UE eval and intervention Flashcards
What is the 10% rule when testing hand strength
Dominant hand possesses 10% greater grip strength than the nondominant hand
-mostly in R handed people
which soft tissues are contractile
-muscle
-tendon
which soft tissues are inert
-capsule
-ligament
-bursa
-fascia
-dura mater
-nerve
sequencing of pain with PROM assessment
-pain before end-range = acute irritation
-pain at end range = subacute irritation
-pain with overpressure- chronic irritation
At which point in the pain sequence is it indicated the tissue is ready for stress
chronic irritation
Describe acute pain
-0-4 days
-inflammatory stage of healing
-anti-inflammatory treatments
RICE
rest
ice
compression
elevation
Describe Subacute pain
- 4 days - 3 months
-body starts to repair itself, often with medical intervention
Describe chronic pain
- 3 months or longer
- substantial tissue damage
Acute on chronic pain
acute re-exacerbation of long-standing chronic condition
Joint capsule
outer fibrous layer or membrane enclosing a joint
capsular pattern
loss of motion in a predictable pattern for that joint
Shoulder joint capsular pattern
loss in ER, ABD, and IR or flexion
wrist capsular pattern
supination and/or extension, and flexion
with isometric contraction what does a strong and painless reaction indicate?
normal
with isometric contraction what does a strong and painful reaction indicate?
minor lesion in contractile unit
with isometric contraction what does a weak and painless reaction indicate?
- major lesion
- complete tear with neurologic involvement
with isometric contraction what does a weak and painful reaction indicate?
- major lesion
- partial muscle tear or fracture
intrinsic vs extrinsic muscles
intrinsic - origin and insertion are within the hand
extrinsic - origin is not within the hand
Lag vs contracture
lag- PROM normal, AROM limitation
Contracture- PROM limitation of joint
Touch awareness testing
light vs deep pressure
can they feel any pressure
testing temperature awareness
warm vs cool temps
proprioceptive sensation
-movement awareness
-joint position awareness
cortical sensory function testing
-stereognosis and graphesthesia
two-point discrimination testing
static and moving two points
Describe desensitization
- to build tolerance or stimulation
-for hypersensitivity
-use variety of textures upgrading to tougher
describe sensory re-education
- learn to interpret abnormal sensory impulses
- for losses in sensation
- begin when the client can feel protective sensations
Edema vs Lymphedema
Edema- normal consequence of trauma
Lymphedema- condition caused by inadequate drainage or lymphatic fluid
Describe the purpose and technique of retrograde massage
Purpose- decrease edema in affected area following acute trauma
Technique- elevation with distal to proximal massage
When is retrograde massage more effective?
with dependent edema
what is dependent edema
edema that responds to elevation/gravity
Contraindications of manual edema mobilization
infection, blood clots, active cancer, CHF, CKD, inflammation in acute wound healing
Indication for cross friction massage
chronic soft tissue conditions in tendons, muscles, ligaments
indication and process of scar massage
indicated when scar tissue is well healed and can withstand friction
firmly massaging over scar perpendicular to orientation of fibrous elements or in circular pattern
what are the phases of wound healing
- hemostasis
- inflamation
- proliferation
- remodeling or maturation
describe the hemostasis phase of wound healing
immediate
bleeding and blood clot formation
describe the inflammatory phase of wound healing
days 1-4
edema, inflammation, bacteria removal, white blood cells
What is OTs role in the inflammatory stage of wound healing
immobilize and protect affected joints
keep joints in antideformity positions
describe the proliferative phase of wound healing
day 4-21
wound contracts and new tissues are built
what is OTs role during the proliferative stage of wound healing
weeks 1-3- immobilize and protect affected joints
weeks 3-6- progressive mobilization of joints
describe the remodeling/maturation stage of wound healing
collagen remodeling and increasing tensile tissue strength
day 21 - 2 years
what is OTs role in the remodeling stage of wound healing
mobilize joints and use orthoses to counteract tensile strength
definition and purpose of joint mobilizations
def- passive motion to the ligamentous system
purpose- introduce stress/stretch to ligaments and restore accessory motions
Contraindications to joint mobilization
- unstable or recent fracture
- hypermobility
- active infection
-bone tumor
-marked demineralization - joint inflammation
-osteoporosis
-ligament repair
describe low grade joint mobilizations
used for pain modulation
distraction/oscillation occurs at the beginning of the range
describe high grade joint moblization
used for high stress delivery
distraction/oscillation occurs at end of range
Describe a static/resting splint
- Supportive
-Corrective
-Protective
Describe serial static splint
holds tissue in end range until it adapts to its new length to increase ROM
Describe a dropout splint
- allows motion in one direction while blocking motion while blocking motion in another
- regains lost ROM while preventing poor posture
describe dynamic splints
-static portion with a level, spring or traction device to prevent progressive deformity, assist weakened muscles, increase ROM, minimize formation of adhesions
static progressive splints
apply a low-load prolonged stress at end-range that advances to increase ROM and correct soft tissue contractures
Hard end-feel
bone on bone
soft end feel
muscle or fat stops movement
firm end feel
springy (normal)
spasm end feel
pt has pain and muscle stops movement
empty end feel
end range not achieved d/t anticipated pain from pt.
describe Tinel’s test
- tapping on nerve
-used for carpal or cubital tunnel
Finkelstein test
- wrap fingers around thumb, ulnar deviate wrist
-De Quervain’s
Phalen’s test
- place palms together and bring elbows out. hold for 1 minute
- carpal tunnel
CMC grind test
- grind thumb MC joint on carpal bones
- CMC OA
Elbow flexion test
- hold arm to shoulder for 5 minutes
- cubital tunnel
Golfer’s elbow test
- supinate, extend elbow, wrist and fingers
- medial epicondylitis
Reverse Cozen’s test
- supinate, make fist, ulnar deviate, flex wrist, provide resistance
-medial epicondylitis
Polk’s test
- supinate and flex elbow
- medial epicondylitis
Mills test
-elbow flextion, palpate lateral epicondyle, passively pronate arm, flex wrist and extend elbow
- lateral epicondylitis
Maudsley’s test
-palpate lateral epicondyle, pronate forearm, have ct resist extension of D3 distal to proximal IP joint
-Lateral epicondilytis
Cozen’s test
-arm in extension, forearm pronated, wrist in radial deviation, palpate ECRB insertion, make fist and apply pressure
-lateral epicondylitis
