Quiz 6 Flashcards
cumulative trauma
characteristics of pain
condition in soft tissue structures
by repeated stresses/awkward motion
not caused by a single incident
high risk groups for repetitive stress
new on the job with no major previous exposure to repetitive tasks
after a break from this type of activity
older workers
females 10x more likely
type of work - light manufacturing = shoulder pain
meet OSHA’s criteria for cumulative trauma
Condition 1 or 2 and condition 3 must be met.
1. One or more physical finding: redness loss of motion, deformity, swelling a Tinel’s/Phalen’s test, or other provocative tests.
2. One or more subjective findings: pain, paresthesia, numbness, tingling, aching,
stiffness, or burning.
AND
3. Action taken as a result of this condition: medical treatment at the workplace, self-administered or delivered by medical personnel; lost work days, less than full-duty status, or transfer to another job.
tendinitis
inflammation of a tendon
microtears in the tendon disrupt the vascular supply - caused by cumulative trauma (repetitive stress/strain)
pain and edema appear, typically increases with motion/loading
basic rehab concept for exercises and stressing tendinopathies
mechanical and structural factors –> symptomatic RC –> optimized or excessive load –> regeneration-adaptation or tendon disrepair –> anatomical healing or degenerative tendiopathy –> strength and clinical healing
if stress > psych resistance - RC tears
appropriate tx strategies for each stage of tendon injury
Level 1: protect and rest affected regions, reduce pain and inflammation
Tx: restrict provocative activities, splint, ergonomic equipment, frequent breaks, rest and support, ice and modalities
Level 2: increase mobility and length of involved tissue, increase knowledge of cause/prevention
Tx: superficial heat modalities, low level US, massage, myofascial release, AROM, task analysis, educate
Level 3: increase tolerance to controlled stress, enhance motor control in ADLs and other tasks, promote return to pre-injury function
Tx: graded strengthening, practice, task stimulation
tendinitis vs tendinosis
Tendinitis: acute inflammation
microtears of the tendon - disrupts the vascular supply from repetitive stress
pain and edema appear, pain increases with motion
heals with rest
Tendinosis: chronic degeneration of tendon
lack of inflammatory cells
higher risk of tendon rupture
degeneration of tendon’s collagen occurs with chronic overuse/no rest without giving it time to heal
assistive technology devices
sock aids buttoner zipper aid wider grips reacher car lift raised toilet seat hoyer lift environmental controls (high tech) - turn on/off electronics
how can assistive tech be used (3 things)
used as an enabler, preventative, and/or treatment tool
universal designs involves making changes to the environment to improve accessibility
Identify important components of a home exercise program and strategies to improve your client’s understanding of a program
precautions
specific exercise sheets developed for specific diagnosis/problem
protocol sheets - not commonly given to pt
apps
DVD or online education, with questions booklet
powerpoint with touch screen
interactive online tools
youtube/video
Describe the how flexor tendons get their nutrition needed to heal
synovial diffusion: fluid pumping into the tendon through compressive forces of the tendon sheath against the pulley
healing tendons depend on vascular and synovial infusion
mechanical actions of the pulley system “pumps” nutrition via diffusion to the volar surface of the tendons
active flexion of the digit will create a high-pressure system within the pulley to push nutrients into the tendon
Choose the correct flexor tendon zones based on location, prognosis to healing, types of injuries and contents
Zone I: FDP ONLY “jersey finger”
Zone II: campers chiasm
From A1 pulley To FDS insertion.
Majority of protocols are based on this zone
“No Man’s Land”
Risk of damage to pulleys, vinucula & increased adhesions
Poor prognosis
Zone III:
• From distal edge of transverse carpal ligament to proximal edge of A1
Zone IV:
• Carpal Tunnel
Zone V:
From musculotendinous junction of the flexor tendons To proximal edge of transverse carpal ligament
risks of immobilization flexor tendon protocol
0-4wk: orthosis or dorsal blocking cast - wrist 10-30 deg flex, MCPs 40-60 flex and IPs in ext
3-4wk: exercises within the orthosis, PROM and gentle tendon gliding
4-6wk: no orthosis, exercises progressed, block exercises
*risk of developing adhesion and weak tendons
possible complications following a flexor tendon repair
rehab considerations: tendon tensile strength (tendon gliding without gapping or adhesions), associated injuries (skin, nerve, fractures, vascular, pulley system)
flexor lag: full end range passive motion, nor full range AROM
flexion contractures from scar tissue/orthosis/swelling
scar from zone of injury (zone 2 most vulnerable)
difficulty with differential tendon gliding and flexor lags
increased digit edema
Extensor zones
I - mallet injury II - treated with as mallet III - PIP central slip injury IV - prox phalanx V - MCP VI - CMC to MCP VII - wrist VIII - prox to wrist
