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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
Q

What is a serial static?

A

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
Q

How does splinting promote function?

A
  • Optimal positioning

- Assist weak structures

27
Q

Splint classification

A
  1. Articular joint
  2. Purpose of splint
  3. Basis of splint
  4. Description
28
Q

Classification: articular joint e.g.

A

Elbow, forearm, wrist, hand, finger, thumb

29
Q

Classification: purpose of splint e.g.

A

Immobilise, mobilise, restrict

30
Q

Classification: basis of splint e.g.

A

Refers to the location of the splint: finger based, thumb based, forearm based, hand based

31
Q

Classification: description

A

E.g.
Hand based thumb MP joint immobilisation splint

Forearm based wrist immobilisation splint

32
Q

Principles of splinting

A
  • Mechanical
  • Fit
  • Construction
  • Design
  • Edu
33
Q

Main biomechanical principles

A
  1. Minimisation of pressure
  2. Advantageous application of forces
  3. Use of characteristics of materials
34
Q

Pressure =

A

Total force/area of force application

  • The lager the surface area, the small the degree of pressure
35
Q

How to reduce pressure

A
  • Increase the area of force application (longer splint)
36
Q

Things to consider in terms of pressure

A
  • Avoid shear stress
  • Consider skin integrity/circulation/oedema
  • Accommodate bony prominences
37
Q

Design principles for splinting

A
  • 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
Q

Common hand injuries/conditions that require splinting

A
  • Fractures
  • Tendon injuries
  • Nerve compression
  • Ligament injuries, sprains, dislocations
39
Q

What is carpal tunnel syndrome

A
  • Compression of median nerve at carpal tunnel as a result of increased carpal tunnel pressure
40
Q

What is carpal tunnel syndrome characterised by?

A

Pins & needles, numbness in radial digits, night waking, less of dexterity

41
Q

Conservative treatment for carpal tunnel syndrome

A
  • Night splint in wrist neutral
  • Reduce repetitive gripping, pressure through base palm
  • Nerve gliding
42
Q

What is De Quervain’s disease?

A

Inflammatory disease caused by acute trauma

43
Q

What is De Quervain’s disease characterised by?

A

Radial wrist pain with tasks requiring pinch and wrist UD

44
Q

What is Finkelstein’s test? (+ what it is used to test for)

A

De Quervain’s disease

  • Pain on thumb F with wrist ulnar deviation
45
Q

What is thumb MP UCL injury (SKIERS THUMB)

A
  • Thumb forced into radial deviation/hyperextension
46
Q

What is skiers thumb characterised by?

A

MP joint laxity into radial deviation

47
Q

What is mallet finger characterised by?

A
  • Swollen painful, active extension lag, passively correctable
48
Q

Mallet finger treatment

A
  • Splint in slight hyperextension for 6-8 weeks

OCTY2210 MS Exam (7 decks)

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