Musculoskeletal system Flashcards
Intrinsic muscles of hand : Median nerve
- APB (palmar abduction)
- opponens pollicis (opposition)
- flexor pollicis brevis (thumb MCP flexion)
- lumbricals (radial side, 1,2) - (MCP flexion, IP extension)
Intrinsic muscles of hand: Ulnar nerve
- abductor digiti minini
- opponens digiti minini
- flexor digiti minini
- adductor pollicis (adducts CMC of tumb)
- lumbricals (ulnar side, 3,4)- ( MCP flexion, IP extension)
- dorsal interossei ( abduction, DAB)
- palmar interossei ( adduction, PAD)
Extrinsic muscles of hand: Median nerve
- flexor digitorum superficialis (flex PIP)
- flexor digitorum profundus (flexion of DIP joints , digits 2, 3)
- ## flexor pollicis longus ( flexion of IP joint of thumb)
Extrinsic muscles of hand: Ulnar nerve
- ## flexor digitorum profundus (flexion of DIP joints, digits 4,5)
Extrinsic muscles of hand: Radial nerve
- extensors digitorum communis (extension of MCP joints)
- extensor digiti minini (extension of of 5th digit)
- extensor indicis proprius ( extension of MCP joint of 2nd digit)
- extensor pollicis longus (extension of IP joint of thumb)
- extensor pollicis brevis (extension of MCP/CMC joints of thumb)
- abductor pollicis longus (abduction/ extension of CMC joint of thumb)
Wrist flexors: Median nerve
- flexor carpi radialis (wrist flexion, radial deviation)
- palmaris longus (wrist flexion)
Wrist flexors: Ulnar nerve
- flexor carpi ulnaris (wrist flexion, ulnar deviation)
Wrist extensors: Radial nerve
- extensor carpi radialis brevis (wrist extension and radial deviation)
- extensor carpi radialis longus (wrist extension and radial deviation)
- extensor carpi ulnaris (wrist extension and ulnar deviation)
Volar forearm muscles: Median nerve
- pronator teres (forearm pronation)
- pronator quadratus (forearm pronation)
Dorsal forearm muscles: Radial nerve
- supinator (forearm supination)
Elbow flexors
- biceps (musuclocuteanous nerve)
(elbow flexion w/ forearm supinated) - brachialis (musculocuteanous nerve) (elbow flexion w/forearm pronated)
- brachioradialis (radial nerve) (elbow flexion w/ forearm neutral)
Elbow extensors (radial nerve)
- triceps
- anconeus
Rotator cuff muscles
- subscapularis (internal rotation)
- supraspinatus (abduction and flexion)
- infraspinatus (external rotation)
- teres minor (external rotation)
Shoulder flexion
-anterior deltoid (axillary nerve)
-coracobrachialis (musculocutaneous)
-supraspinatus
shoulder abduction muscles
- middle deltoid
- supraspinatus
horizontal abduction muscles
- posterior deltoid
horizontal adduction muscles
- pec major
shoulder extension muscles
- latss dorsi
- teres major
- posterior deltoid
scapula upward rotation
- traps
- serratus anterior
scapula downward rotation
- levator scapulae
- rhomboids
- serratus anterior
- lats
scapula adduction
- mid trapezius
- rhomboid major
scapula abduction
- serratus anterior
scapula elevation
- upper traps
- levator scapulae
scapula depression
- lower traps
Dupuytren’s disease
- flexion deformities of the involved digits
OT Intervention for Dupuytren’s
- wound care- dressing changes
- edema control
- hand based extension splint (wear at all times for ROM and bathing)
- AROM/PROM
- scar management
- occupation-based tasks emphasizing flexion (gripping) and extension (release)
Gamekeeper’s Thumb (Skier’s)
- rupture of UCL of the MCP joint of the thumb
- common cause is a fall
Skier’s thumb OT intervention
Conservative treatment
- thumb splint (4 to 6 weeks)
- AROM/pinch strengthening (6 weeks)
- ADLs that require opposition and pinch strength
Postoperative treatment
- thumb splint for 6 weeks
- AROM/PROM at 8 weeks
- strengthening at 10 weeks
CRPS
- vasomotor dysfucntions (hot flashes and night sweats)
- severe pain, edema, discoloration, osteoporosis, sudomotor (sweating), temperature changes, trophic changes (skin, nail, fingertip appearance) and vasomotor instability
CPRS OT intervention
- modalities to decrease pain
- edema management
- AROM to involved joints
- ADLs to encourage pain-free active use
- stress loading
- splinting
- self- management
- AVOID PROM, PASSIVE STRETCHING, JOINT MOBILIZATION, DYNAMIC SPLINTING AND CASTING
Most common UE fractures
- distal radius fractures - Colles fracture
- humeral shaft fractures can result in radial nerve injuries (wrist drop)
OT Eval for fractures
- occupational profile
- history
- results of special tests (x-rays)
- edema
- pain
- AROM (no PROM)
- sensation
- roles, occupations and ADLs
OT intervention for fractures
- immobilization (stabilizing and healing)
- AROM of uninvolved joints
- edema control
- light ADLs, no resistance
- mobilization (consolidation)
- edema control
- may require splint for protection
- AROM ( for humerus starts PROM, only PROM if doctor approves)
- light purposeful activities
- pain management
- strengthening
Cumulative Trauma Disorders
- repetitive strain injuries
- risk factors- repetition, static position, awkward position, forceful exertions, vibration
- non-work risk factors- acute trauma, pregancy, diabetes, arthitis and wrist size and shape
DeQuervians treatment
- Conservative treatment
- thumb spica splint (IP joint free)
- activity/work modification
- ice massage over radial wrist
- gentle AROM of wrist/thumb - Postop treatment
- (0-2 weeks)- thumb spica splint and gentle AROM
- (2-6 weeks)- strengthening, ADLs, role activities
- (6 weeks)- unrestricted activity
Lateral and medial epicondylitis
lateral epicondylitis (tennis elbow)- overuse of wrist extensors
medial epicondylitis (golfer’s elbow)- overuse of wrist flexors
Lateral and medial epicondylitis: conservative treatment
Conservative treatment
- elbow strap, wrist splint
- ice/deep friction massage
- stretching
- activity/work modification
- as pain decreases, add strengthening. start with isometric, then do isotonic/eccentric exercises
Trigger finger
- tenosynovitis of the finger flexors, commonly A1 pulley
- caused by use of tools that are placed too far apart and by repetition
Trigger finger: conservative treatment
- hand/finger based trigger finger splint (MCP extended, IP joints free)
- scar massage
- edema control
- tendon gliding
- activity/work modification- avoid repetitive gripping activities and using tools with handles too far apart
Tendon repairs: Reason for Early mobilization
- prevent adhension formation
- facilitate wound/tendon healing
Tendon repairs: OT goals
- increase tendon excursion
- improve strength at repair site
- increase joint ROM
- prevent adhensions
- resuming of meaningful roles, occupations and activities
Carpal Tunnel Syndrome: symptoms
- median nerve compression
- numbness and tingling in thumb, index, middle, and radial half of ring finger
- paresthesias during the nighttime
- complaint of dropping things
- positive Tinel’s/Phalen sign
Carpal Tunnel Syndrome: conservative treatment
- WRIST SPLINT IS NEUTRAL: should be worn at night and during day if performing repetitive activity
- median nerve gliding
- activity modifications
- avoid activities with extreme wrist flexion
- avoid wrist flexion with repetitive finger flexion
- avoid wrist flexion with a static grip
Median, radial and ulnar nerve injuries: post-op treatment
- edema control
- AROM
- nerve/tendon gliding exercises
- sensory re-ed
- strengthening of thenar muscles (at 6 weeks)
- work/activity modification
Pronator teres syndrome: symptoms and conservative treatment
Symptoms
- aching pain in proximal forearm
- Positive Tinel sign at forearm
- no night symptoms
Conservative treatment
- elbow splint 90 degrees w/ forearm neutral
- avoid activities include repetitive forearm pronation and supination
Guyon’s canal: symptoms and conservative treatment
symptoms
- numbness and tingling at ulnar part of hand
-positive tinel’s sign at guyon’s canal
Conservative treatment
- wrist splint in neutral
- work/activity modification
Cubital tunnel syndrome: symptoms and conservative treatment
Symptoms
- pressure at elbow and extreme elbow flexion
- numbness and tingling along ulnar aspect of forearm and hand
- pain at elbow w/ extreme elbow flexion
- weakness of power grip
- positive tinel’s sign at elbow
Conservative Treatment
- elbow splint at 30 degrees of flexion
- elbow pad to decrease compression on nerve when leaning on elbows
Radial nerve palsy (Saturday night palsy): symptoms and conservative treatment
Symptoms
- weakness or paralysis of extensors to the wrist, MCPs and thumb
- wrist drop
- described as radial nerve compression
ex. sleeping in position that places stress on radial nerve, compression from humeral shaft fracture
Conservative treatment
- dynamic wrist and MCP extension splint
- strengthening wrist and finger extensors
Median nerve laceration : Function loss, OT intervention and splinting
Functional loss
- loss of thumb opposition
- weakness of pinch
- sensory loss
- motor loss to intrinsic hand muscles (low lesion)
- motor loss to extrinsic hand muscles (high lesion)
OT intervention
- dorsal protection splint w/ wrist in 30 degrees flexion (low lesion), 90 degrees flexion (high lesion)
- AROM/PROM of digits w/ wrist in flexed position (2 weeks post-op)
- scar management
- AROM at wrist (4 weeks)
- sensory re-ed
Splint
- C-bar to prevent thumb adduction contracture
Ulnar nerve laceration : Function loss, OT intervention and splinting
Symptoms
- positive Froment’s sign (assessing thumb adductors- laterally pinching paper)
- claw hand
- flattened metacarpal arch
- sensory loss
- motor loss to intrinsic hand muscles (low lesion)
- motor loss to extrinsic hand muscles (high lesion), flexor carpi ulnaris of wrist
Functional loss
- loss of power grip
- decreased pinch strength
OT intervention
- dorsal protection splint w/ wrist in 30 degrees flexion (low lesion), 90 degrees flexion (high lesion)
- AROM/PROM of digits w/ wrist in flexed position (2 weeks post-op)
- scar management
- AROM at 4 wrist (4 weeks)
- sensory re-ed
Splint
- MCP flexion block splint
Radial nerve injury : Function loss, OT intervention and splinting
Functional loss
- inability to extend digits to release objects
- difficulty manipulating objects
- sensory loss
- motor loss of extrinsic hand muscles (low lesion)
- motor loss of wrist extensors, brachioradialis, triceps (at axilla) (high lesion)
OT intervention
- dynamic extension splint
- ROM
- sensory re-ed
- instruct home program
-activity mod
- NMES
Rotator cuff: OT conservative intervention
- avoid above shoulder level activities until pain is gone
- avoid sleeping with arm overhead or combined adduction and internal rotation
- decrease pain
- restore pain-free ROM
- strengthening- below shoulder level
- occupation- based activties
Rotator cuff: post-op intervention
- PROM (0 to 6 weeks)
- AAROM/AROM (6 to 8 weeks)
- Decrease pain (start with ice, then heat later)
- strengthening (begin w/ isometrics then isotonic) (below shoulder level exercises start 8-10 weeks)
Adhesive capsulitis (frozen shoulder)
- restrictive PROM (greatest limitation is external rotation)
Conservative intervention
- encourage active use through ADL and role activities
- PROM
- modalities
Post-op OT intervention
- PROM after surgery
- pain relief
- encourage use of extremity for all ADLs and role activities
Shoulder Dislocations
- anterior dislocation most common
OT intervention
- Regain ROM- avoid combined abduction and external rotation with anterior dislocation
- pain-free ADLs and role activities
- strengthen rotator cuff
Arthritis: Eval
- occupational profile
- AROM, no PROM
- Muscle strength (avoid MMT, document as it relations to function)
- grip strength
- ADLs and role activities
- pain scales
- edema
Arthritis: Intervention
- splinting
- resting hand splint in acute stage
-joint protection techniques
- resting hand splint in acute stage
- energy conservation
- ONLY AROM
- DO GENTLE PROM IF PERSON CAN’T TO AROM
- ALL EXERCISES HAVE TO BE PAIN FREE - heat modalities
- AVOID DURING ACUTE/INFLAMMATORY STAGE
- paraffin good for hands - strengthening
- NO STRENGTHENING IN ACUTE STAGE
- strengthen through functional activities - purposeful and occupation-based activities
Hip fractures: Eval
- review precautions and weightbearing status before starting eval
- occupational role requirements and expectations
- ADLs- focus on dressing, bathing and transfers
Hip fractures: Intervention
- bed mobility and bedside ADLs
- UE strengthening
- functional ambulation and transfers with appropriate weight bearing status
- instruction of assistive devices to use at home
Hip arthoplasty (surgery): eval
- occupational profile
- Assess ADLs: focus on dressing, bathing and transfers
- Assess ROM and UE strength
Hip arthoplasty (surgery): intervention
- education on hip precautions (anterolateral and posterolateral)
- instruction w/ long handled equipment
- transfer training (practice with tub bench, raised toilet seat, car transfers, bed to chair transfers)
- practice occupational-based activities using weight bearing status and assistive device
Preprosthetic treatment
- change of dominance activities
- ROM of uninvolved joints
- prepare limb for prothesis
- desensitization
- WRAPPING to shape and shrink residual limb
- wrap distal to proximal
- tension should decrease with proximal wrapping
- ADL training (education in skin care)
- supportive counseling
- individualize treatment to enhance physical and psychological adjustment
Prosthetic treatment
- functional training with prosthesis
- don/doff prosthesis
- increase prosthetic wearing tolerance
- individualize treatment to enhance physical and psychological adjustment
Treatment for LE Amputations
- wrapping to shape residual limb and decrease swelling
- desensitize
- UE strenghtening, focus on triceps
- transfer training, stand pivot
- ADL training- LE training is most difficult
-standing tolerance - wheelchair mob
Burns eval and intervention : superficial and deep partial thickness burns
Eval
- occupational profile
- ROM, 72 HOURS post op
- sensation and strength, WHEN WOUNDS HEAL
- ADLs and meaningful role activities
Intervention
- wound care and debridement, sterile whirlpool and dressing changes
- Gentle AROM and PROM to tolerance
- edema control
- splinting
- ADL and role activities
Burns eval and intervention : full thickness burns (requires grafting)
Eval
- occupational profile
- ROM, 5-7 days post-op
- sensation and strength, WHEN WOUNDS HEAL
- ADLs and meaningful role activities
Intervention
- dressing changes, splint at all times (72 hours)
- 5-7 days, begin AROM, light ADLs and meaningful activities, sterile whirlpool
- after 7 days, PROM as tolerated, ADLs and meaningful activities
- Massage, when wounds heal
- compression garments
- otoform/elastomer inserts
- strenghtening
OT Intervention for pain
- PAMS and massage in preparation for functional activities
- teach proper positioning techniques
- splint in resting position
- gentle ROM
- Relaxation techniques
- proper body mechanics
- correct environmental factors
- correct standing and seated posture
- modify activities
- alternative exercise programs (aquatic therapy, tai chi)
types of pain
acute pain
- recent onset and last for short duration
chronic pain
- long duration and can lead to depression and prescription drug misuse
myofascial pain (myofascial pain syndrome)
- persistent, deep aching pain
- well-defined, highly sensitive tender spots (trigger points)
fibromyalgia
- widespread pain with tenderness of muscles and soft tissues
- pain and fatigue disorder
low back pain
low back pain
- most common work-related injury
- causes
- poor posture
- repetitive bending w/ poor body mechanics
- heavy lifting
- sleeping w/ poor posture
- symptoms
- pain
- difficulty w/ self-care activities and LE activities
- difficulty sleeping
hand splints for burns
burns to hand
- wrist in 20-30 extension
- MCP joints in 70 flexion
- IP joints in full extension
- thumb abducted and extension
web space burn
- C-splint
if burns to volar surface of hand develop flexion contractures
- palmar extension splint
- wrist in 0-30 extension
- MCP joints in neutral to slight extension and abducted (monitor collateral ligament)
- IP joints in full extension
- Thumb abducted and extended
complications of amputations
- neuromas- can be very painful and hypersensitive
- skin breakdown
- phantom limb syndrome- the feeling of the limb that is no longer there
- phantom limb pain- as sensations of burning, cramping, stabbing
- infection
- knee flexion contractures in transtibial amputation
- psychological impairments
hypertrophic scars
- appears 6-8 weeks after wound closure
- 1-2 years to mature
- compression garments when wounds are healed
- for 24 hours a day for 1-2 years or when scars matured
osteogenesis imperfecta
symptoms
- malformed bones (barrel chest, brittle bones, multiple fractures, triangular face)
- loose joints
- brittle teeth
- respiratory problems
eval
- activity interests can be done safely
- environmental factors
- pain
intervention
- weight-bearing
- activity adaptation and assistive devices
- environmental modifications
- preventive positioning and protective splinting
- activities to increase muscle strength
- health education
- family education
types of splint
static
- no moving parts
- immobilizes joint
- external support, prevention of motion, resting joints, healing joints
dynamic
- has elastic components that provide gentle force (elastic, rubber band, spring)
- designed to increase PROM or augment AROM
- assist w/ weak motions
- substitute for lost motion
- for less mature scar tissue
serial static
- static splint or casting that is remolded to address changes in joint motion
- which promotes tissue remodeling/elongation
- use for a slow, progressive increase in motion by progressive remolding
static progressive splint
- has inelastic components (velcro, hook-and-loop, outrigger line, hinges, nylon cord) to apply an
adjustable amount of tension/force/torque to a joint in an effort to position the joint in as close to end range as possible
- for mature/dense tissue
purposes of splinting
- rest
- prevent deformities
- increase joint ROM
- protect joints, bones, soft tissue
- increase functional use
- decrease pain
- restrict ROM
hand splint design
maintain arch of hand
- proximal transverse arch
- distal transverse arch
- longitudinal arch
don’t impinge on creases of hand
- distal/proximal palmar creases
- distal/proximal wrist creases
- thenar creases
mechanical principles of splinting
- decrease pressure (wide, long splint base)
- sling w/ 90-degree angle of pull
- low load to increase duration
- 3-point pressure
- avoid positions of deformity
- MCP hyperextension
- IP joint flexion
- thumb adducted
