Musculoskeletal system disorders (ch 6) Flashcards
Dupuytren’s disease
- Disease of fascia of the palm and digits. Fascia becomes thick and contracted.
- Surgical release required.
- OT intervention: wound care; edema control; extension splint; A/PROM and eventually strengthening, scar management (massage), purposeful tasks that emphasize flexion and extension.
Skier’s Thumb (Gamekeeper’s Thumb)
Rupture of ulnar collateral ligament of the MCP joint of thumb.
OT intervention: thumb splint (for 4-6 weeks); AROM (at 6 weeks); PROM (8 weeks) and pinch strengthening (10 weeks)
CRPS (Complex Regional Pain Syndrome)
Can be localized to one area or spread to other parts of extremity. May follow trauma/surgery, but cause is really unknown.
Symptoms: severe pain, edema, discoloration, osteoporosis, sudomotor (sweat) changes, temp changes, trophic changes, and vasomotor instability.
-OT intervention: modalities to decrease pain; edema management; AROM to involved joints; ADL to encourage use; stress loading (weight bearing and joint distraction); splinting t prevent contractures; CAREFUL about PROM, stretching, joint mobilization, dynamic splinting.
comminuted fracture is…
when bone is broken into many pieces.
what is arthrodesis?
fusion (of joint)
what is arthroplasty?
joint replacement
what is Colles’ fracture?
fracture of distal radius with dorsal displacement
what is Smith’s fracture?
fracture of distal radius with volar displacement
most common carpal fracture is…
scaphoid (60%). Proximal scaphoid has poor blood supply and may become necrotic.
A Boxer’s fracture is…
fracture of 5th metacarpal (requires ulnar gutter splint)
most common proximal phalanx fractures are…
thumb and index finger. Common complication is loss of PIP A/PROM
Distal phalanx fracture is the most common finger fracture! It may result in…
mallet finger
Humeral shaft fractures may cause injury to the radial nerve resulting in…
wrist drop.
OT eval of fractures should include…
- hx of injury and fracture management
- results of tests (xrays, MRI, CT)
- edema
- pain
- AROM (do NOT assess PROM until ordered by physician. Exception is humerus fractures, which often begin with PROM or AAROM)
- sensation
- roles, occupations, ADL and activities related to roles
OT intervention for fractures….
- immobilization phase (stabilization and healing are the goals)… AROM of joints above/below the stabilized part; edema control (elevation, retrograde massage, and compression garments); light ADL with no resistance.
- mobilization phase (consolidation is the goal)… edema control (can now do compression baths), AROM (progress to PROM when approved by physician 4-8 weeks), light occupation activities, pain management, strengthening (begin with isometrics when approved by MD)
Cumulative trauma disorders (CTD) aka repetitive strain injuries (RSI) from overuse or musculoskeletal disorders. Just know that :)
That’s all :)
de Quervain’s (what is it? tx?)
Stenosing tenosynovitis of abductor pollicis longus and extensor pollicis brevis. Pain and swelling over radial styloid; positive Finkelstein’s test.
Tx: thumb spica splint (IP joint free); activity/work modification; ice; gentle AROM of wrist and thumb to prevent stiffness. Maybe surgery.
Lateral epicondylitis (what is it? tx?)
degeneration of the tendon origin as a result of repetitive microtrauma from overuse of wrist extensors, especially extensor carpi radialis brevis. aka tennis elbow.
Tx: elbow strap; wrist splint; ice and deep friction massage; stretching. Later begin isometric exercises.
Medial epicondylitis (what is it? tx?)
Degeneration of the tendon origin as a result of repetitive microtrauma from overuse of wrist flexors. aka golfer’s elbow.
Tx: elbow strap; wrist splint; ice and deep friction massage; stretching. Later begin isometric exercises.
Trigger finger (what is it? tx?)
tenosynovitis of the finger flexors, most commonly is is A1 Pulley. Caused by repetition and the use of tools that are placed too far apart.
Tx: hand based trigger finger splint (MCP extended, IP joints free), scar massage, edema control, tendon gliding, work modification (avoid repetitive gripping activities)
Kleinert Protocol
following tendon repair, passive flexion using rubber band traction and active extension to the hood of the splint.
0-4 weeks: dorsal block splint. wrist flex, MCP flex, IP ext… passive flexion and active extension within limits of splint.
4-7 weeks: continue dorsal block splint, but adjust wrist to neutral. place/hold exercises and differential flexor tendon gliding exercises; scar management.
6-8 weeks: AORM. differential tendon gliding; light purposeful activity. d/c splint.
8-12 weeks: strengthening and work and leisure activities.
Duran Protocol
following tendon repair, passive flexion and extension of digit.
0-4.5 weeks: dorsal blocking splint. exercises in splint include passive flex of PIP, DIP, and to DPC. 10 reps/hour.
4.5-6 weeks: active flexion and extension within limits of splint.
6-8 weeks: tendon gliding and differential tendon gliding, scar management, and light activity.
8-12 weeks: strengthening and work activities.
for Mallet finger deformity, what kind of splint?
DIP extension splint
for Boutonniere deformity, what kind of splint?
PIP extension splint (DIP free)
Carpal tunnel syndrome (CTS) is a compression of what nerve?
median!
Symptoms of carpal tunnel syndrome
numbness and tingling of the thumb, index, middle, and radial half of the ring fingers. Positive Tinel’s sign at wrist. Positive Phalen’s sign.
what is Tinel’s sign?
indicative of nerve irritation- lightly tapping nerve causes pins and needles.
what is Phalen’s sign?
indicative of carpal tunnel syndrome- put backs of hands together facing down (wrist flexed, fingers extended) and if tingling/numbness occurs it is positive for CTS.
Pronator teres syndrome
a median nerve compression between the two heads of pronator teres, caused by repetitive pronation and supination and excessive pressure on volar forearm.
Symptoms: same as CTS + aching pain in proximal forearm. Positive Tinel’s sign at forearm.
Tx: elbow splint at 90 degrees w/ forearm in neutral.
Guyon’s canal
an ulnar nerve compression at the wrist. From repetition, ganglion, pressure, and fascia thickening.
Symptoms: numbness and tingling in the ulnar nerve distribution of hand; motor weakness of ulnar nerve-innervated musculature; positive Tinel’s sign at Guyon’s canal.
Tx: wrist splint in neutral.
Cubital tunnel syndrome
an ulnar nerve compression at the elbow. Caused by pressure at elbow (leaning on elbow) and extreme elbow flexion.
Symptoms: numbness/tingling along ulnar aspect of forearm and hand; pain at elbow with extreme position of elbow flexion; weakness of power grip; positive Tinel’s at elbow
Tx: elbow splint to prevent positions of extreme flexion; elbow pad to decrease compression of nerve when leaning on elbows.
