Managing UE injuries Flashcards
Which bones are broken in a Boxer’s fracture?
Metacarpals
Which bones are broken in a colles fracture?
Distal end of radius with a backward displacement of the hand
Which sensory areas of the hand are messed up from a radial nerve palsy?
Loss of sensation in lateral arm, posterior forearm, radial half of dorsum of hand and dorsal aspect of radial 3.5 digits
Numbness or tingling in radial half of dorsum of hand
Which motordistribution is distrubed with radial nerve palsy?
Innervates: Triceps, bradioradialis, forearm extensors
Functions disturbed: extension of forearm, weak supination, loss of extension of hands and fingers. Wrist drop
Name 5 symptoms of carpal tunnel syndrome?
- Numbness/tingling in teh thumb, middle finger, index, 1/2 of ring
- Weakness in thumb
- Pain
- Trouble gripping objects
- Thenar atrophy
What is the most effective provocative test for carpal tunnel syndrome? How do you conduct it?
- Tinel’s sign: Tap on the inside of client’s wrist over median nerve. Positive is whne client feels tingling, numbness, pins and needles or mild electrical shock sensation in hand.
- Phalen’s Test-Fully flex wrists with dorsum of hands pressing against each other. Positive is the client reports tinging in median nerve distribution within one minute
What are the six elements of conservative treatment for carpal tunnel syndrome?
- Night wrist immoblizing orthosis-wrist in 0-20 degrees extension
- Median nerve gliding exercises
- Tendon gliding exercises
- Kinesiotaping
- Activity modification
- Frequent breaks
- Posture
- Ergonomic eval
- Injections to carpal canal
Which motor distribution is disturbed by ulnar neuropathy?
Flexor carpi ulnaris, flexor digitorum profundus 3 and 4
Which sensory is disturbed by ulnar neuropathy?
Dorsal and palmar surface of ulnar side of the hand
What is the elbow flexion test for ulnar neuropathY?
Pt bends elbow for up to 3 minutes
Positive if paraesthesia occurs in ring and small fingers
What is the difference between a swan neck deformity and a boutonniere contracture?
Swan neck: Hyperextension of PIP joint and flexion of DIP joint
Boutonniere: Flexion of PIP hyperextenion of DIP
What is the Finkelstein test and what does it detect?
Forearm in neutral with composite fist. Ask to ulnar deviate. If pain in radial styloid process adn along lenth of extensor pollicis brevis and abductor pollicis longus tendons=positive for dequervians tenosynovitis
What is Froment’s test and what does it detect?
Ulnar nerve palsy/neuropathy
Have client hold a piece of paper between the thumb and clenched fist. Positive test:Client uses flexor pollicis longus mucle to maintain pinch grip.
List five changes in appearance to look for when evaluating an injured hand
- Wounds
- Edema
- Scar
- Inflammation
- Coloration
What is DASH? What does it assess?
Disabilities of the arm, shoulder, and hand.
Assesses pain and function and ability to perform ADL tasks
Explain 3 color concept in wound assessment
Red=Granulated (ideal color. Protect properly healing wounds. No debridement. Keep wound moist to protect new cells, cover with sterile guaze and non-adherant bandage
Yellow: Fibrinous, “slough” Devitalized tissue. Possible infection, lots of drainage. Debride and use wet to moist dressing
Black: Necrotic tisssue “eschar”. Non-viable tissue, inhibits healing process, Debride with sharps, mechanical, or chemical
Name the seven signs of skin infection
- color
- odor
- drainage
- swelling
- pain
- streaking
- heat
What are two ways to measure limb edema?
Volumetrics: Displace water
Circumferential measurements: Flexible measuring tape
List 5 techniques that can be used to manage edema
- Elevate hand above heart
- Use of hand for ADLs WNL
- Manual edema mobilization
- AROM
- Compression
List 3 fine motor dexterity tests
- Jebson hand function test
- The purdue pegboard
- The minnesota rate of manipulation test
- Rolyan 9 hole peg test
Name 3 strategies to improve digital mobility for a patient with a stiff hand after hand injury
Early mobilzation
Pain control
Edema massage
What are the components of a thorough sensory eval?
West Monofilament test
2 point discrimination
Vibration testing
Hot/cold testing
List indications for joint mobilization activities
Joint dysfunction:
Inadequate ROM with capsular end-feel of the joint
Pain
List contraindication for joint mobilizations activities
- Malignancy
- Rheumatoid collagen necrosis
- Fracture
- Joint ankylosis
- Stiffening and immobility of joint due to bone fusion
- Acute inflammatory
- Infective arthritis
Which type of arthritis?
Most common joint disease
Degenerative.
Non-inflammatory
Results in cartilage deterioration and secondary bone growth
Affects individual joints
Sx: Joint pain, aching stiffness, impaired ROM, inflammation
Osteoarthritis
Which type of arthritis? Chronic, systemic, inflammatory disease Sudden onset Affects synovial tissue Exaccerbations and remissions Polyarticular and symmetrical Commonly affects neck, jaw, hips, knees, ankles, shoulders, elbows, joints of hand and wrist
Rhematoid arthritis
Whcih type of arthrisits?
Sx include hot, inflammed painful joints, symmetrical arthrisits is small joints of hands and feet, joint deformities include swan neck, boutonniere, ulnar drift, wrist subluxations, CMC joint subluxation
Rhematoid Arthritis
Define synovitis
Inflammation of synovial membrane that lines the joint capsule of diarthrodial joints. Synovium stops producing lubricating liquid and instead produces matrix-degrading enzymes that weaken the capsule and distend ligaments and tendons
What are the 3 types of joint deformity seen in OA
- Heberden’s nodes of the DIPs and Bouchard’s nodes of the PIP
- Osteophytes
- Subchondral cysts
Name the four stages of functional ability with RA
- Class one: Performs usual ADLs and vocational activities
- Class two:Able to perform usual self-care and vocational activities, limited in avocational activities
- Class three: Able to perform self-care, but limited in vocational and a vocational activvities
- Class four: Limited in ability to perform usual self-care, vocational and avocational activities
List 5 causes of decreased fuctional ability related to RA
- Pain
- Joint stiffness
- Joint changes/deformity
- Fatigue
- Unpredictability of symptoms
What is trigger finger? How is addressed non-surgically?
Caused by a nodule on the flexor tendon or stenosis of tendon sheath affecting tendon glide. Locking or catching of flinger in flexion.
Splinting and corticosteroid injection
What is mutilans deformity?
FLoppy joints and redundant skin. Cause unknown. Shortens bones making joints unstable. See mostly in MCP and PIP joints
List seven general treatments for RA
- Orthotics
- Pain management strategies
- Edema management
- ROM, gentle therapeutic exercises
- Adaptive equipment for ADLs and environmental modifications
- Energy conservation, joint protection, activity modification, stress management
- Education on diet, stress relief and other lifestyle habits
What general exercise guidelines do you advise for a person with RA?
- Pain free ROM
- Avoid repetitive exercises
- Avoid agressive strengthening
- Avoid ulnar deviation fo wrist and MCP
What is the purpose of resting hand splint for RA?
- Provide rest and support
- Decrease swelling
- Pain relief
- ALlow for functional use of the fingers and thumb while supporting painful wrist
- Worn day and or night
When is resistive exercise contraindicated for a person with RA?
Acute stage
How do you perform modified moberg pick up test? What does it measure
10 small items on table. Ask client to pick up and place in container as fast as possible. Do with other hand. Blindfold for both hands, ask client to ID each item with vision and then wihtout.
Name SX for lupus
- Rash butterfly shaped on face
- Joint and muscle swelling
- Fatigue
- Fever with exacerbations
- Raynaud’s phenomemonon
- fibromyalgia syndrome
What is raynaud’s
instability of vasomotor system: Skin blanching, cyanosis, erthema with exposure to cold
Name Sx for Scleroderma
C:calcinosis
R: Raynauds
E: Esophageal dyfunction
S: Sclerodactyly: thickening and tightening of skin
T: Telangiesctasis: Dilation of capillaries on skin
Name Sx of gout
Fever, exhaustion, kidney stones, intense joint pain, lingering discomfort, inflammation and redness
Sx of Ehlers-Danlos syndrome
Joints: Hypermobility, unstable joints prone to dislocations/subluxations,
SKin: soft velvet like skin, fagile skin that bruises and tears, severe scarring, slow and poor wound healing, development of lesions
Tx for Ehlers-Danlos syndrome
SPlinting or bracing Taping and compression garments Paint management joint protections education/training environmental adaptation
