hand and upper extremity disorders and injuries Flashcards
Dupuytren’s disease
splint?
intervention?
-The fascia becomes thick and contracted. develops cords and bands that extend into the digits results in flexion deformities of the involved digits usually 4 and 5
-Extension splint at all times
-A/PROM progress to strengthening when wounds heal- causes wounds and scars
-Wound Care: dressing
changes.tasks that emphasize
flextion (griping) and
extension (release).
Skiers thumb (gamekeepers thumb) splint? intervention?
- Rupture of the ulnar collateral ligament of the MCP joint of the hand
- Thumb splint 4 to 6 weeks
- AROM and pinch strength at 6 weeks focus ADL that requires opposition
colle’s fracture
orthotics?
splint?
intervention?
-Fracture of the distal radius with dorsal displacement
Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.
-wrist extension splint
smith’s fracture
orthotics?
splint?
intervention?
-Fracture of the distal radius with volar displacement
Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate.Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.
-thumb splint
Klienert protocol 0-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks
Kleinert 0-4 weeks
dorsal block splint. passive flexion and active extension within limits of splint
kleinert 4-6 weeks
wristlet. place/hold exercises. scar management.
kleinert 6-8 weeks
AROM. tendon gliding and differential tendon gliding. light ADL and role activities. D/C splint
Kleinert 8-12 weeks
strengthening and work and leisure activities
Duran protocol 0-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks
passive flexion and extension of digit duran 0-4.5 weeks dorsal blocking splint. exercises in splint include passive flexion of PIP jt, DIP jt and to DPC. 10 reps every hour. duran 4.5-6 weeks active flexion and extension within limits of splint duran 6-8 weeks tendon gliding and differential tendon gliding, scar management, light ADL and role activities duran 8-12 weeks strengthening and work activities
Best modality used for UE pain
TENS unit
Complex regional pain syndrome usually come from what injury? splint? Intervention? Interventions to avoid?
- Distal radius fracture can develop after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.
- surgery to remove thickened nerve, medication injection in neck
- temperature change, severe pain, skin discoloration, edema, osteoporosis
-splinting to prevent contractures
static and dynamic splint as tolrated , volar splint in extension as tolerated, circumferential wrist might be used to avoid edema
-insertion of spinal cord stimulator to contol pain, insertion of peripheral nerve stimulator for pain, sympathetic block, removal of neuroma
-edema management, elevation, manual edema mobilization, compression glove/garment, desensitation, fluidotherapy, Gentle AROM
stress loading program ( ex. scrubbubing the floor carrying a weighted bag) and use of the upper extremity in functional activities
-PROM, Passive stretching, joint mobilization, dynamic splinting and serial casting, arm sling
de querveins
diagnosis?
splint?
pain and swelling on the radial styloid
positive Finkelstein’s test
thumb spica
carpal tunnel
diagnosis?
splint?
Positive Tinel’s test
- wrist splint in neutral should be worn at night
- immobilization splint rest and reduce inflammation
- can fabric a wrist cock up splint (can have thumb spica also) for wrist support (to inhibit wrist flexion, usually in 10-‐15 degress of wrist extension).
- nerve gliding, AROM, strenthening, ergonomics
- tinel sign tap on the median nerve at wrist to elicit symptoms
- phalens sign check changes in sesation
- Moberg pick up test picking up holding and manipulating object to test median nerve function
Arthritis symptoms? Eval? splint? Heat modality? interventions?
RA-splint?
-inflammation of a joint or joints
pain, stiffness, limited ROM
-Avoid MMT
-resting hand splint only in acute stage
wrist splint if arthritis is specific to wrist
ulnar drift splint to prevent deformity
silver ring splint to prevent Boutiniere’s and swan neck deformity
- RA functional splint or safe splint depending on stage, or intrinsic plus splint
- RA acute flare up no stress on joints no dynanometer during eval
- Use soft straps and thick padding.
- paraffin is recommended for hands
- hot packs can be used before exercise but avoid during inflammatory stages
Trigger finger
splint?
Intervention?
intervention recommended?
-Tenosynovitis of the finger flexor’s: most commonly in the A1 pulley
-caused by repetitive gripping actions and tools that are placed to far apart
-lack of smooth flexion and extension in the finger then
-gentle pull through with bending and
straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the
client is awake.
-hand based trigger finger splint splints (inhibit full digit flexion/making a tight fist) splintsusually focuses on preventing the MP to flex
-edema control, tendon gliding avoid repetitive gripping
cubital tunnel syndrome
diagnosis?
splint?
intervention?
- ulnar nerve compression at elbow can come from leaning on elbow
- positive Tinel’s sign at elbow
- elbow splint, elbow padding
- elbow splint prevent positions of extreme flexion
- avoid extension and putting pressure or leaning on elbow
- edema control, active ROM and nerve gliding
Radial nerve palsy
splint?
intervention?
-radial nerve compression/wrist drop
compression as a result of a humeral shaft fracture, or at elbow
-dynamic extension splint, Forearm-based wrist orthotic.
- you can also use Thumb Extension Splint, duran dorsal protection splint, volar splint with wrist in neutral, wrist cock up
- nerve gliding and strengthening
what time period is the flexor tendon repair the weakest and most likely to rupture?
10-12 days post surgery
Mallet finger
what happens?
splint?
Tendon separates from the bone and its insertion and removes bone material with the tendon (Avulsion injury)
-DIP extension splint for 6 weeks to prevent extensor lag
Boutonniere deformity
what happens?
intervention?
splint?
Tendon separates from the bone and its insertion and removes bone material with the tendon (Avulsion injury) isolated - DIP flexion exercises are performed. -Silver rings/ tri tip PIP is splinted in extension -PIP extension splint -oval 8
lateral and medial epicondylitis
recommendation?
splint?
intervention at least 5?
for work?
-lateral-overuse of wrist extensors, you avoid active/aggressive extension of the wrist and digits.
medial-overuse of wrist flexors, you avoid active/aggressive flexion of the wrist and digits.
- elbow strap wrist splint
- Brace recommended to provide support to the muscle/tendon while they heal.
- static splinting in acute phase
-ice and deep friction massage, and
stretching, isometric exercises, isotonic exercises, and eccentric exercises contrast baths, ultrasound, inferential
stimulation. Subacture phase:slow stretching, myofascial release,
progressive resistive exercises as tolerated, proper body mechanics,
-Activity
modification and proper
body mechanics
Adhesive capulitis
intervention
-frozen shoulder
restricted shoulder ROM
- most important to encourage use of ADL and role activities PROM and modalities for pain management
Cumulative trauma disorder
work
-also known as CTD, is defined as the excessive wear and tear on tendons, muscles and sensitive nerve tissue caused by continuous use over an extended period of time examples are - carpal tunnel and trigger finger
-Activity
modification and proper
body mechanics
MCP joint extension helps isolate?
IP joint flexion and FDP excursion
Important considerations for applying a splint?
consider the adjacent digits- make room for adjacent digits that are unaffected
Osteogenesis imperfecta
OT intervention
- activity adaptation, assistive device fabrication
- preventitive positioning and protective splinting
- weight bearing activities to facilitate bone growth
- exercise swimming, water therapy, and walking
- healthy dieting and weight control
swan neck
Tendon separates from the bone and its insertion and removes bone material with the tendon
- flexion of the DIP and hyperextension of the PIP. Can use an oval 8 to correct
- oval 8 splint, silver ring or tri tip
- splint button hole
guyon’s canal syndrome
-wrist splint in neutral, immobilization splint, wrist cock-up splint
Ape hand
what is it?
-People who cannot move the thumb away from the rest of the hand. It is an inability to abduct the thumb. High median nerve injury at the elbow or proximal forearm. Sensory loss in index, middle, and radial side of finger; loss of pinch, thumb opposition, index finger MCP and PIP flexion; and decreased pronation.
Bennet’s frature
what is it?
orthotic?
-Fracture of the first metacarpal base -Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.
Boxers Fracture
(Proximal Fracture)
what is it?
splint?
-A boxer’s fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits.
-Ulnar gutter splint
Brachial plexus injury
intervention?
splint?
contraindication?
-Probable recovery, with additional upward movement of the wrist, as well as straightening of thumb and fingers an even stronger indicator of excellent spontaneous improvement. Gentle range of motion exercises.
-Flail arm splint provides the needed stability at both the shoulder and elbow for functional positioning of the hand.
-Any motion beyond 90° abduction may induce added stress to the brachial plexus and its roots.
CMC arthritis
what is it
splint
most common in post-menopasul women may stem from RA or Gout
-hand based thumb splint
carpal fracture
fracture to the carpal bone associated with keinbocks disease
pillar pain
pain on either side of the carpal tunnel release surgery
CMC osteoarthritis
splint?
splinting and activity modification
-thermoplastic splint and neoprene wrap
Double crush
intervention?
Occurs when a peripheral nerve is entrapped in more than one location. Symptoms: Intermittent diffuse arm pain and paresthesias
-Nerve gliding exercises, and exercises for scapular stability, posture, and core trunk strengthening.
elbow fracture
intervention?
orthotics?
-involvement of radial head
-Orthotics are used for
immobilization as needed
ROM begins early, withinin 1 week if medically cleared. A sling is used for Type 1 fracture (nondisplaced) or comfort if the client has pain and is nervous in public places.
Erb’s palsy
treatment?
splint?
-Paralysis of the arm caused by injury to the upper group of the arm’s main nerves, specifically the severing of the upper trunk C5–C6 nerves. atrophy/paralysis of arm muscles
-resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery
-Elbow lock splint stabilizes the elbow to enable the individual to position the hand closer to or away from his/her body for funcational use.
Extensor Tendon Injury
modalities?
interventions?
-extensor digitorum communis, extensor indicis proprius (EIP
-Modalities include heat, to gradually prepare the tissue for motion, and NMES to promote tendon excusion and activation.
- tendon gliding
- strengthening is initiated 8-12 weeks after surgery
Flaccid wrist (wrist drop) intervention splint?
Support the user’s wrist in 10 to 20 degrees of extension to prevent contracture, but allows digits to function
-wrist cock up splint
Flexor tendon injury
intervention?
splint?
tendon weakest?
zone II
-A deep cut on the palm side of
your fingers, hand, wrist, or
forearm can damage your flexor
tendons,
-intervention klienhert or Duran Protocol
-Passive
extension of the distal
interphalangeal joint if the
metacarpal and proximal
phalangeal joints are
flexed.
-A tendon repair is
typically at its
weakest 10–12
days postsurgery
during the
fibroplasia phase, in
which collagen is
just beginning to be
laid down to
strengthen the
repair.
-dorsal blocking splint
-no mans land because excessive
scarring makes it difficult
to get good results from a
repair.
Median nerve injury
intervention?
2 splint?
-AROM and PROM in splint for digits and thumb, tendon gliding exercises, scar massage, discontinue splint at 6 weeks and begin strengthening exercises.
Duran protocol
Non-operative
treatment: Static
thenar web spacer
splint.
Operative
treatment: dorsal wrist
blocking splint worn
for 4-6 weeks.
Thoracic outlet syndrome
Excess pressure placed on a
neurovascular bundle passing
between the anterior scalene
and middle scalene muscles
tendonitis/tenosynovitis
intervention?
2 splint?
Inflammation of a tendon Treatment is largely conservative with rest,
and gradual return to
exercise is a common
therapy.
-Rest, Ice, compression and elevation. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks. Treatment of tendinitis helps reduce some of the risks of developing tendonosis, which takes longer to heal.
-Duran /dorsal protection splint, -volar splint with wrist in neutral
Median and Ulnar nerve injury at same time?
2 splint?
Injury to both the median and ulnar nerves results in an impairment of function. Can be caused by car accidents and glass injuries.
-Figure of eight splint to
prevent MP
hyperextension or
-dynamic MCP flexion
splint
Froment’s sign?
It tests for palsy of the ulnar nerve at the wrist, specifically, the action of adductor pollicis. Occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual. To perform the test, a patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The OT then attempts to pull the object out of the subject’s hands. A normal individual will be able to maintain a hold on the object without difficulty. However, with ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect. The compensation of the affected hand results in a weak pinch grip with the tips of the thumb and index finger, therefore, with the thumb in obvious flexion.
MCP flexion limitation
meaning?
The correct angle of pull for a finger loop is 90°. This angle of pull distributes the pressure most evenly to the proximal phalanx.
pronator teres syndrome
splint?
Elbow splint at 90° (forearm in neutral),
opponens splint used for?
fist contractures
Radial tunnel syndrome
protocol?
splint?
avoid?
Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm.
-Operative treatment: long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, the -wrist cock up for 2 more weeks, passive and active pronation and supination, hand strengthening exercise at 3 weeks, resistive exercise at 6 weeks.
Non-operative: Long arm splint, elbow flexed, forearm supinated, wrist neutral, massage or TENS for pain management, pain free ROM, nerve gliding, activity modification
-Avoid foreceful wrist
extension and
supination.
Proximal
interphalangeal
(PIP) flexion
contracture
splint?
splint helps?
A prefabricated
dynamic PIP
extension
- splint will improve PIP extension and takes less therapy time to fit than to custom make this splint.
Index finger injury
splint?
-strap incorporating the index and middle fingers provides passive rom to the index finger
Klumpke’s syndrome
what happens?
paralysis of the lower brachial plexus
paralysis of the hand and wrist with ipsilateral horners syndrome (miosis, ptosis, and facial anhidrosis)
Ulnar nerve injury
intervention
splint
-Orthotics are used for immobilization as needed. ROM is begun early, within 1 week if medically cleared. A sling is used for type 1 fractures or comfort if the client has pain and is nervous in public places.
-Ulnar nerve injury splint, dynamic/static splint to position MP’s in flexion. MCP block splint. If it is a low level ulnar nerve injury, then a splint that prevents hyperextension of the MCP joints and allows MCP flexion. -dorsal blocking splint with wrist in 20-30 degrees flexion
anterior interosseous compression
median nerve
posterior interosseous compression
radial nerve/radial tunnel syndrom
