Hand And Upper Extremity Conditions Flashcards
1
Q
Name the bones of the forearm and upper arm.
A
Radius
Ulna
Humerus
2
Q
Name the bones of the wrist.
A
Distal radius
Ulna
Eight carpal bones (hamate, capitate, trapezoid, trapezium, pisiform, lunate, triquetrum, and scaphoid.)
+ Associated joint capsule and several ligaments
3
Q
Name the muscles of the arm.
A
Deltoid
Triceps
Anconeus
Biceps brachii
Brachialis
Brachioradialis
NOTE: The other muscles that originate in the forearm control the hand, and thus are considered extrinsic muscles of the hand
4
Q
What is the difference between the blood supply to the right arm and left arm?
A
Right arm
Originates from the brachiocephalic artery, passes through the right subclavian artery, divides into the right arm’s axillary, brachial, radial, and ulnar arteries.
Left arm
Supplied by left subclavian artery, divides into left arm’s axillary, brachial, radial, and ulnar arteries.
Key difference: Right arm originates from the brachiocephalic artery, left arm does not.
5
Q
Name the bones of the distal row of the wrist in order.
A
hamate, capitate, trapezoid, and trapezium
6
Q
Name the bones of the proximal row of the wrist in order.
A
pisiform, lunate, triquetrum, and scaphoid.
7
Q
What 7 muscles originate from the lateral epicondyle?
A
Extensor Supinators
Anconeus
Supinator
Extensor carpi radialis longus (ECRL)
Extensor carpi radialis brevis (ECRB)
Extensor carpi ulnaris (ECU)
Extensor digitorum (ED)
Extensor digiti minimi (EDM)
8
Q
What 5 muscles originate from the medial epicondyle?
A
Flexor Pronators
Pronator teres
Flexor carpi radialis (FCR)
Flexor carpi ulnaris (FCU)
Palmaris longus (PL)
Flexor digitorum superficialis (FDS)
9
Q
The main artery/ies supplying the hand and wrist is/are…
A
Radial and ulnar arteries
10
Q
What are the 3 sensory receptors of the hand?
A
- Pacinian corpuscles, responsible for vibration
- Ruffini end organs, responsible for tension
- Merkel cells, responsible for pressure
11
Q
What is the difference between intrinsic and extrinsic muscles of the hand?
A
Intrinsic muscles are the small muscles in the hand.
Extrinsic muscles are longer musculotendinous units that originate proximal to the hand.
12
Q
A hand and upper extremity assessment includes an occupational profile, and assessment of psychosocial and coping status, and cognition.
In addition, observations can be extremely informative. What are 4 observations that should be made?
A
- Nonverbal communication
- Position of the injured extremity
- Posture and trunk
- Spontaneous use of UE and hand
- Guarding
- Scar
- Wounds
- Skin.
13
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Available in numeric and visual analog scales, verbal rating scale, graphic representation, pain questionnaire.
A
Pain scales
14
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Observations of size, depth, granulation tissue, drainage, odor, temperature
A
Wound assessment
15
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Observations of color, size, flat/raised, adhesions
A
Scar assessment
16
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Observation of color and trophic changes, palpation (pulse, capillary refill assessment, modified Allen’s test), and temperature assessment
A
Vascular assessment
17
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Measurements of the forearm, wrist, fingers, and thumb; Active and passive goniometric measurements
A
Range of Motion (ROM)
18
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Done either via circumferential (tape measure) and volumetric measurements (volumeter)
A
Edema
19
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Often, the Semmes–Weinstein monofilament and two-point discrimination are used. Monofilament is used for nerve compression, and two-point discrimination is typically used for nerve laceration and recovery.”
A
Sensation
20
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
Grip strength, pinch strength, and manual muscle testing. These tests are not to be performed unless resistance has been approved by the referring physician, and testing is contraindicated before full healing of a fracture, ligament repair, tendon laceration, or tendon transfer, or as determined by the referring physician.
A
Strength testing
Grip strength test: Jamar dynamometer
Pinch strength test: Use pinch gauge device. Client is seated, elbow flexed at 90° with arm adducted at side, forearm in neutral position. Each test is repeated 3 times, and an average is calculated.
–Lateral pinch (key pinch): pinch meter is placed between the radial side of index finger and thumb.
–Three-point pinch (three-jaw-chuck pinch): pinch meter is placed between the pulp of the thumb and pulp of the index and middle fingers.
–Two-point pinch (tip-to-tip pinch): pinch meter is placed between the tip of the thumb and tip of the index finger.
21
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
strength is graded according to normal (5), good (4), fair (3), poor (2), and trace (1).
A
Manual muscle testing (MMT)
22
Q
Name the following assessment/area of assessment commonly used in hand and upper extremity evaluation.
ability to manipulate items in the environment, ranging from gross coordination to fine coordination tasks. Standardized assessments include the O’Conner Dexterity Test, Nine-Hole Peg Test, Jebsen–Taylor Hand Function Test, Minnesota Rate of Manipulation Test, and Purdue Pegboard Test.
A
Coordination
23
Q
_______________ consists of an array of clinical entities involving the shoulder region. This region is further divided into four subregions:
- Sternocostovertebral space
- Scalene triangle
- Costoclavicular space
- Pectoralis minor (coracopectoral) space.
A
Thoracic Outlet Syndrome (TOS)
24
Q
Brachial plexus allows for individual neurons from spinal nerves to reach their respective peripheral nerve.
Use the different areas of the brachial plexus (e.g., trunks, cords) to complete the below.
- ______________ supplies the scapula.
- ______________ supplies the hand intrinsic muscles.
- The ______________ of the lower trunk supplies the medial cord.
- The ______________ of the ________ and ______________ supply the lateral cord.
- The ______________ supply the elbow and wrist flexors with the exception of the brachioradialis.
- The ______________ supply the posterior cord (which also supplies the brachioradialis).
- The ______________ supplies the elbow and wrist extensors.
A
- Upper trunk supplies the scapula.
- **Lower trunk supplies the hand intrinsic muscles.
- The anterior division of the lower trunk supplies the medial cord.
- The anterior divisions of the upper and middle trunk supply the lateral cord.
- The anterior divisions supply the elbow and wrist flexors with the exception of the brachioradialis.
- The posterior divisions of all trunks supply the posterior cord (which also supplies the brachioradialis).
- The posterior cord supplies the elbow and wrist extensors.
25
What are 2 nonoperative treatments for thoracic outlet syndrome (TOS)?
1. Education on **safe boundaries of motion** to minimize irritation
2. **Diaphragmatic breathing** to minimize use of scalene
3. Education on **safe sleeping positions**
4. Education on proper posture to minimize stress on brachial plexus
5. **Guided exercises** to strengthen scapular stabilizers and elevators
6. **Visual feedback exercises** to facilitate scapular proprioception.
26
Frozen shoulder/adhesive capsulitis is the progressive loss of glenohumeral range of motion (usually begins with external rotation being most limited, followed by abduction, and internal rotation).
Which phase of FS/AC is described below?
*Movement patterns demonstrated as individuals attempt to compensate for lack of glenohumeral mobility; pain typically occurs with stretching at end of motion*
Frozen phase
27
Frozen shoulder/adhesive capsulitis is the progressive loss of glenohumeral range of motion (usually begins with external rotation being most limited, followed by abduction, and internal rotation).
Which phase of FS/AC is described below?
*Characterized by shoulder pain interrupting sleep, pain with ADLs, and often pain at rest; ROM usually close to full however with pain often experienced before the end of motion*
Freezing phase
28
Frozen shoulder/adhesive capsulitis is the progressive loss of glenohumeral range of motion (usually begins with external rotation being most limited, followed by abduction, and internal rotation).
Which phase of FS/AC is described below?
*Gradual return of motion and lasts up to 26 months*
Thawing phase
29
What is the role of OT in working with someone with frozen shoulder/adhesive capsulitis?
Role of OT is to **assist individuals in ADL modifications or adaptive equipment** for ADLs; workstation modifications may also be considered.
*Overstretching and pushing the joint to the point that reinitiates the inflammatory process should be avoided.*
30
Up to 70% of shoulder disorders are related to rotator cuff disease. Structures involved include muscles of the rotator cuff, the long head of the biceps tendon, the subdeltoid–subacromial bursa, and the coracoacromial (CA) arch.
What are some nonoperative treatments OT can partake in to support their client with RTC disease?
Initially, focus is on **rest and anti-inflammatory modalities**.
**Early ROM exercises** (pendulum and wand-assisted elevation in scapular plane)
**Strengthening** the healthy part of the rotator cuff and scapular stabilizer muscles; *isometrics and resistance band* exercises may be considered
31
When is surgery for rotator cuff disease indicated?
Indications for surgery include full or partial tears that **have not responded to conservative care and that continue to interfere with participation** in ADLs.
32
How many weeks post-op for rotate cuff repair should a patient be immobilized?
2-4 weeks
33
After the immobilization period for a post-op rotator cuff repair, how soon after can an OT work with a client on range of motion? Strengthening?
Therapy then begins to *regain ROM, progressing from passive to active* motion exercise for the next **2 to 3 weeks**.
At **8 to 10 weeks** following surgery, *strengthening* exercises are initiated.
34
Half of all hand fractures occur as ___________________________________ (what area)?
**Finger metacarpal fractures** of the base shaft, neck, or head
35
What is a Boxer's fracture?
Fracture of the 4th and/or 5th metacarpal
36
What is a Bennet's fracture?
Fracture of the **base** of the **thumb**
37
What is a Skier’s thumb?
Torn ligament of the thumb
38
________________ injuries occur when the tendon separates from the bone and insertion and removes bone material with the tendon.
Avulsion
39
A _____________ is an avulsion of the terminal tendon; splinted in full extension for 6 weeks.
Mallet finger
40
________________________ is a disruption of the central slip of the extensor tendon characterized by proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hyperextension; the PIP is splinted in extension, and isolated DIP flexion exercises are performed.
Boutonniere deformity
41
___________________ is an injury to the metacarpophalangeal (MCP), PIP, or DIP joints characterized by PIP hyperextension and DIP flexion; the PIP is splinted in slight flexion.
Swan neck deformity
42
Name the stages of bone healing described below.
________________ provides the cellular activity needed for healing.
________________ forms the callus for stabilization.
________________ deposits bone
**Inflammatory** provides the cellular activity needed for healing.
**Repair** forms the callus for stabilization.
**Remodeling** deposits bone
43
What is a closed reduction (CR) fracture repair?
A procedure that **realigns a broken bone without surgery**.
A doctor or other medical professional pushes or pulls the ends of the broken bone back into place.
44
What is an open reduction, internal fixation (ORIF) repair?
A **surgical procedure that stabilizes and heals broken bones using plates, screws, and/or other special devices**.
A doctor surgically repositions the broken bones and then uses special devices to hold them in place while they heal. Often, they are not removed.
45
Modalities for pain relief and tissue healing include... (name at least 3)
heat
ultrasound
cryotherapy (ice)
paraffin
transcutaneous electrical nerve stimulation (TENS)
46
True or false: Some fractures can heal on their own without surgical intervention or with a fabricated orthotic.
**True!**
It depends on the type of fracture and severity.
47
True or false: Early mobilization is often contraindicated.
**FALSE**
Early controlled mobilization through therapeutic exercises can HELP keep unaffected bones, tendons, and muscles strong and functional, and reduce the instances of tightness and adhesions.
48
How soon after injury should an OT consider intrinsic tightness versus extrinsic tightness, joint capsule tightness, and tendon adhesion?
**3–8 weeks** post fracture or surgery
49
This type of fracture is the most common UE fracture, usually resulting from a fall on an outstretched hand (FOOSH).
Distal radius fracture
50
This type of fracture is a complete distal radius fracture with dorsal displacement (radius moves dorsally). It is the most common type of wrist fracture.
**Colles fracture**
*Can also be referred to as a **dinner fork deformity**.*
51
This type of fracture is a complete distal radius fracture with volar displacement (radius moves volar). It results from a fall on a flexed wrist.
Smith's fracture
52
It is common to see this type of wrist fracture alongside a distal radius fracture (uncommon to see them in isolation).
**Distal ulna fractures**
*Include injuries to the ulnar styloid, ulnar head, or ulnar metaphysis.*
53
These type of fractures are the most common fracture seen and missed in injuries to the wrist
**Carpal fractures**
*The most common bone fractured is the scaphoid, accounting for 90% of all carpal fractures.*
*Lunate fractures* are associated with *Kienbock’s disease*, a pathological process where blood flow to the lunate is compromised.
54
This type of fracture-related nerve injury produces carpal tunnel–like symptoms, such as palmar numbness and numbness of the first digit to half of the fourth digit. It also produces generalized weakness and pain.
Median nerve injury
55
This type of fracture-related nerve injury results in a claw deformity. It produces numbness of the medial side of the hand and the fifth and half of the fourth digits. It also produces generalized weakness of the ulnar side of the hand and pain.
Ulnar nerve injury
56
This category of fractures occurs when a bone is fractured but overall anatomical alignment is maintained.
Nondisplaced fractures
57
This category of fractures occurs when a bone breaks and it is no longer aligned.
Displaced fracture
58
This category of fractures occurs outside of the joint and does not interrupt articular cartilage; often requires little intervention
Extraarticular fracture
59
This category of fractures extends into the joint and can lead to osteoarthritis.
Intraarticular fracture
60
The main goal of distal radius and capral fractures is...
maximize functional recovery of the UE
61
During the _____________ phase (______ weeks), immobilization is common, contributing to detrimental effects. Fewer than 10% of clients are referred to therapy in acute phase.
Acute
0-6 weeks
62
During the acute phase of a distal radius or carpal fracture, what are at least 2 ways to manage edema?
AROM
elevation
cold application
compression
lymphatic drainage
63
During the acute phase of a distal radius or carpal fracture, proper management can reduce risk for CRPS. 2 examples of pain management techniques include...
pain medication
ice
heat (if edema resolving)
contrast baths
graded motor imagery (GMI)
64
True or false: During all distal radius and carpal fracture, no lifting is allowed.
**FALSE**
Lifting and carrying is usually **limited to 1–2 pounds**, and **no weight bearing** is allowed
65
During the subacute phase (6 weeks and beyond) of a distal radius or carpal fracture, the primary goal of _______________ (intervention) is to support soft tissues and encourage the wrist to remain in extension to promote finger motion.
**Cast/orthotic use**
Typically worn during participation in heavier tasks, at night, and when out in public.
*Dynamic or static-progressive orthotics* can be used after the fracture is healed to increase ROM.
66
True or false: If edema persists beyond 6 weeks in a distal radius or carpal fracture, elevation is no longer helpful.
True
67
These exercises are used to facilitate movement and improve performance of the UE. Examples include AROM with wrist extended and fingers flexed; blocking exercises; tendon and nerve gliding exercises; and stretching exercises.
Range of motion (ROM)
68
During the subacute phase (6 weeks and beyond) of a distal radius or carpal fracture, pain is typically managed with... (name 2)
ice
*moist heat* application
contrast baths
graded motor imagery
transcutaneous electrical nerve stimulation (TENS)
69
When are orthoses to address adherence and tissue shortening used (for distal radius and carpal fractures)?
When traditional methods of **stretching do not improve ROM to the functional** level.
70
For a distal radius or carpal injury, strengthening usually started around _______________ (weeks).
**8–10 weeks**
*Beginning with isometric exercises*
Followed by *open-chain* exercises
Followed by *closed-chain* exercises
Grip strengthening is initiated with a sponge ball or theraputty.
71
This type of fracture is the most common type of elbow fracture, usually caused by a fall on an outstretched hand (FOOSH). The most common complication is elbow flexion contracture, the loss of full elbow extension.
**Radial head fracture**
95% of radial head fractures can be managed *nonoperatively*.
72
This type of fracture results from a fall onto a bent elbow or a direct blow to the elbow.
In these injuries, the ulnar nerve is susceptible to injury due to its location in relation to the elbow.
**Olecranon fractures**
Most olecranon fractures *require ORIF*.
73
Falling is usually the cause of this type of elbow fracture, however these fractures are relatively uncommon.
**Distal humerus facture**
Almost all distal humeral fractures *require operative* intervention.
74
In elbow fractures, when can gentle passive motion, joint mobilization, and soft-tissue mobilization be initiated?
Once physician determines that there is evidence of fracture union and sufficient stability
75
After about _______________ (weeks), once fracture consolidation is achieved, resistive exercises may be introduced to facilitate the strengthening of the involved UE to return to the previous level of function without pain.
**8–12 weeks** (following injury or surgery)
76
These types of fractures are the most common fracture of the upper arm. They may involve the articular surface, greater or lesser tuberosity, or surgical neck or be located on the anatomical head, anatomical neck, or anatomical shaft.
Proximal humeral fractures
77
One-part fractures of the proximal humerus are initially treated by immobilization with the use of a sling for ______________ (weeks).
**1 to 3 weeks**
Passive movements when the humeral shaft and head move as a unit can be as early as a couple of days.
78
Two- to-four-part proximal humeral fractures require ___________ (weeks) of immobilization.
**4 to 6 weeks**
The *one exception* to this is clients with *hemiarthroplasties*, who begin PROM exercises on postoperative Day 1. Operative treatment most commonly includes ORIF.
79
True or false: Treatment with a client who experienced a proximal humeral fracture should not begin while still in the immobilizer.
**FALSE**
Gripping exercises and AROM of the elbow and wrist to prevent edema and stiffness may be introduced.
*ROM may begin as early as 2 weeks after* a nonoperative fracture as medically prescribed.
80
For proximal humeral fractures, a ROM protocol consists of aggressive stretching and can begin __________ (weeks) after the fracture as prescribed by the physician. Emphasis should be on proper glenohumeral and scapulothoracic movement.
4–6 weeks
81
For proximal humeral fractures, strength training is initiated at ____________ (weeks) postinjury/repair. The emphasis during this phase is on the rotator cuff muscles and scapular stabilizer/force couple muscles. Open and closed chain exercises are included.
8 to 12 weeks
82
At ___________ (weeks) post RTC injury, if functional ROM and normal movement patterns are achieved, plyometrics may be integrated.
12 weeks
83
Name all 6 extensor tendons to the digits.
Extensor digitorum communis (EDC)
Extensor indicis proprius (EIP)
Extensor digiti minimi (EDM)
Extensor pollicis longus (EPL)
Extensor pollicis brevis (EPB)
Abductor pollicis longus (APL)
84
Tendons cross the wrist dorsally under the ____________________, separating into eight compartments to prevent bowstringing.
extensor retinaculum
85
________________ center the extensor tendons over the MCP joint.
Sagittal bands
86
What are the 7 extensor zones of the digits (II-V)?
Zone I: Distal interphalangeal joint
Zone II: Middle phalanx
Zone III: Proximal interphalangeal joint
Zone IV: Proximal phalanx
Zone V: Metacarpophalangeal joint
Zone VI: Metacarpals
Zone VII: Carpal bones and wrist
87
What are the 5 extensor zones of the thumb?
Zone I: Falls over the interphalangeal (IP) joint
Zone II: Falls over the proximal phalanx
Zone III: Falls over the MCP joint
Zone IV: Falls over the first metacarpal
Zone V: Falls over the wrist
88
Most clients who have had an extensor tendon repair are allowed to use their hand for light activities by _____________ (weeks) following repair.
6 to 8 weeks
89
It is appropriate to introduce __________ when adhesions limit active motion more than passive motion. All programs must be individualized, especially to minimize risk of tendon rupture.
**Resistance (to tendon motion)**
Avoid gapping or potential rupture of a tendon until *12 weeks after repair*.
Initiate active motion gently with a gradual increase in tension, as healing advances.
90
Name at least 2 goals of tendon rehabilitation.
Achieve **tendon gliding** while minimizing tension on the repair
**Decreasing edema and stiffness**
Performing **movements slowly** and gently
Regarding the positioning of proximal joints during active motion to help **minimize tension** on the tendon while mobilizing
91
*Topic: Rehabilitation of **Zones III and IV** extensor tendon injuries*
During the early phase (____ - _____ weeks) a fabricated orthosis is worn full-time. In this phase, the client is to move only the joints that are not restricted within the orthosis.
**immediately after repair - 3-4 weeks**
The orthosis is worn for a total of 3-4 weeks.
92
*Topic: Rehabilitation of **Zones III and IV** extensor tendon injuries*
During the intermediate phase (_____ - _____ weeks), discontinue use of orthosis and begin active flexion with individual joint flexion. If edema is not present, heat may be used to warm the tissues prior to active exercises. At 5 weeks, advance to gentle composite flexion.
4-8 weeks (following tendon repair)
93
*Topic: Rehabilitation of **Zones III and IV** extensor tendon injuries*
During the late phase (_____ - ______ weeks), the client usually is allowed full normal use of injured hand. Limited flexion should be treated with heat combined with stretch, passive and active flexion of individual joints, blocking exercises, composite flexion exercises, and grip stretching. Static progressive or dynamic flexion orthoses may be used as needed.
8-12 weeks
94
*Topic: Rehabilitation of **Zones V, VI, and VII** extensor tendon injuries*
What is the key difference between rehab of extensor tendon zones III and IV versus V, VI, and VII?
*III, IV*: Orthosis is discontinued after 4 weeks.
*V, VI, VII*: Orthosis is used only intermittently during work and heavy activities after 4 weeks following repair, and gradually discontinued.
95
Pulleys are found on the flexor side to prevent bowstringing. Name the placement of the 9 pulleys.
**A5**: DIP
**A4**: middle phalanx
**A3**: PIP
**A2**: proximal phalanx
**A1**: MC head
**C4**: distal phalanx base *(not all people have)*
**C3**: middle phalanx head
**C2**: middle phalanx base
**C1**: proximal phalanx head
96
True or false: Blood supply to the fingers is plentiful, providing nutrition to the ligaments.
**FALSE**
Blood supply is limited; nutrition is provided mainly by synovial diffusion.
97
Name the 5 flexor zones of the hand.
**Zone I** extends from the *fingertip* to the center portion of the *middle phalanx*.
**Zone II** extends from the center portion of the *middle phalanx to the distal palmar crease* (known as no man’s land, because of difficulty of tendon gliding without scarring to surrounding tissues).
**Zone III** extends from the *distal palmar crease to the transverse carpal ligament*.
**Zone IV** overlies the *transverse carpal ligament*.
**Zone V** extends *beyond* the level of the *wrist*.
98
What are 3 main flexors of the digits and thumb?
**For each finger:**
flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP)
**For thumb:**
flexor pollicis longus (FPL)
99
Regarding flexor tendon injuries, muscle actions are affected by impairment in __________ and ________ of the wrist and digits.
Flexion
Deviation
100
What is a frequent complication following flexor tendon repair?
**PIP flexion contracture** where the PIP joint is unable to be passively extended.
101
True or false: In flexor tendon injuries, nerve involvement (usually laceration) is common because of the mechanisms by which tendons are injured.
True
102
True or false: Unlike extensor tendon repairs, flexor tendon repairs are typically not immobilized.
**TRUE**
The are only *3 EXCEPTIONS* to this:
1. Children age 12 years and younger are most often placed in immobilization for first 3–4 weeks.
2. When there is a concomitant fracture or significant loss of skin requiring a skin graft, a period of immobilization may be necessary.
3. May be used with people who have cognitive limitations.
103
Within 3-4 days following a traditional two-strand flexor tendon repair, immediate _____________ protocol is initiated.
**passive flexion**
*Two categories of immediate passive flexion protocols:*
1. Orthosis that holds IP joints statically between exercises during the early phase of tendon healing
2. Orthosis with elastic traction that holds the fingers in flexion dynamically between exercises.
104
A _____________ (orthosis) that holds the wrist and MP joints in flexion and IP joints in extension to prevent excessive tension on the repaired tendons is used.
Clients are instructed to passively flex fingers using Duran and Houser’s technique (1975) to improve tendon gliding and active IP extension within the dorsal blocking orthosis.
**dorsal blocking orthosis**
Benefits of this approach include improved circulation for tendon healing, decreased joint stiffness, and partial distal gliding of the flexor tendon.
105
Name the following approach to flexor tendon rehabilitation.
*Benefit of this approach following tendon repair is to achieve flexor tendon gliding prior to formation of adhesions. Protect client in a dorsal blocking orthosis at rest and during place and active hold exercise of the fingers in flexion. Exercises consists of slow gradual passive flexion to decrease edema and stiffness, followed by the same passive flexion and active IP extension exercises that are used for immediate passive flexion approaches (see above). Wrist tenodesis exercises and active hold finger flexion exercises are also included.*
Immediate active flexion approach
106
True or false: Active flexion is initiated right after surgery in the immediate active flexion approach.
**True**
However, clients with immobilization and immediate passive flexion approaches do not begin active flexion until 3 to 4 weeks following repair.
Exercises should begin with those that result in the least force to the tendon repair.
107
For flexor tendon injuries, force in exercises advances in this order, from least force to most force(name the 7 levels)...
1. Passive flexion and protected extension
2. Place and active hold in flexion
3. Active composite fist
4. Hook and straight fist
5. Isolated joint motion (blocking)
6. Resisted composite fist
7. Resisted blocking.
108
What modality/ies can be used in flexor tendon injuries?
- **Heat** to gradually prepare the tissue for motion
- **Neuromuscular electrical stimulation (NMES)** to promote tendon excursion and activation
**Use of modalities begins once cleared by the prescribing physician or provider.**
109
This nerve injury is the most common injury of the UE peripheral nerves after humeral fractures. Symptoms include wrist drop with possible lack of finger and thumb extension. Often treated nonoperatively with a wrist cock-up.
**Radial nerve injury**
*Other nonoperative treatments* include passive and active ROM and isotonic strengthening exercises upon muscle reinnervation.
*Operative treatment* includes static wrist extension splint 30°; after 4 weeks, adjust splint to 10° to 20° extension.
110
This common radial nerve entrapment occurs when the radial nerve is entrapped in an area extending from the radial head to the supinator muscle. Symptoms include burning pain in lateral forearm.
**Radial tunnel syndrome**
*Nonoperative treatment*
- Long arm splint with elbow flexed, forearm supinated, wrist neutral.
- Massage or transcutaneous electrical nerve stimulation (TENS) for pain management
- Pain-free ROM
- Nerve glides
- No forceful wrist extension and supination.
*Post-operative treatment:*
- Operative treatment
- Long arm splint with elbow flexed, forearm supinated, wrist neutral for 2 weeks
- Then wrist cock-up splint for 2 more weeks
- Passive and active pronation and supination
- Hand-strengthening exercise at 3 weeks
- Resistive exercise at 6 weeks.
111
This common radial nerve entrapment occurs as a rare nerve palsy involving some of the wrist extensors and all of the finger extensors. It presents as weakness or paralysis of ulnar wrist extension, digit extension, and extension and radial abduction of the thumb. Symptoms include pain, described as a “deep ache” with palpation over the proximal lateral forearm; more symptomatic at night and with activities that engage the extensor muscles of the wrist and fingers (e.g., typing on a computer)
**Posterior interosseous nerve syndrome (PINS)**
*Nonoperative treatment*: Orthosis splint with combined positioning of elbow flexion, forearm supination, and wrist extension. If uncomfortable, using a wrist brace that positions the wrist in extension and avoiding prolonged positions of pronation with elbow extension may be recommended.
112
This type of nerve injury causes ape hand deformity. Symptoms also include sensory loss in index, middle, and radial side of ring finger, Loss of pinch, thumb opposition, index finger MCP and PIP flexion, and decreased pronation.
**Median nerve injury**
*Nonoperative treatment*: static thenar web spacer splint
*Operative treatment*
- Dorsal wrist blocking splint worn for 4–6 weeks
- AROM and PROM in splint for digits and thumb
- Tendon gliding exercises
- Scar massage
- Discontinue splint at 6 weeks and begin strengthening exercises and light functional activities.
113
This common median nerve entrapment occurs when there is compression to the anterior interosseous nerve. Symptoms include nonspecific deep aching pain in the proximal forearm that increases with activity; usually no sensory symptoms; negative Tinel’s sign (i.e., no tingling sensation when tapping the nerve over the skin).
It presents as motor loss involving the flexor pollicis longus to the thumb, flexor digitorum profundus to the index and long finger, collapsed distal IP joints when attempting to make the “okay” sign (called Ballentine’s sign), and possible paresis of the pronator quadratus.
**Anterior interosseous syndrome**
Orthotics involve stabilizing the IP joint of the thumb and, often, the index finger in a position of flexion to enhance function and tip pinch with activities.
114
This common median nerve entrapment occurs when there is entrapment of the proximal median nerve between the heads of the pronator muscles. Symptoms include deep pain in the proximal forearm with activity; sometimes sensory involvement
Symptoms may be provoked by resisted elbow flexion and are exacerbated with concurrent resisted forearm pronation; negative Tinel’s sign.
**Pronator syndrome**
*Nonoperative treatment:*
- Splint elbow 90° to 100° flexion, forearm neutral
- TENS for pain
- Gentle prolonged stretching supination and elbow, wrist, and finger extension
- Activity modification
- No repetitive forearm rotation with resistance and prolonged elbow flexion.
*Operative treatment*:
- Half cast
- AROM all UE joints while wearing cast
- Muscle strengthening in 1 week
- Full AROM gained by 8 weeks.
115
_____________________ is caused by entrapment of the median nerve as it courses through the carpal tunnel. It is the most common nerve compression injury of the UE. Symptoms include paresis of the thenar muscles with weakness or loss of thumb opposition; sensory impairment generally involves numbness and tingling in the thumb and index and middle fingers, especially at night. Numbness or tingling and pain are typically worse at night. Motor impairment presents as diminished fine motor coordination; in advanced cases, the abductor pollicis brevis and opponens pollicis muscles may be atrophied.
**Carpal tunnel syndrome**
*Other causes* include fluid retention leading to temporary swelling at the carpal tunnel of the wrist, compressing the median nerve (e.g., from pregnancy, trauma, infection, diabetes, hypothyroidism, gout, rheumatoid arthritis, etc.); occupations requiring repetitive motion, such as meat packing and automobile parts assembly; and prolonged positioning such as working on a computer keyboard).
*Nonoperative treatment*
- A carpal tunnel syndrome splint or splint with wrist in neutral position to relieve pressure on the median nerve in the carpal tunnel and control edema; a prefabricated wrist cock-up splint can be used if wrist position is adjustable.
- Nerve and tendon gliding exercises.
- Activity modification that includes ergonomic handles, gel pads, or padding on handles.
- Avoid sustained pinch or gripping, when wrist is in a flexed posture. Avoid repetitive overuse of the wrist. Avoid positioning wrist in flexed posture when sleeping—use orthosis at night to keep wrist from bending.
- Postural retraining and proximal conditioning exercise.
- Ergonomic evaluation and modification of workstation.
*Surgical treatment*
- Surgical treatment includes traditional open carpal tunnel release or endoscopic release.
- After surgery, some clients may not need therapy.
- For more complicated cases, wound care and scar mobilization are provided.
- Pain management may include use of gel pads on the scar. Pain on either side of the surgical release is called pillar pain.
- Splinting is provided only to clients who sleep with the wrist flexed or who will engage in too much activity too soon (e.g., immediate return to work).
- AROM of wrist, thumb, and fingers begins 1–2 days postsurgery.
- Nerve and tendon-gliding exercises are provided.
- Strengthening activities begin in 3 to 6 weeks.
116
This nerve allows for simultaneous wrist flexion and ulnar deviation in addition to power grip via full flexion of the ulnar two digits (e.g., used for swinging a golf club or hammer). It is necessary to allow for tip and lateral or key pinch. It also enables hypothenar and interrosei muscles to allow the hand to powerfully cup an object (e.g., doorknob).
Injury to this nerve results in flattening of the normal arches of the hand. Low-level lesions (wrist) result in classic claw deformity of the digits with hyperextension of the MP joints and flexion of the IP joints. Paralysis of the thenar adductor causes loss of pinch strength.
**Ulnar nerve**
*Considerations for evaluation of ulnar nerve injuries*
1. *Froment’s sign*: flexion of the IP of the thumb when a lateral pinch is attempted
2. *Wartenberg’s sign*: the fifth finger held abducted from the fourth finger.
3. *Jeanne’s sign*: hyperextension of the thumb MCP.
117
This common ulnar nerve entrapment occurs at Guyon's canal. Clients experience sensory loss occurs in the little finger, ulnar side of the ring finger, and the palmar ulnar hand; if sensory loss is on the dorsal side of the hand, the injury is proximal to Guyon’s canal. There is also loss of intrinsic ulnar innervated muscles (interossei and adductor pollicis, flexor and abductor digiti minimi) and subsequent motor loss result in claw deformity, in which the MCPs hyperextend and the IPs flex, hand arches are flattened, and pinch strength is lost.
**Ulnar tunnel syndrome** or **Guyon’s canal compression**
*Causes* include ganglion, neuritis, arthritis, or carpal fractures at Guyon’s canal.
*Nonoperative treatment*
- An ulnar nerve palsy or anticlaw splint is used, and dynamic PIP extension assist may be added if PIP flexion contractures are present.
- A padded antivibration glove can be used during activity to protect from further nerve irritation.
- Activity modification includes ergonomic handles, gel pads, and padding on handles of vibratory equipment (e.g., lawn mower).
- Client education includes avoiding postures and activities that aggravate the condition, such as ulnar deviation combined with wrist flexion.
*Postoperative treatment*
- Bulky dressing is applied for 3–10 days.
- Splints: Dorsal blocking splint maintains the wrist at 20°–30° flexion; an MCP block maintains 45° flexion to protect nerve repair. Splint is adjusted at 3–6 weeks to increase wrist position to neutral. Discontinue the splint at 6 weeks. Use of the splint continues until muscle function returns.
- Wound care and scar mobilization are performed.
- Sensory desensitization begins when the wound has healed and stitches are removed.
- AROM of the wrist and hand begins at 6 weeks; clients may resume ADLs and begin muscle strengthening and work conditioning, if needed.
- Sensory reeducation begins at 10–12 weeks post surgery, once protective sensation has returned.
- Tendon transfer is done if the nerve has not regenerated within 1 year. After surgery, the OT practitioner may provide EMG biofeedback, NMES, and instruction in avoiding substitution of movement patterns
118
_______________ is caused by proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process. It is the second most common nerve compression of the UE after carpal tunnel syndrome. Sensation is decreased in the little finger and ulnar half of the ring finger. Motor problems may include decreased grip and pinch strength because of weak interossei, adductor pollicus, and flexor carpi ulnaris muscles.
**Cubital tunnel syndrome**
*Causes* include fracture or dislocation of the elbow, osteoarthritis, rheumatoid arthritis, diabetes, alcohol abuse, tourniquets, and assembly-line work.
*Nonoperative treatment*
- Edema control
- Pain management
- Elbow splint or positioning at 30°–70° flexion for 3 weeks, forearm and wrist in neutral, and digits free
- Ulnar nerve gliding
- Proximal conditioning activities
- Posture and ergonomic training
*Postoperative treatment*
- Therapy following cubital tunnel release in situ will focus on addressing pain or hypersensitivity; typically no ROM restrictions.
- If an endoscopic release is performed, postoperative splinting is usually not ordered and the client is encouraged to begin AROM and nerve gliding within the symptom-free range.
- If an ulnar nerve transportation was performed, the need for orthotics, activity restrictions, and a postoperative therapy program is based on the type of surgery, and the surgeon will dictate the course of rehabilitation.
119
____________ occurs when a peripheral nerve is entrapped in more than one location. Symptoms include intermittent diffuse arm pain and paresthesia with specific postures.
**Double crush syndrome**
*Nonoperative treatment*: treat according to each nerve injury or syndrome. Avoid movements or postures that aggravate the symptoms. Nerve-gliding exercises and exercises for scapular stability, posture, and core trunk strengthening are recommended.
120
__________________ is caused by cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist. Causes include forceful, repetitive thumb abduction with wrist ulnar deviation, carpometacarpal (CMC) osteoarthritis, scaphoid fracture, intersection syndrome, or radial nerve neuritis.
**de Quervain syndrome**
*Finkelstein’s test*: instruct the client to flex the thumb into the palm of the hand, then ulnar deviate the wrist; test is positive if symptoms are reproduced.
At highest risk are women ages 35–55; women in late pregnancy; mothers of young children; and people who engage extensively in keyboarding, piano playing, knitting, needlepoint, and racket sports.
*Nonoperative treatment*
- Medical treatment includes corticosteroid injections.
- Forearm-based thumb spica splint with wrist in neutral and thumb in opposition; thumb IP should be left free. Orthosis should be worn during the day as much as possible and always worn at night for 4 to 6 weeks.
- Activity modification and avoidance of pinch are recommended.
- Once pain and swelling are addressed after orthosis wear and activity modification, stretching and ROM are initiated. If stretching and ROM do not exacerbate symptoms, strengthening exercises commence, beginning with isometrics, advancing to light weight (1–2 lb), and progressing to full weight bearing.
- Ergonomic education.
*Operative treatment*
- Surgical intervention is recommended if two corticosteroid injections combined with 6 months of conservative management do not relieve symptoms.
- Medical treatment includes surgical release of the first dorsal compartment.
- Postoperative therapy may be initiated 10 to 14 days after surgery.
- Active and active assisted ROM exercises may be introduced 2 weeks after surgery.
- Progressive strengthening program may be initiated 4 weeks after surgery.
- Scar management and desensitization techniques are used.
121
This condition occurs with sheath inflammation or nodules near the A1 pulley.
It is described as “snapping,” “popping,” or “catching” of the flexor tendon during finger movement.
**Digital stenosing tenosynovitis (trigger finger)**
*Nonoperative treatment*
- Splinting the MCP at 0°–15°
- Avoidance of activities that cause pain and triggering
- Home exercise program including passive - PIP and DIP joint flexion, active composite full-finger flexion, both active and passive full-finger extension, and active hook fisting.
- Steroid injection into tendon sheath.
*Operative treatment*
- Surgically releasing the A1 pulley
- Clients will be able to return to normal activities 1 to 4 weeks following surgery.
- Most do not require therapy services after an A1 pulley release. If it is required, it is due to decreased motion from a PIP joint flexion contracture, scar tenderness, or generalized limited hand motion.
122
Name at least 2 assessments of sensory function used in hand therapy.
**Semmes-Weinstein monofilament testing**
**Two-point discrimination testing**: Assess client’s ability to discriminate between one point and two points of pressure applied randomly to the fingertip
Localization of touch
**Moberg pickup test**: Timed test involving picking up, holding, manipulating, and identifying small objects. It is used with children and adults with cognitive impairment to test median nerve function.
**Hoffman-Tinel’s sign**: Tap on the median nerve at the wrist to elicit symptoms; test distal to proximal for best accuracy.
123
Name at least 2 components of sensory reeducation after nerve injury.
**Protective reeducation** teaches clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60°.
**Discriminative reeducation** uses motivation and repetition in a visual–tactile matching process in which clients identify objects with and without vision.
**Sensory recovery** begins with pain perception and progresses to vibration of 30 cycles per second, moving touch, and constant touch.
**Desensitization** is a process of applying different textures and tactile stimulation to reeducate the nervous system so that clients can tolerate sensations during functional use of the UE.
124
This condition is marked by pain disproportionate to an injury that is either sympathetically maintained or independent of the sympathetic nervous system (formerly called reflex sympathetic dystrophy).
Complex regional pain syndrome (CRPS)
125
This type of CRPS has do definitive evidence of a major nerve injury; can occur spontaneously.
Type I
126
This type of CRPS develops after a nerve injury.
Type II
127
Name at least 5 symptoms of CRPS.
- Neuropathic pain (spontaneous burning pain)
- Allodynia (sensation misinterpreted as pain)
- Hyperalgia (increased response to painful stimuli)
- Hyperpathia (exaggerated, sometimes delayed response to sensory stimuli)
- Edema
- Contractures
- Bluish or red, shiny skin
- Abnormal sweating and hair growth
- Muscle spasms
- Decreased strength
- Low tolerance for activity
128
Name one medical treatment for CRPS.
**Stellate or sympathetic block**: an injection of local anesthetic into the front of the neck or lumbar region of the back to block pain
**Intrathecal analgesia**: injection of pain medication into the spinal canal
Removal of neuroma: surgery to remove a thickened nerve
**Installation of spinal cord stimulator**: a small electrical pulse generator implanted in the back to control pain
**Installation of peripheral nerve stimulator**: electrodes placed on the peripheral nerves to send electrical impulses to control pain.
129
Name at least 3 ways OT is involved in CRPS rehabilitation.
**Gentle, pain-free AROM** for short periods; no PROM or painful treatment
**Stress loading**: for example, scrubbing the floor, carrying a weighted handbag
Pain control techniques: TENS, splinting (static, then dynamic as tolerated), continuous passive motion
**Edema control techniques**: elevation, massage, AROM, contrast baths, compression
**Desensitization techniques**, fluidotherapy
**Mirror therapy** with cortical audio-tactile interaction
**Blocked exercises**, tendon gliding
Joint protection, **energy conservation**
Consideration of **mind–body connection**, including cognitive–behavioral techniques, mindfulness, relaxation, and diaphragmatic techniques
*Best managed with multidisciplinary approach that includes a physician who specializes in treating neuropathic pain and CRPS.*
130
This mechanism of injury occurs as trauma to soft tissue caused by repeated force (also called overuse syndrome and repetitive strain injury). It is NOT a diagnosis.
**Cumulative trauma disorder (CTD)**
*Diagnoses*: tendinitis (e.g., lateral epicondylyitis or de Quervain’s tenosynovitis); nerve compression syndromes (e.g., carpal tunnel syndrome or cubital tunnel syndrome); myofascial pain
*Work-related risk factors*: repetition, high force, direct pressure, vibration, cold environment, poor posture, cis-female gender, and prolonged static position
*Symptoms*: muscle fatigue, pain, chronic inflammation, sensory impairment, and decreased ability to work.
131
What are the five grades of Cumulative trauma disorder (CTD)?
**Grade I**: Pain after activity, resolves quickly, no decrease in amount or speed of work
**Grade II**: Pain during activity, resolves when activity stopped
**Grade III**: Pain persists after activity and affects work productivity; objective weakness and sensory loss
**Grade IV**: Use of extremity results in pain up to 75% of time, work is limited
**Grade V**: Unrelenting pain, unable to work.
132
Occupational therapy intervention during the acute phase for Cumulative trauma disorder (CTD) looks like...
Reduction of inflammation and pain through static splinting
ice
contrast baths
ultrasound phonophoresis
iontophoresis
high-voltage electric and interferential stimulation
133
Occupational therapy intervention during the subacute phase for Cumulative trauma disorder (CTD) looks like...
Slow **stretching**
**myofascial release**
**progressive resistive** exercise as tolerated
proper **body mechanics**
education on **identifying triggers** and returning to acute phase treatment with flareups
**static splint** during activities that cause pain
134
A splint is an orthopedic device designed, fabricated, or selected in conjunction with a client to temporarily support, protect, or immobilize a body part. Splints and other orthoses can be classified as _________ or __________ according to the location, direction, purpose, type, or number of joints included.
Articular, nonarticular
135
Which type of splint is described below?
*maintains the wrist in extension, thumb in abduction, MCP joints in flexion, and PIP and DIP joints in slight flexion.*
A. Resting hand splint
B. Static splints, static-progressive splints, and serial casting
C. Antideformity resting hand splint
D. Ball or cone antispasticity splints
E. Wrist cock-up splints
A. Resting hand splint
136
Which type of splint is described below?
*maintain the wrist in neutral position or extension, the MPs in flexion, the IPs in extension, and the thumb in abduction with opposition.*
A. Resting hand splint
B. Static splints, static-progressive splints, and serial casting
C. Antideformity resting hand splint
D. Ball or cone antispasticity splints
E. Wrist cock-up splints
C. Antideformity resting hand splint
*Also called burn intrinsic plus*
137
Which type of splint is described below?
*No moving parts; entirely immobilizes the joints it crosses*
A. Resting hand splint
B. Static splints, static-progressive splints, and serial casting
C. Antideformity resting hand splint
D. Ball or cone antispasticity splints
E. Wrist cock-up splints
B. Static splints, static-progressive splints, and serial casting
138
Which type of splint is described below?
*maintain hand arches, full thumb movement, and full MP flexion.*
A. Resting hand splint
B. Static splints, static-progressive splints, and serial casting
C. Antideformity resting hand splint
D. Ball or cone antispasticity splints
E. Wrist cock-up splints
E. Wrist cock-up splints
*Can have dorsal or volar wrist immobilization*
139
Which type of splint is described below?
*ulnar- or volar-based and provide thumb palmar or radial abduction; a hard surface in contact with finger flexors; and serial casting for the wrist, elbow, knee, or ankle to decrease soft tissue contractures*
A. Resting hand splint
B. Static splints, static-progressive splints, and serial casting
C. Antideformity resting hand splint
D. Ball or cone antispasticity splints
E. Wrist cock-up splints
D. Ball or cone antispasticity splints
140
Which type of splint is described below?
*Includes foot-drop splints to maintain 90° ankle dorsiflexion and ankle–foot orthoses.*
A. Thumb spica splints
B. Finger splints
C. Elbow splints
D. Knee extension splints
E. Ankle splints
E. Ankle splints
141
Which type of splint is described below?
*Includes PIP extension (i.e., Boutonniere, Capener, prefabricated dynamic extension assist, and serial casting) splints, PIP flexion splints, PIP hyperextension block (swan neck) splints, DIP extension (mallet finger, serial casting) splints, DIP flexion splints, and silver ring splints.*
A. Thumb spica splints
B. Finger splints
C. Elbow splints
D. Knee extension splints
E. Ankle splints
B. Finger splints
142
Which type of splint is described below?
*include anterior and posterior elbow immobilization splints.*
A. Thumb spica splints
B. Finger splints
C. Elbow splints
D. Knee extension splints
E. Ankle splints
C. Elbow splints
143
Which type of splint is described below?
*(volar or radial gutter immobilization) are used on the long or short opponens to provide CMC immobilization.*
A. Thumb spica splints
B. Finger splints
C. Elbow splints
D. Knee extension splints
E. Ankle splints
A. Thumb spica splints
144
Which type of splint is described below?
*provide posterior full knee extension to the extent possible.*
A. Thumb spica splints
B. Finger splints
C. Elbow splints
D. Knee extension splints
E. Ankle splints
D. Knee extension splints
145
The splint described below is fabricated for which condition?
*block fourth and fifth MCPs to 30°–45° flexion to prevent hyperextension*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
C. Ulnar nerve at the wrist
146
The splint described below is fabricated for which condition?
*cock-up splint, with dynamic finger extension assist optional*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
A. Radial nerve injury
147
The splint described below is fabricated for which condition?
*wrist in neutral to 10° extension*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
D. Carpal tunnel syndrome
148
The splint described below is fabricated for which condition?
*forearm and wrist neutral, elbow in 90° flexion*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
E. Pronator syndrome
149
The splint described below is fabricated for which condition?
*wrist in 30° extension, forearm supinated, elbow in 90° flexion.*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
B. Radial tunnel syndrome
150
The splint described below is fabricated for which condition?
*forearm neutral, elbow in 90° flexion*
A. Radial nerve injury
B. Radial tunnel syndrome
C. Ulnar nerve at the wrist
D. Carpal tunnel syndrome
E. Pronator syndrome
F. Anterior interosseous syndrome
F. Anterior interosseous syndrome
151
What are some special splinting considerations for the older adult population? (Name 2)
Age
frame of reference
client’s environment
existing medical issues
any cognitive or perceptual deficits
low vision
hearing impairments
pain perception
thinning of skin and decreased adipose tissue
any medication side effects
use stockinette under splint, pad splint well, soft straps, label splint
152
What are some special splinting considerations for the pediatric population? (Name 2)
age
frame of reference
child’s environment
make the splint appealing to the child by using colored materials or drawing animals on it
limit fit time by using a cold pack to set the splint more quickly
consider using a soft splint
153
Dynamic splints have moving parts, and soft splints allow movement. Dynamic splints are designed to correct contractures, increase passive motion, protect recent surgery, or substitute for lost active motion.
*To correct contractures*: mechanical stretch of prolonged gentle pull over __________ (hours) to remodel soft tissue.
8–12 hours
154
Dynamic splints have moving parts, and soft splints allow movement. Dynamic splints are designed to correct contractures, increase passive motion, protect recent surgery, or substitute for lost active motion.
*To increase passive motion*: finger loop angle of pull of _________ (degrees); adjust splint as client improves to maintain _________ (degrees) angle of pull.
90° (both)
155
Dynamic splints have moving parts, and soft splints allow movement. Dynamic splints are designed to correct contractures, increase passive motion, protect recent surgery, or substitute for lost active motion.
*To protect recent hand flexor tendon repair surgery*: ______________ splint can be used.
dorsal blocking (splint)
156
Dynamic splints have moving parts, and soft splints allow movement. Dynamic splints are designed to correct contractures, increase passive motion, protect recent surgery, or substitute for lost active motion.
*To substitute for lost active motion*: ______________ splint, with dynamic MCP extension assist if needed.
radial nerve injury (splint)
