UE Conditions and Orthoses Flashcards
What are 4 things to consider when working with a fracture?
- Type of fx (ex. open or closed)
- Non-op or surgery
- Weight-bearing restrictions
- Associated healing time (see protocols)
List types of weight-bearing restrictions.
- Non-weight bearing (NWB)
- Toe-touch weight bearing (TTWB)
- Partial weight bearing (PWB)
- Weight bearing as tolerated (WBAT)
- Full weight bearing (FWB)
From most to least severe
What is the difference between partial weight bearing (PWB) and weight bearing as tolerated (WBAT)?
Partial weight bearing (PWB) is rather vague; it involves weight bearing but is still less than full weight bearing therefore physical limitations are still present and restrictions are still in place. Most sources define partial weight bearing as being 30% to 50% of a patient’s body weight.
Weight bearing as tolerated (WBAT) signifies that the patient is medically cleared to weight bear up to their full body weight. The patient retains the right to self-manage and pace their weight bearing activities according to their tolerance, balance, and pain levels day by day.
Describe the clinical presentation of a humerus fracture. Consider: location(s) of fx, and nerve involvement.
Humerus fx typically occur at the surgical neck/ midshaft.
The fx could effect adjacent nerves such as the radial nerve. The radial nerve innervates the muscles of the posterior arm and posterior forearm. These muscles include the extensor muscles which allow the wrist and fingers to extend.
Describe wrist drop. Which UE fracture can result in wrist drop? Why?
Wrist drop is when the wrist is unable to extend. Wrist drop is usually caused by damage to the radial nerve (radial nerve palsy). The radial nerve innervates the extensor muscles in the forearm, therefore damage to it inhibits wrist extension. The radial nerve can become damage in a humerus fracture.
When is it appropriate to use immobilization slings and a sarmiento brace?
sarmiento brace
For non-displaced humeral fractures
Describe the clinical presentation of an elbow fracture. Consider: location of fx, and nerve involvement.
Elbow fractures typically occur at the olecranon. Radial nerve may be affected.
What issue arises as a result from immobilization for an elbow fracture?
Development of contractures, specifically Volkmann’s contracture (aka compartment syndrome).
Decreased forearm ROM and wrist pronation/supination
Olecranon casting is at how many degrees of elbow flexion?
60 deg to 90 deg
List the 3 types of forearm fractures.
Type I: non-displaced
Type II: displaced
Type III: comminuted
Describe the clinical presentation of a radius fracture. Consider: location of fx, and nerve involvement.
Usually resulting from falling on an outstretched arm/hand (ext wrist).
Fracture usually occurs at distal radius. The median nerve can be affected.
What is a Colles fracture?
Falling on an extended wrist resulting in a distal radius fracture with dorsal displacement.
Which orthoses is used to temporarily immobilize a Colles fx?
Due to the dorsal displacement of the radius, a volar wrist orthosis is used.
What is a Smith’s fx?
And which nerve can be impacted?
An extraarticular fracture of the distal radius featuring a (foward or palmar =) volar displacement or angulation of the distal fragment. Usually occurs from trauma to a flexed wrist; ex. caused by a fall on the back of the hand (flexed)
Usually involves median nerve.
What is a Bennett’s fx?
Fx of the base of the first metacarpal base (base of thumb) resulting from forced abduction of the first metacarpal.
The CMC joint
Which orthoses is best for a Bennett’s fracture?
Thumb spica
What is a Boxer’s fracture?
A boxer’s fracture is a break in the neck of the 4th or 5th metacarpal bone in the hand. It usually happens when you punch an object at a high speed.
Which orthoses is best for a Boxer’s fracture?
Ulnar gutter splint
Which 2 nerves are often affected by wrist fractures?
Median and ulnar nerves
What causes carpal tunnel syndrome (CTS)?
Compression of the median nerve that runs through the carpal tunnel
M comes before U
Which digits are innervated by the median nerve?
Digits 1, 2, 3, and medial side of 4
palmar side
U comes after M
Which digits are innervated by the ulnar nerve?
Digits 4 and 5
palmar and dorsal side
Which orthosis is recommended for carpal fractures?
thumb spica
scaphoid and lunate
What is complex regional pain syndrome (CRPS)?
It is a chronic pain condition that typically affects one limb, often after an injury or trauma. The exact cause of CRPS is not well understood, and it can occur without any apparent nerve damage. Client is hypersensitive, painful, muscle weakness, edema, and/or contractures in one location despite lack of explainable cause.
What is a contraindication to treat CRPS?
No PROM exercises
What intervention should you start with if a client has CRPS?
AROM exercises
What is the purpose of a vasomotor interventions for CRPS?
Vasomotor interventions in occupational therapy aim to address the dysregulation of blood flow and autonomic nervous system function associated with CRPS. These interventions are designed to improve circulation, reduce pain, and enhance function.
Examples:
- stress loading (ex. scrubbing floors)
- desensitization / temperature biofeedback
- thermal modalities for circulation and pain
- positional changes / ROM exercises
- mirror therapy using non-affected limb
Describe the purpose of tendon excursion exercises.
Definition: Tendon excursion refers to the movement of a tendon within its surrounding sheath. It involves the gliding and sliding of the tendon as the associated muscle contracts and relaxes.
Importance: Adequate tendon excursion is crucial for normal joint movement and hand function. If tendons are restricted in their movement, it can lead to stiffness, reduced range of motion, and compromised hand function.
Define tendon excursion.
Tendon excursion = distance a tendon travels in its sheath upon movement
Tendon excursion takes place as the muscle contracts and the joint rotates. The amount of tendon excursion is related to the amount of the joint rotation. A pulley-type constraint keeps the tendon path close to the bone when the tendon crosses a joint.
excursion: how much the tendon moves from its resting position
Describe the purpose of tendon gliding exercises
- Promote smooth tendon gliding and excursion (movement).
- Improve ROM by preventing adhesions and stiffness.
- Improve finger flexibility, strength, and coordination.
What are tendon gliding exercises?
Tendon gliding exercises typically involve a series of controlled and coordinated movements of the fingers and hand. These exercises are often divided into different hand positions or finger postures.
Describe a common sequence of tendon gliding exercises, such as the “flexor tendon glide” or “Kleinert protocol”.
Involves 5 positions to make w/ your affected hand. #3 & #5 are the same
Position 1 (Full Fist): Make a full fist with the thumb on the outside.
Position 2 (Hook Fist): Bend the large knuckles while keeping the fingertips straight.
Position 3 (Straight Fist): Straighten all fingers.
Position 4 (Tabletop): Keep the wrist straight with fingers extended.
Position 5 (Straight Fist): Repeat the straight fist position.
What is the difference between Duran and Kleinert protocols?
Duran uses a blocking orthoses and PROM exercises but no AROM exercises.
Kleinert uses rubber bands for traction on the digits, AROM exercises for extension, and PROM exercises for flexion.
Calvin Klein underwear has an elastic just like the rubber band in Kleinert protocol.
Which hand sign indicates median nerve laceration?
Hand of Benediction / Ape Hand
Atrophy of thenar eminence. Poor thumb opposition. Poor MCP flexion of D
Which orthosis is used for median nerve laceration (non-op)?
Static thenar orthosis
Open up the webspace
Which orthosis is used for median nerve laceration and/or ulnar nerve laceration (post-op)?
Dorsal bocking splint
Which hand sign indicates ulnar nerve laceration?
Claw hand
Atrophy of hypothenar m. and intrinsic m. of hand. cause WEAK grip
Which orthosis is used for ulnar nerve laceration (non-op)?
Anti-claw splint
Which hand sign indicates radial nerve laceration?
Wrist drop
no wrist extension
What is a contraindication for rotator cuff tendonitis?
Impingement syndrome, swimmer shoulder
Above shoulder exercises
Which test can assess for a rotator cuff tear?
Drop test
What are signs of a rotator cuff tear?
- Positive drop test
- Hike up shoulders (trapezius m. compensation)
- Decreased shoulder strength in abduction and external rotation
- Decreased UE endurance above shoulder level
What are signs of adhesive capsulitis (aka frozen shoulder)?
Decreased shoulder ROM, especially in external rotation
Which 3 ROM mobility exercises should be used to treat adhesive capsulitis/ frozen shoulder?
Shoulder ROM exercises:
- abduction
- external rotation
- internal rotation
What is subacromial impingement syndrome/ shoulder impingement?
Subacromial impingement syndrome, also known as shoulder impingement, is a condition that involves compression or pinching of the structures in the subacromial space of the shoulder. This space contains tendons of the rotator cuff and the subacromial bursa, a fluid-filled sac that helps reduce friction between the tendons and the acromion.
Shoulder impingement occurs when there is narrowing or inflammation in the subacromial space, leading to compression of the tendons and bursa during certain arm movements. This compression can cause pain, inflammation, and, over time, may result in damage to the rotator cuff tendons.
Difficultly at 90 deg shoulder flex
The subacromial space is the area between the acromion (a bony prominence on the shoulder blade) and the head of the humerus (the upper arm bone).
What is lateral epicondylitis / tennis elbow?
Lateral epicondylitis, commonly known as tennis elbow, is a condition characterized by pain and inflammation on the outer part of the elbow. The condition is caused by overuse or repetitive strain on the forearm muscles and tendons that attach to the lateral epicondyle, a bony prominence on the outer part of the elbow.
Repetitive strain injury of the forearm and wrist
WRIST EXTENSOR OVERUSE
What are symptoms of lateral epicondylitis / tennis elbow?
- Pain: The primary symptom is pain on the outer part of the elbow, particularly when gripping or lifting objects.
- Weakness: Weakness in the forearm and difficulty with activities that involve wrist extension.
- Stiffness: Stiffness in the elbow, especially in the morning or after periods of inactivity.
What is medial epicondylitis / golder’s elbow?
Medial epicondylitis, commonly known as “golfer’s elbow,” is a condition characterized by pain and inflammation at the medial epicondyle, which is the bony bump on the inner side of the elbow. Medial epicondylitis is often caused by repetitive stress or overuse of the forearm muscles and tendons that attach to the medial epicondyle.
Activities that involve repeated gripping, wrist flexion, or pronation can contribute to the development of medial epicondylitis
WRIST FLEXOR OVERUSE
What are symptoms of medial epicondylitis / golfer’s elbow?
- Pain and tenderness on the inner side of the elbow, near the medial epicondyle.
- Weakness in the hands and wrists.
- Pain exacerbated by gripping or lifting objects.
- Stiffness in the elbow, particularly after periods of inactivity.
Which splint is used for both lateral and medial epicondylitis?
Elbow splint
What nerve is compressed in pronator teres syndrome?
The median nerve
Which splint is required for pronator teres syndrome?
Elbow splint at 90 deg flexion
Which condition/syndrome has the same symptoms as pronator teres syndrome?
Carpal tunnel syndrome (CTS)
Which nerve is compressed in cubital tunnel syndrome?
Ulnar nerve
What are the symptoms of cubital tunnel syndrome?
- pain at the elbow
- numbness and tingling at ulnar side of forearm and hand
- Tinel test
What splint is used for median or ulnar nerve compression injuries of the forearm?
median = pronator teres syndrome & ulnar = cubital tunnel syndrome
Elbow splint
What nerve is compressed in radial tunnel syndrome?
Radial nerve
Tunnel is compressed by supinator m.
The radial tunnel is a space formed by the muscles and bones in the forearm, and the radial nerve travels through this tunnel. When the radial nerve becomes compressed or irritated in this area, it can lead to symptoms such as pain, tenderness, and weakness in the forearm and hand.
What are symptoms of radial tunnel syndrome?
- pain at the lateral forearm; typically felt on the top of the forearm, near the outer part of the elbow. It may be a dull, aching pain.
- tenderness
- forearm weakness
What splint is used for radial tunnel syndrome?
Long arm splint
What does the supinator muscle do?
The supinator muscle plays a crucial role in the movement of supination, allowing for the rotation of the forearm and positioning of the palm facing upward or forward.
What is carpal tunnel syndrome?
Carpal Tunnel Syndrome (CTS) is a condition characterized by the compression or irritation of the median nerve as it passes through the carpal tunnel—a narrow passageway in the wrist formed by bones and ligaments. The median nerve is responsible for controlling sensations to the palm side of the thumb and fingers (excluding the little finger) and also controls some of the small muscles in the hand that allow for fine movements.
Which nerve is compressed in carpal tunnel syndrome?
Median nerve
What are symptoms of carpal tunnel syndrome?
- numbness or tingling in the thumb, index finger, middle finger, and ring finger. This sensation can extend up the arm
- weakness in the hand, making it difficult to perform tasks that require fine motor skills
- pain or discomfort in the wrist and hand; may radiate up the forearm and is often more pronounced at night
Which two tests are positive for carpal tunnel syndrome?
+ Tinel sign and + Phalen’s test
Describe a + Phalen’s test
During the Phalen test, the goal is to put pressure on the median nerve by compressing the carpal tunnel. If the individual has Carpal Tunnel Syndrome, this compression may exacerbate symptoms such as numbness, tingling, or pain in the thumb, index finger, middle finger, and ring finger. These symptoms may radiate up the arm.
Describe a + Tinel sign
Here’s how the Tinel sign test is typically performed:
The healthcare professional lightly taps or percusses over the course of a nerve, usually with their fingers or a reflex hammer.
A positive Tinel sign occurs when the tapping or percussion elicits tingling, pins and needles, or a “shock-like” sensation along the nerve pathway. This is an indication that there may be nerve irritation or compression at that particular site.
In the context of Carpal Tunnel Syndrome:
Median Nerve: In the wrist, a positive Tinel sign would involve tapping over the course of the median nerve, which runs through the carpal tunnel. If a person with CTS experiences tingling or other symptoms during this test, it suggests that there may be compression of the median nerve in the carpal tunnel.
Which traditional exercises should be used for carpal tunnel syndrome?
Median nerve gliding exercises
new: finger abd and add
What is Guyon’s Canal Syndrome / Handlebar Palsy?
Which nerve is compressed
Ulnar nerve compression.
Guyon’s Canal Syndrome, also known as ulnar tunnel syndrome or handlebar palsy, is a condition that involves compression or irritation of the ulnar nerve as it passes through Guyon’s canal. Guyon’s canal is a narrow tunnel or space formed by the pisiform and hamate bones of the wrist and the ligament that connects them.
Which test is + for Guyon’s Canal Syndrome / Handlebar Palsy?
+ Tinel Test
What are symptoms of Guyon’s Canal Syndrome / Handlebar Palsy?
- Tingling and numbness in the little finger and part of the ring finger
- Weakness in the hand and difficulty with fine motor skills, such as gripping or manipulating small objects
- Pain may be present in the affected area, and it can sometimes radiate up the forearm
- Loss of coordination and dexterity in the affected hand
Which exercises should be used to treat Guyon’s Canal Syndrome / Handlebar Palsy?
same as another condidtion
Same exercises as in CTS
median nerve gliding exercises
What is Gamekeeper’s Thumb / Skier’s Thumb? Which structure is ruptured?
Damage/rupture to the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb caused by forceful hyperextension or abduction of the thumb.
Usually from a fall with outstretched hand.
What is the purpose of the ulnar collateral ligament of the MCP joint of the thumb?
This ligament is located on the inner side of the thumb and provides stability to the joint, particularly during pinch or grip activities.
What are symptoms of Gamekeeper’s Thumb / Skier’s Thumb?
- Pain and swelling at the base of the thumb.
- Weakness in gripping or pinching activities.
- Tenderness over the ulnar side of the MCP joint.
- Instability or a feeling of “giving way” in the thumb.
What is De Quervain’s tenosynovitis?
A condition that affects the tendons on the thumb side of your wrist; the abductor pollicis longus and extensor pollicis brevis. These tendons run through a tunnel-like sheath (the first dorsal compartment) at the base of the thumb. The sheath becomes swollen and constricted, leading to pain and tenderness at the base of the thumb and along the side of the wrist.
Which provocative test is used to assess for De Quervain’s tenosynovitis?
Finklestein Test.
Procedure: The patient makes a fist with the fingers closed over the thumb, and the wrist is then bent toward the little finger. The examiner may stabilize the forearm while moving the wrist.
Positive Finding: Pain along the thumb side of the wrist during this movement is considered a positive sign for De Quervain’s tenosynovitis.
What is dupuytren’s disease?
A progressive condition where the tissue beneath the skin, in the palm of the hand, forms nodules and cords. Over time, these nodules and cords can tighten and pull the fingers into a bent position (contracture).
Can result in hand deformity
Which splint in used to stabilize de Quervain’s?
Thumb spica splint
What is boutonnieres deformity?
Which joints are affected? Think of the direction of the deformity?
PIP flexion
DIP hyperextension
What is swan neck deformity?
Which joints are affected? Think of the direction of the deformity?
PIP hyperextension
DIP flexion
What is mallet finger?
Which joints are affected? Think of the direction of the deformity?
Decreased DIP extension (tip of finger looks bent)
What is trigger finger / stenosing tenosynovitis?
A condition that affects the flexon tendons in the fingers or thumb. It is characterized by the finger or thumb getting stuck in a flexed position, thus requiring external force to ne applied to allow for extension which risks the tendon snapping or popping.
The condition is caused by inflammation of the tendons or the tendon sheath within the affected digit.
Which splint is used for boutonnieres, swan neck, and mallet finger?
IP extension splint / silver ring
