UE and Hand Flashcards
1
Q
Lateral epicondyle tendons
A
Extensors (anconeus, supinator, ECRL, ECRB, ECU, ED, EDM)
2
Q
Medial epicondyle tendons
A
Flexors (pronator teres, FCR, FCU, PL, FDS)
3
Q
UE blood supply
A
Aortic arch - brachiocephalic - subclavian (2) - axillary (2) - brachial (2) - ulnar/radial (2) - digital arteries
4
Q
Extensor zone I
A
DIP
5
Q
Extensor zone II
A
Middle phalanx
6
Q
Extensor zone III
A
PIP
7
Q
Extensor zone IV
A
Proximal phalanx
8
Q
Extensor zone V
A
MP
9
Q
Extensor zone VI
A
Metacarpal
10
Q
Extensor zone VII
A
Carpal bones/wrist
11
Q
Extensor zone VIII
A
Forearm
12
Q
Extensor thumb zone I
A
IP
13
Q
Extensor thumb zone II
A
Proximal phalanx
14
Q
Extensor thumb zone III
A
MCP
15
Q
Extensor thumb zone IV
A
Metacarpal
16
Q
Extensor thumb zone V
A
Wrist
17
Q
Flexor zone I
A
Fingertip to center of middle phalanx
18
Q
Flexor zone II
A
Center of middle phalanx to distal palmar crease “no mans land”
19
Q
Flexor zone III
A
Distal palmar crease to transverse carpal ligament
20
Q
Flexor zone IV
A
Overlies transverse carpal ligameent
21
Q
Flexor zone V
A
Proximal to wrist
22
Q
Distal row of carpal bones (radial to ulnar)
A
trapezium, trapezoid, capitate, hamate
23
Q
Proximal row of carpal bones (radial to ulnar
A
Scaphoid, lunate, triquetrum, Pisiform
24
Q
Main blood supply of the hand
A
Ulnar and radial arteries
25
Boxer fracture
Finger metacarpal fractures most common in 4th and 5th digits (shaft, neck, head)
26
Bennett's fracture
Thumb fracture (shaft, neck)
27
Skier's thumb
Injury to thumb ulnar collateral ligament
28
Avulsion injury
When terminal tendon separates from the bone and insertion and removed bone material with the tendon
29
Types of avulsion injuries
Mallet finger, boutonniere deformity, swan neck deformity
30
Mallet finger
Avulsion of terminal tendon resulting in flexed DIP requiring continuous extension splint for 6 weeks, typically not painful but impacts function
31
Boutonniere deformity
Disruption of central slop of extensor tendon causing PIP flexion and DIP hyperextension requiring continuous PIP extension splint for 6 weeks and DIP free for isolated flexion exercises
32
Injury to extensor zones 5-7 splint
Volar wrist splint in 30-30 degrees extension and 0-10 degrees MCP flexion
33
Swan neck deformity
Injury to MCP, PIP or DIP joint resulting in PIP hyperextension and DIP flexion requiring continuous PIP slight flexion splint for 6 weeks
34
3 Phases of fx healing
Inflammation: cellular activity for healing
Repair: forms callus for stabilization
Remodeling: deposits bone
35
General timeframe for AROM post fracture
3-6 weeks if fixation is stable
36
Colles fracture
Distal radius fracture with dorsal displacement (most common)
37
Smiths fracture
Distal radius fracture with palmar displacement
38
Most common carpal bone fracture
Scaphoid
39
What disease in lunate fracture associated with
Kienbock's disease (causes block of blood supply)
40
Most severe complication of fracture
CRPS
41
Mechanism of injury for radial head fractures (forearm)
FOOSH
42
Types of radial head fracture
Type I: non-displaced treated with long arm sling
Type II: displaced with single fragment treated non operatively with immobilization for 2-3 weeks and then early motion
Type III: comminuted treated operatively with immobilization and early motion within first week post-op and use of long arm sling for 3-4 weeks
43
Most common fracture of upper arm
Proximal humeral fractures
44
Treatment for nonoperative humeral fracture
Sling to immobilize fracture with ROM as early as 2 weeks and stretching 4-6 weeks after fracture
45
CRPS
Pain disproportion to an injury
46
Type 1 CRPS
Develops after noxious event
47
Type 2 CRPS
Develops after nerve injury
48
Common symptoms of CRPS
Allodynia, hyperalgia, hyperpathia, edema, contractures , shiny skin, abnormal sweating, abnormal hair growth, low activity tolerance, decreased strength, muscle spasm
49
Treatment for CRPS
Gentle and pain from AROM (NO PROM)
Stress loading exercises (scrubbing and carrying)
TENS/splinting for pain mgmt
Edema control with elevation, massage, compression, contrast bath
Desensitization with fluidotherapy
Tendon gliding
Joint protection technique
50
Cumulative trauma injuries (CTD)
AKA overuse syndrome or repetitive strain (deQuerevains, CTS, tendinitis, rotator cuff tear)
51
Grade 1 CTD
Pain after activity that resolved quickly
52
Grade 2 CTD
Pain during activity that resolved when activity is stopped
53
Grade III CTD
Pain persists after activity and affects work productivity including objective weakness and sensory loss
54
Grade IV CTD
Use of extremity results in pain up to 75% of time and work is limited
55
Grade V CTD
Unrelenting pain and unable to work
56
Acute phase of CTD Tx (1)
Reduction of inflammation and pain with static splint, ice, contrast bath, ultrasound, iontophoresis
57
Subacute phase of CTD Tx (2)
Slow stretch, myofascial release, progressive resistance exercise as tolerated, body mechanic and trigger identification education, static splint during painful activity, return to acute phase treatment with flareups
58
Return to work phase of CTD tx (3)
Assessment of job site, tools, body positioning
Work simulator and functional activities
Strengthening
(4) Functional capacity evaluation (capacity to perform work activities related participation in employment)
(5) Work hardening (tasks around your specific requirements for returning to work)
59
Role of tendon glides in flexor/extensor rehab
Promote excursion and prevent tendon/scar adhesion
60
Initiation of strengthening in flexor/extensor rehab
Week 8
61
Discontinuation of splints in flexor/extensor rehab
Week 6
62
When is a tendon repair the weakest
10 -12 days post-op during fibroplasia phase in which collagen is being to be laid down and original strength of suture is gone
63
Why is early mobilization important in flexor/extensor rehab
Prevents adhesion formation
64
Splint for flexor tendon
Dorsal block splint to prevent patient moving into full extension to prevent tendon rupture
65
Dorsal block splint positioning
20-30 wrist extension
50-70 MCP flexion
IP extension
66
Early mobilization protocols for flexor tendon rehab
1. Duran protocol
2. Kleinert protocol
67
Duran protocol
0-4 weeks: passive flexion/active extension using dorsal block splint
4-6 weeks: tendon gliding exercises and place/hold into light fist
6-8 weeks: light occupation based activities
8-12 weeks: strengthening
12 weeks: resume normal activities
68
Kleinert protocol
Passive flexion/extension with active extension via rubber band traction with similar timeframe as Duran protocol
69
Immobilization protocol
Complete immobilization in cast used for patient unable to care for self or with low cognitive capacity (always for children under 12) to ensure safety and prevent rupture
70
Purpose of heat with tendon injury
Prepare tissues for motion
71
Purpose of NMES with tendon injury
Promote excursion and activation of tendons
72
Sequence of tendon glides
Straight
MCP flexion "table top"
Hook fist (MCP straight)
Straight fist
Full fist
73
Common complications of flexor tendon injuries
1. Nerve involvement - laceration due to mechanism of tendon injury
2. Edema/stiffness
3. Pain
74
Median nerve distribution
Brachial plexus, moves through anterior arm and ends in palmar surface of digits 1-3
75
Common signs of median nerve injury
Thenar atrophy, weakness of 1st and 2nd lumbricals, pain/paresthesia/sensory loss, in digits 1-3, difficulty with thumb opposition and AB, decreased pronation, loss of tip pinch
76
Common median nerve injury
Carpal tunnel syndrome
77
Ape hand
Hand deformity due to median nerve damage resulting in atrophy of thenar eminence and inability to oppose thumb
78
Sign of benediction
Hand deformity due to median nerve damage that prevents patient from being able to make full fist with digits 1-3 remaining in full extension
79
Muscles innervated by median nerve
Pronator teres, FCR, PL, FDS
80
Ulnar nerve distribution
originates from brachial plexus, moves through anterior/lateral arm and ends in palmar/dorsal surfaces of digits 4-5
81
Common ulnar nerve injury
Fracture to medial epicondyle of humerus, cubital tunnel syndrome, Guyon's canal
82
Common signs of ulnar nerve injury
Hypothenar atrophy, sensory loss in digits 4-5, weakness in digits 4-5, poor opposition in 5th digit, weakness with thumb AD and AB/AD of digits 2-5
83
Claw hand
Hand deformity due to ulnar nerve damage resulting in paralysis of medical two lumbricals causing MCP digits 4-5 to remain extended at rest with flexed IP joints, pinch strength loss, sensory loss digits 4 and 5 (dorsal hand if injury proximal to Guyon's canal)
84
Jeanne's sign
Hyperextension of thumb MCP and sign
85
Muscles innervated by ulnar nerve
FCU, FDP, palmaris brevis, lumbricals, hypothenar and interossei muscles.
86
Radial nerve distribution
Originates from brachial plexus, moves through posterior arm and ends in dorsal surface of digits 1-3
87
Radial tunnel syndrome
Compression of radial nerve in proximal forearm resulting in dull ache and burning sensation along lateral forearm from radial head to supinator muscle
88
Common radial nerve injury
Midshaft fracture of humerus, radial tunnel syndrome
89
Common signs of radial nerve injury
Weakness of supinator and extensor muscles, sensory loss of dorsal hand
90
Wrist drop
Hand deformity due to radial nerve damage resulting in weakness of finger extensors and unopposed action of wrist and finger flexors causing resting flexion
91
Saturday night palsy
Compression of radial nerve at brachial plexus resulting in paralysis of triceps and loss of elbow/wrist/finger extension
92
Muscles innervated by radial nerve
Triceps, brachialis, brachioradialis, anconeus, extrinsic/intrinsic extensors, supinator
93
Conservative treatment for radial nerve injury
Cock-up splint with or without dynamic extension assist, PROM/AROM, isotonic strengthening post re innervation
94
Operative treatment for radial tunnel syndrome
Long arm splint with elbow in flexion, forearm in supination and wrist in neutral followed by wrist cock-up splint for 2 more weeks, PROM/AROM pronation/supination, hand strengthening (3 week) and resistive exercises (6 weeks)
95
Nonoperative treatment for radial tunnel syndrome
Long arm splint with elbow in flexion, forearm in supination and wrist in neutral, TENS for pain mgmt, pain-free ROM, nerve glides, avoidance of forceful wrist extension and supination
96
Splinting for median nerve compression to facilitate functional pinch
Thumb splinted in opposition and palmar AB
97
Benefits of contrast bath
Reduced edema and inflammation by providing alternating vasoconstriction and vasodilation to increase circulation
98
Keys for brachial plexus injury
No shoulder AROM above 90 degrees
Reduce overhead activities
99
Deformity due to high level ulnar nerve injury
MCP hyperextension fingers 4 and 5 due to loss of extension controlling forces in 3rd and 4th lumbricals
100
Splinting for lateral/medial epicondylitis
Wear counterforce braces during any activity that provokes pain to rest muscles/tendons and protect against pain with activity
101
Use of Iontophoresis
Decreased inflammation using low electrical current and dexamethasone (anti-inflammatory)
102
Use of phonophoresis
Decrease inflammation using ultrasound with hydrocortisone (steroid)
103
Radial tunnel syndrome
Compression of radial nerve in proximal forearm resulting in dull ache and burning sensation along lateral forearm from radial head to supinator muscle
104
Line of pull for dynamic MCP flexion splint
90 degrees
105
Trigger finger
locking of finger into flexion due to inflammation and thickening of flexor tendon sheath
106
Trigger finger treatment
MCP extension blocking splint with gentle PIP/DIP AROM with splint ON
107
Anterior interosseous syndrome
Compression of anterior interosseous nerve resulting in motor loss with FPL, FDP, and pronator quadratus
108
Pronator Teres Syndrome
Entrapment of proximal median nerve between heads of pronator muscle causing deep pain in proximal forearm
109
Nonoperative treatment for pronator syndrome
Splint with elbow in 90 degrees flexion and forearm neutral, TENS for pain, gentle stretch into supination, avoid repetitive forearm rotation with resistance and prolonged elbow flexion
110
Operative treatment for pronator syndrome
Half cast with AROM of UE joints while wearing cast, muscle strengthening in 1 week with full AROM by 8 weeks
111
Nonoperative median nerve splint
Static thenar web spacer splint
112
Operative treatment median nerve injury
Dorsal wrist blocking splint 4-6 weeks, AROM/PROM in splint , tendon gliding exercises, scar massage
113
Most common nerve compression of UE
Carpal tunnel (median nerve)
114
Impairment due to median nerve injury
Numbness/tingling digits 1-3, diminished FMC, atrophy
115
Evaluation for carpal tunnel
Tinel's test (tap median nerve to elicit symptoms)
Phalen's test (hold wrist in full flexion for 1 min)
Moberg pick-up
Semmes Weinstein
116
Nonoperative treatment carpal tunnel
wrist cock-up splint 10 degrees wrist extension to relieve pressure on median nerve, tendon/nerve gliding exercises, activity modification and client education
117
Operative treatment carpal tunnel
Surgical open carpal tunnel release surgery or endoscopic release, pain mgmt with gel pads, splinting for sleep if needed and clients who engage in too much activity, AROM wrist, thumb fingers and nerve/tendon gliding (1-2 days post-op, strengthening (3-6 weeks post-op)
118
Pillar pain
pain on either side of surgical release for carpal tunnel
119
Cubital tunnel syndrome
Ulnar nerve compression at the elbow between medial epicondyle and olecranon process
120
Impairments due to cubital tunnel syndrome
Decreased sensation in 4-5th digits, decreased grip strength, decreased lateral pinch due to weak interossei and FCU
121
Evaluation for cubital tunnel syndrome
Tinels (tap over cubital tunnel)
Froment's sign
Wartenberg's sign
Elbow flexion test
122
Froment's sign
Flexion of thumb IP when a lateral pinch is attempted (ulnar nerve)
123
Wartenberg's sign
5th digit held in abduction from the e4th digit (ulnar nerve)
124
Elbow flexion test
Holding elbow in flexion for 5 minutes with the wrist neutral to elicit symptoms of ulnar nerve injury
125
Nonoperative splint for cubital tunnel syndrome
Elbow splint positioned in 30-60 degrees flexion for 3 weeks
126
Operative treatment for cubital tunnel syndrome in protection phase (1 day - 3 weeks)
Elbow splint in 70-90 degrees flexion, wound care, edema mgmt, pain mgmt, AROM uninvolved joints, one-handed ADL technique
127
Operative treatment for cubital tunnel syndrome in active phase (3+ weeks)
Discontinue elbow splint, add elbow AROM in pronation first and then progress to in supination, start with wrist AROM with elbow flexed and progress to elbow extended, ulnar nerve gliding and desensitization technique
128
Nonoperative splint for claw hand
Ulnar nerve palsy or anti-claw splint with or without dynamic PIP extension assist if PIP flexion contractures are noted
129
Operative Claw hand tx
- Bulk dressing (3-10 days)
- Dorsal blocking splint wrist 20 degrees flexion and MCP block 45 degrees flexion
- Adjust splint at 3-6 weeks to neutral wrist
- Discontinue splint 6 weeks
- Wound care/scar mobilization
- Sensory desensitization when would is healed
- AROM wrist/hand 6 weeks
- Sensory reeducation once protective sensation has returned (10-12 weeks)
130
Double crush syndrome
Peripheral nerve is entrapped in more than one location causing paresthesia and pain with specific posturing
131
DeQuervain syndrome
Tenosynovitis to APL and EPB in the first dorsal compartment of the wrist due to repetitive thumb AB with ulnar deviation
132
DeQuervain syndrome splint
Forearm-based thumb spica splint with wrist in neutral (20 degrees if surgical release performed) and thumb radially AB for 3 weeks
133
Protective reeducation
Educated to visually compensate for sensory loss
134
Discriminative reeducation
Repetition of tactile identification of variety of objects with and without vision
135
Properties of thermoplastic splints
Elasticity, memory, bonding, durability, rigidity, perforations
136
Resting hand splint
Wrist 20 degrees extension
Thumb 45 degrees palmar AB
MCP 35 degrees flexion
PIP/DIP slight flexion
137
Intrinsic plus position (anti-deformity)
Wrist 30 degrees extension
Thumb 45 degrees palmar AB
MCP 70 degrees flexion
PIP/DIP full extension
138
Wrist cock-up splints (volar or dorsal) allow for full
Thumb ROM and MCP flexion
139
Carpal tunnel splint
Cock-up neutral to 10 degrees extension
140
Ulnar nerve wrist splint
Block digits 4 and 5 50 30 degrees flexion to prevent hyperextension
141
Radial nerve splint
Cock-up splint with dynamic finger extension assist optional
142
Pronator syndrome splint
Forearm and wrist in neutral with 90 degrees elbow flexion
143
Anterior interosseous splint
Forearm neutral with elbow in 90 degree flexion
144
Radial tunnel syndrome splint
Wrist in 30 degrees extension, forearm supinated and elbow in 90 degree flexion
145
Purpose of dynamic splinting
Correct contracture, increase PROM, substitute for active motion, protect post surgery
146
Finger pull for dynamic splinting
90 degrees
147
Stages of wound healing
1. Inflammatory
2. Proliferative
3. Remodeling
148
Inflammatory phase of wound healing
(4-6 days) clot formation, vasoconstriction, change in skin color, temp, edema, pain, healing process triggered, WBC initiate debridement and attack bacteria
149
Proliferation phase of wound healing
(4-21 days) tissue granulation, fibroblasts lay down collagen for wound contraction and tensile strength, scab formation, beginning of scar formation, revascularization and re-epithelialization
150
Remodeling phase of wound healing
(21 days – 2 years) collagen remodeling, scar matures and tissue soften while tensile strength increases, strengthening, erythema lessens
151
How to document wound
Anatomical location
Length/depth/width/shape
Color and presence of Necrotic tissue
Wound exudate
Granulation
Surrounding intact skin
152
Systemic factors impacting wound healing
Diabetes mellitus, nutrition deficiency, atherosclerosis, HIV/AIDS, aging, radiation
153
Allodynia
Pain due to a stimulus that does not normally provoke pain.
154
Hyperalgia
Increased sensitivity to feeling pain and an extreme response to pain
