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
Dupuytren's disease
- flexion deformities of the involved digits
26
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)
27
Gamekeeper's Thumb (Skier's)
- rupture of UCL of the MCP joint of the thumb - common cause is a fall
28
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
29
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
30
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
31
Most common UE fractures
- distal radius fractures - Colles fracture - humeral shaft fractures can result in radial nerve injuries (wrist drop)
32
OT Eval for fractures
- occupational profile - history - results of special tests (x-rays) - edema - pain - AROM (no PROM) - sensation - roles, occupations and ADLs
33
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
34
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
35
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
36
Lateral and medial epicondylitis
lateral epicondylitis (tennis elbow)- overuse of wrist extensors medial epicondylitis (golfer's elbow)- overuse of wrist flexors
37
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
38
Trigger finger
- tenosynovitis of the finger flexors, commonly A1 pulley - caused by use of tools that are placed too far apart and by repetition
39
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
40
Tendon repairs: Reason for Early mobilization
- prevent adhension formation - facilitate wound/tendon healing
41
Tendon repairs: OT goals
- increase tendon excursion - improve strength at repair site - increase joint ROM - prevent adhensions - resuming of meaningful roles, occupations and activities
42
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
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
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
51
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
52
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
53
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)
54
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
55
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
56
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
57
Arthritis: Intervention
- 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
Hip fractures: Eval
- review precautions and weightbearing status before starting eval - occupational role requirements and expectations - ADLs- focus on dressing, bathing and transfers
59
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
60
Hip arthoplasty (surgery): eval
- occupational profile - Assess ADLs: focus on dressing, bathing and transfers - Assess ROM and UE strength
61
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
62
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
63
Prosthetic treatment
- functional training with prosthesis - don/doff prosthesis - increase prosthetic wearing tolerance - individualize treatment to enhance physical and psychological adjustment
64
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
65
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
66
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
67
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)
68
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
69
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
70
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
71
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
72
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
73
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
74
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
75
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
76
purposes of splinting
- rest - prevent deformities - increase joint ROM - protect joints, bones, soft tissue - increase functional use - decrease pain - restrict ROM
77
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
78
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