quiz 3 Flashcards
mobile rays of the hand
thumb, ring, and small digit metacarpals
fixed rays of the hand
index and long fingers metacarpals
annular pulleys in each finger and function
A1-A5 → prevent bowstringing
cruciate ligaments and function
C1-C3
prevents outer sheath from collapsing
flexor tendon pulley system is positioned around
flexor digitorum profundus and superficialis
which muscles contribute to the extensor mechanism
lumbricals, interossei, extensor digitorum
function of extensor mechanism
safely extend digits, provide shortcuts for extensor tendons across joints, permits full flexion
intrinsic plus position of the hand
safe position, MPs flexed 90 degrees and IPs extended
interossei and lumbricals at their shorterst
clinical implications of the intrinsic plus position of the hand
using it in any split/orthosis
mechanisms of tenodesis
- passive insufficiency
- when wrist is flexed, fingers extend; when wrist is extended, fingers flex
- a technique to assist with functioning of the hand when there is no active control of the fingers, but the wrist functions
- no muscular innervations needed
six motions of the thumb
flexion, radial abduction/adduction, palmar abduction/adduction, opposition, retropulsion
Kapandji
reliable functional thumb opposition measure
look at picture) (touches 9 different locations
rotary force
- Occurs around a center axis
- Rotating objects change orientation during motion
- Two points moving in a circle move at different speeds
- the point further away from the center moves faster than the point closer to the center
linear force
- Occurs along a straight line
- keeps its original orientation through the movement
- Two points in a segment moving a line from one place to another move at the same speed.
Active Range of Motion (AROM)
Active muscle contraction moving joint
Active Assist Range of Motion (AAROM)
- Muscle actively move the joint, but external assistance is required (therapist or a strap)
- Start to recruit muscle, but the muscle creates a compressive force on bone or tendon (next in line after passive)
Passive Range of Motion (PROM)
- No muscle contraction while the joint is passively moved by either a therapist or external equipment
- If a tendon is healing, it can’t handle muscle contractions so passive is the most safe (this is where you want to start)
Passive Stretch
- Passive over-pressure to a joint to reach end range
- Too much stress on initial healing structures (more aggressive than PROM)
therapy interventions that position joints in the open-pack position
Phase I: inflammatory and early repair (immobilization, edema control)
Phase II: repair stage (A/AROM, continue phase I)
Phase III: late repair stage and remodeling: A/PROM, gradual strengthening
intrinsic tightness
muscle and tendon tightness of lumbricals
Identify measures for intrinsic tightness
Bunnell test
- positive test finding for PIP restriction: increased PIP flexion with MCP flexion (implies intrinsic restriction)
- full PIP flexion with MCP extension is a normal test finding
extrinsic tightness
position of wrist impacts motion
Identify measures for extrinsic tightness
- digit extension increases as wrist moves towards flexion, or digit flexion increases as the wrist moves towards extension due to tightness at extrinsic wrist flexors
- hold a fist, extend their wrist and then have them drop out of their fist and if they have trouble with it, they have issues with extrinsic extensor tightness
order of muscle return following a median nerve surgical repair (proximal to distal innervated muscles)
median nerve is medial side of the biceps tendon, proximal to carpal tunnel
the muscles most proximal to the lesion will return first and that muscle’s motion will be first as well
motor return continues proximal to distal
(look at pic)
orthoses for median, ulnar, and radial nerve injuries and what injuries look like
look at pics
median: patient can’t flex index and middle finger (holding up a peace sign)
* if patient is unable to make the “ok” sign with their hand, it is a damaged anterior interosseous nerve (branch of median nerve)
ulnar: injury: 4th and 5th digit are injured
radial: wrist drop
sunderland 1st degree
disruption: intact axon and preserved structures
prognosis: full recovery in days to week
therapy: short term, focused
tx: observe, conservative
sunderland 2nd degree
disruption: disrupted axon with intact endoneurium
prognosis: variable recovery, worse with proximal injuries
therapy: short term/moderate
tx: surgical or conservative intervention
sunderland 3rd degree
disruption: endometrium disrupted with perineum intact
prognosis: 60-80 recovery, incomplete
therapy: moderate
tx: surgical may be required
sunderland 4th degree
disruption: endometrium and perineurium disrupted and epineuruem intact
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention
sunderland 5th degree
disruption: loss of nerve trunk continuity, complete disorganization/transection
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention
peripheral nerve injury
decreased sensation in the peripheral pattern; decreased strength in specific peripheral nerve muscle innervations
causes and components of peripheral nerve injury
Mechanical, thermal, chemical, or ischemic
presentation motor, sensory, sympathetic
Components: numbness, tingling, pain, atrophy, sensory deficits
nerve root injury
dermatomal patterns of decreased sensation; myotome patterns of decreased strength
which sensations return first
pain and temp
Review hand anatomy
Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Describe the dart thrower motion of the wrist
- contributes to stability of the proximal carpal row
- motion of the wrist moving from radial deviation combined with extension towards ulnar deviation and flexion
- associated with may occupations
- appropriate motion for early rehab of wrist fractures and carpal instabilities
(scaphoid is stable in 30deg of radial extension and ulnar flexion)
(use for conservative management of scaphoid lunate and lunate triquetrum fractures)
- Describe the contract/relax method to increase joint range of motion
Place the joint in end range
Contract the antagonist by pushing away (reciprocal inhibition)
Use a max isometric contraction (HOLD the stretch) for 3-10 seconds
Relax the muscle and therapist pushes into further ROM
Repeat as much as needed
contraindications for performing AROM
- many types of tissue injury and/or treatment
- cardiac status
precautions: pain, cognition
benefits of AROM
maintain tissue length
increase circulation
decrease atrophy
may help with edema
benefits of PROM
preserves soft tissue length and prevents contractures
allows tissue gliding and joint nutrition
PROM will NOT
maintain muscle strength, prevent atrophy, reduce edema
