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NBCOT Exam > Hand/UE > Flashcards

Hand/UE Flashcards

1
Q

Avulsion Injury

A

When the tendon separates from the bone and its insertion and its insertion and removes bone material w/the tendon

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2
Q

Is mallet finger an avulsion?

A

Yes - is splinted in full extension for 6 weeks

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3
Q

What is boutonniere deformity?

A

Disruption of the extensor tendon with PIP flexion and DIP hyperextension. The PIP is splinted in extension and isolated DIP flexion exercises are performed.

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4
Q

What is Swan Neck deformity?

A

PIP hyperextension and DIP flexion - the PIP is splinted in slight flexion.

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5
Q

What are the three common phases of fracture healing?

A

inflammation
repair
remodeling

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6
Q

Describe (inflammation) part of fracture healing

A

provides cellular activity needed for healing

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7
Q

Describe (repair) part of fracture healing

A

forms the callus for stabilization

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8
Q

Describe (remodeling) part of fracture healing

A

deposits bone

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9
Q

Modalities for pain relief and tissue healing include:

A 
Heat
Ultrasound
Cryotherapy
Paraffin
Transcutaneous Electrical Nerve Stimulation (TENS)
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10
Q

When does controlled AROM begin after fracture?

A

3-6 weeks

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11
Q

What is the most severe complication of hand fractures?

A

Complex regional pain syndrome

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12
Q

Colles Wrist Fracture

A

Complete fracture of the distal radius w/dorsal displacement

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13
Q

Smith’s Wrist Fracture

A

Complete fracture of the distal radius w/palmar displacement

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14
Q

Bennet’s Wrist Fracture

A

Fracture of the first metacarpal base

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15
Q

Median Nerve Injury is?

A

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

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16
Q

Ulnar Nerve Injury is?

A

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.

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17
Q

Radial Head Fractures (elbow fracture) - Type 1

A

Nondisplaced

-treated w/a long arm sling

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18
Q

Radial Head Fractures (elbow fracture) - Type 2

A

Displaced w/a single fragment

treated nonoperatively w/immobilization for 2-3 weeks and early motion w/medial clearance

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19
Q

Radial Head Fractures (elbow fracture) - Type 3

A

Comminuted

-treated operatively, w/immobilization and early motion within the first postoperative week

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20
Q

Radial Head Fractures (elbow fracture) - Interventions

A

Orthotics - for immobilization as needed
ROM within the 1st week
A sling for type 1 fractures

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21
Q

Proximal humeral fractures - Interventions

A
  • 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
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22
Q

What is complex regional pain syndrome (CRPS) or called reflex sympathetic dystrophy?

A

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
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23
Q

Allodynia

A

sensation misinterpreted as pain

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24
Q

Hyperalgia

A

increased response to painful stimuli

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25
Q

Hyperpathia

A

pain that continues after stimuli is removed

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26
Q

What is cumulative trauma disorder (CTD)?

A

trauma to soft tissue caused by repeated force

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27
Q

Work-related risk factors of CTD

A

repetition, high force, direct pressure, vibration, poor posture

28
Q

Symptoms of CTD

A

muscle fatigue, pain, chronic inflammation, sensory impairment

29
Q

OT Intervention to CTD - Acute Phase

A

Reduction of inflammation and pain through static splinting, ice, contrast baths, ultrasound, Estim

30
Q

OT Intervention to CTD - Subacute Phase

A

Slow stretching, myofascial release, progressive resistive stretch exercise, proper body mechanics, static splint during activity

31
Q

OT Intervention to CTD - Return to Work

A

Assessment of Job site, tools, body positioning

  • Work simulator, elastic bands, putty, functional activities, strengthening
  • Work hardening
32
Q

myofascial release

A

soft tissue therapy for pain

33
Q

work hardening

A

aggressive approach focuses on the functional aspect of the job. Work stimulation tasks with small components of strength and conditioning blended in.

34
Q

Work Conditioning

A

strengthening and conditioning tasks to restore function

35
Q

OT Interventions - Extensor Tendons

A
  • 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
36
Q

tendon excursion

A

the distance a tendon travels upon movement of a joint

37
Q

OT Interventions - Flexor Tendons

A

-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

38
Q

The Duran protocol

A

an early passive ROM program

39
Q

Kleinert Protocol

A

active extension of digits w/passive flexion via traction, typically a rubber band

40
Q

The early active motion protocol

A

begins within days of surgery to prevent adhesion and promote gliding and excursion

41
Q

tendon glides exercises

A

to promote circulation in the hand to reduce swelling

42
Q

Neuromuscular electrical stimulation (NMES)

A

promote tendon excursion and activation

43
Q

Radial Nerve Injury

A

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

44
Q

Radial Tunnel Syndrome

A

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

45
Q

Anterior Interosseous Syndrome

A

Compression to the anterior interosseous Nerve

-Results in a motor loss involving the flexor digitorum longus, flexor profundus and pronator quadratus

46
Q

Pronator Syndrome

A

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

47
Q

Median Nerve Injury

A

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

48
Q

Double crush syndrome

A

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
49
Q

Carpal Tunnel syndrome

A

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
50
Q

Cubital tunnel syndrome

A

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

51
Q

de Quervain syndrome

A

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
52
Q

Claw Deformity

A

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.
53
Q

Digital stenosing tenosynovitis (trigger finger)

A

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.
54
Q

Cryotherapy (ice massage, ice, cold packs, cold water immersion baths)

A

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
55
Q

Thermotherapy (warm whirlpools, fluidotherapy, hot packs, contrast batths, and paraffin baths)

A 
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
56
Q

Ultrasound heats tissue (1-5 cm depth)

A

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.

57
Q

Electrical Stimulation

A

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.

58
Q

Low-level laser/Light therapy

A

decreased pain, edema, inflammation, increased wound healing and decrease scar tissue.

-Precautions/contraindications: wear protective eyewear, eyes, infection or cancer.

59
Q

Wound closure - Primary

A

Wound is closed w/sutures

60
Q

Wound closure - Secondary

A

Wound is left open and allowed to close on its own

61
Q

Would closure - Delayed primary

A

Wound is cleaned, debrided and observed 4-5 days before suturing it closed.

62
Q

Wound closure - Remolding phase

A

wearing pressure garments helps collagen fibers realign.

dynamic splinting, serial casting, passive motion, stretching, NMES and silastic gel pads can help decrease hypertrophic scarring

63
Q

Wound healing phases - Inflammatory Phase

A

clotting, vasoconstriction

-24-48 hrs to 7 days

64
Q

Wound healing phases - Proliferative Phase

A

tissue forms new collagen/blood vessels

65
Q

Wound healing phases - Remodeling Phase

A

collagen is broken down/remodeled

NBCOT Exam (21 decks)

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