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MedPsych Exam 3 > Hand Injuries > Flashcards

Hand Injuries Flashcards

1
Q

what portion of UE injuries do hand injuries make up?

A

1/3

sports related, farm injuries, industrial

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2
Q

what are the problems caused by hand injuries?

A 
difficulty in movement
lack of strength
tiring
lack of coordination 
pain or numbness
swelling
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3
Q

what defines a hand injury?

A

any impairment to function or cosmesis of the hand including the skin, nails, tendon, bone, nerve or blood supply

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4
Q

what are the qualifications of a certified hand therapist?

A

OT or PT with 5 years of experience
4,000 hours of documented direct patient care
Pass exam

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5
Q

what are examples of hand injury diseases?

A

RA
Tenosynovitis
Dupuytren’s

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6
Q

what causes occupation hand injury?

A

Repetitive stress

accidental injuries

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7
Q

what should be evaluated after hand injury?

A 
Medical history
Social & employment history
Surface anatomy
Observation & inspection
ROM/Muscle strength 
Grip & pinch strength 
Dexterity
Edema
Sensibility 
ADLs
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8
Q

what is important to remember when txing hand injury patients?

A

they arent sick and have an active role in tx

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9
Q

what are the methods used in hand rehab?

A 
Patient education
Positioning
Edema control (wraps)
Splinting
Functional activities (exercise)
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10
Q

what are the risk factors that prevent healing?

A 
Infection
Physical location
Size
Appearance
Stage of wound healing
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11
Q

what is wound healing initiated by?

A

tissue & platelet disruption

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12
Q

what is would healing regulated by?

A

biomechanical exchange producing
• Phagocytosis
• Neovascularization
• Biosynthesis of collagen

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13
Q

what are the wound healing phases?

A

1st: Inflammatory Phase
• Macrophage clearing, 6-48 hours

2nd: Fibroblastic (Repairative)
• Collagen synthesis begins 2-5 days

3rd: Proliferation
• Maturation and remodeling

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14
Q

what are the surgical concerns for fingertip injuries?

A

Wound coverage
Adequate sensation, joint ROM
Maximum length
Appearance

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15
Q

what are the therapeutic concerns of fingertip injuries?

A

Sensation—too much? Too
little?
Fine motor

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16
Q

what are the skin coverage options for hand injury?

A 
Advancement flap 
Local flap
Myocutaneous flap 
Pedicle flap
Rotational flap
17
Q

when is a full thickness graft used?

A

when a tumor is being removed and a large area needs to be covered

18
Q

what is a degloving injury and how is it txed?

A

skin taken off like glove.

treated with pedicle skin graft

19
Q

how is surgery for a flexor tendon injury determined?

A

depends on location of injury

Tendons divided into “zones” 1-5

20
Q

whih tendons of the hand are most important for pulley system?

A

proximal phalange

metacarpal

21
Q

when does a flxeor tendon repair have to occur?

A

12-24 hours after laceration

22
Q

what is the importance of the flexor tendon pulley system?

A

Holds tendon close to bone to improve mechanical advantage for ROM

23
Q

what does therapeutic management of flexor tendons depend on?

A

surgeons training, nature of injury, patient, type of surgery

24
Q

what are the tx protocols for flexor tendon injury?

A

Immobilization, 3 weeks
Early passive motion
Early motion (modified Duran)
Early Active motion (Indiana Protocol)

25
Q

when is immobilization after surgery of flexor tendon best?

A

when dealing with children or people with cognitive issues

26
Q

how should a pt initiate early active rehab?

A

active extension, with passive flexion. using rubber bands, elastic to pull on tendon

27
Q

what is the staged tendon repair surgery?

A

“Hunter Rod” procedure
• Used when primary repair fails or never initially repaired.
• Rod holds place for tendon, sheath forms around rod, tendon pulled thru when rod remove

28
Q

what is a zone 1 extensor injury?

A 
Mallet finger
• Hyper flexion injury (rupture of ext tendon)
• Inability to extend DIP
• Splint for 12 weeks
• DIP extension, PIP free
29
Q

what is a zone 2 extensor injury?

A

Boutonniere deformity
• Rupture central slip with volar migration of lateral bands
• PIP flexion with DIP extension
• Closed injury: splint, PIP extension, DIP free
• Open injury: surgical repair of tendon, may need ORIF of PIP joint

30
Q

what is a zone 3 extensor injury?

A

Swan neck deformity
• PIP hyperextension with DIP flexion
• Caused by RA, old mallet finger, intrinsic muscle contracture

31
Q

what is a zone 4 extensor injury?

A

Flexion deformity of MCP joints
• Therapeutic management
• Early motion
• immobilization

32
Q

what is a zone 5 deformity?

A

Flexion deformity of MCP joints

33
Q

what are special surgical considerations for hand fractures?

A

Prevent angulation or rotation of fingers

• Proper positioning during immobilization period preserves eventual motion of hand is “protective position”

34
Q

what is the burns position?

A

PROTECTS LENGTH OF COLLATERAL LIGAMENT FOR MPS AND MCPS

MP flexion (65-70) degrees, IP’s full extension

35
Q

what are repetitive stress injuries?

A

Usually not just from work activities

• Takes weeks, months, years to develop and to “cure”

36
Q

what are examples of repetitive stress diseases?

A

Carpal Tunnel Syndrome, DeQuervain’s Disease

37
Q

what is dupuytrens disease?

A

disease of the palmer fascia resulting in thickening & shortening of fibrous bands on palmer surface of hand & fingers resulting in flexion deformity of the 4th and 5th fingers

38
Q

what are the implications for a hand/finger replant?

A 
General health & age of patient
Mechanism of injury
Associated injuries
Ischemia time
Availability of skilled team 
Desire of patient
39
Q

what are the ethical considerations for transplant from another body?

A 
Scientific background of innovation
Skill & experience of team
Ethical climate of institution
Open display
Public evaluation
Public & professional discussion

MedPsych Exam 3 (7 decks)

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