Managing Upper Extremities Flashcards
Which bones are broken in a Boxer’s fracture?
metacarpal bones
Which bones are broken in a Colles Fracture?
a fracture of the lower end of the radius in the wrist with a characteristic backward displacement of the hand (distal radius fracture)
What sensory distribution is disturbed with radial nerve palsy?
Sensory deficit: Loss of sensation in lateral arm, posterior forearm (extensors), the radial half of dorsum of hand, and dorsal aspect of digits 1 and ½ of 2 (see photo below)-excluding their nail beds
Numbness and tingling in radial half of dorsum of hand
What motor distribution is disturbed with radial nerve palsy?
Major muscles lost: triceps; ECRL (extensor carpi radialis longus); ECRB (extensor carpi radialis brevis); ECU (extensor carpi ulnaris), EDC (extensor digitorum communis); EPL (extensor pollicis longus); APL (abductor pollicis longus)
Loss of elbow extension, wrist extension, MCP extension of IF-SF, thumb extension and abduction
List five symptoms of carpal tunnel syndrome.
Numbness and/or tingling in the thumb, middle finger, index, ½ 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 the test?
- Phalen’s test – fully flex wrists with dorsum of hands pressing against each other. Positive is the client reports tingling, in median nerve distribution within 1 minute.
- Tinel’s sign: Tap on the inside of client’s wrist over the median nerve. Positive is client feels tingling, numbness, “pins and needles,” or a mild “electrical shock” sensation in hand when wrist it tapped
- Compression test – the examiner places pressure over the median nerve in the carpal tunnel for up to 30 seconds. Positive if tingling occurs in median n. distribution.
List six elements of conservative treatment for carpal tunnel syndrome.
Night wrist immobilization orthosis – wrist 0-20 degrees of extension Median nerve gliding exercises Tendon gliding exercises Kinesiotaping Activity modification Frequent breaks Posture Ergonomic eval Injections to carpal canal
What motor and sensory distribution is disturbed by ulnar neuropathy?
Things that are affected by ulnar nerve: flexor carpi ulnaris, FDP (flexor digitorum profundus) of ring and small finger, adductor pollicis, deep head of FPB (flexor pollicis brevis), abductor/opponens/flexor digiti minimi, 3rd and 4th lumbricals
Numbness in ring and small finger
What is the elbow flexion test for ulnar neuropathy?
It is a test to determine whether or not a person has cubital tunnel syndrome, which is compression of the ulnar nerve at the elbow
Fully flex elbows with wrists fully extended for 3-5 minutes…test result is positive if tingling is reported in the ulnar nerve distribution of the forearm and hand (ulnar ring finger and small finger)
What is the difference between a Swan Neck and a Boutonniere contracture?
Swan Neck: hyperextension of the PIP joint and flexion of the DIP joint with possible flexion of the MCP joint; function compromised by inability to flex the PIP joint with loss of the ability to make a fist or hold small objects
Boutonniere: flexion of the PIP joint and hyperextension of the DIP joint; function of the finger is compromised by inability to straighten the finger and the loss of flexion at the fingertip for pinching
What is the Finkelstein test and what is it used to detect?
Finkelstein’s test is used to diagnose De Quervain’s tenosynovitis in people who have wrist pain. To perform the test, the examining physician or therapist grasps the thumb and ulnar deviates the hand sharply, as shown in the image. If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain’s tenosynovitis is likely
What is Froment’s test and what is it used to detect?
Detects: Ulnar Nerve Weakness/ulnar nerve palsy
Positive if thumb IP flexes
Ask the client to hold a piece of paper between the thumb and clenched fist. Flexion of the thumb with resistance indicates significant adductor pollicis weakness (supplied by the ulnar nerve).
List five changes in appearance that you look for in evaluating an injured hand.
Wounds Edema Scar Inflammation Coloration
What is the DASH? What does it assess?
DASH Outcome Measure = Disabilities of the Arm, Shoulder, and Hand
The DASH and Quick DASH assesses pain and function and ability to perform ADL tasks (optional work and performing arts/sports modules)
Explain the 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 gauze, and non-adherent dressings
Yellow = Fibrinous, “slough.” Devitalized tissue. Possible infection… high exudate (drainage). Debride and use wet to moist dressing
Black = necrotic tissue or “eschar”, non-viable tissue, inhibits healing process. Debride – sharp, mechanical, chemical. Wet-moist dressing, sterile gauze, and non-adherent dressings
List seven signs of skin infection.
Color Odor Drainage Swelling Pain Streaking Heat “Cardinal Signs”
Describe two ways to measure limb edema.
Volumetrics = “gold standard” measures hand volume with displaced water (accurate to within 10 ml). Immerse hand in a full volumeter and catch displaced water to measure.
Circumferential Measurements = quick and easy to administer, measure with a flexible measuring tape, not as accurate, but used when volumetrics are contraindicated (e.g. open wounds…)
List 5 techniques that may be used to manage edema.
- Elevate hand above the heart
- Use of hand for ADLs within limits prescribed by the physician
- MEM – manual edema mobilization (light massage in specific patterns)
- AROM – maximum available ROM performed firmly (Also with uninvolved joints like the elbow and shoulder)
- Compression – light compression using coban wraps of the affected area or light compression garments can help control swelling, especially at night
