Hands Flashcards
What’s a proximal fracture?
a metacarpal fracture, such as boxer’s (4th and 5th finger) fracture
What’s the most common carpal fracture?
scaphoid
What carpal fracture is associated w/ Keinbock’s disease?
lunate
What’s mallet finger and the treatment?
avulsion of the terminal tendon, splinted in full extension for 6 weeks
What’s boutonniere deformity and treatment?
disruption of the central slip of the extensor tendon.. PIP flexion and DIP hyperextension; PIP splinted in extension, isolated DIP flexion exercises
What’s swan neck deformity and treatment?
injury to the MCP, PIP, or DIP joints– PIP hyperextension, DIP flexion; PIP is splinted in slight flexion
What’s the OT eval for hand fractures?
1) visual examination and observation, client interview, history
2) sensory (monofilament for nerve compression, two-point for nerve laceration)
3) goniometric measurements for motion
4) dynamometer and pinch gauge for strength
5) occupational performance using ADL or IADL checklist
6) outcomes through quick DASH
What are the OT interventions for hand fractures?
1) orthotic fabrications as prescribed by physician
2) PAMS
3) therapeutic exercises for ADLs; controlled AROM begins 3-6 weeks after fracture if fixation stable
4) HEP
5) most severe complication is CPRS
What’s a colles fracture?
complete fracture of distal radius with dorsal displacement; most common
What’s a smith’s fracture?
complete fracture of the distal radius with palmar displacement
What’s Bennet’s fracture?
fracture of the first metacarpal base
What does a median nerve injury produce?
carpal-tunnel like symptoms, such as palmar numbness and numbness of first digit to half of fourth digit
What does an ulnar nerve injury produce?
claw hand, numbness of ulnar side of hand, half of fourth and fifth digit
What are OT interventions for wrist fractures/ nerve injuries?
1) ROM allowed early
2) orthotics for joint protection
3) HEP
4) exercises to improve performance; AROM, blocking exercises, tendon and nerve gliding exercises, strengthening exercises
5) PAMS
What’s complex regional pain syndrome?
pain disproportionate to an injury that is either sympathetically maintained or independent of the sympathetic nervous system
What’s the OT intervention for CPRS?
1) GENTLE, pain free AROM, NO PROM
2) stress loading: scrubbing floor, carrying weighted handbag
3) pain control: TENS, static and dynamic splinting
4) edema control
5) desensitization
6) blocked exercises, tendon gliding
7) joint protection, energy conservation
What’s the intervention after a surgical repair to an extensor tendon?
1) exercises promote tendon excursion and prevent adhesions
2) modalities: heat, NMES to promote tendon activation (modalities need to be cleared by MD first)
3) HEP
4) tendon glides
5) ROM
6) strengthening LATE phase of repair 8-12 weeks AFTER surgery
What’s the duran protocol used for?
for flexor tendon injury; early passive ROM
What’s the Kleinert protocol?
for flexor tendon injury; active extension of digits with passive flexion via traction with rubber band
What are interventions for flexor tendon injuries?
1) exercises to promote tendon excursion and prevent adhesions
2) modalities: heat & NMES
3) HEP
4) tendon glides (tendon glide dance)
5) ROM
6) strengthening LATE phase 8-12 weeks after
7) cast protected if pt can’t cognitively follow protocol
What are the symptoms of a radial nerve injury?
posture of hand is wrist drop; lack of finger and thumb extension
treatments for radial nerve injury
nonoperative: wrist cock-up splint w/ or w/o dynamic finger and thumb extension assist, ROM, strengthening
operative: static wrist extension splint 30 degrees, then 10 to 20 degrees after 4 weeks
What happens in radial tunnel syndrome?
entrapment of radial nerve in area extending from radial head to supinator muscle
-burning pain in lateral forearm is symptom
treatments for radial tunnel
nonop: long arm splint; elbow flexed; forearm supinated, massage or TENS, ROM pain free, nerve glides, activity mod
op: long arm splint; same as above… wrist cock up splint for two weeks… passive and active pronation and supination, hand strengthening at 3 weeks, resistive at 6 weeks
What happens in pronator syndrome?
entrapment of the proximal median nerve between the heads of the pronator muscles; deep pain proximal forearm with activity
treatments for pronator syndrome
nonop: splint elbow flexion 9-100, forearm neutral, TENs, gentle stretching, activity modification
op: half cast; AROM all UE joints while wearing cast; muscle strengthening in 1 week, full AROM gained by 8 weeks
What happens in a median nerve injury?
causes ape hand deformity; sensory loss in index, middle, and radial side of ringer finger loss of pinch and thumb opposition
What are the treatments for median nerve injury?
nonop: static thenar web spacer splint
op: dorsal wrist blocking splint for 4-6 weeks; AROM and PROM in spint; tendon gliding exercises; strengthening at 6 weeks
What’s double crush syndrome and symptoms?
occurs when a peripheral nerve is entrapped in more than one location;
symptoms: intermittent diffuse arm pain and paresthesias with specific postures
treatments of double crush syndrome
nonop: treat accordingly to each nerve injury or syndrome, avoid movements or postures that aggravate symptoms; nerve gliding
What is carpal tunnel syndrome? what are the symptoms?
caused by entrapment of median nerve- most common nerve compression of the UE
- sensory impairment: numbness and tingling in thumb, index, and middle fingers especially at night
- motor impairment presents as diminished fine motor
What are some evals for CTS?
tinel’s sign: tap on median nerve at wrist
phalen’s test: hold wrist full flexion in 1 min
Moberg Pickup test; pick up, hold, manipulate, ID objects
Semmes-Weinstein: monofilament testing for sensation
What are nonoperative treatments for CTS?
1) CTS splint, wrist cock-up splint at 0-10 wrist extension
2) nerve, tendon gliding exercises
3) activity modification, ergonomic handles
4) client education: biomechanics
5) postural retraining; conditioning exercises
What are post-operative treatments for CTS?
1) wound care and scar mobilization for more complex cases
2) pain management: gel pads on the scar: pain on either side of the surgical release is pillar pain
3) splinting ONLY for clients who sleep with wrist flexed or will return to work ASAP
4) AROM of wrist, thumb, fingers 1-2 days after surgery
5) nerve and tendon gliding exercises
6) strengthening in 3-6 weeks
What is cubital tunnel syndrome and symptoms?
proximal ulnar nerve compression at the elbow between the medial epicondyle and olecranon process (second most common);
sensation: decreased in little finger and ulnar half of ring finger
motor: decreased grip and pinch strength
What are some evals for cubital tunnel syndrome?
Tinel’s sign: tap over cubital tunnel to elicit symptoms
Froment’s sign: flex of the IP thumb when lateral pinch attempted
Wartenberg’s sign: fifth finger abducted from fourth
Elbow Flexion test: hold elbow in flexion
What are nonop treatments for cubital tunnel?
1) edema control
2) pain management
3) elbow splinting of position at 30-60 flexion for 3 weeks
4) ulnar nerve gliding
5) conditioning activities
6) ergo
What are post op treatments for cubital tunnel?
- during protection phase (1 day to 3 weeks), splint elbow at 70-90 flexion; wound care, edema control, pain management, AROM of uninvolved joints; one-handed ADL techniques
- during active phase (3 week); no more splint; add elbow AROM, ulnar nerve gliding, desensitization
What’s deQuervain syndrome?
caused by cumulative microtrauma resulting in tenosynotitis of thumb muscle tendon unit; forceful thumb abduction with wrist ulnar deviation
What’s the nonoperative treatment for DQ syndrome?
1) corticosteroid injections (but we can’t do that)
2) forearm-based thumb spica splints with wrist in neutral, thumb radially abducted
3) activity modification and avoidance of pinch
4) computer ergo, strengthening exercises
What’s the operative treatment for DQ syndrome?
1) forearm-based thumb spica splint with wrist at 20 degrees extension and thumb radially abducted for 3 weeks
2) gentle ROM and tendon gliding
3) Grip and pinch strengthening at 2 weeks
4) scar management and desensitization
What is claw deformity?
distal ulnar nerve compression or lesion at the wrist
Symptoms of claw deformity
sensory loss: little finger and ulnar side of ring finger plus palmar ulnar hand; if dorsal, injury is proximal to Guyon’s canal
motor: pinch strength is lost
Evaluations for claw deformity:
Froment’s
Wartenberg’s
Jeanne’s sign
Semmes-Weinstein
What are the nonop treatments for claw deformity?
1) ulnar nerve palsy or anticlaw splint used
2) padded antivibration glove
3) activity modification
4) client education on postures
What’s the post-op treatment for claw deformity?
1) bulky dressing applied for 3-10 days
2) dorsal blocking splint; wrist 20-30 flexion, will be neutral at 3-6 weeks; quit splint at 6 weeks
3) wound care, scar mobilization
4) sensory desnsitization
5) AROM of wrist and hands at 6 weeks
6) sensory re-education 10-12 weeks post surgery
7) tendon transfer if nerve has not regenerated in a year
What is digital stenosing tenosynovitis (trigger finger)?
sheath inflammation or nodules near A1 pulley
treatment of trigger finger
splint MCP at 0 for 3-6 weeks
Protective reeducation (sensory)
educates client to visually compensate for sensory loss; avoid working with machinery and temperatures below 60
discriminative reeducation (sensory)
use motivation and repetition in a vision-tactile matching process where clients ID objects with and without vision
sensory recovery
starts with pain perception, progresses to vibration of 30 cycles per second, moving touch, constant touch
desensitization
process of applying diff textures and tactile stimulation to reeducate nervous system to clients can tolerate sensations
