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Occupational Therapy > OTX311 > Flashcards

OTX311 Flashcards

1
Q

Interventions in hand therapy (6)

A
  • Splinting
  • Joint mobilisation exercises (blocking exercises & place-and-hold exercises)
  • Dexterity training
  • Functional activities (occupations)
  • Scar management
  • Oedema management
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2
Q

When to see a hand therapist (6)

A
  • When ROM is affected
  • When muscle strength is affected
  • Sensation is affected
  • Pain
  • Dexterity is affected
  • Grip is affected
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3
Q

Common causes of hand injuries (7)

A
  • Carelessness
  • Lack of awareness
  • Disregard for safety procedures
  • Distractions
  • Boredom
  • Using tools incorrectly/ home-made tools
  • Not performing a safety analysis before work
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4
Q

How to avoid hand injuries at work

A
  • Wear correct gloves for tasks
  • Avoid moving surfaces
  • Avoid wearing loose clothing/ jewellery which can get stuck in machinery
  • Beware of hot surfaces
  • Never put your hands near moving machinery
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5
Q

Assessments to perform in hand therapy (8)

A
  • ROM
  • Sensation
  • Vascular assessment (cap refill & compare)
  • Oedema assessment
  • Scar assessment (width, length &height)
  • Wound assessment (3- colour concept)
  • Dexterity
  • Pinch and grip strength (jamar dynamometer, pinch meter)
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6
Q

Oedema management (6)

A
  • Massage (Manual Edema Massage)
  • Elevation
  • Contrast baths
  • Compression
  • Active range of motion
  • Pressure garments
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7
Q

Scar management

A
  • Silicone gel
  • Massage
  • Pressure garments
  • Vibration
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8
Q

Describe the two joint mobilisation exercises

A
  1. Blocking exercises: Immobilization a joint so that you can move a specific one (digital cylinders for IPs & blocking splint for MPs)
  2. Place-and-hold exercises: to ensure patient sustains a position, without assistance, after it was placed there using PROM
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9
Q

Joint protection principles (6)

A
  • Maintain ROM and muscle strength
  • Avoid positions of deformity or that encourage deformity
  • Correct movement patterns
  • Avoid prolonged static positioning
  • Use larger and stronger joints
  • Use joints in most stable and neutral anatomical plane.
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10
Q

Stiffness of the hand is characterised by (2)

A
  • Increased muscular effort to achieve end range

- Loss passive ROM

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11
Q

Causes of stiffness in hand (5)

A
  • Long-standing oedema (sausage effect)
  • Adhesions and scarring
  • Intrinsic tightness vs extrinsic tightness
  • Soft tissues (eg contractures) vs bony structures
  • Skin tightness
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12
Q

Intrinsic tightness vs extrinsic tightness

A
  • Intrinsic tightness: Muscle tightness, causing shortening of intrinsic muscles due to prolonged incorrect immobilisation
  • Extrinsic tightness: muscle-tendon tightness, causing shortening of muscles/ tendons due to prolonged incorrect immoblisation
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13
Q

Treatment methods for stiffness

A
  • Splinting
  • Mobilisation splinting
  • Mobilisation techniques (joint mobilisation exercises and tendon-gliding exercises)
  • Functional activities
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14
Q

Disadvantages of mobilisation splinting

A
  • Splint can be removed (less DERT)
  • Immobilisation can prevent pumping of venous and lymphatic system
  • Possibility of excess force (which causes scarring)
  • Constriction increase oedema
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15
Q

Types of splints (3) and differentiate

A

Serial static splint:

  • Usually made out of plastic of paris
  • Puts join in its end range, for a long time
  • Removed and reapplied once desired end range has been achieved

Dynamic splint:

  • Compensates for muscle loss/ specific movements.
  • Allows for movement
  • Slowly improves range of motion

Static progressive splint:

  • Places joint in its end-range
  • Adjusted once end-range has been achieved to accommodate new end range of joint
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16
Q

Two types of ligaments of the wrist

A
  1. Extrinsic ligaments: found between radius, carpal bones, and metacarpals
  2. Intrinsic ligaments: Originate and insert between carpal bones
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17
Q

Name the three carpal bones that are prone to avascular necrosis due to being dependent on a single blood supply

A
  • Scaphoid
  • Lunate
  • Capitate (long enough to go into proximal row)
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18
Q

Clinical picture after removal of immobilisation

A
  • Thickened appearance
  • Skin dry and flaky
  • Limited motion
  • Extensor lag
  • Possible hypersensitivity
  • Pain
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19
Q

Complications of wrist fractures

A
  • Stiffness
  • Carpal tunnel syndrome
  • Malunion
  • Chronic pain syndrome
  • Loss of grip strength
  • Tendon adhesion
  • Delayed rupture of EPL
  • Palmar fasciitis (Dupuytrens)
  • Post traumatic arthritis
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20
Q

What to keep in mind during immobilisation

A
  • Maintain web spaces
  • Active and passive motion to facilitate tendon gliding
  • Maintain length of intrinsic muscles by encouraging flexion of IP joints while the MP joints are actively/passively held in extension
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21
Q

What qualifies a severely injured hand

A
  • Crush injury
  • Long standing oedema
  • Multiple fractures
  • Extensive tissue damage
  • Multiple joint injuries
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22
Q

Name the bones of the two rows of the wrist

A
  1. Distal row:
    - Trapezium
    - Trapezoid
    - Capitate
    - Hamate

2 Proximal row:

  • Scaphoid
  • Lunate
  • Triquetrum
  • Pisiform
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23
Q

Motions of the hand (5)

A
  • Flexion
  • Extension
  • Radial deviation
  • Ulnar deviation
  • Rotation
24
Q

Name the three wrist articulations

A
  • Carpometacarpal articulation
  • Midcarpal articulation
  • Radiocarpal articulation
25
Q

Tendon healing phases (and weeks)

A
  • Inflammatory phase (0-2 weeks)
  • Fibroplastic phase/ fibroplasia (2-6 weeks)
  • Remodelling phase (>6 weeks)
26
Q

Flexor finger snd wrist muscles (5)

A
  • Flexor digitor superficialis
  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Flexor carpi ulnaris
  • Flexor carpi radialis
27
Q

Which flexor muscles are innervates by median nerve?

A
  • Flexor digitorum superficialis
  • Flexor digitorum profundus (2+ 3rd digits)
  • Flexor pollicis longus
  • Flexor carpi radialis
28
Q

Which flexor muscles are innervated by unlar nerve

A
  • Flexor digitorum profundus (4th + 5th digits)

- Flexor carpi ulnaris

29
Q

Clinical picture after injury of flexor-tendon/muscle

A
  • Odema
  • Bleeding for an open wound or bruising for a closed wound
  • Pain
  • Inability or weakened flexion of digit
30
Q

Assessments (flexor-tendon injuries)

A
  • Odema assessment
  • Pain
  • ROM
  • Muscle strength
  • Pinch and grips
  • Hand function (dexterity)
  • Sensation
31
Q

Treatment (flexor-tendon)

A
  • Splinting
  • Mobilisation exercises
  • Dexterity training
  • Odema management
  • Scar management
  • Functional activities
  • Passive and active motion
32
Q

How many zones for flexor-tendon injuries

A

5 zones

33
Q

How many zones for extensor-tendon injuries and name them

A

8 zones (odd= joints & even= segments)

  1. DIPJ
  2. PIPJ
  3. MCP joint
  4. Carpals
  5. Middle phalanx
  6. Proximal phalanx
  7. Metacarpals
  8. Proximal wrist
34
Q

Which nerve innervates extensor muscles

A

Radial nerve

35
Q

Action of extensor digitorum communis

A
  • Extension of digits/ interphalangeal joints (2-5)

- Extension of metacarpophalangeal joints

36
Q

Action of extensor pollicis longus

A
  • Extension of interphalangeal joint of thumb
37
Q

Treatment of extensor-tendon injuries

A
  • Oedema management
  • Scar management
  • Splinting
  • Mobilisation exercises
  • Adhesion prevention
  • Wound management
38
Q 
Complex Regional
pain Syndrome (definition)
A

Pain that is disproportionate to inciting event (time + severity).

39
Q

Signs and symptoms of CRPS (5)

A
  • Atrophy in advanced stages
  • Tissue abnormalities (trophic changes, vasomotor changes, bone+joint changes)
  • Motor changes (decreased ROM, weakness)
  • Pain
  • Heightened sensitivity
40
Q

Assessment(4) and treatment(5) of CRPS

A

Assessment:

  • ROM
  • Muscle strength
  • Sensation
  • Pain assessment

Treatment:

  • Pain management
  • Desensitization
  • Functional activities
  • Oedema management
41
Q

Dupuytrens (description)

A

A conditioned characterised by the inability to fully extend fingers. The usually affected fingers are the 4th + 5th fingers

(Aka palmar fasciitis)

42
Q

Treatment of Dupuytrens

A
  • Forearm based splint that retains extension of fingers.
  • Scar management
  • Oedema management
  • Dexterity training
  • Strengthening exercises
  • Mobilization exercises
43
Q

De Quervains (description)

A
  • A painful condition that affects the tendons of the thumbs
  • Difficulty moving fingers during functional tasks
44
Q

De Quervains treatment

A
  • Splinting
  • Strengthening exercises
  • Scar management
  • Adaptation of functional tasks
45
Q

Mallet Finger

A

(Aka baseball finger)

- Characterised by a forced flexion of the DIPJ, that ruptures the extensor tendon at the base of distal phalanx

46
Q

Treatment of Mallet Finger

A
  • Splint that retains extension of DIPJ
  • Mobilisation of uninjured joints
  • Dexterity training
  • Gentle active flexion of DIPJ (after 6 weeks)
47
Q

Swan neck deformity is caused by untreated _______

A

Mallet finger

48
Q
  • Swan neck deformity is characterised by:

- Causes of swan neck (3)

A
  • Swan neck is characterised by hyperextension PIPJ and flexion of DIPJ

Causes (aetiology)

  • Untreated mallet finger
  • Instability of PIPJ
  • Fracture of the finger that didn’t heal properly
49
Q

Similarities and differences between Boutonniere snd Volar plate injury

A

The PIPJ is affected in both

50
Q

In the hand, osteoarthritis affects which 3 sites

A
  1. CMC joint, at the base of the thumb
  2. PIPJ
  3. DIPJ
51
Q

Diiferentiate between the 2 nodes at the PIPJ and DIPJ (osteoarthritis)

A
  • Heberden’s nodes= bony nodules at DIPJ

- Bouchard’s nodes= bony nodules at PIPJ

52
Q

Osteoarthritis quintet

A
  • Heberden’s nodules
  • Carpal tunnel syndrome
  • Trigger finger
  • OA of 1st carpometacarpal joint
  • Mucoid cyst
53
Q

Ensuring client complies with wearing the splint (5)

A
  1. Making it look good: Use correct temperature when heating material, to avoid impressions of fingers; stroke splint into place & don’t use direct pressure; round off edges
  2. Offer options: ensure process is client centred & client is part of the decision-making process || Options such as prefabricated/custom fabricated; colour of thermoplastic material, velcro
  3. Empathise with client: Splints can cause discomfort, attention in public and retain swear when it’s hot
  4. Lightweight: Avoid creating bulky edges; not always necessary to use 3.2mm thick material
  5. Durability: Select materials that can withstand stress when client performs activities
54
Q

Clinical pictures of osteoarthritis and rheumatoid arthritis

A
  • Osteoarthritis: Nodules form at the PIPJ (Bouchard’s nodes) and DIPJ (Heberden’s nodes) || Swelling at CMC joint
  • Rheumatoid arthritis: Radial deviation of wrist; ulnar deviation of metacarpals; Swan neck deformity of PIPJ
55
Q

Client education (Splinting)

A
  • How to clean and take care of a splint
  • Correct application and removal of splint
  • Indications of poor fit (pressure points)
  • Circumstances of removing it for long periods of time

Occupational Therapy (6 decks)

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