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OCTY2210 MS Exam > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

Clinical applications for splints

A
  • Hand and upper limb injuries
  • Burns and plastics
  • Neurological rehab
  • General rehab
  • Rheumatology
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2
Q

When should you use a splint?

A
  • Splints are only ONE PART OF TREATMENT
  • Splits do the hand harm by restricting movement and use of the hand
  • They should only be used if the good that it will do will outweigh the harm and restriction
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3
Q

What do you need to consider when evaluating a hand?

A
  • Diagnosis
  • Stage of healing
  • Individual needs regarding function
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4
Q

What do you need to assess when evaluating a hand?

A
  • Observe, palpate and measure

- Pain, swelling, ROM, sensibility, skin/scarring

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5
Q

What to consider before you splint (2 main things)

A
  • Why are you fitting the splint

- Will its benefit outweigh the harm?

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6
Q

Aims of splinting

A
  1. Protect healing tissues/promote healing
  2. Maintain optimal anatomic position
  3. Restrict/control movement
  4. Improve ROM
  5. Promote function
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7
Q

How does splinting protect health tissues/promote healing?

A
  • Rest allows healing and minimises the inflammatory stage
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8
Q

Stages of tissue healing and repair

A
  • Inflammatory stage
  • Fibroblastic stage
  • Remodelling phase
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9
Q

Inflammatory stage

A
  • Initial stage after the injury - body is trying to get injury back to normal
  • Involves a cellular and chemical response to fight infection and prepare for healing
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10
Q

How long does the inflammatory stage last for?

A

~ 72 hours

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11
Q

What is the inflammatory stage characterised by?

A
  • Blood clot
  • Pain
  • Oedema
  • Wound weakness
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12
Q

Fibroblastic stage

A
  • Lays down immature collagen which cross links with time

- Requires significant O2 & nutrients (encourage good diet!)

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13
Q

When does the fibroblastic stage start and how long does it last for?

A

Starts from 3-5 days

Lasts for ~ 6 weeks

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14
Q

Why does the scar look red during the fibroblastic stage?

A

Extra blood vessels

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15
Q

What can slow inflammatory and fibroblastic stages?

A
  • Extent of injury
  • Infection
  • Oedema
  • Reduced O2 in tissues (smokers, diabetics, etc.)
  • Nutrition
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16
Q

What does prolonged inflammatory stage increase the likelihood of?

A

Scarring and stiffness

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17
Q

Remodelling stage

A
  • Equilibrium between collagen synthesis and degradation
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18
Q

How does splinting maintain optimal anatomic position

A
  • Maintaining soft tissue length & alignment
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19
Q

What is the position of safe immobilisation?

A
  • Position that maintains soft tissues in correct alignment and at sufficient length to minimise joint stiffness
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20
Q

What types of injuries would you use the position of safe immobilisation on?

A
  • Severe crush injury
  • Burns
  • Infections
  • Inflammatory arthritis
21
Q

What types of injuries would you NOT use the position of safe immobilisation on?

A
  • Extensor tendon repair

- Metacarpal fracture

22
Q

Effects of prolonged immobilisation on soft tissue

A
  • Skin: reduced length and glide

- Cartilage: degeneration

23
Q

Restrict/limit motion benefits and weaknesses

A
  • Allows tissue healing
  • Prevents tissue adhesion
  • Stiffness
24
Q

Maintain/improve range of motion benefits

A
  • Prevents stiffness
    (e. g. night extension splint)
  • Gain range
25
What is a serial static?
Splint that is moulded at the end of range of elastic limit for a period of time to elicit plastic response in soft tissue length - Take a joint to maximum, passive, comfortable range; add plaster and leave it on for a couple of days
26
How does splinting promote function?
- Optimal positioning | - Assist weak structures
27
Splint classification
1. Articular joint 2. Purpose of splint 3. Basis of splint 4. Description
28
Classification: articular joint e.g.
Elbow, forearm, wrist, hand, finger, thumb
29
Classification: purpose of splint e.g.
Immobilise, mobilise, restrict
30
Classification: basis of splint e.g.
Refers to the location of the splint: finger based, thumb based, forearm based, hand based
31
Classification: description
E.g. Hand based thumb MP joint immobilisation splint Forearm based wrist immobilisation splint
32
Principles of splinting
- Mechanical - Fit - Construction - Design - Edu
33
Main biomechanical principles
1. Minimisation of pressure 2. Advantageous application of forces 3. Use of characteristics of materials
34
Pressure =
Total force/area of force application - The lager the surface area, the small the degree of pressure
35
How to reduce pressure
- Increase the area of force application (longer splint)
36
Things to consider in terms of pressure
- Avoid shear stress - Consider skin integrity/circulation/oedema - Accommodate bony prominences
37
Design principles for splinting
- Purpose - Patient functional needs - Allow maximum sensation - Ability to apply and remove - Simple and attractive - Time spent in splint - DO THE BENEFITS OUTWEIGH THE RISKS
38
Common hand injuries/conditions that require splinting
- Fractures - Tendon injuries - Nerve compression - Ligament injuries, sprains, dislocations
39
What is carpal tunnel syndrome
- Compression of median nerve at carpal tunnel as a result of increased carpal tunnel pressure
40
What is carpal tunnel syndrome characterised by?
Pins & needles, numbness in radial digits, night waking, less of dexterity
41
Conservative treatment for carpal tunnel syndrome
- Night splint in wrist neutral - Reduce repetitive gripping, pressure through base palm - Nerve gliding
42
What is De Quervain's disease?
Inflammatory disease caused by acute trauma
43
What is De Quervain's disease characterised by?
Radial wrist pain with tasks requiring pinch and wrist UD
44
What is Finkelstein's test? (+ what it is used to test for)
De Quervain's disease - Pain on thumb F with wrist ulnar deviation
45
What is thumb MP UCL injury (SKIERS THUMB)
- Thumb forced into radial deviation/hyperextension
46
What is skiers thumb characterised by?
MP joint laxity into radial deviation
47
What is mallet finger characterised by?
- Swollen painful, active extension lag, passively correctable
48
Mallet finger treatment
- Splint in slight hyperextension for 6-8 weeks

OCTY2210 MS Exam (7 decks)

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