Hand/UE Flashcards
Avulsion Injury
When the tendon separates from the bone and its insertion and its insertion and removes bone material w/the tendon
Is mallet finger an avulsion?
Yes - is splinted in full extension for 6 weeks
What is boutonniere deformity?
Disruption of the extensor tendon with PIP flexion and DIP hyperextension. The PIP is splinted in extension and isolated DIP flexion exercises are performed.
What is Swan Neck deformity?
PIP hyperextension and DIP flexion - the PIP is splinted in slight flexion.
What are the three common phases of fracture healing?
inflammation
repair
remodeling
Describe (inflammation) part of fracture healing
provides cellular activity needed for healing
Describe (repair) part of fracture healing
forms the callus for stabilization
Describe (remodeling) part of fracture healing
deposits bone
Modalities for pain relief and tissue healing include:
Heat Ultrasound Cryotherapy Paraffin Transcutaneous Electrical Nerve Stimulation (TENS)
When does controlled AROM begin after fracture?
3-6 weeks
What is the most severe complication of hand fractures?
Complex regional pain syndrome
Colles Wrist Fracture
Complete fracture of the distal radius w/dorsal displacement
Smith’s Wrist Fracture
Complete fracture of the distal radius w/palmar displacement
Bennet’s Wrist Fracture
Fracture of the first metacarpal base
Median Nerve Injury is?
Produces carpal tunnel-like symptoms such as palmar numbness and numbness of first digit to half of the fourth digit w/generalized weakness and pain
Ulnar Nerve Injury is?
Results in ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits w/generalized weakness of the ulnar side of the hand and pain.
Radial Head Fractures (elbow fracture) - Type 1
Nondisplaced
-treated w/a long arm sling
Radial Head Fractures (elbow fracture) - Type 2
Displaced w/a single fragment
treated nonoperatively w/immobilization for 2-3 weeks and early motion w/medial clearance
Radial Head Fractures (elbow fracture) - Type 3
Comminuted
-treated operatively, w/immobilization and early motion within the first postoperative week
Radial Head Fractures (elbow fracture) - Interventions
Orthotics - for immobilization as needed
ROM within the 1st week
A sling for type 1 fractures
Proximal humeral fractures - Interventions
- Orthotics (humeral fracture brace)
- ROM as early as 2 weeks
- Sling to immobilize the fracture
- ROM consists of aggressive stretching and can start 4-6 weeks after the fracture as by MD
- Home exercise program
What is complex regional pain syndrome (CRPS) or called reflex sympathetic dystrophy?
pain to an injury
Symptoms
- edema
- contractures
- bluish/red shiny skin
- abnormal sweating
OT Intervention
- Gentle, pain free AROM - (NO PROM or PAINFUL TREATMENT!)
- Stress loading - scrubbing floor, carrying a weighted handbag)
- Pain control - TENS, splinting (Static then dynamic)
- Edema control
- Fluidotherapy
- Joint protection/energy conservation
Allodynia
sensation misinterpreted as pain
Hyperalgia
increased response to painful stimuli
Hyperpathia
pain that continues after stimuli is removed
What is cumulative trauma disorder (CTD)?
trauma to soft tissue caused by repeated force
Work-related risk factors of CTD
repetition, high force, direct pressure, vibration, poor posture
Symptoms of CTD
muscle fatigue, pain, chronic inflammation, sensory impairment
OT Intervention to CTD - Acute Phase
Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, Estim
OT Intervention to CTD - Subacute Phase
Slow stretching, myofascial release, progressive resistive stretch exercise, proper body mechanics, static splint during activity
OT Intervention to CTD - Return to Work
Assessment of Job site, tools, body positioning
- Work simulator, elastic bands, putty, functional activities, strengthening
- Work hardening
myofascial release
soft tissue therapy for pain
work hardening
aggressive approach focuses on the functional aspect of the job. Work stimulation tasks with small components of strength and conditioning blended in.
Work Conditioning
strengthening and conditioning tasks to restore function
OT Interventions - Extensor Tendons
- exercises to promote tendon excursion and prevent adhesions
- modalities include heat to prepare the tissue for motion, NMES to promote tendon excursion and activation.
- home exercise program
- tendon glides exercises
- ROM
- Strengthening
tendon excursion
the distance a tendon travels upon movement of a joint
OT Interventions - Flexor Tendons
-exercises promote tendon excursion and prevent adhesions
-modalities include heat, to prepare the tissue for motion, NMES to promote tendon excursion and activation.
-Home exercise program
-Tendon glides exercise
-ROM
Strengthening
The Duran protocol
an early passive ROM program
Kleinert Protocol
active extension of digits w/passive flexion via traction, typically a rubber band
The early active motion protocol
begins within days of surgery to prevent adhesion and promote gliding and excursion
tendon glides exercises
to promote circulation in the hand to reduce swelling
Neuromuscular electrical stimulation (NMES)
promote tendon excursion and activation
Radial Nerve Injury
Symptoms
-posture of hand is wrist drop, possible lack of finger/thumb extension
Nonoperative treatment
-Wrist cock-up splint with or without dynamic finger/thumb extension assist, passive/active ROM, isotonic strengthening exercises
Operative Treatment
-Static wrist extension splint 30 degrees, after 4 weeks adjust splint to 10-20 degrees
Radial Tunnel Syndrome
Entrapment of the radial nerve in an area extending from the radial head to the supinator muscle
Symptoms
-Burning pain the lateral forearm
- Nonoperative treatment
- Long arm splint, elbow flexed, forearm supinated, wrist netural, Massage/TENS for pain, ROM, nerve glide
Operative treatment
-Long arm splint, elbow flexed, forearm supinated, wrist neutral for 2 weeks, then wrist cock up for 2 more weeks
Anterior Interosseous Syndrome
Compression to the anterior interosseous Nerve
-Results in a motor loss involving the flexor digitorum longus, flexor profundus and pronator quadratus
Pronator Syndrome
Entrapment of the proximal median nerve between the heads of the pronator muscles
Symptoms
-Deep pain proximal forearm w/activity
Nonoperative treatment
-Splint elbow 90-100 degrees flexion, forearm neutral, TENS for pain, gentle stretching
Operative Treatment
-Half cast, AROM all UE joints while wearing cast, muscle strengthening in 1 weeks, full AROM by 8 weeks
Median Nerve Injury
Causes Ape hand deformity
Symptoms
-Ape hand deformity, sensory loss in index, middle, and radial side of ring finger, loss of pinch, thumb opposition
Nonoperative treatment
-Static thenar web spacer splint
Operative treatment
-Dorsal wrist blocking splint worn for 4-6 weeks, AROM/PROM in splint for digits/thumb, tendon gliding exercises, scar massage. Discontinue splint at 6 weeks and begin strengthening exercises
Double crush syndrome
Occurs when a peripheral nerve is entrapped in a more than one location
Symptoms
-Intermittent diffuse arm pain and paresthesias w/specific postures
Nonoperative treatment
- avoid movements/postures that aggravate symptoms
- nerve gliding exercises
- exercises for scapular stability
- posture/core trunk strengthening
Carpal Tunnel syndrome
Entrapment of the median nerve as it courses through the carpal tunnel.
Sensory impairment involves numbness/tingling in the thumb/index/middle fingers
Diminished fine motor coordination
Nonoperative treatment
- Wrist cock-up splint= to relive pressure on the median nerve in the carpal tunnel and control edema.
- Nerve/tendon gliding exercises
- Activity modification=ergonomic handles, gel pads, or padding on handles
- Client education=avoidance of postures/activities that aggravate the condition (wrist flexion).
- Postural retraining/proximal conditioning exercises
Postoperative Treatment
- wound care/scare mobilization
- pain management
- splinting
- AROM of wrist, thumb, fingers (1-2 days after surgery)
- Nerve/tendon gliding exercises
- Strengthening begins 3-6 weeks
Cubital tunnel syndrome
Proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process.
- Sensation is decreased in the little finger/ulnar half of the ring finger
- Motor problems such as decreased grip/pinch strength
Nonoperative treatment
- Edema control
- pain management
- elbow splint
- ulnar nerve gliding
- proximal conditioning activities
- posture/ergonomic training
Postoperative treatment
-splint the elbow, wound care, edema control, pain management
de Quervain syndrome
cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit
Caused by forceful, repetitive thumb abduction
Nonoperative treatment
- corticosteroid injections
- forearm-based thumb spica splint w/wrist in neutral/thumb radially abducted
- computer ergonomics education
Operative treatment
- gentle ROM/tendon gliding exercises
- Splinting
- Grip/pinch strengthening begins at 2 weeks
- Scar management/desensitization techniques
Claw Deformity
The distal ulnar nerve compression or lesion at the wrist
Sensory loss occurs in the little finger/ring finger and the palmar ulnar hand
Nonoperative treatment
- anticlaw splint
- padded antivibration glove can be used during activity to avoid further nerve irritation
- Activity modification: ergonomic handles, gel pads, padding on handles of vibratory equipment (lawnmower)
- Client education: avoid postures, activities that aggravate the condtion
Postoperative treatment
- bulky dressing is applied for 3-10 days
- Dorsal blocking splint is used to maintain the wrist flexion.
- AROM of the wrist/hand begins at 6 weeks.
- Sensory reeducation begins at 10-12 weeks.
Digital stenosing tenosynovitis (trigger finger)
Treatment
- Splinting the MCP at zero degrees for 3-6 weeks.
- Protective reeducation for clients to compensate for sensory loss.
- Desensitization of applying different textures/tactile stimulation to reeducate the nervous system.
Cryotherapy (ice massage, ice, cold packs, cold water immersion baths)
Pain relief
decrease edema
decrease muscle spasms
decrease inflammation
Precautions/contraindications:
- clients w/impaired circulation
- peripheral vascular diseasae
- hypersensitivity to cold
- impaired sensation
- open wounds/infections
Thermotherapy (warm whirlpools, fluidotherapy, hot packs, contrast batths, and paraffin baths)
Increase blood flow increased cell metabolism increased inflammation increased muscle contraction increased oxygen consumption decreased muscle spasms decreased pain
Precautions/contraindications:
- clients w/acute inflammation
- edema
- sensory impairment
- cancer
- blood clots
- infection
- cardiac problems
- impaired cognition
Ultrasound heats tissue (1-5 cm depth)
Thermal effects - increase tissue extensibility and blood flood, decrease pain, joint stiffness, muscle spasms, chronic inflammation.
Nonthermal effects - increase protein synthesis and bone healing and decrease inflammation
Precautions/contraindications: avoid w/pregnancy, over eyes, pacemaker, bleeding, infections, cancer, over blood clots, cognitive impairments, sensory impairments.
Electrical Stimulation
NMES - wound healing, maintains muscle mass, increase ROM, decrease edema, facilitates voluntary muscle control, decrease spasm/spasticity.
TENS - controls pain
Iontophoresis - decreases inflammation and controls pain
Precautions/contraindications: do not use over pacemaker, eyes, clients w/epilepsy, cancer, infection, decreased sensation, cardiac disease/stroke.
Low-level laser/Light therapy
decreased pain, edema, inflammation, increased wound healing and decrease scar tissue.
-Precautions/contraindications: wear protective eyewear, eyes, infection or cancer.
Wound closure - Primary
Wound is closed w/sutures
Wound closure - Secondary
Wound is left open and allowed to close on its own
Would closure - Delayed primary
Wound is cleaned, debrided and observed 4-5 days before suturing it closed.
Wound closure - Remolding phase
wearing pressure garments helps collagen fibers realign.
dynamic splinting, serial casting, passive motion, stretching, NMES and silastic gel pads can help decrease hypertrophic scarring
Wound healing phases - Inflammatory Phase
clotting, vasoconstriction
-24-48 hrs to 7 days
Wound healing phases - Proliferative Phase
tissue forms new collagen/blood vessels
Wound healing phases - Remodeling Phase
collagen is broken down/remodeled
