92
nonoperative treatment for median nerve injuries
static thenar web spacer splint
93
operative treatment for median nerve injuries
- dorsal blocking splint
- digit and thumb AROM and PROM
-tendon glides, scar massage
- strengthening
94
anterior interosseous syndrome
- compression of anterior interosseous nerve
- nonspecific deep aching pain to proximal forearm that increases with activity
- decreased flexion in D1-3
95
provocative testing of anterior interosseous syndrome
negative tinels sign
positive Ballentines sign
96
Ballentine's sign
collapsed DIP joint when making OK sign
97
treatment of anterior interosseous syndrome
orthosis stabilizes IP joint of D1 and flexion of D2 to promote tip pinch function
98
pronator syndrome
- entrapment of proximal median nerve between pronator muscle heads
- deep pain in proximal forearm
99
provocative testing of pronator syndrome
negative tinels
provoke with pronation and elbow flexion resistance
100
nonoperative treatment of ponator syndrome
- splint 90-100 degrees in elbow flexion, forearm neutral
- TENS
-gentle prolonged stretch supination, elbow, wrist digit extension
- no repetitive rotation and elbow flexion
101
operative treatment for pronator syndrome
- 1/2 cast
- AROM while wearing cast
- strengthening in 1 week
102
Carpal tunnel syndrome
- entrapment of median nerve in carpal tunnel
- weak thenar muscles and opposition
- numbness and tingling that gets worse at night
103
non operative treatment of carpal tunnel
- splint in neutral position
- nerve and tendon glides
- postural retraining, avoid pinching and gripping with flexed wrist
104
operative treatment in carpal tunnel syndrome
- may or may not need therapy
- pain and scar management
- AROM 1-2 days, strengthening 3-6 weeks
- nerve and tendon glides
105
parasthesia
numbness and tingling
106
pillar pain
pain on either side of the carpal tunnel release
107
ulnar nerve injury
causes flattening of normal arches of hand, claw deformity
108
109
110
111
claw deformity
hyperextension of D5 MCP joint and flexion of PIP and IP joints
112
Wartenberg's sign
D5 is abducted from D4
112
Froment's sign
flexion of DIP joint with lateral pinch
113
Jeanne's sign
D1 MCP hyperextension
114
sensory loss to the dorsal side of hand
ulnar nerve injury is proximal to Guyon's canal
115
ulnar tunnel/guyon's canal
- sensory loss in D5 and ulnar D4
- claw deformity
-decreased movement of intrinsic movements
116
nonoperative treatment of ulnar tunnel
anticlaw splint or antivibration glove
117
operative treatment of ulnar tunnel
- dorsal blocking splint with wrist MCP flexion
- wound care, scar mobilization, desensitization
-AROM at 6 weeks
118
Cubital tunnel
- decreased sensation at D5 and ulnar D4
- decreased pinch and grip strength
119
nonoperative treatment of cubital tunnel
- edema and pain control
- elbow splint with 30-70 flexion
- nerve gliding
- postural training
120
121
122
operative treatment of cubital tunnel
- pain managment and desensitization
- AROM and nerve gliding
122
Double crush syndrome
- peripheral nerve trapped in more than 1 location
- intermittent diffuse arm pain and parasthesia
- treat according to each nerve injury
123
De Quervain Syndrome
- cumulative microtrauma to abductors of D1
- pain felt on radial styloid exacerbated iwth thumb and wrist movements
- caused by forceful, repetitive thumb abduction
124
stenosing
narrowing
125
nonoperative treatment of De Quervain Syndrome
- corticosteroir injections
- forearm based thumb spica
126
operative treatment of de quervain syndrome
- AROM at 2 weeks
- strengthening at 4 weeks
127
Assessments of Sensation
- semmes-weinstein monofilaments
- 2-point discrimination
- Moberg pickup test
-Tinel's sign
128
When to use moberg pick up test
- for those with cognitive impairments
- median nerve injury
129
CPRS
- pain disproportionate to injury that is either maintained or independent of SNS
130
symptoms of CPRS
- neuropathic pain
- hyperathia
-edema
-bluish-red/shiny skin
- muscle spasm
- allodynia
-hyperalgia
-contracture
-abnormal sweating
-decreased strength and endurance
131
allodynia
sensation misinterpreted as pain
132
hyperalgia
increased response to painful stimuli
133
type 1 CPRS
- no definitive major nerve injury
- may be spontaneous
134
type 2 CPRS
develops s/p nerve injury
135
