quiz 3

Question 1

mobile rays of the hand

Answer 1

thumb, ring, and small digit metacarpals

Question 2

fixed rays of the hand

Answer 2

index and long fingers metacarpals

Question 3

annular pulleys in each finger and function

Answer 3

A1-A5 → prevent bowstringing

Question 4

cruciate ligaments and function

Answer 4

C1-C3

prevents outer sheath from collapsing

Question 5

flexor tendon pulley system is positioned around

Answer 5

flexor digitorum profundus and superficialis

Question 6

which muscles contribute to the extensor mechanism

Answer 6

lumbricals, interossei, extensor digitorum

Question 7

function of extensor mechanism

Answer 7

safely extend digits, provide shortcuts for extensor tendons across joints, permits full flexion

Question 8

intrinsic plus position of the hand

Answer 8

safe position, MPs flexed 90 degrees and IPs extended

interossei and lumbricals at their shorterst

Question 9

clinical implications of the intrinsic plus position of the hand

Answer 9

using it in any split/orthosis

Question 10

mechanisms of tenodesis

Answer 10

• 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

Question 11

six motions of the thumb

Answer 11

flexion, radial abduction/adduction, palmar abduction/adduction, opposition, retropulsion

Question 12

Kapandji

Answer 12

reliable functional thumb opposition measure

look at picture) (touches 9 different locations

Question 13

rotary force

Answer 13

• 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

Question 14

linear force

Answer 14

• 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.

Question 15

Active Range of Motion (AROM)

Answer 15

Active muscle contraction moving joint

Question 16

Active Assist Range of Motion (AAROM)

Answer 16

• 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)

Question 17

Passive Range of Motion (PROM)

Answer 17

• 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)

Question 18

Passive Stretch

Answer 18

• Passive over-pressure to a joint to reach end range

- Too much stress on initial healing structures (more aggressive than PROM)

Question 19

therapy interventions that position joints in the open-pack position

Answer 19

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

Question 20

intrinsic tightness

Answer 20

muscle and tendon tightness of lumbricals

Question 21

Identify measures for intrinsic tightness

Answer 21

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

Question 22

extrinsic tightness

Answer 22

position of wrist impacts motion

Question 23

Identify measures for extrinsic tightness

Answer 23

• 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

Question 24

order of muscle return following a median nerve surgical repair (proximal to distal innervated muscles)

Answer 24

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)

Question 25

orthoses for median, ulnar, and radial nerve injuries and what injuries look like

Answer 25

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

Question 26

sunderland 1st degree

Answer 26

disruption: intact axon and preserved structures
prognosis: full recovery in days to week
therapy: short term, focused
tx: observe, conservative

Question 27

sunderland 2nd degree

Answer 27

disruption: disrupted axon with intact endoneurium
prognosis: variable recovery, worse with proximal injuries
therapy: short term/moderate
tx: surgical or conservative intervention

Question 28

sunderland 3rd degree

Answer 28

disruption: endometrium disrupted with perineum intact
prognosis: 60-80 recovery, incomplete
therapy: moderate
tx: surgical may be required

Question 29

sunderland 4th degree

Answer 29

disruption: endometrium and perineurium disrupted and epineuruem intact
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention

Question 30

sunderland 5th degree

Answer 30

disruption: loss of nerve trunk continuity, complete disorganization/transection
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention

Question 31

peripheral nerve injury

Answer 31

decreased sensation in the peripheral pattern; decreased strength in specific peripheral nerve muscle innervations

Question 32

causes and components of peripheral nerve injury

Answer 32

Mechanical, thermal, chemical, or ischemic
presentation motor, sensory, sympathetic
Components: numbness, tingling, pain, atrophy, sensory deficits

Question 33

nerve root injury

Answer 33

dermatomal patterns of decreased sensation; myotome patterns of decreased strength

Question 34

which sensations return first

Answer 34

pain and temp

Question 35

Review hand anatomy

Answer 35

Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

Question 36

Describe the dart thrower motion of the wrist

Answer 36

• 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)

Question 37

11. Describe the contract/relax method to increase joint range of motion

Answer 37

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

Question 38

contraindications for performing AROM

Answer 38

• many types of tissue injury and/or treatment
• cardiac status
  precautions: pain, cognition

Question 39

benefits of AROM

Answer 39

maintain tissue length
increase circulation
decrease atrophy
may help with edema

Question 40

benefits of PROM

Answer 40

preserves soft tissue length and prevents contractures

allows tissue gliding and joint nutrition

Question 41

PROM will NOT

Answer 41

maintain muscle strength, prevent atrophy, reduce edema