Musculoskeletal Disorders Flashcards
Dupuytren’s Disease
A gradual thickening and tightening of tissue under the skin in the hand that results in flexion deformities of involved digits.
OT Interventions
Wound Care- dressing, whirlpool
Edema Control- elevation
Splinting
AROM/PROM
Scar Mngmnt- massage, scar pad, compression
Interventions that emphasize gripping/releasing
Complex Regional Pain Syndrome (CRPS
Can occur in UE/LE after injury or immobilization. Pain out of proportion to initial event/injury.
Characterized by pain, sensitivity to touch, irregular blood flow, edema, changes in skin temp and color, and decreased ROM
OT Interventions
Mod to decrease pain- hot packs, TENS
AROM
Edema Mngmnt- elevation, compression
Desensitization
Stress Loading
Splinting (prevent contractures)
Avoid PROM, joint mobilization, dynamic splinting and casting
Open vs Closed Fractures
Closed fracture- bone doesn’t break skin.
Open fracture/compound fracture- bone pierces skin.
Medical treatment of fractures
Closed reduction: fixed from the outside
Stabilization: short arm cast (SAC), long arm cast (LAC), splint, sling, or fracture brace
Open Reduced Internal Fixation (ORIF): fixed from the inside. Includes nails, screws, plates, or wire
External fixation: fixed from the outside with hardware placed under the skin
Arthrodesis: fusion
Arthroplasty: joint replacement
Colles’ fracture
fracture of distal radius with dorsal displacement
Smith’s fracture
fracture of the distal radius with volar displacement
Carpal fractures
Most common carpal fractured: scaphoid (60%)
Proximal scaphoid has poor blood supply and may become necrotic
Metacarpal fractures
classified according to location (head, neck, shaft or base) common complication of rotational deformities
Proximal phalanx fractures
digits most commonly injured: thumb and index common
complication: loss of PIP A/PROM Middle phalanx fractures are uncommon
Distal phalanx fractures
most common finger fracture may result in Mallet Finger
Elbow fracture
if radial head is involved, there may be limited rotation of the forearm
Humerus fractures
Etiology: fall onto an outstretched UE
Fracture of greater tuberosity may result in rotator cuff injuries
Fracture of humeral shaft may cause injury to radial nerve, resulting in wrist drop
OT Eval of fractures
Occupational Profile, Hx
Results of special test (Xrays, MRI, CT)
Edema, Pain, Sensation
AROM Do not assess PROM or strength until ordered by MD (exception: humerus fractures which often begin with PROM or AAROM)
Roles, occupations, ADLs, activities related to roles
Phases of OT intervention with fractures
immobilization phase: goals of stabilization and healing
mobilization phase: goal is of consolidation
Immobilization phase interventions
AROM of joints above and below stabilized part
Edema control: elevation, retrograde massage, and compression garments
Light ADLs and role activities with no resistance, progress as tolerated
Mobilization phase interventions
Edema control: elevation, retrograde massage, contrast baths, compression garments
AROM: progress to PROM when approved by MD (4 to 8 weeks), exceptions: humerus fractures
Light functional/purposeful activity. Progress to occupation-based activities
Pain management: positioning and physical modalities
Strengthening: begin with isometrics when approved by MD
Cumulative Trauma Disorders (CTD)
Risk factors: repetition, static position, awkward postures, forceful exertions, vibration
Non-work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape
Most common types: DeQuervains, Lateral and medial epicondylitis, trigger finger, nerve compressions
DeQuervains
Stenosing tenosynovitis of abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
Pain, swelling over radial styloid
Positive Finkelstein’s test
Conservative treatment:
Thumb spica splint (IP joint free)
Activity/work mod
Ice massage over radial wrist,
Gentle AROM of wrist and thumb to prevent stiffness
Post-op treatment:
Thumb spica splint and gentle AROM (0 to 2 weeks) Strengthening, ADLs, and role activities (2 to 6 weeks) Unrestricted activity (6 weeks)
Lateral and Medial epicondylitis
Degeneration of the tendon origin as a result of repetitive microtrauma
Lateral: Tennis Elbow. overuse of wrist extensors
Medial: Golfer’s Elbow. overuse of wrist flexors
Conservative treatment: elbow strap, wrist splint, ice and deep friction massage, stretching, activity/work mod, and strengthening (as pain decreases)
Trigger finger
Tenosynovitis of the finger flexors
Caused by repetition and the use of tools that are placed too far apart
Treatment: scar massage, edema control, tendon gliding, activity/work modification
Carpal Tunnel Syndrome
Median nerve compression at wrist
Cause: repetition, awkward postures, vibration, anatomical anomalies, and pregnancy
Symptoms:
numbness/tingling of thumb, index, middle, and radial half of ring finger; Paresthesias at night. dropping things.
posTinel’s sign. pos Phalen’s sign.
Advanced CTS muscle atrophy of thenar eminence.
Treatment
Wrist splint in neutral (day/night)
Activity Modification- avoid repetition/extreme postures
Ergonomics- work station design
Surgery
Post-Op: edema control, AROM, nerve-gliding exercises, sensory re-ed, strengthening of thenar muscles, work/activity mod
Cubital Tunnel Syndrome
Ulnar nerve compression at elbow
Cause: pressure/leaning at elbow, extreme elbow flx
Symptoms: Numbness/tingling at ulnar side of forearm and hand, pain at elbow w/extreme flx, weakness of power grip, pos Tinel’s sign
Tx: Elbow splint (block extr posit), elbow pad (decrease compression), act/work mod, sx
Post-op: edema control, scar mngmnt, AROM and nerve-gliding ex (2wk post-op), strgnth (4wk), MCP flx splint if clawing
Radial Nerve Palsy
Radial nerve compression
Cause: sleeping in a position that places stress on the radial nerve. Also, compression as a result of a humeral shaft fracture.
Symptoms: weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop
Tx: Dynamic ext splint, work/act mod, strgth wrist/finger extensors when motor func returns. Sx
Post-op: ROM, nerve-gliding, strgth (6-8wk/op), ADLs
Rotator Cuff Tendonitis
Cause: repetitive overuse, curved/hook acromion, weakness of rotator cuff, weakness of scapula musculature, ligament/capsule tightness, trauma
Interventions: act mod (avoid above shoulder lvl acts w/pain), ed in sleeping posture (avoid sleeping w/arm overhead or combined add/int-rot), decrease pain (positioning, modalities, and rest), restore pain free ROM, strngth (below shoulder level), occupation-based acts. Sx
Post-op: PROM (0-6wks – progressing to AA/AROM), decrease pain (begin w/ice, progress to heat), strngth (6wks/op – begin isometrics, progress to isotonic below shoulder level), act mod, leisure/work activities (8-12 wks post-op)
