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OT EXAM > Musculoskeletal system > Flashcards

Musculoskeletal system Flashcards

1
Q

Intrinsic muscles of hand : Median nerve

A
  • APB (palmar abduction)
  • opponens pollicis (opposition)
  • flexor pollicis brevis (thumb MCP flexion)
  • lumbricals (radial side, 1,2) - (MCP flexion, IP extension)
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2
Q

Intrinsic muscles of hand: Ulnar nerve

A
  • 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)
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3
Q

Extrinsic muscles of hand: Median nerve

A
  • flexor digitorum superficialis (flex PIP)
  • flexor digitorum profundus (flexion of DIP joints , digits 2, 3)
  • ## flexor pollicis longus ( flexion of IP joint of thumb)
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4
Q

Extrinsic muscles of hand: Ulnar nerve

A
  • ## flexor digitorum profundus (flexion of DIP joints, digits 4,5)
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5
Q

Extrinsic muscles of hand: Radial nerve

A
  • 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)
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6
Q

Wrist flexors: Median nerve

A
  • flexor carpi radialis (wrist flexion, radial deviation)
  • palmaris longus (wrist flexion)
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7
Q

Wrist flexors: Ulnar nerve

A
  • flexor carpi ulnaris (wrist flexion, ulnar deviation)
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8
Q

Wrist extensors: Radial nerve

A
  • 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)
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9
Q

Volar forearm muscles: Median nerve

A
  • pronator teres (forearm pronation)
  • pronator quadratus (forearm pronation)
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10
Q

Dorsal forearm muscles: Radial nerve

A
  • supinator (forearm supination)
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11
Q

Elbow flexors

A
  • biceps (musuclocuteanous nerve)
    (elbow flexion w/ forearm supinated)
  • brachialis (musculocuteanous nerve) (elbow flexion w/forearm pronated)
  • brachioradialis (radial nerve) (elbow flexion w/ forearm neutral)
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12
Q

Elbow extensors (radial nerve)

A
  • triceps
  • anconeus
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13
Q

Rotator cuff muscles

A
  • subscapularis (internal rotation)
  • supraspinatus (abduction and flexion)
  • infraspinatus (external rotation)
  • teres minor (external rotation)
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14
Q

Shoulder flexion

A

-anterior deltoid (axillary nerve)
-coracobrachialis (musculocutaneous)
-supraspinatus

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15
Q

shoulder abduction muscles

A
  • middle deltoid
  • supraspinatus
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16
Q

horizontal abduction muscles

A
  • posterior deltoid
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17
Q

horizontal adduction muscles

A
  • pec major
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18
Q

shoulder extension muscles

A
  • latss dorsi
  • teres major
  • posterior deltoid
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19
Q

scapula upward rotation

A
  • traps
  • serratus anterior
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20
Q

scapula downward rotation

A
  • levator scapulae
  • rhomboids
  • serratus anterior
  • lats
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21
Q

scapula adduction

A
  • mid trapezius
  • rhomboid major
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22
Q

scapula abduction

A
  • serratus anterior
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23
Q

scapula elevation

A
  • upper traps
  • levator scapulae
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24
Q

scapula depression

A
  • lower traps
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25
Q

Dupuytren’s disease

A
  • flexion deformities of the involved digits
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26
Q

OT Intervention for Dupuytren’s

A
  • 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)
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27
Q

Gamekeeper’s Thumb (Skier’s)

A
  • rupture of UCL of the MCP joint of the thumb
  • common cause is a fall
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28
Q

Skier’s thumb OT intervention

A

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

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29
Q

CRPS

A
  • 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
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30
Q

CPRS OT intervention

A
  • 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
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31
Q

Most common UE fractures

A
  • distal radius fractures - Colles fracture
  • humeral shaft fractures can result in radial nerve injuries (wrist drop)
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32
Q

OT Eval for fractures

A
  • occupational profile
  • history
  • results of special tests (x-rays)
  • edema
  • pain
  • AROM (no PROM)
  • sensation
  • roles, occupations and ADLs
33
Q

OT intervention for fractures

A
  • 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
34
Q

Cumulative Trauma Disorders

A
  • 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
35
Q

DeQuervians treatment

A
  • 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
36
Q

Lateral and medial epicondylitis

A

lateral epicondylitis (tennis elbow)- overuse of wrist extensors
medial epicondylitis (golfer’s elbow)- overuse of wrist flexors

37
Q

Lateral and medial epicondylitis: conservative treatment

A

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

38
Q

Trigger finger

A
  • tenosynovitis of the finger flexors, commonly A1 pulley
  • caused by use of tools that are placed too far apart and by repetition
39
Q

Trigger finger: conservative treatment

A
  • 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
40
Q

Tendon repairs: Reason for Early mobilization

A
  • prevent adhension formation
  • facilitate wound/tendon healing
41
Q

Tendon repairs: OT goals

A
  • increase tendon excursion
  • improve strength at repair site
  • increase joint ROM
  • prevent adhensions
  • resuming of meaningful roles, occupations and activities
42
Q

Carpal Tunnel Syndrome: symptoms

A
  • 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
43
Q

Carpal Tunnel Syndrome: conservative treatment

A
  • 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
44
Q

Median, radial and ulnar nerve injuries: post-op treatment

A
  • edema control
  • AROM
  • nerve/tendon gliding exercises
  • sensory re-ed
  • strengthening of thenar muscles (at 6 weeks)
  • work/activity modification
45
Q

Pronator teres syndrome: symptoms and conservative treatment

A

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

46
Q

Guyon’s canal: symptoms and conservative treatment

A

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

47
Q

Cubital tunnel syndrome: symptoms and conservative treatment

A

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

48
Q

Radial nerve palsy (Saturday night palsy): symptoms and conservative treatment

A

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

49
Q

Median nerve laceration : Function loss, OT intervention and splinting

A

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

50
Q

Ulnar nerve laceration : Function loss, OT intervention and splinting

A

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

51
Q

Radial nerve injury : Function loss, OT intervention and splinting

A

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

52
Q

Rotator cuff: OT conservative intervention

A
  • 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
53
Q

Rotator cuff: post-op intervention

A
  • 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)
54
Q

Adhesive capsulitis (frozen shoulder)

A
  • 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

55
Q

Shoulder Dislocations

A
  • 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

56
Q

Arthritis: Eval

A
  • occupational profile
  • AROM, no PROM
  • Muscle strength (avoid MMT, document as it relations to function)
  • grip strength
  • ADLs and role activities
  • pain scales
  • edema
57
Q

Arthritis: Intervention

A
  • splinting
    • resting hand splint in acute stage
      -joint protection techniques
  • 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
58
Q

Hip fractures: Eval

A
  • review precautions and weightbearing status before starting eval
  • occupational role requirements and expectations
  • ADLs- focus on dressing, bathing and transfers
59
Q

Hip fractures: Intervention

A
  • bed mobility and bedside ADLs
  • UE strengthening
  • functional ambulation and transfers with appropriate weight bearing status
  • instruction of assistive devices to use at home
60
Q

Hip arthoplasty (surgery): eval

A
  • occupational profile
  • Assess ADLs: focus on dressing, bathing and transfers
  • Assess ROM and UE strength
61
Q

Hip arthoplasty (surgery): intervention

A
  • 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
62
Q

Preprosthetic treatment

A
  • 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
63
Q

Prosthetic treatment

A
  • functional training with prosthesis
  • don/doff prosthesis
  • increase prosthetic wearing tolerance
  • individualize treatment to enhance physical and psychological adjustment
64
Q

Treatment for LE Amputations

A
  • 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
65
Q

Burns eval and intervention : superficial and deep partial thickness burns

A

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

66
Q

Burns eval and intervention : full thickness burns (requires grafting)

A

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

67
Q

OT Intervention for pain

A
  • 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)
68
Q

types of pain

A

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

69
Q

low back pain

A
  • 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
70
Q

hand splints for burns

A

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

71
Q

if burns to volar surface of hand develop flexion contractures

A
  • 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
72
Q

complications of amputations

A
  • 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
73
Q

hypertrophic scars

A
  • 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
74
Q

osteogenesis imperfecta

A

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

75
Q

types of splint

A

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

76
Q

purposes of splinting

A
  • rest
  • prevent deformities
  • increase joint ROM
  • protect joints, bones, soft tissue
  • increase functional use
  • decrease pain
  • restrict ROM
77
Q

hand splint design

A

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

78
Q

mechanical principles of splinting

A
  • 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

OT EXAM (17 decks)

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