Hand and Upper Extremity Flashcards
Mallet Finger
Avulsion of the terminal tendon and is splinted in full extension for 6 weeks
Boutonniere Deformity
- Disruption of the central slip of the extensor tendon
- PIP flexion
- DIP hyperextension
- PIP splinted in extension and isolated DIP flexion exercises are performed
Swan Neck Deformity
- PIP hyperextension
- DIP flexion
- PIP splinted into slight flexion
3 Phases of Fracture Healing
- Inflammation
- Repair
- Remodeling
Colles Fracture
Complete fracture of the distal radius with dorsal displacement
Smith’s Fracture
Complete fracture of the distal radius with palmar displacement
Bennet’s Fracture
Fracture of the first metacarpal base
Median Nerve Injury
- Carpal tunnel-like symptoms
- Palmar numbness
- Numbness of first digit to half of the fourth digit
- Generalized weakness and pain
Ulnar Nerve Injury
- Results in ulnar claw deformity
- Numbness of the ulnar side of the hand and the fifth and half of the fourth digits
- Generalized weakness of the ulnar side of the hand
- Pain
Forearm Fracture Type I
Nondisplaced, can be treated with a long arm sling
Forearm Fracture Type II
Displaced with a single fragment, is typically treated non operatively with immobilization for 2-3 weeks and early motion with medical clearance
Forearm Fracture Type III
Comminuted, treated operatively, immobilization and early motion within the first post-op week as medically prescribed
Complex Regional Pain Syndrome
- Allodynia (sensation misinterpreted as pain)
- Hyperalgia (increased response to painful stimuli)
- Hyperpathia (pain that continues after stimuli removed)
- Edema
- Contractures
- Bluish or red shiny skin
- Abnormal sweating and hair growth
- Muscle Spasms
- Decreased strength
- Low tolerance for activity
OT Intervention for Complex Regional Pain Syndrome
- Gentle AROM
- Stress loading
- Edema control
- Desensitization
- Tendon gliding
- NO PROM and painful activities
Grading of Cumulative Trauma Disorder
Grade I: pain after activity, resolves quickly
Grade II: pain during activity, resolves when activity stopped
Grade III: pain persists after activity, affects work productivity, objective weakness and sensory loss
Grade IV: use of extremity results in pain up to 75% of the time, work is limited
Grade V: unrelenting pain, unable to work
Cumulative Trauma Disorder: Acute Phase
Reduce inflammation and pain through static splinting, ice, contrast baths, ultrasound phonophoresis, iontophoresis, high-voltage electric stimulation
Cumulative Trauma Disorder: Subacute Phase
Slow stretching, myofascial release, progressive resistive exercise, proper body mechanics, identifying triggers, static splint during painful activities
Extensor Tendon Repair Interventions
Heat modalities, NMES, HEP, tendon glides to promote excursion and prevent adhesions, ROM, strengthening in late phase (8-12 weeks post-op)
Duran Protocol (Flexor Tendon Repair Interventions)
Early PROM
Klienert Protocol (Flexor Tendon Repair Interventions)
Active extension of the digits with passive flexion via traction, typically a rubber band
When is a repaired tendon at its weakest?
10-12 days post-op
Radial Nerve Injury
- Wrist drop, lack of finger and thumb extension
- Wrist cock-up splint, P/AROM isotonic strengthening
Radial Tunnel Syndrome
- Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
- Symptoms: burning pain in lateral forearm
- Long arm splint, elbow flexed, forearm supinated, wrist neutral, massage, TENS, pain free ROM, nerve glides
Anterior Interosseous Syndrome
- Compression to the anterior interosseous nerve
- Results in motor loss
Pronator Syndrome
- Entrapment of the proximal median nerve between the heads of the pronator muscles
- Symptoms: deep pain proximal forearm with activity
- Splint elbow 90-100 degrees flexion, forearm neutral, TENS, gentle prolonged stretching supination and elbow, wrist, and finger extension, activity modification
Median Nerve Injury
- Causes ape hand deformity
- Sensory loss in index, middle, and radial side of ring finger
- Loss of pinch, thumb opposition, index finger MCP and PIP flexion, decreased pronation
- Static thenar web spacer splint
Double Crush Syndrome
- Peripheral nerve is entrapped in more than one location
- Intermittent diffuse arm pain and paresthesias with specific postures
- Nerve gliding exercises, exercises for scapular stability, posture, core trunk strengthening
Carpal Tunnel Syndrome
- Entrapment of the median nerve through the carpal tunnel
- Sensory impairment involved numbness and tingling in the thumb and index and middle fingers, especially at night
- Motor impairment presents as diminished fine motor coordination, adductor pollicis muscle atrophied
- Positive Tinel’s sign
- Positive Phalen’s test
- Moberg Pickup Test
- Semmes-Weinstein
What is the Phalen’s test?
Holding the wrist in full flexion for 1 minute to elicit changes in sensation (positive with carpal tunnel syndrome)
What is the Moberg Pickup test?
A timed test involving picking up, holding, manipulating, and identifying small objects
What is the Froment’s sign?
Flexion of the IP of the thumb when a lateral pinch is attempted (positive with cubital tunnel syndrome)
Carpal Tunnel Intervention
- Wrist cock-up splint at 0-10 degrees wrist extension
- Nerve and tendon gliding exercises
- Postural retraining
- Post-op: splinting for clients who sleep with their wrist flexed, AROM of wrist, thumb, and fingers 1-2 days post-op, stretching 3-6 weeks post-op
Cubital Tunnel Syndrome
- Caused by proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process
- Sensation decreased in the little finger and ulnar half of the ring finger
- Motor problems: decreased grip and pinch strength
- Positive Tinnel’s sign at cubital tunnel
- Positive Froment’s sign
- Positive Wartenberg’s sign
Cubital Tunnel Syndrome Intervention
- Edema control
- Pain management
- Elbow splint 30-60 degrees flexion for 3 weeks
- Ulnar nerve gliding
- Proximal conditioning activities
- Posture and ergonomic training
de Quervain Syndrome
- Cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longs and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist
de Quervain Syndrome Intervention
- Forearm-based thumb spica splint with the wrist in neutral and thumb radially abducted for 3 weeks
- Activity modification and avoidance of pinch
- Strengthening
Claw Deformity
- Distal ulnar nerve compression or lesion at the wrist
- Sensory loss in the little finger and ulnar side of the ring finger plus the palmar ulnar hand
- Loss of intrinsic ulnar innervated muscles
- Motor loss result in deformity in which the MCPs hyperextend and the IPs flex, hand arches are flattened, and pinch strength is lost
- Positive Froment’s sign
- Positive Wartenberg’s sign
- Positive Jeanne’s sign
What is the Jeanne’s sign?
Hyperextension of the thump MCP
Claw Deformity Intervention
- Bulky dressing 3-10 days
- Dorsal blocking splint, wrist in 20-30 degrees flexion and MCP block to 45 degrees extension to protect nerve repair
- Sensory desensitization
- AROM of the wrist and hand begins at 6 weeks
- Sensory reeducation 10-12 weeks post-op
Trigger Finger
- Sheath inflammation or nodules near the A1 pulley
- Splinting the MCP at 0 degrees for 3-6 weeks post-op
Resting Hand Splint
- Wrist at 20-30 degrees extension
- Thumb at 45 degrees palmar abduction
- MCPs at 35-45 degrees flexion
- PIPs and DIPs in slight flexion
Anti-deformity Resting Hand Splint
- Maintain wrist at 30-40 degrees extension
- Thumb at 45 degrees palmar abduction
- MCPs at 70-90 degrees flexion
- PIPs and DIPs in full extension
Cone Anti-spasticity Splint
- Ulnar or velar based
- Provide thumb palmar or radial abduction
- Hard surface in contact with finger flexors
- Serial casting for the wrist, elbow, knee, ankle to decrease soft tissue contractures
Wrist Cock-up Splint
- Maintain hand arches
- Full thumb movement
- Full MCP flexion
Thumb Spica Splint
Used on long or short opponens to provide CMC immobilization
Carpal Tunnel Syndrome Splint
Wrist in neutral to 10 degrees extension
Ulnar Nerve at Wrist Splint
Block 4th and 5th MCPs to 30-45 degrees flexion to prevent hyperextension
Radial Nerve Injury Splint
Cock-up splint, with dynamic finger extension assist optional
Pronator Syndrome Splint
Forearm and wrist neutral, elbow in 90 degrees flexion
Anterior Interosseous Splint
Forearm neutral, elbow in 90 degrees flexion
Radial Tunnel Syndrome Splint
Wrist in 30 degrees extension, forearm supinated, elbow in 90 degrees flexion
Phases of Wound Healing
Inflammation, Proliferative, Remodeling
