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.